Gas-less Video-assisted Thyroidectomy for a Solitary Thyroid Nodule: Technical Report of the First Case Performed at a Rural Teaching Hospital in India and Review of Literature.

Minimally invasive thyroidectomy is still in its phase of evolution with various techniques being practiced only in certain centers internationally. The conventional thyroidectomy performed by the Kocher's cervicotomy often leaves an undesirable scar over the neck, the size of which is usually around 8-10 cm long. The main aim of minimally invasive thyroid surgery is to minimize or avoid the scar over the neck. Endoscopic thyroid surgery in India, especially in the state of Kerala, is still in its infancy. Here, we describe the first case report of a modified technique of video-assisted thyroid surgery using a laparoscope and conventional open surgical instruments. Video-assisted thyroidectomy enables adequate visualization of the operative field and provides a magnified view of the vital structures like the parathyroid gland, the recurrent laryngeal nerve, and the thyroid vasculature. The procedure described here can be considered as a more cost-effective alternative to the conventional minimally invasive video-assisted thyroidectomy (MIVAT), and therefore is feasible in a rural setup.