Contributions of the Video-Assisted Approach to Thyroid and Parathyroid surgery

Abstract

Background: The authors report their initial experience with partial and total thyroidectomy, and neck exploration for hyperparathyroidism using the video-assisted approach.Patients and methods: Between June 1999 and March 2001, 114 patients underwent a thyroid (n = 57) or parathyroid (n = 57) operation using a video-assisted cervical approach. Video-assisted neck exploration was conducted in all cases under general anaesthesia leading to a partial or total thyroidectomy, and to a selective adenoma removal in PHPT or to a subtotal parathyroid resection in SHPT.Results: In the thyroid group: the mean cranio-caudal and transversal diameter of the resected specimen were respectively 4.9 ± 0.9 and 2.8 ± 0.6 cm, and mean total lobar weight was 11.7 ± 5.8g. Conversion to conventional surgery was required in 5 patients (8,8%). The mean operative time was 133,9 ± 26,9 and 86,5 ± 22,5 minutes for total and partial thyroidectomy respectively. The laryngeal nerve was identified in 96% of cases. The mean length of skin incision was 24.0 ± 2 mm. There were 3 cases of postoperative hypocalcemia, and 2 cases of postoperative hoarseness. The postoperative hospital stay was less than 24 hours for 72.7% of patients. The pain intensity at day one (VAS) was 2.1 ± 1.3. In the parathyroid group: seven of the 44 patients who underwent PHPT (15.9%) and 4 of the 13 patients who underwent surgery for SHPT (30.8%) were converted to a conventional surgical technique. The mean operative time in PHPT and SHPT was 47.3 ± 22.3 minutes and 136.8 ± 18.7 minutes, respectively. Recurrent laryngeal nerve was identified in 53.1% of the patients. The median diameter and weight of the resected parathyroid glands were 1.5 cm (range 0.8–2.7) and 0,9 g (range 0.5–7), respectively. The length of skin incision was 24 ± 2mm. All but 2 patients are currently cured. Postoperative complications included hematoma and transient hoarseness each in one patient (1.75%). The median pain intensity at day one (VAS) was 0.5 (range: 0 to 3.6). In the PHPT group, the postoperative hospital stay was less than 24 hours for 56.7% of the patients, and less than 48 hours for 91.9% of them.Conclusion: The video-assisted approach for thyroid and parathyroid surgery is feasible, safe and effective in selected cases. Benefits for the patients should be further assessed in future prospective comparative trials.