Is minimally invasive surgery appropriate for small differentiated thyroid carcinomas?

Endoscopy-assisted thyroid surgery via a subclavian approach

PURPOSE

To evaluate the effectiveness of an endoscopy-assisted surgical technique, designed to leave a scar-free neck, for removing large benign thyroid tumors.

METHODS

The subjects were 63 patients who underwent endoscopy-assisted surgery via a subclavian approach (endoscopic group) and 79 patients who underwent similar surgery via the conventional approach (conventional group). With the endoscopy-assisted approach, a 4-6 cm incision was made over the larger side of the tumor, at the lower edge of the clavicle, 3-5 cm beside the midline.

RESULTS

There was no significant difference in the distribution of patients within each group and pathological examination proved benign for all patients. The cosmetic results of the endoscopic group were significantly better than those of the conventional group (Z = 9.900, P = 0.000). None of the patients in either group suffered permanent recurrent laryngeal nerve paralysis. The only minor complications in the endoscopic group were transient hypocalcemia, which resolved within 1 week (n = 2); skin tension which cleared up within 3 months (n = 2); and temporary recurrent laryngeal nerve paralysis, which resolved within 1 month (n = 1). No significant distinction was found between the endoscopic group and the conventional group (χ (2) = 1.129, P = 0.466).

CONCLUSION

Endoscopic surgery via a subclavian approach is appropriate and effective for treating patients with a benign thyroid tumor larger than 4 cm.

Minimally invasive video-assisted versus conventional open thyroidectomy: a systematic review of available data

PURPOSE

Minimally invasive video-assisted thyroidectomy (MIVAT) is now emerging as a novel and less invasive procedure for thyroid diseases. This study conducted a systematic review of the available data to evaluate the safety and efficacy of this new technique over conventional procedure.

METHODS

A systematic literature search was performed on Medline, Embase, and The Cochrane Library. Randomized controlled trials comparing the MIVAT with open thyroidectomy were selected and meta-analyzed.

RESULTS

Nine RCTs involving 730 patients were included and all were restricted to patients with a thyroid nodule no larger than 4 cm and surgery did not involve lymph node dissection. Both procedures were of similar efficacy in nodule resection. Open surgery had a 1.6 times higher rate of postoperative complications than the novel technique, with no significant difference (P = 0.08), especially in transient recurrent nerve palsy (OR = 0.93, P = 0.87). Although longer operative time was required for MIVAT (MD = 15.0 min, P < 0.00001), patients experienced less postoperative pain, especially in the early postoperative period (MD = -11.52, P = 0.0003). There was also a shorter incision length (MD = -2.36 cm, P < 0.00001), better cosmetic results and greater patient satisfaction in the novel technique group (WD = 2.59; P < 0.00001).

CONCLUSIONS

MIVAT is a feasible, practical, and safe alternative with better cosmetic benefits, and it can be performed with an ease of manipulation that is similar to that of conventional neck surgery.