1
|
Lu Q, Zhu X, Wang P, Xue S, Chen G. Comparisons of different approaches and incisions of thyroid surgery and selection strategy. Front Endocrinol (Lausanne) 2023; 14:1166820. [PMID: 37529600 PMCID: PMC10390217 DOI: 10.3389/fendo.2023.1166820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/13/2023] [Indexed: 08/03/2023] Open
Abstract
To date, the traditional open thyroid surgery via a low collar incision remains the standard approach for patients undergoing thyroidectomy. However, this conventional approach will inevitably leave patients a neck scar and even cause a variety of complications such as paresthesia, hypesthesia, and other uncomfortable sensations. With the progress in surgical techniques, especially in endoscopic surgery, and the increasing desire for cosmetic and functional outcomes, various new approaches for thyroidectomy have been developed to avoid or decrease side effects. Some of these alternative approaches have obvious advantages compared with traditional surgery and have already been widely used in the treatment of thyroid disease, but each has its limitations. This review aims to evaluate and compare the different approaches to thyroidectomy to help surgeons make the proper treatment strategy for different individuals.
Collapse
|
2
|
Singaporewalla RM, Rao AD. Minimally invasive video-assisted thyroidectomy in Asian patients: experience from Singapore. ANZ J Surg 2020; 90:1721-1726. [PMID: 32734637 DOI: 10.1111/ans.16201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/03/2020] [Accepted: 07/11/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Minimally invasive video-assisted thyroidectomy (MIVAT) although well established in Europe has not yet gained widespread acceptance in Asia. We describe our learning experience in the first reported series of 105 cases from Singapore. METHODS A retrospective analysis of outcomes in 105 patients who underwent MIVAT from April 2011 to 2018 was performed. The inclusion criteria were - symptomatic benign thyroid pathologies and follicular lesions or neoplasms needing a hemi-thyroidectomy. A thyroid lobe volume less than 35 mL was used as cut-off. Patients underwent surgeon-performed thyroid ultrasound with biopsy of solid nodules. All cases were operated by one surgeon using standard Miccoli technique with energy device used in all cases. RESULTS From a total of 424 patients with nodular goitres undergoing thyroidectomy, 105 (24%) symptomatic eligible patients underwent the MIVAT procedure (M:F - 23:82). The mean incision lengths at start and completion were 1.7 cm (range 1.5-2 cm) and 2.4 cm (range 2-2.7 cm), respectively. Mean operating time was 97 min (range 59-160 min). There were four conversions (3.8%) in the first 25 cases and four patients (3.8%) experienced transient hoarseness with full recovery. Visual analogue pain scores at 6 and 24 h post-operatively were 2.7 and 1.1, respectively. Scar satisfaction was reported as excellent (75%), satisfactory (23%) and poor (2%). CONCLUSION Although technically more demanding, MIVAT is a safe and useful operation in a thyroid surgeon's armamentarium. The limitation of goitre size, however, allows only a small percentage of symptomatic patients to undergo this procedure.
Collapse
Affiliation(s)
| | - Anil D Rao
- Endocrine Surgical Service, Department of Surgery, Khoo Teck Puat Hospital, Singapore
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
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.
Collapse
|
6
|
Dralle H, Machens A, Thanh PN. Minimally invasive compared with conventional thyroidectomy for nodular goitre. Best Pract Res Clin Endocrinol Metab 2014; 28:589-99. [PMID: 25047208 DOI: 10.1016/j.beem.2013.12.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Since minimally invasive thyroidectomy was introduced in 1997, different surgical approaches to the thyroid have been described: the minimal neck incision and the anterior chest, areolar breast or axillary access. Whereas conventional open thyroidectomy is suitable for any thyroid disease, minimal neck incision thyroidectomy or extracervical scarless neck thyroidectomy are limited to small-volume disease. In 11 prospective randomized studies and six systematic reviews, minimally invasive video-assisted thyroidectomy via a central or lateral neck approach afforded better cosmesis in the first 3 months than conventional open thyroidectomy, with less postoperative pain for the first 48 h. Surgical morbidity did not differ in these limited studies. No head-to-head comparison is available for extracervical scarless neck thyroidectomy and conventional open thyroidectomy. Extracervical scarless neck thyroidectomy caused more postoperative pain and gave rise to complications not seen with minimal neck incision thyroidectomy or conventional open thyroidectomy. In the absence of evidence to the contrary, conventional open thyroidectomy continues to remain the gold standard for any nodular goitre.
Collapse
Affiliation(s)
- Henning Dralle
- Department of General, Visceral and Vascular Surgery, University Hospital, Medical Faculty, University of Halle-Wittenberg, Ernst-Grube-Str. 40, D-06097 Halle/Saale, Germany.
| | - Andreas Machens
- Department of General, Visceral and Vascular Surgery, University Hospital, Medical Faculty, University of Halle-Wittenberg, Ernst-Grube-Str. 40, D-06097 Halle/Saale, Germany
| | - Phuong Nguyen Thanh
- Department of General, Visceral and Vascular Surgery, University Hospital, Medical Faculty, University of Halle-Wittenberg, Ernst-Grube-Str. 40, D-06097 Halle/Saale, Germany
| |
Collapse
|
7
|
Shana YZ, Zhoua LM, Yu ZF, Wang SG, Gao GL, Shen Y, Zhang XL. Comparison between Transareola Singlesite Endoscopic Thyroidectomy and Minimally Invasive Video-assisted Thyroidectomy. J Int Med Res 2012; 40:2213-9. [PMID: 23321178 DOI: 10.1177/030006051204000619] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES: To compare surgical outcomes between transareola single-site endoscopic thyroidectomy (TASSET) and minimally invasive video-assisted thyroidectomy (MIVAT). Methods: Patients with thyroid nodules were randomized to TASSET (n = 24) or MIVAT (n = 24). Surgical outcomes and patient-rated cosmetic results, based on numerical (0 [worst], 10 [best]) and verbal (1 [poor], 4 [excellent]) response scales, were compared. Results: There were no significant differences between groups for age, sex, indication for operation, estimated blood loss, postoperative pain and length of postoperative stay. TASSET was associated with a significantly longer mean ± SD operative time than MIVAT (156.84 ± 41.42 vs. 66.38 ± 17.58 min), and significantly improved cosmetic results according to the numerical (9.63 ± 0.60 vs 7.90 ± 1.38) and verbal response (3.8 ± 0.5 vs 3.1 ± 0.7) scales. Postoperative complaints were comparable between the two approaches, although MIVAT involved a shorter operation time. Conclusions: Patients treated with TASSET had superior cosmetic results compared with those treated with MIVAT.
Collapse
Affiliation(s)
- Y-Z Shana
- Department of General Surgery, Fengxian Central Hospital (Fengxian Branch of Shanghai Sixth People's Hospital), Shanghai Jiao Tong University, Shanghai, China
| | - L-M Zhoua
- Department of General Surgery, Fengxian Central Hospital (Fengxian Branch of Shanghai Sixth People's Hospital), Shanghai Jiao Tong University, Shanghai, China
| | - Z-F Yu
- Department of General Surgery, Fengxian Central Hospital (Fengxian Branch of Shanghai Sixth People's Hospital), Shanghai Jiao Tong University, Shanghai, China
| | - S-G Wang
- Department of General Surgery, Fengxian Central Hospital (Fengxian Branch of Shanghai Sixth People's Hospital), Shanghai Jiao Tong University, Shanghai, China
| | - G-L Gao
- Department of General Surgery, Fengxian Central Hospital (Fengxian Branch of Shanghai Sixth People's Hospital), Shanghai Jiao Tong University, Shanghai, China
| | - Y Shen
- Department of General Surgery, Fengxian Central Hospital (Fengxian Branch of Shanghai Sixth People's Hospital), Shanghai Jiao Tong University, Shanghai, China
| | - X-L Zhang
- Department of General Surgery, Fengxian Central Hospital (Fengxian Branch of Shanghai Sixth People's Hospital), Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
8
|
Miccoli P, Materazzi G, Baggiani A, Miccoli M. Mini-invasive video-assisted surgery of the thyroid and parathyroid glands: a 2011 update. J Endocrinol Invest 2011; 34:473-80. [PMID: 21427526 DOI: 10.1007/bf03346715] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Thyroid surgery during the last century was characterized by a development of Kocher's concepts: through a relentless work of surgeons from all over the world thyroidectomy reached a standard of quality in terms of overall results which was unimaginable in the first half of the XX century. The flattering data collected in the literature until the 90's were all concordant in assuming that there would be little space for a real improvement in the quality standard of thyroid surgery. The introduction of laparoscopic surgery, though, changed very quickly the attitude of surgeons towards their operative behavior and countless new mini-invasive techniques were soon proposed for almost any field of surgery. In 1994, Gagner published the first series of laparoscopic adrenalectomies. Soon after, parathyroid adenomas seemed to offer an ideal field of application of these new surgical concepts. The first report of an endoscopic parathyroidectomy was in 1996. One year later other videoscopic procedures were described whose results seemed quite encouraging so as to push surgeons to try the same access and the same technique also for operations on thyroid. During the following decade several endoscopic or video-assisted approaches were proposed for the removal of thyroid gland. This paper aims to evaluate the results of minimally invasive thyroid and parathyroid surgery through an extensive review of the literature, in particular as far as minimally invasive video-assisted thyroidectomy is concerned.
Collapse
Affiliation(s)
- P Miccoli
- Department of Surgery, University of Pisa, Pisa, Italy.
| | | | | | | |
Collapse
|
9
|
Ruggieri M, Zullino A, Straniero A, Maiuolo A, Fumarola A, Vietri F, D’Armiento M. Is minimally invasive surgery appropriate for small differentiated thyroid carcinomas? Surg Today 2010; 40:418-22. [DOI: 10.1007/s00595-009-4108-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Accepted: 07/09/2009] [Indexed: 10/19/2022]
|
10
|
Samy AK, Ridgway D, Orabi A, Suppiah A. Minimally invasive, video-assisted thyroidectomy: first experience from the United Kingdom. Ann R Coll Surg Engl 2010; 92:379-84. [PMID: 20385050 DOI: 10.1308/003588410x12628812459977] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Minimally-invasive, video-assisted thyroidectomy (MIVAT) was developed to reduce scarring/trauma associated with cervical incisions used in open thyroidectomy. Results from various centres have been published internationally but none from the UK. This study reports the first results from the UK and compares them with other centres. We also aim to compare the results of a single-surgeon experience in a small/moderately-sized hospital to those of larger tertiary centres. PATIENTS AND METHODS Retrospective analysis of a single surgeon experience in a district general hospital RESULTS The cohort was 55 patients (52 female, 3 male), mean age 48 years (range, 21-77 years) who had 64 MIVAT procedures. There were 49 hemithyroidectomies (HTs), 2 isthmusectomy, 4 total thyroidectomies (TTs) and 9 completion thyroidectomies (CTs) with median operating time of 86 min (IQR 66-110 min). Individual operating times were HT 85 min (IQR 60-110 min); TT 130 min (IQR 100-140 min) and CT 77 min (IQR 70-98 min). Median operating time was shorter in the second half of this series (76 min vs 92 min; P < 0.001). Length of stay was < 1 day in 92%. Conversions occurred in 6.3% with no haematoma or re-operation. Transient voice change was present in 7 (11%), permanent unilateral recurrent laryngeal nerve palsy in 2 (3%), and transient hypocalcaemia in 2 (3%). CONCLUSIONS The first results from the UK are similar to those of other international centres. A single-surgeon practice can obtain results comparable to larger tertiary centres provided there is sufficient case-load. MIVAT is safe and effective, but has a steep learning curve with rapid improvement observed within first 30 cases. Future studies should focus on objective assessment of scar/cosmesis and cost-effectiveness. MIVAT is an acceptable alternative to open surgery in highly selected patients.
Collapse
Affiliation(s)
- A K Samy
- Diana Princess of Wales Hospital, Grimsby, UK.
| | | | | | | |
Collapse
|
11
|
Current world literature. Curr Opin Otolaryngol Head Neck Surg 2010; 18:134-45. [PMID: 20234215 DOI: 10.1097/moo.0b013e3283383ef9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
12
|
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]
|
13
|
Abstract
PURPOSE OF REVIEW To review the literature regarding the safety and feasibility of outpatient thyroid surgery. RECENT FINDINGS Outpatient thyroidectomy is increasingly reported especially for hemithyroidectomy. Meta-analysis of 11 randomized trials comparing routine drain with no drains found no significant difference in respiratory distress or wound reexploration but found an increased length of stay with drain usage. In addition to risk from delayed hematoma formation, risk of hypocalcemia developing from hypoparathyroidism has traditionally challenged outpatient total or completion thyroidectomy. Routine calcium and vitamin D supplementation has been shown to reduce the risk of hypocalcemia. A meta-analysis of rapid postoperative parathyroid hormone (PTH) measurement confirmed a significantly increased risk of hypocalcemia for PTH less than 15 pg/ml. SUMMARY Outpatient thyroidectomy is increasingly performed and reported. The senior author currently offers outpatient thyroidectomy for patients not requiring drain placement (smaller goiters without significant blood loss) and with postanesthesia care unit PTH levels of at least 30 pg/ml or with postanesthesia care unit PTH levels of at least 20 pg/ml with oral calcium supplementation.
Collapse
|
14
|
Current world literature. Curr Opin Otolaryngol Head Neck Surg 2009; 17:132-41. [PMID: 19363348 DOI: 10.1097/moo.0b013e32832ad5ad] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
15
|
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]
|