The degree of difficulty of the 3D MIVAT technique was graded by the surgeon using a 5-point subjective scale, ranging from 5 (very easy) to 1 (very difficult) in order to recognize the upper and lower vascular pedicles, the parathyroids, the superior and inferior laryngeal nerves. Patients were asked to report their opinion according to the cosmetic results and postoperative pain. Cosmetic results were graded using a 4-point Citarinostat ic50 scale,

ranging from 1 (very happy) to 4 (unhappy), while postoperative pain was evaluated by a visual analogue scale (VAS) from 1 (no pain ever) to 10 (worse pain). Results Two female and 1 male with a mean age (±SD) of 44.5 years (±8.4) underwent 3D MIVAT. Mean operative time for the total thyroidectomy was 80 minutes (range 72-90). Conversion into conventional technique was never required. Neither intra-nor postoperative complications were observed during the study. A suction drain was placed at the end of surgery and it was removed when blood loss was <2 mL/hour. All patients were discharged 24 hours after surgery. Table  1 summarizes clinical, pathologic and operative findings. The surgical team noticed a good perception of depth and easy recognising of anatomic structures, especially concerning Caspase inhibitor the upper and lower vascular

pedicles, the parathyroids, the superior and inferior laryngeal nerves (Figure  2). The recognition of these anatomic structures worsened in presence of blood in the surgical field. This PRKD3 new perception of depth and volume allowed an easy use of the endoscope during the procedure and an intuitive manipulation of critical structures, making comfortable and safe surgical maneuvres using instrumentation. The negligible weight of the handle and the absence of lateral cables made the device light and easy to manage. The surgeons wore polarizing glasses without any problem even during the open part of the surgery. No user side-effects

related to the dual-camera device were reported. Two surgeons considered the technique as very easy, while one surgeon as easy. All patients were very happy about the cosmetic results. Pain VAS at 1, 3 and 7 postoperative day ranged from 1 to 2 in all cases. Table  2 summarizes the subjective qualitative evaluation of 3 D endoscopic system. Table 1 Clinical, pathologic and operative findings of the patients Patients Goiter volume (mL) Dominant nodule major diameter (cm) Operative time (min) Intraoperative blood loss (mL) Postoperative blood loss (mL) Pathologic findings Hositaliztion (days) No. 1 20 2.8 90 45 30 Follicular adenoma 1 No. 2 18 1.4 78 35 25 Multinodular goiter 1 No. 3 22 1.1 72 35 10 Multinodular goiter 1 Figure 2 An intraoperative 3D view of the operative field. The upper vascular pedicle (white arrow) and the superior laryngeal nerve (black arrow) on the right side are easily recognized with good depth perception by the surgical team.