Minimally invasive, nonendoscopic thyroidectomy: A cosmetic alternative to robotic-assisted thyroidectomy (original) (raw)
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Clinical Benefits of Minimally Invasive Techniques in Thyroid Surgery
World Journal of Surgery, 2008
Background Recently there has been a strong impetus to develop minimally invasive techniques in endocrine neck surgery. This study was designed to investigate the potential benefits of two minimally invasive thyroidectomy procedures, namely video-assisted and open minimalincision thyroidectomy (VAT and MIT, respectively) when compared with conventional thyroidectomy. Methods Between May 2000 and June 2006, a prospective, nonrandomized study was performed on 957 consecutive patients undergoing thyroid surgery. Fifty-six (5.8%) patients underwent VAT, 214 (22.4%) underwent MIT, and 687 (71.8%) underwent a conventional procedure. Results Patients were selected for VAT when total thyroid volume was £30 ml and for MIT when total thyroid volume was [30 but £80 ml as determined by ultrasonography. The length of the central neck skin incision was 1.5-2 cm for VAT, 2.5-3.5 cm for MIT, and 6-10 cm for the conventional operation. The incidence of definitive hypoparathyroidism or recurrent laryngeal palsy after VAT or MIT was comparable with that occurring after conventional treatment. Patients having VAT or MIT experienced significantly less postoperative pain than patients undergoing conventional treatment. Less pain was also registered in the VAT patient cohort when compared with the MIT cohort. Patients having VAT or MIT were more satisfied with the cosmetic result than patients who underwent conventional treatment, but no significant differences in patient satisfaction were found between the VAT and MIT groups.
Aim: We aimed to test the hypothesis that minimally invasive video-assisted thyroidectomy (MIVAT) affords comparable safety and efficacy as open conventional surgery in patients with unilateral thyroid nodules or follicular lesions in terms of cosmetic results, intraoperative and postoperative complications, postoperative pain, and hospital stay. Methods: A single-blinded randomized controlled trial compared MIVAT with conventional thyroidectomy. The primary endpoints of the study were measurement of postoperative pain after 24 and 48 hours and cosmetic outcome 3 months postoperatively. The secondary outcome measures were operative time, incidence of recurrent laryngeal nerve injury, length of incision, and hospital stay. Results: Operative time was less with open thyroidectomy than with MIVAT, while MIVAT was associated with less pain 24 hours postoperatively. Pain score showed statistically significant differences in favor of MIVAT after 24 hours. MIVAT was associated with less scarring and more satisfaction with cosmetic results. There was no difference between both procedures for presence of transient recurrent laryngeal nerve palsy and hypoparathyroidism. Conclusion: MIVAT is a safe procedure that produces outcomes similar to those of open thyroidectomy, and is superior in terms of immediate postoperative pain and cosmetic results
We aimed to test the hypothesis that Minimally Invasive Video-assisted Thyroidectomy (MIVAT) affords comparable safety and efficacy as to the open conventional surgery, when dealing with patients with unilateral thyroid nodules or follicular lesions, in terms of cosmetic results, intraoperative and postoperative complications, postoperative pain and hospital stay. MATERIALS AND METHODS: This was a single-blinded randomised controlled trial comparing the MIVAT with conventional thyroidectomy. The primary endpoints of the study were measurement of postoperative pain after 24 and 48 hours from operation and self-rated patient satisfaction with cosmetic outcome three months postoperatively. The secondary outcome measures were operative time, incidence of temporary and permanent recurrent laryngeal nerve injury, postoperative haematoma formation, length of incision, and duration of hospital stay. RESULTS: Operative time was signifi cantly less with open thyroidectomy than with MIVAT, while MIVAT was associated with less pain 24 hours postoperatively. Blood loss did not reach signifi cance between procedures. Comparisons between the two procedures with regard to pain scores after 24 and 48 hours, respectively, depicted statistically signifi cant differences in favour of the MIVAT after 24 hours. MIVAT was associated with less scarring and more satisfactory cosmetic results. There were statistically no signifi cant differences between both procedures for the presence of transient recurrent laryngeal nerve palsy and hypoparathyroidism. CONCLUSIONS: MIVAT is a safe procedure that produces outcomes, in view of short-term adverse events, similar to those of open thyroidectomy, and is superior in terms of immediate postoperative pain and cosmetic results.
Surgery, 2008
Background. The role of minimally invasive thyroid surgery (MITS) is currently in evolution. The aim of this study is to compare the outcomes of MITS using the direct approach through a lateral incision with conventional hemithyroidectomy (CHT) for the management of atypical thyroid nodules. Methods. A prospective, single-blinded, randomized controlled trial involving patients presenting with atypical thyroid nodules of 3-cm diameter or less was performed. Patients were randomized to MITS through a lateral 2.5-cm incision or CHT through a traditional 5-to 6-cm cervicotomy. Pain was measured using a 7-point visual analog scale on the 1st and 10th postoperative days. Serum C-reactive protein was measured on postoperative days 1 and 10. Satisfaction with cosmetic outcome was measured at 3 months. Results. One-hundred patients were randomized to undergo MITS or CHT. The 2 groups were equivalent in terms of age and thyroid nodule size. Mean operative times were longer for the MITS group (56 vs 46 min, P < .001). Mean pain scores were less in the MITS group on the 1st postoperative day (2.67 vs 3.43, P = .032). Pain scores at 10 days were equivalent (1.5 vs 1.8, P = .36). Serum C-reactive protein levels were equivalent postoperatively. At 3 months, patients undergoing MITS reported a greater mean cosmetic satisfaction score (6.3 vs 5.0, P = .002). Incision lengths measured at 3 months were 2.6 cm for MITS and 5.4 cm for CHT group, P < .001. Conclusion. In the management of small, atypical thyroid nodules, MITS through a direct lateral approach results in less early postoperative pain and superior cosmetic results when compared with conventional thyroidectomy.
Better Outcomes With Minimally Invasive Thyroidectomy Than Conventional Thyroidectomy
Acta Medica, 2019
Introduction Aim of this study was to evaluate our results from conventional and minimally invasive thyroidectomy and compare their outcomes. Materials and Methods 137 patients undergone conventional and minimally invasive thyroidectomy (video-assisted and open technique with mini-cervicotomy) were reviewed. Demographic data, blood loss, operative time, postoperative pain, cosmetic outcome and complications were examined and compared. Results Minimally invasive group consists of 53 cases(39%) and conventional group is composed of 84 cases(61%). No conversion from minimally invasive to conventional techniques was observed. In minimally invasive group, 25 patients(47%) had differantiated thyroid carcinoma and 28 patients(53%) had benign pathologies. Postoperative complications include transient hypocalcemia in 5 patients(3.6%) (4 in conventional, 1 in minimally invasive group), permanent hypocalcemia in 4 patients(3%) (3 in conventional, 1 in minimally invasive group), unilateral voca...
Minimally Invasive Video-Assisted versus Minimally Invasive Nonendoscopic Thyroidectomy
BioMed Research International, 2014
Minimally invasive video-assisted thyroidectomy (MIVAT) and minimally invasive nonendoscopic thyroidectomy (MINET) represent well accepted and reproducible techniques developed with the main goal to improve cosmetic outcome, accelerate healing, and increase patient's comfort following thyroid surgery. Between 2007 and 2011, a prospective nonrandomized study of patients undergoing minimally invasive thyroid surgery was performed to compare advantages and disadvantages of the two different techniques. There were no significant differences in the length of incision to perform surgical procedures. Mean duration of hemithyroidectomy was comparable in both groups, but it was more time consuming to perform total thyroidectomy by MIVAT. There were more patients undergoing MIVAT procedures without active drainage in the postoperative course and we also could see a trend for less pain in the same group. This was paralleled by statistically significant decreased administration of both opiates and nonopiate analgesics. We encountered two cases of recurrent laryngeal nerve palsies in the MIVAT group only. MIVAT and MINET represent safe and feasible alternative to conventional thyroid surgery in selected cases and this prospective study has shown minimal differences between these two techniques.
Comparing Small Incision & Conventional Large Incision Thyroidectomy
2014
ABSTRACT: The conventional technique of thyroidectomy normally requires a long skin incision and wide skin flaps on the anterior neck. The target of Minimal invasive surgery is to achieve the same results as those obtained with traditional surgery, less trauma, better postoperative course and improved cosmetic results. The aim of this Prospective Cohort study is to compare Small Incision (3.5-4cm) Thyroidectomy with conventional large incision Thyroidectomy with respect to post-op complications & Cosmesis. Most of the patients were in the age group 30-50yrs. There was no statistically significant difference between the two groups with respect to complications, which were Hematoma (6%), Seroma (25%), Hypocalcemia (52.5%)[Transient (37%), Permanent (15%)], Recurrent Laryngeal Nerve Involvement (33%) [Complete (6%)]. The scar in Small Incision surgery was cosmetically far better compared to the large incision Surgery & this difference was statistically significant. This technique not r...
Minimally invasive video-assisted thyroidectomy (MIVAT)
Gland Surgery
Background: Minimally invasive video-assisted thyroidectomy (MIVAT) was first described in 1999 and it has become a widespread technique performed worldwide. Although initially limited to benign thyroid nodules, MIVAT was progressively adopted for all types of thyroid diseases, while remaining within the selection criteria. It is reported that, in selected cases, MIVAT is comparable to standard open thyroidectomy (SOT) in terms of oncologic radicality, time, costs and complications rate, with the advantage of a better cosmetic result and a lower post-operative pain. Methods: The authors conducted a retrospective analysis about patients who underwent MIVAT between 1998 and 2019 in the Endocrine Surgery Unit of the University Hospital in Pisa. Indications and contraindications are mentioned and strictly followed. Results: Total thyroidectomy was performed in 1,862 cases (69%) and hemithyroidectomy was performed in 763 cases (28.3%). Conversion occurred in 43 cases (1.6%). In 188 cases (7%) a postoperative transient hypoparathyroidism was reported, whereas definitive hypoparathyroidism was reported in 12 cases (0.4%). Thirty-eight patients (1.4%) suffered from a definitive postoperative recurrent laryngeal nerve palsy. No definitive bilateral recurrent laryngeal nerve palsy occurred. Conclusions: From our multi-years' experience which spreads over 20 years, we can reaffirm the concept that MIVAT is a safe procedure which is not burdened by an increase complications rate or additional costs. Furthermore, this technique offers advantages in terms of cosmetic results and post-operative pain.
World Journal of Surgery, 2008
Background Minimally invasive thyroidectomy techniques are being developed in an effort to minimize pain, shorten the length of hospital stay, and improve cosmesis. Various minimally invasive thyroid surgery (MITS) techniques have been shown to be safe and feasible with some benefits in terms of cosmesis and pain outcomes; however, no single technique has been broadly accepted. This study was designed to review the evidence in relation to MITS and our experience with the direct lateral mini-incision technique. Methods A review of literature published until December 2007 on minimally invasive thyroidectomy techniques was undertaken. Three issues were addressed: 1) Does MITS provide any benefit compared with conventional open thyroidectomy? 2) Is there any advantage to the use of endoscopic or video-assisted techniques compared with the direct mini-incision technique? 3) Is the lateral mini-incision technique safe and efficacious? Additional data in relation to the above issues was derived from a retrospective cohort study of patients undergoing mini-incision thyroid surgery within our unit. Results Issue 1: Five prospective randomized studies and eight studies at a lower level of evidence have demonstrated consistent advantages of MITS compared with open thyroid surgery in terms of reduced pain and improved cosmesis with equivalent operative safety. Issue 2: In compiling four level III and IV studies that compared open and videoassisted minimally invasive surgery, there do not seem to be significant differences in patient satisfaction with the incision. The video-assisted approaches require significantly longer operative times but also seem to be less painful. Issue 3: Three cohort studies (level IV) have demonstrated that the lateral mini-incision technique is both safe and efficacious compared with open surgery for hemi-thyroidectomy. Data from our cohort study of 1281 patients (open hemithyroidectomy 1054 vs. MITS 227) confirmed MITS to be a safe and effective procedure. The rate of postoperative hematoma formation and wound infection was equivalent between groups. The rate of permanent recurrent laryngeal nerve injury was 0.4% for MITS and 0.3% for CHT and not significantly different (p = 0.7). Conclusions MITS has demonstrated advantages over conventional open approaches for both hemi-and total thyroidectomy and the benefits do not depend on the open or video-assisted approach. For thyroid lobectomies, the lateral mini-incision approach can be performed with an operative time and postoperative complication profile equivalent to conventional hemi-thyroidectomy while providing excellent cosmesis with a 2-3 cm scar.
Conventional thyroidectomy: what is the impact of the scar on the lives of operated patients?
Archives of Endocrinology and Metabolism, 2021
Objective: This study was aimed at investigating the aesthetic impact of scars on the lives of patients who undergo conventional thyroidectomy. Materials and methods: This cross-sectional study was based on a retrospective analysis of 98 electronic medical records of patients who underwent conventional thyroidectomy performed by the same surgeon. The impact was determined through a qualitative question and categorized into three levels of dissatisfaction. Results: Among the 98 patients, 96 (97.95%) reported experiencing no functional or visual discomfort with their scars. The two unsatisfied individuals were women, and both classified their discomfort as moderate. Although the diseases that indicated surgery varied, papillary thyroid carcinoma predominated. Conclusion: The sample's satisfaction level indicates that, in line with the current literature, the decision to opt for cosmetically appealing methods is not justified by aesthetic complaints about scars. The benefits of lower cost and fewer complications make conventional thyroidectomy an old but reliable option for afflictions of the thyroid gland that require surgery.