Minimally Invasive Video-Assisted Thyroidectomy

Abstract

Objective: To report the results of a multiinstitutional experience with the minimally invasive videoassisted thyroidectomy, which was conceived in Europe and Asia and has only recently been embraced in the United States.Design: Prospective, nonrandomized analysis.Setting: Four academic thyroid surgical practices.Patients: Consecutive series of 228 patients who required thyroid surgery and were deemed at surgeon discretion to be eligible for a minimal access surgery.Interventions: Minimally invasive video-assisted thyroidectomy was performed in 216 patients. Main Outcome Measures:The data, which were recorded prospectively, included age, sex, indication for surgery, incision length, and complications of surgery.Results: Because conversion to an open approach was required in 12 of the 228 patients, the study group comprised 216 patients (25 men and 191 women; mean [SD] age, 44.5 [14.1] years). There were no hematomas and no cases of permanent hypoparathyroidism or permanent vocal cord paralysis. Nine patients had a transient vocal cord paresis (3.2% of nerves at risk); 5 patients experienced temporary hypocalcemia (8.1% of total thyroidectomies); 1 patient reported a change in voice pitch; and 1 patient required a scar revision.Conclusions: Use of the minimally invasive videoassisted thyroidectomy technique has been adopted cautiously in the United States. The safety of the procedure represented by the data from this multi-institutional experience would support its expanded adoption by highvolume thyroid surgeons. Surg. 2008;134(1):81-84 M INIMAL-ACCESS THYroid surgery was conceived primarily in Europe and Asia. A number of groups [1][2][3][4][5][6][7] have made pioneering contributions to this field. While a variety of minimally invasive approaches have been endorsed, the technique most widely practiced in North America is the minimally invasive videoassisted thyroidectomy (MIVAT), as originally described by Miccoli et al. 1 As with many new surgical techniques, adoption of MIVAT in the United States has been slow and somewhat deliberate. Increasingly, however, high-volume thyroid surgical centers have embraced this approach, and modest-sized case series 8,9 have been published detailing their experiences. Arch Otolaryngol Head NeckTo provide a more comprehensive reflection of the North American experience with MIVAT, we consolidated data that were compiled prospectively at 4 academic medical centers, paying specific attention to the safety and feasibility of this approach. The findings, as well as a proposal for more widespread adoption of this technique, are presented herein. METHODSPatients requiring thyroid surgery were carefully selected at the surgeon's discretion to undergo MIVAT at 1 of 4 academic institutions (Medical College of Georgia, Augusta; Northwestern University, Chicago, Illinois; University of Cincinnati, Cincinnati, Ohio; and Loma Linda University, Loma Linda, California). Typical indications included nonobese individuals with nodules that were no larger than 3 cm and with no thyroiditis...

Application of minimal invasive technique for thyroidectomy without remote access in locally advanced thyroid carcinoma with gross extra-thyroidal extension

“…There have been more than 20 techniques for MIT over the last 20 years. Italian groups first reported MIT techniques [ [5] , [6] , [7] , [8] , [9] ] and American groups made an enthusiastic ovation for MIT [ 10 , 11 ]. They reported that MIT technique makes patients more satisfied because the neck incision is smaller and makes patients feel less postoperative pain.…”

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

“…MIVAT's design on the other hand allows it to be as radical as CT when its selection criteria are met without compromising its safety. In terms of safety, multicenter studies in Europe and North America demonstrated MIVAT's comparability to CT (12,13). Furthermore, MIVAT does not have the potential for unprecedented complications introduced by other minimal access thyroid surgeries.…”

Retroauricular thyroidectomy with a single‐arm robotic surgical system: Preclinical cadaveric study

“…Minimally invasive video-assisted thyroidectomy (MIVAT) consists of a 2-cm cervical transverse incision with videoscope assistance and allows for minimal dissection and tissue damage. 7,8 Endoscopic thyroidectomy via a transoral incision has gained favor in recent years, as it avoids a cutaneous incision altogether. Robotic approaches have also been described through an axillary, breast, axillobreast, posterior auricular, or transoral incision.…”