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Rossi L, Materazzi G, Bakkar S, Miccoli P. Recent Trends in Surgical Approach to Thyroid Cancer. Front Endocrinol (Lausanne) 2021; 12:699805. [PMID: 34149628 PMCID: PMC8206549 DOI: 10.3389/fendo.2021.699805] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 05/19/2021] [Indexed: 12/12/2022] Open
Abstract
Over the past decade, the incidence of thyroid cancer has rapidly increased worldwide, and thyroid surgery has become one of the most common performed surgical procedure. Even though conventional open thyroidectomy remains the gold standard, this approach leaves a neck scar which could be worrying mainly for young women. The recent progress in surgical technology, as well as patient cosmetic requests, have led to the development of alternative access to the thyroid lodge. Thus, alternative techniques have been established in order to potentially provide a more appealing cosmetic result, both with a minimally-invasive cervical or remote-access approach. However, the introduction of these new techniques was initially approached with caution due to technical challenges, the introduction of new complications and, above all, skepticism about the oncologic effectiveness. Among several alternative approaches proposed, the minimally invasive video-assisted thyroidectomy and the robot-assisted transaxillary thyroidectomy became popular and obtained the favor of the scientific community. Moreover, the recent introduction of the trans-oral endoscopic thyroidectomy with vestibular approach, although the safety and the efficacy are still under discussion, deserves particular attention since it represents the only technique truly scarless and provides the best cometic result. The purpose of this article is to provide an overview of the current main alternative approaches for the treatment of thyroid cancer with particular focus on the oncological effectiveness of the procedures.
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Affiliation(s)
- Leonardo Rossi
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Gabriele Materazzi
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Sohail Bakkar
- Department of Surgery, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Paolo Miccoli
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
- *Correspondence: Paolo Miccoli,
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Lombardi CP, Carnassale G, D'Amore A, Milano V, De Crea C, Raffaelli M, Bellantone R. Morbidity from minimally invasive video-assisted thyroidectomy: a general review. Gland Surg 2017; 6:488-491. [PMID: 29142839 DOI: 10.21037/gs.2017.06.05] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Minimally invasive video-assisted thyroidectomy (MIVAT) is known and used worldwide, it combines the advantages associated with endoscopic magnification with those due with traditional surgery. In selected patients, it should be considered a safe and valid alternative. Indeed, a lot of comparative studies have demonstrated the advantages of MIVAT in terms of low rate of complications, reduced postoperative pain, improved cosmetic results and higher patient satisfaction over traditional surgery. Anyway, for obtaining the best results, with similar or even less complication rate than traditional surgery, surgeons should be well trained, acquired confidence with a smaller surgical incision and with the use of endoscopic instruments.
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Affiliation(s)
- Celestino Pio Lombardi
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Agostino Gemelli, Rome, Italy
| | - Giulia Carnassale
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Agostino Gemelli, Rome, Italy
| | - Annamaria D'Amore
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Agostino Gemelli, Rome, Italy
| | - Valentina Milano
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Agostino Gemelli, Rome, Italy
| | - Carmela De Crea
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Agostino Gemelli, Rome, Italy
| | - Marco Raffaelli
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Agostino Gemelli, Rome, Italy
| | - Rocco Bellantone
- Division of Endocrine and Metabolic Surgery, Fondazione Policlinico Agostino Gemelli, Rome, Italy
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Hensler MS, Falciglia M, Yaqub A, Yang H, Steward DL. Elective central node dissection: Comparison of open to minimally invasive video-assisted approach. Laryngoscope 2016; 126:1715-8. [DOI: 10.1002/lary.25844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 11/08/2015] [Accepted: 12/01/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Matthew S. Hensler
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati; Cincinnati Ohio
| | | | - Abid Yaqub
- Division of Endocrinology; University of Cincinnati; Cincinnati Ohio
| | - Huaitao Yang
- Department of Pathology; University of Cincinnati; Cincinnati Ohio U.S.A
| | - David L. Steward
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati; Cincinnati Ohio
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Duke WS, White JR, Waller JL, Terris DJ. Six-Year Experience With Endoscopic Thyroidectomy: Outcomes and Safety Profile. Ann Otol Rhinol Laryngol 2015; 124:915-20. [PMID: 26082473 DOI: 10.1177/0003489415591837] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Though minimally invasive video-assisted thyroidectomy (MIVAT) offers many advantages over traditional thyroid surgery, its adoption in North America has been limited. This study analyzes the largest series of MIVAT in North America to explore its safety. METHODS A prospectively maintained database of all patients undergoing thyroid surgery by a single surgeon from 2003 to 2011 at an academic tertiary care medical center was evaluated. Demographic information, surgical and pathologic data, and postoperative outcomes were analyzed. RESULTS Beginning in 2005, a total of 260 MIVATs were performed during the study period. Outpatient surgery was accomplished in 234 MIVATs (90%). MIVAT patients were predominantly young (46.8±14.8 years vs 52.4±14.6 years for conventional thyroidectomy) and female (88.5% vs 75.5% for conventional thyroidectomy). There were no cases of permanent hypoparathyroidism or permanent recurrent laryngeal nerve dysfunction. Observed complications included transient recurrent laryngeal nerve dysfunction (n=10; 3.8%), cellulitis (n=1; 0.4%), and temporary hypocalcemia (n=6; 2.3%). The overall complication rate for MIVAT (6.5%) was lower than the overall complication rate in conventional thyroidectomy (18.5%, P<.0001). CONCLUSION MIVAT can be performed safely with a low complication profile in a high-volume practice. The safety of MIVAT represented by this experience supports broader adoption across surgical practices.
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Affiliation(s)
- William S Duke
- Department of Otolaryngology-Head and Neck Surgery, Georgia Regents University, Augusta, Georgia, USA
| | - Jennifer R White
- Department of Otolaryngology-Head and Neck Surgery, Georgia Regents University, Augusta, Georgia, USA
| | - Jennifer L Waller
- Department of Biostatistics and Epidemiology, Georgia Regents University, Augusta, Georgia, USA
| | - David J Terris
- Department of Otolaryngology-Head and Neck Surgery, Georgia Regents University, Augusta, Georgia, USA
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Minimally invasive video-assisted thyroidectomy: experience of 200 cases in a single center. Wideochir Inne Tech Maloinwazyjne 2014; 9:337-43. [PMID: 25337155 PMCID: PMC4198635 DOI: 10.5114/wiitm.2014.43077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 01/27/2014] [Accepted: 02/17/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction Minimally invasive techniques in thyroid surgery including video-assisted technique originally described by Miccoli have been accepted in several continents for more than 10 years. Aim To analyze our preliminary results from minimally invasive video-assisted thyroidectomy (MIVAT) and to evaluate the feasibility and effects of this method in a general department over a 4-year period. Material and methods Initial experience was presented based on a series of 200 patients selected for MIVAT at the General Surgery Department of Yantai Yuhuangding Hospital affiliated with Qingdao University during the period from May 2008 to June 2012. The enrolling criteria were rigorously observed. An above sternal incision with average length of 2.5 cm (1.5–3.0 cm) was made. Clinicopathologic characteristics, postoperative pain, length of hospital stay, cosmetic results and complications were retrospectively analyzed. Results All patients received general anesthesia. Thyroid unilateral lobectomy was successfully accomplished in 108 cases, total thyroidectomy in 84, and partial lobectomy in 8. Conversion to standard conventional thyroidectomy was required in 6 patients (3%) because of thyroiditis and bleeding. The mean lymph node yield of the cancer specimens was 3.6 per patient. Permanent unilateral recurrent laryngeal nerve (RLN) palsy occurred in 1 case (0.5%), transient unilateral RLN palsy in 6 patients (3.0%, complete recovery after 1–6 months), and transient hypocalcemia in 7 patients (3.5%). No definitive hypocalcemia was observed. No postoperative hematomas occurred. Postoperative pain was endurable. The cosmetic result was excellent in most cases. Conclusions The MIVAT is feasible and safe in selected patients, with better results comparable to conventional thyroidectomy. The MIVAT can also be performed in a general surgery department.
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Kania R, Kania R, Hammami H, Vérillaud B, Blancal JP, Sauvaget E, Tran H, Leclerc N, Altabaa K, Herman P, Pons Y. Minimally invasive video-assisted thyroidectomy: tips and pearls for the surgical technique. Ann Otol Rhinol Laryngol 2014; 123:409-14. [PMID: 24671545 DOI: 10.1177/0003489414526845] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The objectives of this study were first to show principles of the minimally invasive video-assisted thyroidectomy (MIVAT), based on a video highlighting critical steps, and second to discuss tips and pearls to assist surgical teams that would like to start using this technique. METHODS Based on a video, we described tips and pearls of a MIVAT. RESULTS MIVAT includes 5 main steps: (1) skin incision and identification of the common carotid artery, (2) dissection and ligation of the upper pedicle, (3) identification of the inferior laryngeal nerve and parathyroid glands, (4) isthmectomy and lobe extraction, and (5) closure. DISCUSSION Coordination between the surgeon and the 2 assistants is of paramount importance for the performance of MIVAT. Appropriate material is also required. The magnification and tissue contrast emphasizes the identification of the vessels, the superior and inferior laryngeal nerves, and parathyroid glands, on a large-view screen.
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Abstract
Recent technologic advances have engendered alternative and innovative approaches to thyroid surgery aimed at reducing cosmetic sequelae. Minimally invasive techniques via small anterior cervical incisions hidden in natural skin creases and remote access approaches that eliminate anterior neck incisions entirely have emerged as viable options for patients who regard cosmesis as a priority. The safe application of these techniques to both benign and malignant thyroid disease has been evaluated.
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Affiliation(s)
- William S Duke
- Department of Otolaryngology, Georgia Regents University, 1120 Fifteenth Street, BP-4109, Augusta, GA 30912-4060, USA
| | - Katrina Chaung
- Department of Otolaryngology, Georgia Regents University, 1120 Fifteenth Street, BP-4109, Augusta, GA 30912-4060, USA
| | - David J Terris
- Department of Otolaryngology, Georgia Regents University, 1120 Fifteenth Street, BP-4109, Augusta, GA 30912-4060, USA.
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Abstract
Advances in surgical technology and patient-driven demands have fueled exploration into methods to improve cosmetic outcomes in thyroid surgery. This exploration has produced 2 fundamentally different pathways for reducing the visible thyroidectomy scar. Minimally invasive anterior cervical approaches use small incisions hidden in natural skin creases and reduce the overall extent of dissection required to remove the thyroid. Remote access approaches remove the incision from the anterior neck completely but require more extensive dissection to access the thyroid compartment.
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Affiliation(s)
- William S Duke
- Department of Otolaryngology, GRU Thyroid Center, Georgia Regents University, 1120 Fifteenth Street, BP-4109, Augusta, GA 30912-4060, USA
| | - David J Terris
- Department of Otolaryngology, GRU Thyroid Center, Georgia Regents University, 1120 Fifteenth Street, BP-4109, Augusta, GA 30912-4060, USA.
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Current World Literature. Curr Opin Oncol 2013; 25:325-30. [DOI: 10.1097/cco.0b013e328360f591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Melvin TAN, Eliades SJ, Ha PK, Fakhry C, Saunders JM, Califano JA, Blanco RGF. Neck dissection through a facelift incision. Laryngoscope 2012; 122:2700-6. [PMID: 23023877 DOI: 10.1002/lary.23386] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 03/03/2012] [Accepted: 04/05/2012] [Indexed: 01/29/2023]
Abstract
OBJECTIVES/HYPOTHESIS To determine the feasibility and safety of neck dissection through a facelift incision. STUDY DESIGN Prospective case series. METHODS Cadavers and live subjects underwent neck dissection using a facelift incision with and without endoscopic assistance. In the live facelift neck dissection (FLND), the preoperative surgical indications, staging, adjuvant therapy, intraoperative technical procedure, pathology reports on lymph nodes, and short-term outcomes were reviewed. RESULTS FLND was successfully performed in four cadavers and four live subjects, including selective (less than five neck levels removed) and comprehensive (levels I-V removed) neck dissections. All levels were accessible through this approach, with additional retraction required for levels I and IV. Endoscopic assistance was required in one neck dissection for adequate visualization. Short-term complications and number of excised lymph nodes were comparable to those from traditional neck dissection approaches. CONCLUSIONS Open neck dissection through a facelift incision is feasible and offers an alternate approach to traditional incisions. This can be performed without requiring robotic assistance and with endoscopic assistance only in certain cases. Endoscopic assistance can offer enhanced visualization of the surgical field and complement open direct approaches in neck dissection. Although FLND offers improved cosmetic outcomes when compared to those of traditional neck incisions, further study is required to determine its efficacy and indications.
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Affiliation(s)
- Thuy-Anh N Melvin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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Lombardi CP, Raffaelli M, De Crea C, Sessa L, Rampulla V, Bellantone R. Video-assisted versus conventional total thyroidectomy and central compartment neck dissection for papillary thyroid carcinoma. World J Surg 2012; 36:1225-30. [PMID: 22302283 DOI: 10.1007/s00268-012-1439-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although video-assisted (VA) thyroidectomy emerged as effective treatment for selected patients with papillary thyroid carcinoma (PTC), some concerns remain about obtaining adequate central neck node clearance. We compared patients who underwent VA and conventional total thyroidectomy (TT) and central compartment dissection (CCD) for PTC. METHODS A total of 52 consecutive patients successfully underwent VA-TT and VA-CCD for PTC (VA group) were compared to 52 controls who underwent conventional TT and CCD (C group) for PTC. RESULTS The two groups were matched for age (p = 0.75), sex (p = 0.07), and tumor size (p = 1.0). Operating time (p = 0.23), overall postoperative complications (p = 0.41), pT (p = 0.44), and pN (p = 0.84) were similar in the two groups. The mean number of removed nodes was similar (10.6 ± 4.6 in VA group vs. 12.2 ± 5.6 in C group) (p = 0.11).Mean postoperative serum thyroglobulin (sTg) off levothyroxine (LT4) suppressive treatment was 3.2 ± 5.0 ng/ ml in the VA group and 2.6 ± 7.4 ng/ml in the C-group (P = 0.67). Mean postoperative radioiodine uptake (RAIU) was similar in the two groups (1.5 ± 1.3 vs. 1.7 ± 1.3%) (p = 0.49). When pN1a patients alone were considered, no difference was found between the VA group (21 patients) and the controls (24 patients) concerning the mean number of removed nodes (10.3 ± 4.1 vs. 12.4 ± 5.6) (p = 0.16), the mean sTg off LT4 (4.4 ± 6.0 vs. 1.9 ± 2.7 ng/ml) (p = 0.07) and the mean RAIU (1.9 ± 1.5 vs. 1.7% ± 1.3%) (p = 0.63). CONCLUSIONS The results of VA-TT and CCD in selected cases of PTC appear to be comparable to those of conventional surgery. A longer follow-up and larger series are necessary to draw definitive conclusions concerning longterm outcomes.
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Affiliation(s)
- Celestino P Lombardi
- Division of General and Endocrine Surgery, Department of Surgery, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, L.go A. Gemelli 8, 00168 Rome, Italy
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Pons Y, Vérillaud B, Blancal JP, Sauvaget E, Cloutier T, Le Clerc N, Herman P, Kania R. Minimally invasive video-assisted thyroidectomy: Learning curve in terms of mean operative time and conversion and complication rates. Head Neck 2012; 35:1078-82. [PMID: 22791472 DOI: 10.1002/hed.23081] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2012] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the learning curve for minimally invasive video-assisted thyroidectomy (MIVAT). METHODS Fifty consecutive patients were prospectively included in groups corresponding to their surgical order (10 patients in each group). RESULTS The mean operation times between 2 neighboring groups were 33.9 minutes longer in group 1 than in group 2 (p = .01) and 25.8 minutes longer in group 3 than in group 4 (p = .002). The conversion rate for technical difficulties in group 1 was 6% (3 of 50). The definitive complication rate was 2% (1 of 50). CONCLUSIONS In terms of operative time, 10 patients represented the early stage of the learning curve, and 30 patients represented the number of procedures required to reach an advanced level of skill. Considering the low conversion and complication rates, improved aesthetic results and postoperative course, MIVAT should become a tool in the repertoire of high-volume thyroid surgeons.
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Affiliation(s)
- Yoann Pons
- Head and Neck Surgery Department, Hôpital Lariboisière, Paris, France.
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