Endoscopic Retro-auricular (Facelift Incision) Approach to Hemithyroidectomy for Benign Solitary Thyroid Nodule

Thyroid surgery continues to evolve with focus on eliminating neck scarring and its potential for unsightly keloid formation. Several endoscopic remote access approaches through transaxillary, periareolar, transoral and retroauricular routes have been developed.In this video demonstration we present a 42years female having solitary thyroid nodule with benign criteria on ultrasonography (TR3) and elastography (F1) who underwent endoscopic hemithyroidectomy via Retro-auricular approach.A hybrid procedure combining pure insufflation technique (starting with 3 ports insertion along the planned occipital hairline incision that were later connected and converted into a single port) and  an open space lift Video-assisted technique was exercised. Through this incision  the large pathological thyroid lobe is to be extracted. Dissection proceeds on the subplatysmal plane toward the midline, then approaching the thyroid lobe from within the carotid triangle after violating the investing deep cervical fascia in its roof. Mobilization of the pathologic thyroid lobe was achieved by violating its anchoring anatomical tissue structures through sequential craniad to caudad dissection with sealing and dividing the superior thyrovascular pedicle, the isthmus, the lateral fasciovascular ligament,  the inferior thyrovascular pedicle and finally the Berry’s ligament.Throughout the whole dissection procedure the the laryngeal nerves as well as the parathyroid glands were deliberately identified and safeguarded.