Minimally invasive video-assisted thyroidectomy: experience of 200 cases in a single center

Transaxillary gasless endoscopic hemithyroidectomy versus conventional open hemithyroidectomy: early single-centre experience

Conventional open thyroidectomy is defined as a gold standard in thyroid gland disease treatment. However, progressive surgery methods such as endoscopic technique provide better structure visualisation and improved cosmetic effect. Our study aim is to compare conventional open (COH) and endoscopic transaxillary hemithyroidectomy (TAH) and define the learning curve for TAH procedure. We retrospectively analysed 107 COH and 65 TAH cases. Patients' demographic data and surgery results were compared. Also, surgeon learning curve analysis using cumulative sum (CUSUM) was performed for the duration of the surgery. TAH was applied to younger female patients with lower thyroid gland volume. COH group patients were hospitalised for longer in comparison with TAH (p < 0.05). Mean TAH surgery time was longer (78.1 min, SD = 22.6) compared with COH (66.7 min, 15.3) (p < 0.05). Overall complication rate was comparable between groups. There was a tendency towards a lower unintentional parathyroidectomy rate in TAH group. TAH group results showed significantly longer surgery time for patients whose body mass index (BMI) was over 30 (kg/m²), compared to whose BMI was below 30 (kg/m²) (p = 0.004). Shortest endoscopic surgery time (64.9 ± 12.45 min) was achieved between 41 and 50 cases. CUSUM analysis showed that surgery time decreased after the 30th TAH case. TAH approach compared to COH results in longer surgery time, shorter hospital stay and comparable rate of postoperative complications. However matched pair studies are necessary to clarify the results. After thirty cases, the surgeon became proficient in transaxillary endoscopic thyroid surgery.

Minimally invasive video-assisted thyroidectomy and transoral video-assisted thyroidectomy: A comparison of two systematic reviews

Background:

We compared two systematic reviews, one focusing on transoral video-assisted thyroidectomy (TOVAT) and the other on minimally invasive video-assisted thyroidectomy (MIVAT), to highlight the pros and cons that can determine the choice of one or the other procedure.

Materials and Methods:

PubMed, Scopus and ISI Web of Science databases were searched for relevant articles published from 2000 to June 2018. Both searches were performed using the same keywords. All articles describing human surgical case series of any size were included, while the following were excluded: articles published in languages other than English, case reports, reviews, early cadaver and animal studies and old reports of cases now included in more recent works. Application of the above selection criteria yielded 151 articles on TOVAT and 246 on MIVAT. Of these, 34 articles were selected for inclusion in the present study: 17 for the TOVAT group and 17 for the MIVAT group. The comparison was made considering the most common variables used in evaluating thyroid surgery procedures. The statistical methods used were Cohen's delta, Student's t-test and the non-parametric Mann–Whitney U-test.

Results:

The variable 'operative time' was found to show a very large effect size, and 'hospital stay' also differed significantly between the MIVAT and TOVAT groups.

Conclusions:

TOVAT and MIVAT should not be considered in competition with each other, but seen simply as alternative choices. Both appear to be safe methods, comparable in terms of post-operative complications, although the main reason for using TOVAT seems to be purely aesthetic.