Meta‐analysis of minimally invasive video‐assisted thyroidectomy

Radford, Peter; Ferguson, M. S.; Magill, Jennifer; Karthikesalingham, Alan P.; Alusi, Ghassan

doi:10.1002/lary.21864

Cited by 42 publications

(32 citation statements)

References 26 publications

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“…Five meta-analyses have so far been conducted that have evaluated this comparison in the literature. [5][6][7][8][9] These studies collectively suggest that smaller scars yielded by minimally invasive video-assisted thyroidectomy are more cosmetically favourable than longer scars yielded by conventional thyroidectomy. To determine cosmetic favourability, the studies examined in these meta-analyses had patients rate the acceptability of their own scars on a 10-point scale, without a frame of reference to compare their own scars against.…”

Section: Discussionmentioning

confidence: 99%

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A paired comparison analysis of third-party rater thyroidectomy scar preference

et al. 2016

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Objective: To determine the length and position of a thyroidectomy scar that is cosmetically most appealing to naïve raters.Methods: Images of thyroidectomy scars were reproduced on male and female necks using digital imaging software. Surgical variables studied were scar position and length. Fifteen raters were presented with 56 scar pairings and asked to identify which was preferred cosmetically. Twenty duplicate pairings were included to assess rater reliability. Analysis of variance was used to determine preference.Results: Raters preferred low, short scars, followed by high, short scars, with long scars in either position being less desirable ( p < 0.05). Twelve of 15 raters had acceptable intra-rater and inter-rater reliability.Conclusion: Naïve raters preferred low, short scars over the alternatives. High, short scars were the next most favourably rated. If other factors influencing incision choice are considered equal, surgeons should consider these preferences in scar position and length when planning their thyroidectomy approach.

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Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] The major proposed benefit of the endoscopic approach is that it yields superior cosmetic results when compared to the open approach in select patients. [5][6][7][8][9] Despite this benefit, open thyroidectomy, through an anterior cervical incision, remains the predominant surgical approach in most centres.…”

Section: Introductionmentioning

confidence: 99%

A paired comparison analysis of third-party rater thyroidectomy scar preference

et al. 2016

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“…While this has been demonstrated by many (7,27) studies, others concluded that a shorter cervical scar was not associated with improved patient satisfaction (36)(37)(38). Furthermore, it may be argued that shorter incisions may compromise the safety of a procedure without favorably influencing patient satisfaction (39).…”

Section: Mivat's Advantagesmentioning

confidence: 98%

“…The two advantages of MIVAT over CT that bring about improved patient satisfaction are its improved pain and cosmetic outcomes (27). A recent meta-analysis demonstrated that MIVAT patients experienced less pain during the entire postoperative period (7).…”

Section: Mivat's Advantagesmentioning

confidence: 99%

Minimally Invasive Video-Assisted Thyroidectomy (MIVAT) in the Era of Minimal Access Thyroid Surgery

Bakkar

Miccoli

2017

J Minim Invasive Surg Sci

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Background: In the era of minimal access thyroid surgery, the terms minimal access and minimally invasive are often used interchangeably and in most instances this is far from being accurate. The aim of this article is to examine the characteristics and potential of one of the first minimal access thyroid procedures described; minimally invasive video-assisted thyroidectomy (MI-VAT). Methods: The purpose of this article was obtained by almost two decades of experiences with the procedure at the authors' center, and a systemic literature review was undertaken of all available medical literature to evaluate available literature by conducting a PubMed search limited to articles originally written in English language between the years 1997 and 2016. The search was limited by using the terms: minimally invasive thyroid surgery, video-assisted, endoscopic, and robotic thyroidectomy. The procedure's design, radicality and safety, learning curve, cost, advantages and disadvantages were addressed. MIVAT's potential as a surgical tool for thyroid pathology was also addressed by evaluating its indications, contraindications, and limitations. Results: MIVAT is a gasless hybrid procedure that is comparable to conventional thyroidectomy (CT) in terms of radicality and safety, with the added advantage of reduced early postoperative voice and swallowing symptoms. MIVAT has a relatively rapid learning curve with an additional advantage over other minimal access procedures; the ability of being adopted by the low-volume surgeon at a cost and time comparable to CT, but with improved patient satisfaction. Furthermore, it is non-inferior to procedures free of a neck scar in terms of patient satisfaction. MIVAT's main drawback is that it is limited by its strict selection criteria. It is a viable treatment option for all types of thyroid pathologies. However, its role in therapeutic neck dissection remains to be validated. Conclusions: MIVAT is a safe and effective procedure which is obviously described in its name "minimally invasive". It seems that in the era of innovative technologies and scarless-in-the neck thyroid surgery, MIVAT is here to stay.

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“…[6][7][8]10,11 Previous meta-analyses based on these RCTs have reiterated the cosmetic advantage of MIVAT over CT [26][27][28][29] but the abovementioned heterogeneity in wound closure, timing of scar assessment, variety and lack of validation of assessment tools should be borne in mind when interpreting these results. One review article 30 acknowledged this, limiting its meta-analysis of 3/5 RCTs.…”

Section: Randomised Controlled Trialsmentioning

confidence: 99%

Short and long-term cosmesis of cervical thyroidectomy scars

Dordea

Aspinall

2016

annals

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INTRODUCTION Multiple surgical approaches to the thyroid gland have been described via cervical or extracervical routes. Improved cosmesis, patient satisfaction, reduced pain (procedure dependent) and early discharge have all been reported for minimally invasive approaches with similar safety profiles and long-term outcomes to conventional surgery. This review summarises the current evidence base for improved cosmesis with minimally invasive cervical approaches to the thyroid gland compared with conventional surgery. METHODS A systematic review was undertaken. The MEDLINE ® , Embase™ and Cochrane databases were searched for relevant articles. RESULTS A total of 57 papers thyroid papers were identified. Of those, 20 reported some form of cosmetic outcome assessment. There were 6 randomised controlled trials with 412 patients (evidence level 2B), 7 cohort studies with 3,073 patients (level 3B) and 7 non-comparative case series with 1,575 patients (level 4). There was significant heterogeneity between studies in terms of wound closure technique, timing of scar assessment and scar assessment scales (validated and non-validated). Most studies performed early scar assessments, some using non-validated scar assessment tools. CONCLUSIONS Assessment of cosmesis is complex and requires rigorous methodology. Evidence from healing/remodelling studies suggests scar maturation is a long-term process. This calls into question the value of early scar assessment. Current evidence does not support minimally invasive surgical approaches to the thyroid gland if improved long-term cosmesis is the goal. KEYWORDSThyroidectomy -Minimally invasive video assisted thyroidectomy -Scar -Cosmesis

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Meta‐analysis of minimally invasive video‐assisted thyroidectomy

Cited by 42 publications

References 26 publications

A paired comparison analysis of third-party rater thyroidectomy scar preference

A paired comparison analysis of third-party rater thyroidectomy scar preference

Minimally Invasive Video-Assisted Thyroidectomy (MIVAT) in the Era of Minimal Access Thyroid Surgery

Short and long-term cosmesis of cervical thyroidectomy scars

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