Meta-analysis of video-assisted thyroidectomy versus conventional thyroidectomy

Abstract

Aim The purpose of this study was to test the hypothesis that video-assisted thyroidectomy (VAT) affords comparable safety and efficacy compared to open conventional thyroidectomy (CT). Patients and Methods Randomized, controlled trials comparing VAT with CT were ascertained by a methodical search using the MEDLINE, Pubmed, Ovid, Embase and Cochrane Library electronic databases. Primary meta-analysis outcomes were operative time, intraoperative blood loss and complications, including transient recurrent laryngeal nerve palsy (TRP), transient hypoparathyroidism (TH), permanent recurrent laryngeal nerve palsy (PRP), permanent hypoparathyroidism (PH) and wound infection (WI). The secondary outcomes were postoperative pain within 12, 24 and 48 h after the operation, length of hospital stay and cosmetic result. Results Operative time was significantly less with CT than with VAT, while VAT was associated with better cosmetic result and less pain at 24 h, postoperatively. Blood loss, TRP, TH, PRP, PH, WI and postoperative pain at 48 h did not reach significance between procedures. Comparisons between two procedures concerning postoperative pain within 12 h and length of hospital stay depicted statistically-significant differences in favour of VAT, but only in the fixed-effects model. Conclusions VAT is a safe procedure that produces outcomes; in view of short-term adverse events, similar to CT, it needs a longer operative time and produces better cosmetic results and less postoperative pain in the early phase.