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Hassan I, Hassan L, Bacha F, Alsalameh M, Qatee O, Hassan W. Clinico-pathological initial outcome of a newly adopted novel surgical technique for nodal metastatic thyroid cancer at a large-volume centre in a high-income developing country. Front Surg 2023; 10:1204230. [PMID: 37377667 PMCID: PMC10291131 DOI: 10.3389/fsurg.2023.1204230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/30/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction Thyroid cancer is the most common tumour in the endocrine system. In the past decade, the incidence of lymph node metastasis has increased, and so has the patient demand for a smaller scar. This research reports the surgical and patho-oncological short-term outcomes of a novel, minimally invasive neck dissection approach for thyroid carcinoma with lymph node metastases at the UAE's leading endocrine surgery centre. Methods This study employed a prospectively maintained surgical database to retrospectively analyse relevant parameters such as surgical complications, including bleeding, hypocalcaemia nerve injury and lymphatic fistula, as well as oncological metrics such as the type of tumour and the ratio of lymph node metastasis to the number of harvested lymph nodes in 100 patients that underwent open minimally invasive selective neck dissection. Results The study comprised 50 patients with thyroidectomy, with bilateral central compartment neck dissection (BCCND; 50%); 34 with thyroidectomy, BCCND and selective bilateral lateral compartment neck dissection (BLCND; 34%); and 16 patients with selective unilateral central and lateral compartment neck dissection by recurrent nodal disease (ULCND; 16%). The female-to-male gender ratio was 78:22, with median ages of 36 and 42 years, respectively. Histopathology findings revealed that 92% of patients had papillary thyroid cancer (PTC) and 8% had medullary thyroid cancer. The mean total number of lymph nodes removed was 22 in the BLCND group, 17 in the ULCND group and 8 in the BCCND group (p = 0.001). Furthermore, the average lymph node metastasis was significantly higher in the BLCND group (p = 0.002). The percentage of temporary hypoparathyroidism was 29.8% and it persisted for 1.3%. The lateral compartment dissection morbidity was as follows: Four male patients with tall cell infiltrative PTC presented with pre-existing vocal cord paresis, necessitating nerve resection and anastomosis, and two more developed it after surgery (1.1% of the nerve at risk). Lymphatic fistulas occurred in four patients (4%) who were treated conservatively. Two patients were readmitted due to symptomatic neck collection. Horner syndrome was discovered in just one female patient. Male gender, aggressive histology and lateral compartment dissection independently increased surgical morbidity. In a high-volume endocrine centre, the adoption of minimally invasive selective neck dissections to treat nodal metastatic thyroid cancer did not increase specific cervical surgery complications.
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Affiliation(s)
- Iyad Hassan
- Department of Surgery, Burjeel Hospital, Abu Dhabi, United Arab Emirates
| | - Lina Hassan
- Department of Surgery, Burjeel Hospital, Abu Dhabi, United Arab Emirates
| | - Farooq Bacha
- Department of Surgery, Burjeel Hospital, Abu Dhabi, United Arab Emirates
| | - Mohammad Alsalameh
- Department of Surgery, Burjeel Hospital, Abu Dhabi, United Arab Emirates
| | - Omran Qatee
- Department of Endocrinology, Burjeel Hospital, Abu Dhabi, United Arab Emirates
| | - Wiam Hassan
- Department of Surgery, Burjeel Hospital, Abu Dhabi, United Arab Emirates
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Jin XX, Zhang QY, Gao C, Wei WX, Jiao C, Li L, Ma BL, Dong C. Thyroidectomy Using the Lateral Cervical Small Incision Approach for Early Thyroid Cancer. Clin Cosmet Investig Dermatol 2022; 15:713-720. [PMID: 35478775 PMCID: PMC9036472 DOI: 10.2147/ccid.s358959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/30/2022] [Indexed: 11/23/2022]
Abstract
Objective Surgical resection is the main treatment for thyroid cancer, but while traditional open thyroidectomy improves prognosis, it also results in poor cosmetic outcomes. Therefore, we devised the lateral cervical small incision approach to thyroidectomy and will evaluate its efficacy. Methods The clinicopathological data of 191 patients who underwent unilateral thyroidectomy and isthmusectomy for early thyroid cancer were collected retrospectively. Of these, 100 patients underwent a traditional thyroidectomy using the median cervical approach (control group), and 91 patients underwent a thyroidectomy using the lateral cervical small incision approach (experimental group). The differences in perioperative prognosis, postoperative complications, and cosmetic outcomes between the two groups were evaluated. Results There was no significant difference in sex, age, tumor size, lymph node dissection, number of metastases, or postoperative complications between the experimental group and the control group (P > 0.05). There were significant differences in the duration of the operation; postoperative blood loss, drainage, and hospital stay; and scar color, blood circulation, hardness, and thickness between the groups (P < 0.05). The cosmetic outcomes of the incisions in the experimental group were more satisfactory than in the control group (P < 0.05). Conclusion When compared with traditional open thyroidectomy, the lateral cervical small incision approach has a lower incidence of complications, a better perioperative prognosis, and an improved cosmetic outcome.
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Affiliation(s)
- Xi-Xin Jin
- Department of Breast, Head and Neck Surgery, Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi, Xinjiang, People's Republic of China
| | - Qian-Yu Zhang
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Chao Gao
- Department of Breast, Head and Neck Surgery, Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi, Xinjiang, People's Republic of China
| | - Wen-Xin Wei
- Department of Breast, Head and Neck Surgery, Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi, Xinjiang, People's Republic of China
| | - Chong Jiao
- Department of Breast, Head and Neck Surgery, Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi, Xinjiang, People's Republic of China
| | - Li Li
- Department of Gynecology and surgery, Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi, Xinjiang, People's Republic of China
| | - Bin-Lin Ma
- Department of Breast, Head and Neck Surgery, Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi, Xinjiang, People's Republic of China
| | - Chao Dong
- Department of Breast, Head and Neck Surgery, Affiliated Cancer Hospital of Xinjiang Medical University, Urumqi, Xinjiang, People's Republic of China
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Paspala A, Spartalis E, Nastos C, Tsourouflis G, Dimitroulis D, Pikoulis E, Nikiteas N. Robotic-assisted parathyroidectomy and short-term outcomes: a systematic review of the literature. J Robot Surg 2020; 14:821-827. [PMID: 32661866 DOI: 10.1007/s11701-020-01119-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 07/09/2020] [Indexed: 11/27/2022]
Abstract
Minimal invasive techniques in endocrine surgery were lately adopted by surgical teams due to significant complications related to inadequate operative space and high risk of injuring crucial surrounding structures, such as vessels and nerves. Over the last years, technological improvements introduced robotic systems and approaches in endocrine surgery. Several case reports and series have described the safety and efficacy of these procedures such as robotic thyroidectomy and robotic parathyroidectomy. In the current review, we included 15 studies which described robotic-assisted parathyroidectomy for cervical parathyroid adenoma, in patients diagnosed with primary hyperparathyroidism or secondary hyperparathyroidism. No significant negative short-term outcomes were observed, in terms of postoperative complications, such as temporary or permanent injury of RLN, postoperative hypoparathyroidism and blood loss. The cosmetic result was, definitely, superior in comparison to conventional open parathyroidectomy. Despite the fact that RAP is an effective and curative method for patients with PHPT or secondary hyperparathyroidism, there are no available randomized clinical trials to establish this modern procedure as a gold-standard treatment strategy for these patients.
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Affiliation(s)
- A Paspala
- Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, Athens, Greece.
- 3rd Department of Surgery, Medical School, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - E Spartalis
- Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, Athens, Greece
| | - C Nastos
- 3rd Department of Surgery, Medical School, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - G Tsourouflis
- Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, Athens, Greece
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - D Dimitroulis
- Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, Athens, Greece
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - E Pikoulis
- 3rd Department of Surgery, Medical School, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - N Nikiteas
- Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, Athens, Greece
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Choi JY, Bae IE, Kim HS, Yoon SG, Yi JW, Yu HW, Kim SJ, Chai YJ, Lee KE, Youn YK. Comparative study of bilateral axillo-breast approach endoscopic and robotic thyroidectomy: propensity score matching analysis of large multi-institutional data. Ann Surg Treat Res 2020; 98:307-314. [PMID: 32528910 PMCID: PMC7263885 DOI: 10.4174/astr.2020.98.6.307] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/30/2020] [Accepted: 03/06/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose The aim of this study was to compare the large multi-institutional data of surgical outcomes of bilateral axillo-breast approach (BABA) robotic (RT) and endoscopic thyroidectomy (ET) and to evaluate the merits of robotic thyroidectomy. Methods From 2004 to 2015, 1,029 patients underwent BABA ET, and from 2008 to 2015, 2003 patients underwent BABA RT in 3 large volume centers in Korea. Two groups were retrospectively compared in terms of clinicopathologic characteristics, complications, surgical completeness, and long-term outcomes using propensity score matching analysis. Results Both groups had similar demographic characteristics including age, sex, tumor size, pathologic stage, and hospital stay after matching. Each group had similar rate of transient hypoparathyroidism, however, ET showed significantly higher rate of permanent hypoparathyroidism (ET 5.2% vs. RT 2.3%, P = 0.05), and transient vocal cord palsy (ET 14.4% vs. RT 9.1%, P = 0.006). Total operation time was longer in the ET group irrespective of surgical extents, including lobectomy (P = 0.016), total thyroidectomy (P = 0.031), and total thyroidectomy with central lymph node dissection (P = 0.019). The rate of patients with off-Tg under 1.0 ng/mL after 1st ablation was significantly higher in RT than ET group (ET 64.6% vs. RT 92.7%, P < 0.001). In long-term follow-up of cancer patients, 1.4% experienced recurrence after ET (10 cases), while 0.3% cases experienced recurrence after RT (5 cases) (P < 0.001). Conclusion Both ET and RT can be safe and effective methods to treat thyroid diseases. However, the application of robotic system may help to overcome the limitations of the instruments and surgeon's skills.
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Affiliation(s)
- June Young Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - In Eui Bae
- Department of Surgery, Konyang University Hospital, Daejeon, Korea
| | - Hyun Soo Kim
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sang Gab Yoon
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jin Wook Yi
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Hyeong Won Yu
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Su-Jin Kim
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Young Jun Chai
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Surgery, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Kyu Eun Lee
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yeo-Kyu Youn
- Yeo-Kyu Youn Thyroid Clinic, St. Peter's Hospital, Seoul, Korea
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Scerrino G, Melfa G, Raspanti C, Rotolo G, Salamone G, Licari L, Fontana T, Tutino R, Porrello C, Gulotta G, Cocorullo G. Minimally Invasive Video-Assisted Thyroidectomy: Analysis of Complications From a Systematic Review. Surg Innov 2019; 26:381-387. [PMID: 30632464 DOI: 10.1177/1553350618823425] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Nowadays, minimally invasive video-assisted thyroidectomy (MIVAT) is considered a safe and effective option. However, its complication rate has not been specifically discussed yet. The aim of this systematic review was enrolling a large number of studies to estimate early and late complications (transient and definitive, uni- and bilateral laryngeal nerve palsy; transient and definitive hypocalcemia; cervical hematoma; hypertrophic or keloid scar) of MIVAT compared with conventional technique. METHODS The review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria in PubMed and Embase. Search terms were "minimally invasive," "video-assisted," and "thyroidectomy." We enrolled randomized clinical trials, nonrandomized trials, and noncontrolled trials. RESULTS Thirty-two articles were considered suitable. Complication rate of MIVAT was quite similar to conventional technique: only one randomized trial found a significant difference concerning overall skin complication, and a single trial highlighted hypocalcemia significantly increased in MIVAT, concerning serologic value only. No difference concerning symptomatic nor definitive hypocalcemia was found. CONCLUSIONS We can confirm that MIVAT is a safe technique. It should be adopted in mean-high-volume surgery centers for thyroidectomy, if a strict compliance with indication was applied.
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Bellantone R, Raffaelli M, De Crea C, Sessa L, Traini E, Princi P, Lombardi CP. Video-Assisted Thyroidectomy for Papillary Thyroid Carcinoma: Oncologic Outcome in Patients with Follow-Up ≥ 10 Years. World J Surg 2018; 42:402-408. [PMID: 29238849 DOI: 10.1007/s00268-017-4392-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Video-assisted thyroidectomy (VAT) arisen as a valid treatment for selected patients with papillary thyroid carcinoma (PTC), but no data concerning long-term oncologic outcome are available. The primary aim of the study was to evaluate the oncologic outcome of patients who underwent VAT for PTC with a follow-up ≥ 10 years. METHODS The medical charts of all the patients who successfully underwent VAT for PTC were reviewed. The patients with a minimum follow-up period of 120-months were included. Patients with unifocal PTC ≤ 1 cm, in the absence of lymph node metastases, without gross extracapsular invasion and age < 45 years were considered "low-risk" patients and followed with ultrasound and serum thyroglobulin (sTg) on levothyroxine (LT4); the remaining patients underwent nuclear medicine evaluation. RESULTS Two hundred and fifty-seven patients, operated on between May 2000 and October 2006, were included. Postoperative complications included four transient recurrent palsies, 76 transient and 1 permanent hypocalcemia. One hundred and four low-risk patients were followed with ultrasound and sTg on LT4. At a mean follow-up of 136.6 months, mean sTg on LT4 was 0.1 ± 0.1 ng/ml. None of them showed recurrence. The remaining 153 patients underwent nuclear medicine evaluation. Among these 153, 62 did not undergo radioiodine ablation (RAI). At a mean follow-up of 150.8 months, mean sTg on LT4 was 0.1 ± 0.1 ng/ml. None of them showed recurrence. The remaining 91 patients underwent RAI. Mean pre-RAI sTg off-LT4 was 8.3 ± 5.8 ng/ml, mean radioiodine uptake was 2.8 ± 4.4%. Among these 91, three pN1a patients developed a lateral neck node recurrence. No other recurrence was registered. At the latest follow-up mean sTg on LT4 in this subgroup of patients was 0.1 ± 0.2 ng/ml. CONCLUSIONS The long-term (≥ 10 years) oncologic outcome further demonstrates that VAT is a valid option for selected PTC patients.
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Affiliation(s)
- Rocco Bellantone
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Marco Raffaelli
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy.
| | - Carmela De Crea
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Luca Sessa
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Emanuela Traini
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Pietro Princi
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Celestino Pio Lombardi
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
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Somashekhar SP, Ashwin KR. Robot-assisted thyroidectomy using a gasless, transaxillary approach for the management of thyroid lesions: Indian experience. J Minim Access Surg 2017; 13:280-285. [PMID: 28872097 PMCID: PMC5607795 DOI: 10.4103/jmas.jmas_42_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aim: Since last decades, more and more thyroidectomies have been performed by the minimally invasive method. Compared to conventional thyroidectomy, minimally invasive thyroidectomy has a superior cosmetic result. However, the outcome depends, in a large extent, on the skill of the operator and the learning curve is relatively long. Robotic thyroidectomy (RT) is a relatively new approach in treating thyroid lesions with improved ergonomics and surgical outcomes. Purpose: We performed a prospective study of robotic-assisted transaxillary approach for thyroidectomy in Indian patients to examine the feasibility of the procedure. Materials and Methods: A total of 35 patients underwent RT. Demographics, surgical indications, operative findings, postoperative functional outcome, local complications and pathological outcomes were recorded and analyzed. Results: The median age of the cohort was 28.6 years and 31 of the patients were women. The median size of the largest nodule was 3.2 cm (range, 1.0–4.5 cm). The median size of the largest nodule was 3.2 cm (range, 1.0–4.5 cm). Eighteen patients underwent less than total thyroidectomy and 17 patients underwent total thyroidectomy, with no conversion. The mean console time standard deviation was 115 min initially, and with experience, it reduced to 106 min for subsequent cases. The mean blood loss was 13 ml. Post-operative outcome was good with no serious complication noted in our series. Conclusion: Robotic-assisted thyroidectomy using a gasless transaxillary approach is a feasible, safe and noninferior surgical alternative for selected patients. We believe with time RT will be widened and it will be performed more often.
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Affiliation(s)
- S P Somashekhar
- Department of Surgical Oncology, Manipal Comprehensive Cancer Center, Bengaluru, Karnataka, India
| | - K R Ashwin
- Manipal Comprehensive Cancer Center, Manipal Hospital, Bengaluru, Karnataka, India
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Dionigi G, Kim HY, Wu CW, Lavazza M, Materazzi G, Lombardi CP, Anuwong A, Tufano RP. Neuromonitoring in endoscopic and robotic thyroidectomy. Updates Surg 2017; 69:171-179. [DOI: 10.1007/s13304-017-0442-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 04/01/2017] [Indexed: 12/01/2022]
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9
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Minimally Invasive Video-Assisted Thyroidectomy (MIVAT) in the Era of Minimal Access Thyroid Surgery. ACTA ACUST UNITED AC 2017. [DOI: 10.5812/minsurgery.42470] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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Kandil E, Hammad AY, Walvekar RR, Hu T, Masoodi H, Mohamed SE, Deniwar A, Stack BC. Robotic Thyroidectomy Versus Nonrobotic Approaches: A Meta-Analysis Examining Surgical Outcomes. Surg Innov 2015; 23:317-25. [PMID: 26525401 DOI: 10.1177/1553350615613451] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Robotic surgery has been recently used as a novel tool for remote access thyroid surgery. We performed a meta-analysis of the current literature to examine the safety and oncological efficacy of robotic surgery compared to endoscopic and conventional approaches for different thyroid procedures. Methods A systematic search of the online data bases was done using the following (MeSH) terms "robotic surgery," "robotic thyroidectomy," "robot-assisted thyroidectomy," and "robot-assisted thyroid surgery." Outcomes measured included total operative time, length of hospital stay, postoperative thyroglobulin levels, and postoperative complications. Statistical differences were analyzed between groups through the standard means and/or relative risk by using STATA analytical software. Results In this study, 144 articles were identified; of which 18 of them met our inclusion criteria, totaling 4878 patients. Robotic approach was associated with longer total operative time (mean difference of 43.5 minutes) when compared to the conventional cervical approach (95% CI = 20.9-66.2; P < .001). Robotic approach was also found to have a similar risk of total postoperative complications when compared to the conventional and endoscopic approaches. Conclusion Robotic thyroid surgery is as safe, feasible and provides similar periperative complications and oncological outcomes when compared to both, conventional cervical and endoscopic approaches. However, robotic thyroid surgery is associated with longer operative time when compared to the conventional open approach.
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Affiliation(s)
- Emad Kandil
- Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Rohan R Walvekar
- Louisiana State University Health Science Center, New Orleans, LA, USA
| | - Tian Hu
- Tulane University School of Public Health, New Orleans, LA, USA
| | - Hammad Masoodi
- Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Ahmed Deniwar
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Brendan C Stack
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
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11
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Lu Q, Xie SQ, Chen SY, Chen LJ, Qin Q. Experience of 1166 thyroidectomy without use of prophylactic antibiotic. BIOMED RESEARCH INTERNATIONAL 2014; 2014:758432. [PMID: 24900986 PMCID: PMC4037569 DOI: 10.1155/2014/758432] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 02/23/2014] [Accepted: 03/22/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although the procedure requires a small surgical incision and a short duration, incision infection rate is very low in thyroidectomy; however, doctors still have misgivings about infection events. AIM We retrospectively analyzed the prevention of incision infection without perioperative use of antibacterial medications following thyroidectomy. MATERIALS AND METHODS 1166 patients of thyroidectomy were not administered perioperative antibiotics. Unilateral total lobectomy or partial thyroidectomy was performed in 68.0% patients with single-side nodular goiter or thyroid adenoma. Bilateral partial thyroidectomy was performed in 25.5% patients with nodular goiter or Graves' disease. The mean time of operation was 80.6 ± 4.87 (range: 25-390) min. RESULTS Resuturing was performed in two patients of secondary hemorrhage from residual thyroid following bilateral partial thyroidectomy. Temporally recurrent nerve paralysis was reported following right-side total lobectomy and left-side subtotal lobectomy in a nodular goiter patient. One case had suppurative infection in neck incision 5 days after bilateral partial thyroidectomy. CONCLUSIONS Thyroidectomy, which is a clean incision, involves a small incision, short duration, and minor hemorrhage. If the operation is performed under strict conditions of sterility and hemostasis, antibacterial medications may not be required to prevent incision infection, which reduces cost and discourages the excessive use of antibiotics.
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Affiliation(s)
- Qiang Lu
- Department of General Surgery, TungWah Affiliated Hospital of Sun Yat-sen University, Dongguan, Guangdong 523110, China
| | - Shu-Qin Xie
- Department of General Surgery, TungWah Affiliated Hospital of Sun Yat-sen University, Dongguan, Guangdong 523110, China
| | - Si-Yuan Chen
- Department of Surgical Oncology, Tung Wah Affiliated Hospital of Sun Yat-sen University, Dongguan, Guangdong 523110, China
| | - Li-Ju Chen
- Operating Room Tung Wah, Tung Wah Affiliated Hospital of Sun Yat-sen University, Dongguan, Guangdong 523110, China
| | - Qian Qin
- Department of General Surgery, TungWah Affiliated Hospital of Sun Yat-sen University, Dongguan, Guangdong 523110, China
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Noureldine SI, Lewing N, Tufano RP, Kandil E. The role of the robotic-assisted transaxillary gasless approach for the removal of parathyroid adenomas. ORL J Otorhinolaryngol Relat Spec 2014; 76:19-24. [PMID: 24662482 DOI: 10.1159/000353629] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 08/20/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND We sought to describe a robotic technique of transaxillary gasless parathyroidectomy for the management of primary hyperparathyroidism (PHPT) due to a parathyroid adenoma. METHODS All consecutive patients who underwent robotic parathyroidectomy for a parathyroid adenoma by a single surgeon were included. Data was obtained by a retrospective review of patients' medical charts. RESULTS Nine patients with confirmed PHPT underwent robotic parathyroidectomy. Curative resection was established in all patients with the aid of intraoperative parathyroid hormone monitoring. One patient required bilateral cervical exploration of multiglandular disease. There were no complications. Patients were followed up for a period exceeding 6 months without any evidence of persistent or recurrent hyperparathyroidism. CONCLUSIONS Our initial experience demonstrates that this technique is safe and effective for the treatment of PHPT. We believe that the use of robotic technology for endoscopic parathyroid surgeries could overcome the limitations of conventional techniques in the management of parathyroid lesions.
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Affiliation(s)
- Salem I Noureldine
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Md., USA
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13
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Qin Q, Li H, Wang LB, Li AH, Chen LJ, Lu Q. Thyroid Surgery without Antibiotic Prophylaxis: Experiences with 1,030 Patients from a Teaching Hospital in China. World J Surg 2014; 38:878-81. [DOI: 10.1007/s00268-014-2453-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ramirez AT, Gibelli B, Tradati N, Giugliano G, Zurlo V, Grosso E, Chiesa F. Surgical management of thyroid cancer. Expert Rev Anticancer Ther 2014; 7:1203-14. [PMID: 17892421 DOI: 10.1586/14737140.7.9.1203] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Thyroid cancer is the most common endocrine neoplasm; however, it only accounts for less than 1% of all human malignances. Thyroid cancers are divided into well differentiated and non-well differentiated cancers, according to their histology and behavior. The surgical management options of well-differentiated thyroid cancer include total or near-total thyroidectomy, subtotal thyroidectomy and lobectomy plus isthmusectomy. The extent of surgery for thyroid cancer continues to be an area of controversy. Complications associated with thyroid surgery are directly proportional to the extent of thyroidectomy and inversely proportional to the experience of the operating surgeon. They occur less frequently with good surgical technique and better understanding of surgical anatomy, and include wound healing and infections (seroma, hematoma and wound infection), nerve injury, hypoparathyroidism, hypothyroidism, postoperative hemorrhage and respiratory obstruction.
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Affiliation(s)
- Adonis T Ramirez
- University Hospital Neiva Colombia, General Surgery Department, Colombia.
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Pisanu A, Podda M, Reccia I, Porceddu G, Uccheddu A. Systematic review with meta-analysis of prospective randomized trials comparing minimally invasive video-assisted thyroidectomy (MIVAT) and conventional thyroidectomy (CT). Langenbecks Arch Surg 2013; 398:1057-68. [PMID: 24162166 DOI: 10.1007/s00423-013-1125-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 09/22/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Minimally invasive video-assisted thyroidectomy (MIVAT) has gained acceptance among surgeons as its feasibility has been well documented. The aim of this systematic review with meta-analysis has been to assess and validate the safety and feasibility of MIVAT when compared to conventional thyroidectomy (CT) and to verify other potential benefits and drawbacks. METHODS A literature search for prospective randomized trials comparing MIVAT and CT was performed. Trials were reviewed for the primary outcome measures: overall morbidity, recurrent laryngeal nerve palsy, postoperative hypocalcemia, and postoperative hematoma; and for the secondary outcome measures: operative time, conversion to standard procedure, intraoperative blood loss, intraoperative drain insertion, nodule size and thyroid weight, postoperative pain evaluation, length of hospital stay, patient satisfactory score, and cosmetics results. Standardized mean difference (SMD) was calculated for continuous variables and odds ratio for qualitative variables. RESULTS Nine prospective randomized studies comparing MIVAT and CT were analyzed. Overall, 581 patients were randomized to either MIVAT (289, 49.7 %) or CT (292, 50.3 %). The primary outcome measures of MIVAT were comparable with those of CT without statistically significant difference. Patients who underwent MIVAT experienced significantly less pain than those operated on conventionally during the whole postoperative period. Patient satisfactory score significantly favored MIVAT (9.0 vs. 6.8, SMD = -3.388, 95 % CI = -5.720 to -1.057). Operative time was significantly longer in MIVAT (75.2 vs. 59.2 min, SMD = 1.246, 95 % CI = 0.227-2.266). CONCLUSIONS MIVAT is a safe and feasible alternative for the removal of small-volume benign thyroid disease and low-risk papillary thyroid carcinomas showing better cosmetics results and less postoperative pain but significantly longer operative time when compared to CT. New multicenter randomized studies are needed to evaluate the technique in more complex circumstances such as intermediate-risk thyroid cancer, lymph node removal, thyroiditis, and Graves' disease.
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Affiliation(s)
- Adolfo Pisanu
- Department of Surgery, Clinica Chirurgica, University of Cagliari, Monserrato, Italy,
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Bhargav PRK, Amar V. Operative technique of endoscopic thyroidectomy: a narration of general principles. Indian J Surg 2012; 75:216-9. [PMID: 24426430 DOI: 10.1007/s12262-012-0494-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 04/04/2012] [Indexed: 12/11/2022] Open
Abstract
Endoscopic thyroidectomy is fast becoming a reality with increasing experience in endocrine surgery. Many techniques of minimally invasive video-assisted thyroidectomy through cervical and extra-cervical routes such as chest wall, transaxillary, trans-oral, post-auricular, trans-luminal approach have been attempted. At present anterior chest wall or trans-axillary routes are favourite extra-cervical routes. In this context, we describe our operative technique of endoscopic thyroidectomy through chest wall to highlight the surgical steps of practical importance.
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Affiliation(s)
- P R K Bhargav
- Endocrine and Metabolic Surgery Department, Mamata Medical College and Hospital (MMC/MGH), Khammam, Andhra Pradesh 507002 India
| | - V Amar
- Advanced Laparoscopic and Bariatric Surgeon, Prime Hospitals, Hyderabad, India
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Kandil EH, Noureldine SI, Yao L, Slakey DP. Robotic Transaxillary Thyroidectomy: An Examination of the First One Hundred Cases. J Am Coll Surg 2012; 214:558-64; discussion 564-6. [DOI: 10.1016/j.jamcollsurg.2012.01.002] [Citation(s) in RCA: 127] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 01/12/2012] [Indexed: 10/28/2022]
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Raffaelli M, De Crea C, Carrozza C, D’Amato G, Zuppi C, Bellantone R, Lombardi CP. Combining Early Postoperative Parathyroid Hormone and Serum Calcium Levels Allows for an Efficacious Selective Post-thyroidectomy Supplementation Treatment. World J Surg 2012; 36:1307-13. [DOI: 10.1007/s00268-012-1556-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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20
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Chowbey PK, Soni V, Khullar R, Sharma A, Baijal M. Endoscopic neck surgery. J Minim Access Surg 2011; 3:3-7. [PMID: 20668611 PMCID: PMC2910378 DOI: 10.4103/0972-9941.30679] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2006] [Accepted: 11/30/2006] [Indexed: 11/04/2022] Open
Abstract
Endoscopic surgery in the neck was attempted in 1996 for performing parathyroidectomy. A similar surgical technique was used for performing thyroidectomy the following year. Most commonly reported endoscopic neck surgery studies in literature have been on thyroid and parathyroid glands. The approaches are divided into two types i.e., the total endoscopic approach using CO(2) insufflation and the video-assisted approach without CO(2) insufflation. The latter approach has been reported more often. The surgical access (port placements) may vary-the common sites are the neck, anterior chest wall, axilla, and periareolar region. The limiting factors are the size of the gland and malignancy. Few reports are available on endoscopic resection for early thyroid malignancy and cervical lymph node dissection. Endoscopic neck surgery has primarily evolved due to its cosmetic benefits and it has proved to be safe and feasible in suitable patients with thyroid and parathyroid pathologies. Application of this technique for approaching other cervical organs such as the submandibular gland and carotid artery are still in the early experimental phase.
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Affiliation(s)
- P K Chowbey
- Department of Minimal Access and Bariatric Surgery Centre, Sir Ganga Ram Hospital, New Delhi, India
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El-Labban GM. Minimally invasive video-assisted thyroidectomy versus conventional thyroidectomy: A single-blinded, randomized controlled clinical trial. J Minim Access Surg 2011; 5:97-102. [PMID: 20407568 PMCID: PMC2843132 DOI: 10.4103/0972-9941.59307] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 11/07/2009] [Indexed: 11/04/2022] Open
Abstract
UNLABELLED 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.
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Affiliation(s)
- Gouda M El-Labban
- Department of Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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Affiliation(s)
- Yin-Long Yang
- The First Affiliated Hospital of Wenzhou Medical College Wenzhou, Zhejiang Province, China
| | - Bao-Rong Lin
- The First Affiliated Hospital of Wenzhou Medical College Wenzhou, Zhejiang Province, China
| | - Yi-Fei Pan
- The First Affiliated Hospital of Wenzhou Medical College Wenzhou, Zhejiang Province, China
| | - Xiao-Hua Zhang
- The First Affiliated Hospital of Wenzhou Medical College Wenzhou, Zhejiang Province, China
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Chen ZQ, Wang L, Li T, Hu SY, Zhi XT. Supraclavicular Lateral Collar Incision Versus Conventional Approach for Thyroidectomy: Supplement for Minimally Invasive Techniques with Extended Indications. J Laparoendosc Adv Surg Tech A 2011; 21:45-50. [PMID: 21029025 DOI: 10.1089/lap.2010.0236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Zhi-qiang Chen
- Minimally Invasive Surgery Centre of Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Lei Wang
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, China
| | - Tao Li
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, China
| | - San-yuan Hu
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, China
| | - Xu-ting Zhi
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, China
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Byrd JK, Nguyen SA, Ketcham A, Hornig J, Gillespie MB, Lentsch E. Minimally invasive video-assisted thyroidectomy versus conventional thyroidectomy: a cost-effective analysis. Otolaryngol Head Neck Surg 2010; 143:789-94. [PMID: 21109079 DOI: 10.1016/j.otohns.2010.08.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2010] [Revised: 07/07/2010] [Accepted: 08/10/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the cost of minimally invasive video-assisted thyroidectomy (MIVAT) with conventional thyroidectomy. STUDY DESIGN A cost-effectiveness study and chart review. SETTING Academic university hospital. SUBJECTS AND METHODS Pediatric and adult patients referred to the Department of Otolaryngology-Head and Neck Surgery for suspicious thyroid nodules, goiters, or known carcinomas. A tertiary care hospital's billing department was queried for all hemithyroidectomies and total thyroidectomies completed by the Department of Otolaryngology-Head and Neck Surgery between January 5, 2006, and November 1, 2007. The charges, including surgery, hospital, pathology, and anesthesia, for minimally invasive video-assisted thyroidectomy (MIVAT) and traditional or minimally invasive open thyroidectomies meeting MIVAT inclusion criteria were then reviewed retrospectively and compared statistically. RESULTS A total of 185 thyroidectomies were performed, 50.3 percent of which met criteria for MIVAT. Length of stay (days) was significantly shorter for patients undergoing MIVAT hemithyroidectomy (mean difference -0.8; 95% confidence interval [95% CI] -1.08 to -0.52) and not significantly different between groups for total thyroidectomy (mean difference 0.1; 95% CI -0.36 to 0.56). Mean anesthesia cost (U.S.$) was similar between groups for hemi- and total thyroidectomies. MIVAT mean pathology cost was significantly less than open thyroidectomy for hemithyroidectomy (mean difference -89.9; 95% CI -179.01 to -0.79) and approached significance for total thyroidectomy. There was no significant difference in hospital cost and total cost for hemithyroidectomy and total thyroidectomy. CONCLUSION In a group of matched cohorts, the cost of MIVAT appears to be equal to that of open thyroidectomy.
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Affiliation(s)
- J Kenneth Byrd
- Department of Otolaryngology-Health and Neck Surgery, Medical University of South Carolina, Charleston, SC 29425, USA.
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Scerrino G, Paladino NC, Di Paola V, Morfino G, Matranga D, Gulotta G, Bonventre S. Total Thyroidectomy Performed With the Starion Vessel Sealing System Versus the Conventional Technique: A Prospective Randomized Trial. Surg Innov 2010; 17:242-7. [DOI: 10.1177/1553350610376394] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Meticulous dissection and accurate hemostasis are required in thyroid surgery. The authors recently performed a number of thyroidectomies using a new device that combines heat and pressure for sealing and cutting tissue. A prospective randomized trial was conducted on 98 patients subjected to total thyroidectomy for benign disease: 49 patients (group A) with the Starion tissue welding system and 49 (group B) with the clamp-and-tie technique. The 2 groups were comparable in mean age, gender, thyroidal volume (20-60 mL), incision length (<35 mm), and pathology. The authors evaluated operative time, postoperative serum calcemia, dosage and length of postoperative calcium and vitamin D treatment, drainage volume, hospital stay, and complications. Student’s t test was used for quantitative variables; for categorical variables, the χ 2 test or Fisher’s exact test, as appropriate, was used. The mean operative time was 53.8 ± 6.1 minutes in group A and 63.2 ± 8 minutes in group B ( P < .0001). The difference in terms of postoperative calcemia was significant (group A: 8.35 ± 0.39 mg/dL; group B: 8.08 ± 0.39 mg/dL; P < .001). The duration of postoperative treatment with calcium and vitamin D was significantly different (group A: 4 days; group B: 5 days; P < .039). No significant difference in terms of postoperative complications was found. The new system reduced operative time and the duration of postoperative hypocalcemia, and there was minimal tissue necrosis and thermal spread. The reduction in duration of postoperative calcium and vitamin D treatment is also an indication of improvement in quality of the treatment.
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Affiliation(s)
- Gregorio Scerrino
- Department of General, Emergency and Transplant Surgery (GENURTO)-Unit of General and Emergency Surgery, University of Palermo, Italy,
| | - Nunzia Cinzia Paladino
- Department of General, Emergency and Transplant Surgery (GENURTO)-Unit of General and Emergency Surgery, University of Palermo, Italy
| | - Valentina Di Paola
- Department of General, Emergency and Transplant Surgery (GENURTO)-Unit of General and Emergency Surgery, University of Palermo, Italy
| | - Giuditta Morfino
- Department of General, Emergency and Transplant Surgery (GENURTO)-Unit of General and Emergency Surgery, University of Palermo, Italy
| | - Domenica Matranga
- Department of Biotechnology and Forensic Medicine - Section of Radiological Sciences
| | - Gaspare Gulotta
- Department of General, Emergency and Transplant Surgery (GENURTO)-Unit of General and Emergency Surgery, University of Palermo, Italy
| | - Sebastiano Bonventre
- Department of General, Emergency and Transplant Surgery (GENURTO)-Unit of General and Emergency Surgery, University of Palermo, Italy
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Evaluation of postoperative pain after minimally invasive video-assisted and conventional thyroidectomy: results of a prospective study. ESES Vienna presentation. Langenbecks Arch Surg 2010; 395:845-9. [PMID: 20628756 DOI: 10.1007/s00423-010-0688-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Accepted: 07/05/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND One of the advocated benefits of minimally invasive video-assisted thyroidectomy (MIVAT) is reduction of postoperative pain. We compared in a prospective study pain after video-assisted and conventional thyroidectomy (CT). METHODS One hundred sixty-nine patients (56 men, 113 women, mean age: 50 ± 14 years) operated between November 2007 and February 2008 were included. MIVAT was performed if thyroid volume was <30 ml or the nodule diameter < 35 mm. Postoperative pain scores were documented on a visual analog scale (VAS; 0 = no and 100 = unbearable pain) at 8, 24, 36, and 48 h after surgery. Additionally, postoperative analgesic consumption was registered. RESULTS Seventy-five patients (17 men, 58 women, mean age: 45 ± 15 years) underwent MIVAT and 94 (39 men, 55 women, mean age: 54 ± 15 years) CT. The mean overall VAS score at 8, 24, 36 and 48 h did not significantly differ between the groups (26 ± 21 vs. 26 ± 19 at 8 h, 17 ± 15 vs. 21 ± 18 at 24 h, 11 ± 13 vs. 10 ± 11 at 36 h and 7 ± 12 vs. 6 ± 8 at 48 h in MIVAT and CT group, respectively) [p = ns]. Twelve vs. 13 patients (16% vs. 14%) required opioid administration on the day of the operation [p = ns]. CONCLUSIONS The length of the skin incision seems not to influence the perception of pain after thyroid surgery.
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Wu CT, Yang LH, Kuo SJ. Comparison of video-assisted thyroidectomy and traditional thyroidectomy for the treatment of papillary thyroid carcinoma. Surg Endosc 2009; 24:1658-62. [DOI: 10.1007/s00464-009-0826-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Accepted: 11/12/2009] [Indexed: 11/29/2022]
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Kania R, Parodi M, Coste A, Herman P, Tran Ba Huy P, Papon JF. La chirurgie thyroïdienne endoscopique par techniques vidéo-assistées et totalement endoscopiques. ACTA ACUST UNITED AC 2009; 126:82-93. [DOI: 10.1016/j.aorl.2009.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Accepted: 01/29/2009] [Indexed: 01/10/2023]
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Minimally invasive video-assisted thyroidectomy compared with conventional thyroidectomy in a general surgery department. Surg Endosc 2009; 23:2263-7. [PMID: 19184215 DOI: 10.1007/s00464-008-0303-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Revised: 11/26/2008] [Accepted: 12/07/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND We retrospectively evaluated a series of patients who underwent minimally invasive video-assisted thyroidectomy (MIVAT) to define its advantages or disadvantages. METHODS Between May 2005 and March 2008, 68 patients underwent MIVAT. Sixty-nine patients who underwent conventional thyroidectomy (CT) during the period before the introduction of the MIVAT technique in our department-chosen with the same inclusion criteria used for MIVAT-served as matched controls. The eligibility criteria for both groups was thyroid nodules < or = 35 mm, thyroid volume < 25 ml, no thyroiditis, and no previous surgery. RESULTS Forty-five MIVAT and 43 CT patients underwent hemithyroidectomy. Twenty-three MIVAT and 26 CT patients underwent total thyroidectomy. No differences were found in terms of complications, operative time, and radicality of the procedure. Patients who underwent MIVAT experienced significantly less pain, better cosmetic results, and shorter hospital stay than patients who underwent conventional surgery CONCLUSION 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.
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Sywak MS, Yeh MW, McMullen T, Stalberg P, Low H, Alvarado R, Sidhu SB, Delbridge LW. A randomized controlled trial of minimally invasive thyroidectomy using the lateral direct approach versus conventional hemithyroidectomy. Surgery 2008; 144:1016-21; discussion 1021-2. [DOI: 10.1016/j.surg.2008.07.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2008] [Accepted: 07/30/2008] [Indexed: 11/28/2022]
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Minimally invasive video-assisted thyroidectomy for benign thyroid disease: an evidence-based review. World J Surg 2008; 32:1333-40. [PMID: 18305997 DOI: 10.1007/s00268-008-9479-y] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND A decade after nearly all surgical disciplines developed minimally invasive techniques, the first report of a single case of minimally invasive thyroidectomy was published. Minimally invasive video-assisted thyroidectomy (MIVAT) is now considered the most widely practiced and most easily reproducible minimally invasive procedure for thyroidectomy. The aim of this review was to analyze the treatment of benign thyroid diseases by MIVAT. METHODS A systematic evidence-based literature review focusing on three questions was carried out. Additional data were obtained on the basis of our personal experience. (1) Are minimally invasive procedures indicated in the treatment of thyroid diseases? (2) Is MIVAT a safe technique and what are the demonstrated advantages? (3) Since different thyroid diseases may be treated by MIVAT, is it of any value in the treatment of benign thyroid diseases? RESULTS MIVAT can be considered an appropriate treatment of some thyroid diseases; it represents a safe procedure with the same incidence of complications as traditional surgery, and also has advantages in terms of both cosmetic result and postoperative distress. CONCLUSIONS In spite of an increasing trend toward performing more extensive procedures other than thyroidectomy alone during videoscopic procedures, the current literature seems to reaffirm that the main and safest indication for MIVAT is benign disease.
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Sgourakis G, Sotiropoulos GC, Neuhäuser M, Musholt TJ, Karaliotas C, Lang H. Comparison between minimally invasive video-assisted thyroidectomy and conventional thyroidectomy: is there any evidence-based information? Thyroid 2008; 18:721-7. [PMID: 18631000 DOI: 10.1089/thy.2008.0028] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The aim of this study was to test the hypothesis that minimally invasive video-assisted thyroidectomy (MIVAT) affords comparable safety and efficacy as to the open conventional surgery in dealing with patients with small thyroid nodules. METHODS Randomized controlled trials comparing the MIVAT with open thyroidectomy were ascertained by methodical search using Medline, Embase, Pubmed, and The Cochrane Library. Primary meta-analysis outcomes were adverse events (laryngeal nerve palsy and hypoparathyroidism), and cosmesis and secondary outcomes were operative time, blood loss, and early and late postoperative pain. RESULTS Operative time was significantly less with open thyroidectomy than with MIVAT, while MIVAT was associated with less pain at 6 hours postoperatively. Blood loss did not reached significance between procedures. Comparisons between two procedures concerning pain score of 24 and 48 hours, respectively, depicted statistically significant differences in favor of the MIVAT but only in the fixed effects model. MIVAT was associated with less scarring. There were no statistically significant differences for the presence of transient recurrent laryngeal nerve palsy and the presence of transient hypoparathyroidism. CONCLUSIONS MIVAT is a safe procedure that produces outcomes; in view of short-term adverse events, similar to those of open thyroidectomy, it needs a longer operative time to be accomplished and is superior in terms of immediate postoperative pain and cosmetic results.
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Affiliation(s)
- George Sgourakis
- Department of General and Abdominal Surgery, Johannes Gutenberg University Hospital, Mainz, Germany.
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Dobrinja C, Trevisan G, Liguori G. “Minimally invasive video-assisted thyroidectomy. Initial experience in a general surgery department”. Langenbecks Arch Surg 2008; 394:273-7. [DOI: 10.1007/s00423-008-0325-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2007] [Accepted: 03/14/2008] [Indexed: 11/29/2022]
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Lombardi CP, Raffaelli M, de Crea C, Princi P, Castaldi P, Spaventa A, Salvatori M, Bellantone R. Report on 8 years of experience with video-assisted thyroidectomy for papillary thyroid carcinoma. Surgery 2007; 142:944-51; discussion 944-51. [DOI: 10.1016/j.surg.2007.09.022] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2007] [Revised: 09/06/2007] [Accepted: 09/11/2007] [Indexed: 11/26/2022]
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Perigli G, Cortesini C, Qirici E, Boni D, Cianchi F. Clinical Benefits of Minimally Invasive Techniques in Thyroid Surgery. World J Surg 2007; 32:45-50. [DOI: 10.1007/s00268-007-9259-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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