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Background Minimally invasive video-assisted thyroidectomy (MIVAT) has received increasing attention for malignant thyroid diseases.The aim of this study was to compare the outcomes of MIVAT with conventional open thyroidectomy (CT) for papillary thyroid microcarcinoma (PTMC).Methods Thirty-one patients were treated with MIVAT and 37 with CT.Their pathological characteristics,surgical complications,5-year postoperative thyroglobulin (TG) and ultrasonic results were followed up.Results All the patients took levothyroxine for suppressing thyroid stimulating hormone (TSH) after surgery,and were followed up with measurement of serum TG and neck ultrasonography at intervals of 6 or 12 months.There was no statistically significant difference between the CT and MIVAT groups for sex ratio,operation time,positive lymph nodes,complications and prognosis,but the MIVAT group had better cosmetic results.Conclusions MIVAT did not differ significantly from CT for PTMC after 5 years follow-up,but it did have better cosmetic results.MIVAT is a safe and valid surgical technique for selected cases.