Conventional versus Minimally Invasive Video-Assisted Thyroidectomy
Authors:
Z. Fík 1,2; M. Chovanec 1,2; M. Zábrodský 1; P. Lukeš 1; J. Astl 1; J. Betka 1
Authors‘ workplace:
Univerzita Karlova v Praze, 1. LF, Klinika otorinolaryngologie a chirurgie hlavy a krku, FN v Motole, Praha
Katedra otorinolaryngologie IPVZ Praha
; přednosta prof. MUDr. J. Betka, DrSc.
Univerzita Karlova v Praze, 1. LF, Anatomický ústav
1; přednosta prof. MUDr. K. Smetana, DrSc.
2
Published in:
Otorinolaryngol Foniatr, 61, 2012, No. 1, pp. 3-12.
Category:
Original Article
Overview
Thyroidectomy represents the most common type of endocrine surgery in the head and neck region. As an alternative to the conventional type of thyroid surgery, large number of different cervical and extracervical approaches was developed, with the main goal to improve cosmetic outcome, accelerate healing and increase patient’s comfort after the procedure. In our prospective study we focused on comparison of the conventional thyroidectomy and minimally invasive video-assisted thyroidectomy (MIVAT). There were 60 patients in each group, undergoing partial or total thyroidectomy with comparable number of indications for the surgery (benign follicular lesions, low risk well differentiated thyroid cancer, toxic goiter). Mean volume of treated thyroid lobe was 12 ml and mean size of nodule was 18 mm in the conventional surgeries while in the MIVAT group it was 10 ml and 19 mm respectively. Mean size of skin incision in case of partial thyroid surgery was 39 mm in the conventional and 19 mm in the MIVAT group, in case of total thyroidectomy it was 44 mm in conventional and 25 mm in the MIVAT procedures. Average length of partial thyroidectomy was 56 min in the conventional and 72 min in case of MIVAT procedures (p = 0.044), in case of total thyroidectomy it was 100 min in conventional and 105 min respectively. There was less hemorrhage following MIVAT procedures as documented with volume of blood collected with active drainage system (42 vs. 49 ml after partial thyroidectomy, and 61 vs. 72 ml after total thyroidectomy). Furthermore active drainage was not employed in 10 patients undergoing MIVAT surgery (p = 0.024). There was tendency to less pain following MIVAT procedures. Significant reduction of pain was documented by patients at 6th hour following total thyroidectomy (p = 0.049). Furthermore less opioids needed on the day of surgery and lower consumption of analgesics since the 1st postoperative day following total thyroidectomy was observed in the MIVAT group (p = 0.00038). In both groups we observed 1 case of injury of the recurrent laryngeal nerve (managed by immediate neurorrhaphy), and 1 transient recurrent laryngeal nerve palsy. Permanent postoperative hypoparathyreosis was not observed. There was shorter postoperative hospitalization time in case of MIVAT partial procedures (p = 0.021). In compliance with the indication criteria, MIVAT is applicable in selected number of patients undergoing thyroid surgery. Increased postoperative comfort and favorable cosmetic outcome represent the main potential benefits of this technique for the patient.
Key words:
thyroidectomy, minimally invasive surgery, MIVAT, endoscopic neck surgery, convalescence, active drainage.
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