الفهرس 
Embryology, Surgical Anatomy& Histology of Thyroid GlandOnly 14 pages are availabe for public view
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Abstract
Goitre is a common problem, with women affected more often than men. Multinodular goitre (MNG) is the most common diagnosis but its aetiology remains unclear. The cause is thought to be multifactorial, involving hereditary factors, dyshormonogenesis, iodine deficiency or goitrogens contributing to intermittent stimulation of thyroid follicle cells by thyroid-stimulating hormone (TSH) from the pituitary gland. Exposure to radation may also cause nodular thyroid disease.
Surgical options for the management of MNG include bilateral subtotal thyroidectomy (BST) and total
thyroidectomy (TT).
The development of a new surgical technique that minimizes the wound size is already possible, but the learning period is very long and the surgical tecnique is very hard. The operation time for minimally invasive video-assisted thyroidectomy is becoming comparable with that of conventional open technique.
The development of cervical incision-free thyroid surgery is a great step towards excellent cosmetic outcomes. Totally endoscopic techniques use cervical, axillary or pectoral.
The fact that many different endoscopic techniques have been described and that none seem to be universally accepted may be a direct result of technical difficulties and unproven superiority of one technique compared with another.
Currently it is not possible to recommend the application of endoscopic thyroidectomy based on evidence. However, there exists general agreement that ET is a valid and feasible option for carefully selected patients.
The development of endoscopic thyroidectomy (ET) is desirable for cosmetic reasons, especially as most patients are women who were concerned about scarring in the anterior neck. Although conventional thyroidectomy (CT) is the “standard procedure”, effective, well-tolerated, and safe.
In the end of the 20th century, minimally invasive surgical techniques have attracted interest of all surgical specialists. This procedure is favored by patients, especially young women, and has become widespread since then.
Endoscopic surgical techniques allow improved visualization and permit thyroidectomy to be performed through small incisions often less than 3cm, which may improve cosmetic outcomes. Surgical robotics, with the promise of further enhanced visualization and surgical dexterity better than that possible with traditional endoscopic approaches, may have future application to thyroid surgery Minimally Invasive, Video-Assisted thyroidectomy.
This may only be reached by centralization of thyroid surgery. Taken together, superiority of endoscopic to conventional thyroidectomy has yet to be demonstrated. The possible advantages of endoscopic thyroid techniques and our patient’s desire for the highest cosmetic outcome justify further development of ET in expert hands of endocrine surgeons.
Open thyroidectomy, minimally invasive video-assisted thryoidectomy, and endoscopic cervical approaches all result in cervical scars. The cervical scar length is shorter and more cosmetically pleasing with minimally invasive video assisted thyroidectomy relative to open thyroidectomy.
Reported complications stress the importance of advanced endoscopic skills and substantial experience in working in two-dimensional field; a must before starting to perform highly advanced endoscopic thyroid surgery. ET should only be offered to carefully selected patients, and therefore, a high volume of patients requiring thyroid surgery is needed.