Minimally invasive video-assisted thyroidectomy: experience of 300 cases

Abstract

We report on patients selected for minimally invasive video-assisted thyroidectomy (MIVAT) over a 3-year period and evaluate the feasibility and effects of this procedure. Between March 2005 and August 2008, 300 patients (36 male, 264 female; mean age = 54.6 years) underwent MIVAT using a single central incision with an average length of 2 cm (range = 1.5-3 cm), about 2 cm above the sternal notch. Small conventional retractors and dissectors, ultrasonic scalpel, 5-mm laparoscope, and a video screen were the instruments used. General anesthesia was used in 295 patients and regional block anesthesia in 5. MIVAT was performed successfully in 280 patients (93.3%). Conversion to open thyroidectomy with a 4-cm-long incision was required to achieve selective lymphadenectomy in 18 patients after frozen sections demonstrated differentiated thyroid carcinoma. Only two patients with benign thyroid nodules were converted because of large volume or massive hemorrhage from the upper pole vessels. Mean operative time was 35 min (range = 20-70 min) for unilateral lobectomy and 58 min (35-90 min) for bilateral thyroidectomy. No patients had wound infections, postoperative bleeding that required reoperation, permanent hypoparathyroidism, or bilateral recurrent laryngeal nerve palsy. However, permanent unilateral recurrent laryngeal nerve palsy appeared in five cases (1.7%), transient unilateral recurrent laryngeal nerve palsy in seven (2.3%), superior laryngeal nerve injury in five (1.7%), transient hypocalcemia in nine (3.0%), and mild skin burn from the ultrasonic scalpel in five (1.7%). Postoperative pain was minimal and better cosmetic results were obtained than conventional open thyroidectomy. Postoperative stay was shorter than with conventional open thyroidectomy. MIVAT appears to be safe and feasible in patients with benign thyroid nodules, with minimal injury and excellent cosmetic results. Furthermore, after properly lengthening the skin incision, MIVAT can be used for patients with large benign thyroid nodules or even early-stage differentiated thyroid carcinoma.