Minimally invasive video-assisted thyroidectomy compared with conventional thyroidectomy in a general surgery department

Dobrinja, Chiara; Trevisan, Giuliano; Makovac, Petra; Liguori, G

doi:10.1007/s00464-008-0303-4

Cited by 30 publications

(21 citation statements)

References 14 publications

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“…Fiftyseven relevant thyroidectomy papers were identified, twenty of which reported some form of cosmetic outcome assessment. These included 6 randomised controlled trials (RCTs) with 412 patients (evidence level 2B), [6][7][8][9][10][11] 7 cohort studies with 3,073 patients (level 3B) [12][13][14][15][16][17][18] and 7 non-comparative case series with 1,575 patients (level 4). [19][20][21][22][23][24][25] The remaining studies made reference to the issue of cosmesis either by assumption, referencing or general statements unsupported by methodological assessment.…”

Section: Review Resultsmentioning

confidence: 99%

“…13,16,18 All four cohort studies containing MIVAT in one arm found this to be cosmetically superior to CT but this only reached statistical significance in three of the studies, 14,15,17 none of which used a validated assessment tool at >6 months postoperatively. The single study that used a validated assessment tool (body image questionnaire) at six months found no significant cosmetic advantage to MIVAT.…”

Section: Cohort Studiesmentioning

confidence: 98%

“…Seven cohort studies (level 3B) compared cosmetic outcomes between CT and minimally invasive approaches to the thyroid gland: four prospective studies, [14][15][16][17] two retrospective 18 one compared CT or BNE vs OMIP 13 and one compared ET with CO 2 insufflation vs CT. 12 Three papers discussed a power calculation for the cosmetic assessment 13,16,18 and three papers discussed the validity of the scar assessment tools used. 13,16,18 All four cohort studies containing MIVAT in one arm found this to be cosmetically superior to CT but this only reached statistical significance in three of the studies, 14,15,17 none of which used a validated assessment tool at >6 months postoperatively.…”

Section: Cohort Studiesmentioning

confidence: 99%

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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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Section: Review Resultsmentioning

confidence: 99%

Section: Cohort Studiesmentioning

confidence: 98%

Section: Cohort Studiesmentioning

confidence: 99%

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Short and long-term cosmesis of cervical thyroidectomy scars

Dordea

Aspinall

2016

annals

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“…This alteration allows it to be adopted by low-volume surgeons, unlike other minimal access thyroid procedures that are only embraced by high-volume centers. An adequate learning curve and the use of re-usable instruments allow MIVAT to be performed at a cost comparable to that of CT (21,22) and with no significant added operative time (23)(24)(25). Although it has been reported that MIVAT requires a significantly longer time to perform in comparison to CT (7), the authors' vast experience with the procedure has demonstrated its comparability to CT in operative time.…”

Section: Learning Curve Operative Time and Costmentioning

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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“…On the second day after the surgery, the aspiration drain was removed. Postoperative pain was assessed by means of a visual analog scale (VAS), which consisted of a 10‐cm line with the words “no pain” on the left side at zero and “worst pain imaginable” on the right side at 10 …”

Section: Case Reportsmentioning

confidence: 99%

Single‐port endoscopic thyroidectomy via a submental approach: Report of an initial experience

et al. 2013

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Minimally invasive video-assisted thyroidectomy compared with conventional thyroidectomy in a general surgery department

Abstract: The MIVAT technique, in selected patients, seems to be a valid option for thyroidectomy and even preferable to conventional surgery because of its significant advantages, especially in terms of cosmetic results, postoperative pain, and postoperative recovery.

Cited by 30 publications

References 14 publications

Short and long-term cosmesis of cervical thyroidectomy scars

Short and long-term cosmesis of cervical thyroidectomy scars

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

Single‐port endoscopic thyroidectomy via a submental approach: Report of an initial experience

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