Identification of the recurrent laryngeal nerve (RLN) is mandatory in thyroid surgery. Continuous intraoperative neuromonitoring (C-ioNM) has not yet been described for minimally invasive thyroidectomy. Furthermore attention to costs is significantly increasing in Italy and Video assisted techniques with Energy Based Devices are far from cheap. We describe the technique for vagal electrode positioning and report on our first experiences with MITHYCO.

Patients elegible for MITHYCO must have a single lobe width < than 6cm. Patients with a thyroid width > 6cm, Basedow disease and with lymph node metastasis were excluded. A cervical incision of 2.5-3cm was made just 2cm above the jugulus. First step is to mobilize the upper pole by tying superior thyroid vessels with 3/4- 0 absorbable braided laces. While the the superior lobe is mobilized and medialized we identify and gently suspend the vagus nerve with a surgical loop. Then we place the vagus electrode that embraces the nerve and start continous monitoring. We proceed with a craniocaudal dissection according to the standard technique by using absorbable laces and protected bipolar coagulation fo middle veins and inferior pole.

We performed 50 thyroidectomy with MITHYCO technique. No major complications were observed, 3 patients suffered from monolateral recurrent laryngeal nerve palsy treated successfully with vocal chord rehabilitation. 2 patients developed suffered of transient hypocalcemia.

In expert hands and with the right indications, MITHYCO techcnique is a feasible, safe and cost-saving procedure. However, more data needs to be collected to improve this technique.