New Technologies in Surgery: Diagnosis and Treatment of Complications of Mivat (Minimally Invasive Video-Assisted Thyroidectomy)

Abstract

The aim of the study was to present evolution of the technique of minimally invasive video-assisted thyroidectomy, its advantages, limitations and possible complications related to the method. Material and methods. Minimally invasive video-assisted thyroidectomy (MIVAT) is characterized by a unique central incision of 1.5 cm, 2 cm above the sternal notch. The operative space is maintained by means of an external retraction: no gas insufflation is utilized. Potential complications of Minimally Invasive Video-assisted Thyroidectomy (MIVAT) are roughly the same as in open surgery. Results. Since June 1998 to March 2008 1524 patients underwent a minimally invasive video-assisted thyroidectomy. Complications were represented by transient monolateral recurrent nerve palsy in 38 cases (2.4%), definitive monolateral recurrent nerve palsy in 18 cases (1.1%), bilateral transient recurrent nerve palsy in 2 cases. Fifty five patients exhibited a hypoparathyroidism, which corresponds to 5.1% of the 1059 total thyroidectomies performed, but only 5 complained of a permanent hypocalcemia which necessitated a substitutive therapy, thus reducing the rate of permanent hypoparathyroidism to 0.4%. We registered in two cases of postoperative bleeding requiring re-operation; wound sepsis occurred in three cases. Conclusions. MIVAT unlike other minimally invasive endoscopic techniques proposed for thyroidectomy, reproduces the standard operation and does not introduce any modification of the traditional technique and in our series total complication rate resulted similar to that described in literature for standard thyroidectomy in large series. As long as these criteria are carefully respected one need not to be concerned that these techniques might increase the complication rate.

Minimally invasive video-assisted thyroidectomy: seven-year experience with 240 cases.

“…The magnification of the endoscope allows for easier identification of some vital structures within the neck, including the RLN and parathyroid glands. Nevertheless, gentle and complete dissection of the RLN with a spatula is recommended at the video-assisted stage of the procedure to minimize the risk of stretch injury to the RLN at the second stage of the operation, when the thyroid lobe is extracted above the wound level, which follows the division of the superior thyroid vessels [11]. The use of any energy-based device (such as harmonic shears) for hemostasis during MIVAT is safe and facilitates dissection, allowing for a significant decrease in the operative time [12, 13].…”

Reply to G. Dionigi’s letter: energy based devices and recurrent laryngeal nerve injury: the need for safer instruments

“…In such cases, morbidity should be at least equal to or even lower after minimally invasive thyroidectomy as compared to its conventional equivalent. A large, uncontrolled prospective series of MIVAT procedures indicated that prevalence of the recurrent laryngeal nerve injury varies from 1.7% to 2.4% for transient events and 0.8% to 1.1% for permanent events [3][4][5]. A recent meta-analysis of randomized controlled trials comparing the MIVAT operation with open thyroidectomy suggested that there was no statistically significant difference in prevalence of either transient laryngeal nerve palsy or transient hypoparathyroidism.…”