Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Endoscopic minimally invasive thyroidectomy (eMIT): some clarifications regarding the idea, development, preclinical studies, and application in humans



The transoral endoscopic approach for thyroid surgery was based on a previous attempt to reach the thyroid gland by an axilloscope. In contrast to this single-port access, endoscopic minimally invasive thyroidectomy (eMIT) uses three access points (sublingual and bivestibular). This results in a sufficient triangulation of instruments, making surgical procedures in the anterior neck region possible.


The idea and development of the eMIT technique are described in detail. Anatomic studies, the development of the surgical access in a cadaver study, and the animal study for safety and feasibility of this transoral endoscopic approach for surgery of the anterior neck are outlined. Also, the foundations and ethical aspects are addressed in the context of developing a surgical innovation, which resulted in the first clinical application of this technique in humans.


The preclinical studies regarding endoscopic minimally invasive thyroidectomy proofed feasibility in a human cadaver studies as well as safety in a short-time survival animal study. The first clinical application in a 53-year old patient was successful without any significant complications; expected benefits (no postoperative pain or dysphagia, no visible scar) could be demonstrated.


The eMIT technique represents a promising new surgical approach for endoscopic surgery in the anterior neck region. The whole development was based on principles for surgical innovation published after the authors’ preclinical studies. At this writing, after an initial clinical study with humans, the time has come to compare this new technique with other endoscopic and minimally invasive approaches in a prospective randomized multicenter trial.

This is a preview of subscription content, log in to check access.

Fig. 1


  1. 1.

    Witzel K, von Rahden BHA, Kaminski C, Stein HJ (2008) Transoral access for endoscopic thyroid resection. Surg Endosc 22:1871–1875

  2. 2.

    Witzel K, Benhidjeb T (2009) Monitoring of the recurrent laryngeal nerve in totally endoscopic thyroid surgery. Eur Surg Res 43:72–76

  3. 3.

    Karakas E, Steinfeldt T, Gockel A, Westermann R, Kiefer A, Bartsch DK (2010) Transoral thyroid and parathyroid surgery. Surg Endosc 24:1261–1267

  4. 4.

    Wilhelm T, Harlaar JJ, Kerver A, Kleinrensink G-J, Benhidjeb T (2010) Surgical anatomy of the floor of the oral cavity and the cervical spaces as a rationale for trans-oral, minimal-invasive endoscopic surgical procedures: results of anatomical studies. Eur Arch Otorhinolaryngol 267:1285–1290

  5. 5.

    Benhidjeb T, Wilhelm T, Harlaar J, Kleinrensink G-J, Schneider TAJ, Stark M (2009) Natural orifice surgery on thyroid gland: totally trans-oral video-assisted thyroidectomy (TOVAT): report of first experimental results of a new surgical method. Surg Endosc 23:1119–1120

  6. 6.

    Caylor HD, Schlotthauer CF (1927) The thyroid gland of swine. Anat Rec 34:331–339

  7. 7.

    Wilhelm T, Metzig A (2010) Endoscopic minimally invasive thyroidectomy: first clinical experience. Surg Endosc 24:1757–1758

  8. 8.

    Wilhelm T, Klemm W, Harlaar JJ, Kerver ALA, Kleinrensink G-J, Nemat A (2010) A new endoscopic method for mediastinal surgery with the usage of natural orifice surgery: anatomical studies on feasibility and surgical technique of the trans-oral endoscopic approach. Br J Surg 95:81–82

  9. 9.

    Wilhelm T, Metzig A (2010) Endoscopic minimally-invasive thyroidectomy (eMIT): prospective proof-of-concept study in humans. Langenbecks Arch Surg 395:481

  10. 10.

    Margo CE (2001) When is surgery research? Towards an operational definition of human research. J Med Ethics 27:40–43

  11. 11.

    Barkun JS, Aronson JK, Feldman LS, Maddern GJ, Strasberg SM, for the Balliol Collaboration (2009) Surgical innovation and evaluation: 1. Evaluation and stages of surgical innovation. Lancet 374:1089–1096

  12. 12.

    Ergina PL, Cook JA, Blazeby JM, Boutron I, Clavien P-A, Reeves BC, Seiler CM, for the Balliol Collaboration (2009) Surgical innovation and evaluation: 2. Challenges in evaluating surgical innovation. Lancet 374:1097–1104

  13. 13.

    McCulloch P, Altman DG, Campbell WB, Flum DR, Glasziou P, Marshall JC, Nicholl J CM, for the Balliol Collaboration (2009) Surgical innovation and evaluation: 3. No surgical innovation without evaluation: the IDEAL recommendations. Lancet 374:1105–1112

  14. 14.

    Neugebauer EAM, Becker M, Buess GF, Cuschieri A, Dauben H-P, Fingerhut A, Fuchs KH, Habermalz B, Lantsberg L, Morino M, Reiter-Theil S, Soskuty G, Wayand W, Welsch T, on behalf of the EAES (2010) EAES recommendations on methodology of innovation management in endoscopic surgery. Surg Endosc 24:1594–1615

Download references


Thomas Wilhelm and Andreas Metzig have no conflicts of interest or financial ties to disclose.

Author information

Correspondence to Thomas Wilhelm.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Wilhelm, T., Metzig, A. Endoscopic minimally invasive thyroidectomy (eMIT): some clarifications regarding the idea, development, preclinical studies, and application in humans. Surg Endosc (2010).

Download citation


  • Development
  • Endoscopic
  • Minimally invasive
  • Preclinical studies
  • Thyroidectomy