Minimally invasive video-assisted thyroidectomy versus conventional thyroidectomy: A single-blinded, randomized controlled clinical trial

Abstract

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 significantly less with open thyroidectomy than with MIVAT, while MIVAT was associated with less pain 24 hours postoperatively. Blood loss did not reach significance between procedures. Comparisons between the two procedures with regard to pain scores after 24 and 48 hours, respectively, depicted statistically significant differences in favour of the MIVAT after 24 hours. MIVAT was associated with less scarring and more satisfactory cosmetic results. There were statistically no significant 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.

Endoscopic Right Lobectomy Axillary-breast Approach: Report of Two Cases

“…Neck surgery is one of the newest and most interesting application of minimally invasive surgery technique in thyroid surgery, particularly with regard to eliminating the unattractive scars [1,2].…”

Minimally Invasive Surgery for Nodular Goiter

“…Большинство опубликованных исследований посвящено MIVAT, являющей-ся наиболее распространенным вариантом малоинвазивной операции [27][28][29][30][31][32][33][34][35][36]. Результаты применения бокового доступа анализирова-лись лишь в одном рандомизированном иссле-довании [37] и одном систематическом обзоре [38].…”

“…Проспективные рандоминизированные и последние ретроспективные исследования подтвердили сопоставимость частоты хирурги-ческих осложнений для ТЭШД и традицион-ной открытой ТЭ [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44]. Однако из-за недо-статочной статистической мощности, необхо-димой для выявления малых или умеренных различий в частоте парезов ВГН или после-операционного гипопаратиреоза, истинный уровень осложнений после ТЭШД нуждается в дальнейшем уточнении [45].…”

“…Удовлетворенность пациентов косметиче-ским результатом через 1 месяц после ТЭШД была выше, чем после традиционной откры-той ТЭ в двух исследованиях [29,33], и выше через 3 месяца в четырех исследованиях [30,31,34,38]. Одно исследование [32] не вы-явило какой-либо разницы через один месяц.…”

Gasless trans-axillary robotic thyroidectomy: the introduction and principle

“…The MIVAT is a technique developed by Miccoli et al in Italy in 1998 (4). The main advantage of this technique is the good cosmetic result (5,6), and its main inconvenient is the limited indications (small glands volume <25 mL). The endoscopic lateral approach is another technique that requires CO 2 insufflation.…”