Invasive Video-assisted Thyroidectomy Research Articles

Management of cervical bronchogenic cyst via minimally invasive video-assisted thyroidectomy: a report of two cases

Management of cervical bronchogenic cyst via minimally invasive video-assisted thyroidectomy: a report of two cases

Natural orifice trans-oral, trans-vestibular endoscopic thyroidectomy: Surgical steps and technique.

Natural orifice scarless cosmetic surgeries are becoming a reality with increasing experience of advanced laparoscopic surgeries and availability of modern energy sources. Many techniques of minimally invasive video-assisted thyroidectomy through cervical and extra-cervical routes such as chest wall, trans-axillary, sub-mental, post-auricular and trans-luminal approach have been attempted. However, trans-oral trans-vestibular endoscopic thyroidectomy with its excellent cosmetic effect has become the more popular option among the surgical community with advantages such as decreased hospital stay and minimal complications. In this case report, we describe natural orifice trans-oral, trans-vestibular endoscopic thyroidectomy approach (NO-TOTVET) and add to literature the technique in which NO-TOTVET can be utilised, thus adding to the repertoire of the operating surgeon.

A Miniaturized Endoscopic Device Integrating Raman Spectroscopy and Laser Speckle Technology Via an Image Fusion Algorithm for Intraoperative Identification and Functional Protection of Parathyroid Glands

Abstract The importance of parathyroid glands (PGs) protection is increasingly recognized by thyroid surgeons in the field of minimally invasive video-assisted thyroidectomy (MIVAT). However, current techniques for intra-operative identification and vascularity assessment of the PGs are contentious and complex. This study presents the design and validation of a miniaturized device for fusion near-infrared autofluorescence (NIRAF) based on Raman spectroscopy and laser speckle contrast imaging (LSCI) via an image fusion algorithm for functional protection of PGs in the MIVAT. Our light source components include an integrated light emitting diode (LED) light source fiber, an NIRAF optical fiber, an acquisition optical fiber, and a laser speckle optical fiber in the endoscopic system to achieve identification and vascularity assessment of PGs using a single endoscopic probe. It has been validated in ex vivo tissue experiments that the fluorescence intensity detected by the device was equivalent to that of the marker indocyanine green (ICG) in visual images and superior to that of the thyroid and all other tissues in the neck. Based on clinical studies, MIVAT using functional fluorescence endoscopy, compared with the White light pattern group, the NIRAF combined with LSCI modality group increased the number of intra-operative confirmations of the PGs (P < 0.001), declined the decrease in parathyroid hormone (PTH) (P < 0.05) and calcium levels (P < 0.05) on the first postoperative day, and reduced the incidence of symptomatic hypocalcemia (P < 0.05). Our device may reduce the incidence of postoperative permanent hypoparathyroidism. Application of an miniaturized functional fluorescence endoscope for real-time and label-free PGs identification and vascularity assessment in MIVAT could be realized.

Mini-invasive video-assisted thyroidectomy vs robot-assisted transaxillary thryoidectomy: analisys and comparison of safety and outcomes.

Thyroid surgery is characterized by large volumes and typically affects a young female population. Mini-invasive or remote access surgical techniques are born driven by the desire to improve aesthetic outcomes of the traditional technique, following technological advances that have upset the surgical world in the last 20years. In our multicenter, retrospective observational study, we first compared an endoscopic technique with a robotic one: minimally invasive video-assisted thyroidectomy (MIVAT) and robot-assisted transaxillary thyroidectomy (RATT). We evaluated intraoperative features, complications, and cosmetic outcomes in a cohort of 609 patients. The efficacy and safety of these techniques are proven by a large literature and the comparison made in our study does not show inferiority of one technique compared to the other. Even the aesthetic results tend to be equal in the long term. It is desirable that further prospective and randomized studies are conducted to evaluate the outcomes of these procedures and the cost-benefit ratio.

A Prospective Randomized Clinical Study of Minimally Invasive Video-assisted Thyroidectomy for Papillary Thyroid Microcarcinoma.

The purpose of this study was to observe the effectiveness of minimally invasive video-assisted thyroidectomy (MIVAT) in treating papillary thyroid microcarcinoma (PTMC). A total of 224 patients with PTMC who met the inclusion and exclusion criteria were selected from the Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, between January 2017 and December 2019. They were randomized into the MIVAT group or traditional open operation group. For both groups, we observed the number of lymph node dissections, amount of intraoperative blood loss, duration of the operation, length of the incision, and number of injuries to the recurrent laryngeal nerve. The average operation time (132.8±29.4min) in the MIVAT group was significantly higher than that in the open surgery group (83.8±14.29min) ( P =0.026). The length of incision (2.8±0.6cm) in patients in the MIVAT group was significantly shorter than that in patients in the open group (7.4±1.1cm) ( P =0.000). No significant differences were observed in the number of lymph node dissections ( P =0.712), the amount of intraoperative bleeding ( P =0.581), and the number of recurrent laryngeal nerve injuries ( P =0.634). The average follow-up was 5 years, and both groups had no recurrence. In the treatment of PTMC, MIVAT had similar outcomes as traditional open operations, although the operation time was longer. However, the length of the incision was significantly shorter and thus provided cosmetic advantages for patients.

Efficacy and Safety of Minimally Invasive Thyroid Surgery: A Network Meta-Analysis.

Minimally invasive and remote surgical approaches for thyroid tumors have been developed primarily for cosmetic benefit. However, conventional meta-analysis could not provide comparative data between new techniques. This network meta-analysis would be able to provide data for clinicians and patients to compare cosmetic satisfaction and morbidity by comparing surgical methods. The PubMed, EMBASE, MEDLINE, SCOPUS, Web of Science, Cochrane Trials, and Google Scholar. The nine interventions included minimally invasive video-assisted thyroidectomy (MIVA), endoscopic and robotic bilateral axillo-breast-approach thyroidectomy (EBAB and RBAB, respectively), endoscopic and robotic retro-auricular thyroidectomy (EPA and RPA, respectively), endoscopic or robotic transaxillary thyroidectomy (EAx and RAx, respectively), endoscopic and robotic transoral approaches (EO and RO, respectively), and a conventional thyroidectomy. We recorded the operative outcomes and perioperative complications; pairwise and network meta-analyses were performed. EO, RBAB, and RO were associated with good patient cosmetic satisfaction. EAx, EBAB, EO, RAx, and RBAB were associated with significantly more postoperative drainage than the other methods. Postoperatively, more flap problems and wound infections were found in the RO than control group, and more transient vocal cord palsy was found in the EAx and EBAB groups. MIVA ranked first in terms of operative time, postoperative drainage amount, postoperative pain, and hospitalization, but cosmetic satisfaction was low. EAx, RAx, and MIVA ranked higher than the other approaches in terms of operative bleeding. It was confirmed that minimally invasive thyroidectomy achieves high cosmetic satisfaction and is not inferior to conventional thyroidectomy in terms of surgical results or perioperative complications. Laryngoscope, 133:2470-2479, 2023.

Recent Trends in Surgical Approach to Thyroid Cancer.

Over the past decade, the incidence of thyroid cancer has rapidly increased worldwide, and thyroid surgery has become one of the most common performed surgical procedure. Even though conventional open thyroidectomy remains the gold standard, this approach leaves a neck scar which could be worrying mainly for young women. The recent progress in surgical technology, as well as patient cosmetic requests, have led to the development of alternative access to the thyroid lodge. Thus, alternative techniques have been established in order to potentially provide a more appealing cosmetic result, both with a minimally-invasive cervical or remote-access approach. However, the introduction of these new techniques was initially approached with caution due to technical challenges, the introduction of new complications and, above all, skepticism about the oncologic effectiveness. Among several alternative approaches proposed, the minimally invasive video-assisted thyroidectomy and the robot-assisted transaxillary thyroidectomy became popular and obtained the favor of the scientific community. Moreover, the recent introduction of the trans-oral endoscopic thyroidectomy with vestibular approach, although the safety and the efficacy are still under discussion, deserves particular attention since it represents the only technique truly scarless and provides the best cometic result. The purpose of this article is to provide an overview of the current main alternative approaches for the treatment of thyroid cancer with particular focus on the oncological effectiveness of the procedures.

Status of Alternative Approaches for Thyroidectomy: Is There Any Evidence to Substitute in Place of Conventional Surgery?

Over the past 20 years, various alternative cervical minimally invasive (partly endoscopically assisted) and extracervical endoscopic (partly robot-assisted) approaches have been developed. All of these alternative access methods aim at optimizing the cosmetic results. In principle, the indication for the use of alternative access procedures does not differ from that for conventional surgery. Nonetheless, appropriate experience in traditional thyroid surgery and suitable patient selection, taking into account thyroid volumes and the underlying pathology, are important prerequisites. General contraindications for an alternative approach are large goiter with symptoms of compression, advanced thyroid carcinoma, recurrent interventions or previous radiotherapy in the operating area. The alternative surgical approaches to the thyroid can be divided into cervical minimally invasive, extracervical endoscopic (robot-assisted) and transoral procedures. This article gives an overview of the clinically used alternative approaches in thyroid surgery. The desire for an optimal cosmetic result should not be prioritized over patient safety. Only a few alternative procedures (minimally invasive video-assisted thyroidectomy, transaxillary robot-assisted thyroidectomy) can currently be viewed as a useful addition to conventional thyroid surgery, even when in responsible, experienced hands for a selected group of patients.

Long-term cosmetic results of video-assisted thyroidectomy: a comparison with conventional surgery.

We present the long-term cosmetic results of the video-assisted thyroidectomy (MIVAT) in comparison to the conventional operation. Forty-eight patients (four males, 44 females; mean age 47.4 ± 12.5 years) constituted the video-assisted group (VA-Group). These were compared with 48 patients (10 males, 38 females; mean age 47.4 ± 12.5 years) operated by conventional surgery (C-Group). The patients were selected from all thyroid operations performed between January 2016 and June 2017. Patient Scar Assessment Scale (PSAS) and Observer Scar Assessment Scale (OSAS) were used for the evaluation performed by an independent surgeon. Both scales contained six items scored numerically on a ten-step scale ranging from 1 (normal skin) to 10 (worst result). Moreover, photos of all scars were taken and analyzed by six team surgeons using modified OSAS. The mean follow-up time was 31.7 ± 6.4 months for the MIVAT group and 32.9 ± 4.6 months for the conventional group (p = 0.39). The mean scar length in the VA-Group was 2.6 cm vs. 3.8 cm in the C-Group (p < 0.0001). The total score of PSAS was 9.93 (6-35) for MIVAT and 9.72 (6-29) for conventional thyroidectomy (p = 0.22). The total OSAS score by the independent surgeon showed a better cosmetic outcome for conventional surgery (13.19 vs. 12.33; p = 0.01). The total OSAS score by the six team surgeons did not differ between both groups in five of six ratings; one surgeon favored MIVAT (12.2 vs. 13.6; p = 0.04). This study does not find cosmetic advantages of minimally invasive video-assisted thyroidectomy compared to conventional thyroidectomy.

Postoperative quality of life and cosmetic outcome between minimally invasive video-assisted thyroidectomy and bilateral axillo-breast approach robotic thyroidectomy: a single center retrospective cohort study.

Different approaches to endoscopic thyroidectomy utilize incisions that result in inevitable physical trauma to patients since postoperative tissue fibrosis and scars will influence their quality of life for a lifetime. Over the past few years, most studies have discussed the safety concerns of different kinds of endoscopic thyroidectomy; conversely, there has been less discussion on postoperative quality of life. Because most patients undergoing thyroidectomy for cancer or benign diseases are likely to have long-term survival, it is essential to study the cosmetic outcome of patients' scars from minimally invasive video-assisted thyroidectomy (MIVAT) and bilateral axillo-breast approach (BABA) robotic thyroidectomy on quality of life. From July 2015 to December 2017, 95 patients-60 who underwent MIVAT and 35 who underwent BABA robotic thyroidectomy-were retrospectively studied. Patient demographics, operative indications, pathologic findings, pain scores after surgery, complications, perception of scars, and overall satisfaction were compared between the two groups. The cosmetic outcome and overall satisfaction were evaluated at least 2years after the operation using the patient scar assessment questionnaire and the 36-item short form health survey (SF-36). There was no statistically significant difference in scar perception between the two groups. However, in the SF-36, the MIVAT group had better satisfaction than the BABA robotic group regarding general health, vitality, mental health, and health change. MIVAT and BABA robotic thyroidectomy can be safely performed in selected patients, and patients who underwent MIVAT had better postoperative qualities of life than those who underwent the BABA robotic approach.

Efficacy of minimally invasive video-assisted thyroidectomy for completion thyroidectomy

ObjectiveMinimally invasive video-assisted thyroidectomy (MIVAT) is among the most common alternatives to conventional open thyroidectomy. Previous reports have shown it to be safe and effective in patients without neck surgery history. However, this contraindication has been called into question in more recent small series. This study aims to evaluate the efficacy and safety of MIVAT in patients with prior neck surgery. MethodsWe retrospectively reviewed the data of 178 patients who underwent completion thyroidectomy in the Department of Otolaryngology-Head and Neck Surgery at Loma Linda University Medical Center between July 2004 and July 2017. Patients were divided into MIVAT group and Conventional group based on method of surgery, and analysis with two sample tests of proportions was carried out as appropriate. ResultsPatients in MIVAT group had significantly shorter operative time (74.1 ± 26.4 min vs. 99.0 ± 49.3 min, p < 0.001), less estimated blood loss (19.5 ± 15.0 mL vs. 39.0 ± 65.9 mL, p = 0.002), smaller incision size (3.5 ± 1.1 cm vs. 6.2 ± 2.2 cm, p < 0.001), and a lighter thyroid weight (7.5 ± 5.2 g vs. 20.5 ± 31.1 g, p < 0.001). The average length of stay was a half day longer, and post-operative admission was higher (78.8% vs. 51.7%, p = 0.005) in MIVAT group, while most was for routine 23-hour observation (63.6% vs. 35.9%, p = 0.009). There were no differences in complications. ConclusionMIVAT is feasible for re-operative patients with equivalent or superior outcomes to those of conventional thyroidectomy, and no significant difference in the incidences of common postoperative complications.

Continuous Intraoperative Neuromonitoring (C-IONM) During Minimally Invasive Video-Assisted Thyroidectomy (MIVAT): A Preliminary Study

Castagnola, Giorgio MD; Cossa, Alessandra MD; Lucarini, Alessio MD; Bellotti, Carlo MD Author Information

Minimally invasive video-assisted thyroidectomy in Asian patients: experience from Singapore.

Minimally invasive video-assisted thyroidectomy (MIVAT) although well established in Europe has not yet gained widespread acceptance in Asia. We describe our learning experience in the first reported series of 105 cases from Singapore. A retrospective analysis of outcomes in 105 patients who underwent MIVAT from April 2011 to 2018 was performed. The inclusion criteria were - symptomatic benign thyroid pathologies and follicular lesions or neoplasms needing a hemi-thyroidectomy. A thyroid lobe volume less than 35 mL was used as cut-off. Patients underwent surgeon-performed thyroid ultrasound with biopsy of solid nodules. All cases were operated by one surgeon using standard Miccoli technique with energy device used in all cases. From a total of 424 patients with nodular goitres undergoing thyroidectomy, 105 (24%) symptomatic eligible patients underwent the MIVAT procedure (M:F - 23:82). The mean incision lengths at start and completion were 1.7 cm (range 1.5-2 cm) and 2.4 cm (range 2-2.7 cm), respectively. Mean operating time was 97 min (range 59-160 min). There were four conversions (3.8%) in the first 25 cases and four patients (3.8%) experienced transient hoarseness with full recovery. Visual analogue pain scores at 6 and 24 h post-operatively were 2.7 and 1.1, respectively. Scar satisfaction was reported as excellent (75%), satisfactory (23%) and poor (2%). Although technically more demanding, MIVAT is a safe and useful operation in a thyroid surgeon's armamentarium. The limitation of goitre size, however, allows only a small percentage of symptomatic patients to undergo this procedure.

Minimally invasive video-assisted thyroidectomy (MIVAT).

Minimally invasive video-assisted thyroidectomy (MIVAT) was first described in 1999 and it has become a widespread technique performed worldwide. Although initially limited to benign thyroid nodules, MIVAT was progressively adopted for all types of thyroid diseases, while remaining within the selection criteria. It is reported that, in selected cases, MIVAT is comparable to standard open thyroidectomy (SOT) in terms of oncologic radicality, time, costs and complications rate, with the advantage of a better cosmetic result and a lower post-operative pain. The authors conducted a retrospective analysis about patients who underwent MIVAT between 1998 and 2019 in the Endocrine Surgery Unit of the University Hospital in Pisa. Indications and contraindications are mentioned and strictly followed. Total thyroidectomy was performed in 1,862 cases (69%) and hemithyroidectomy was performed in 763 cases (28.3%). Conversion occurred in 43 cases (1.6%). In 188 cases (7%) a postoperative transient hypoparathyroidism was reported, whereas definitive hypoparathyroidism was reported in 12 cases (0.4%). Thirty-eight patients (1.4%) suffered from a definitive postoperative recurrent laryngeal nerve palsy. No definitive bilateral recurrent laryngeal nerve palsy occurred. From our multi-years' experience which spreads over 20 years, we can reaffirm the concept that MIVAT is a safe procedure which is not burdened by an increase complications rate or additional costs. Furthermore, this technique offers advantages in terms of cosmetic results and post-operative pain.

Minimally invasive video-assisted thyroidectomy and transoral video-assisted thyroidectomy: A comparison of two systematic reviews.

Background:We compared two systematic reviews, one focusing on transoral video-assisted thyroidectomy (TOVAT) and the other on minimally invasive video-assisted thyroidectomy (MIVAT), to highlight the pros and cons that can determine the choice of one or the other procedure.Materials and Methods:PubMed, Scopus and ISI Web of Science databases were searched for relevant articles published from 2000 to June 2018. Both searches were performed using the same keywords. All articles describing human surgical case series of any size were included, while the following were excluded: articles published in languages other than English, case reports, reviews, early cadaver and animal studies and old reports of cases now included in more recent works. Application of the above selection criteria yielded 151 articles on TOVAT and 246 on MIVAT. Of these, 34 articles were selected for inclusion in the present study: 17 for the TOVAT group and 17 for the MIVAT group. The comparison was made considering the most common variables used in evaluating thyroid surgery procedures. The statistical methods used were Cohen's delta, Student's t-test and the non-parametric Mann–Whitney U-test.Results:The variable 'operative time' was found to show a very large effect size, and 'hospital stay' also differed significantly between the MIVAT and TOVAT groups.Conclusions:TOVAT and MIVAT should not be considered in competition with each other, but seen simply as alternative choices. Both appear to be safe methods, comparable in terms of post-operative complications, although the main reason for using TOVAT seems to be purely aesthetic.

Happy 20th birthday to minimally invasive video-assisted thyroidectomy!

Happy 20th birthday to minimally invasive video-assisted thyroidectomy!

Feasibility and Safety of Endoscopic Thyroidectomy Via a Unilateral Axillobreast Approach for Unilateral Benign Thyroid Tumor in Vietnam.

The purpose of this research study was to assess the safety and surgical outcomes of endoscopic thyroidectomy applied via a unilateral axillobreast approach with CO2 insufflation to one-sided benign thyroid tumors in Vietnam. Only 1 patient of the 50 (2%) had a postoperative hematoma at the surgery site. Open surgical conversions did not occur. The duration of postoperative drainage was from 3 to 8 days, or 4.86±1.24 days on average. The length of stay in the hospital after surgery was 4 to 9 days, or 5.9±1.2 days on average. The postoperative pain in the first postoperative days was lower in intensity compared with open surgeries. The given method provided better results in terms of patient satisfaction with the cosmetic effect of the surgery compared with up-front surgery, minimally invasive video-assisted thyroidectomy, and endoscopic procedures via the breast approach, and 96% of patients were completely satisfied.

Minimally Invasive Video-Assisted Thyroidectomy: Analysis of Complications From a Systematic Review.

Nowadays, minimally invasive video-assisted thyroidectomy (MIVAT) is considered a safe and effective option. However, its complication rate has not been specifically discussed yet. The aim of this systematic review was enrolling a large number of studies to estimate early and late complications (transient and definitive, uni- and bilateral laryngeal nerve palsy; transient and definitive hypocalcemia; cervical hematoma; hypertrophic or keloid scar) of MIVAT compared with conventional technique. The review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria in PubMed and Embase. Search terms were "minimally invasive," "video-assisted," and "thyroidectomy." We enrolled randomized clinical trials, nonrandomized trials, and noncontrolled trials. Thirty-two articles were considered suitable. Complication rate of MIVAT was quite similar to conventional technique: only one randomized trial found a significant difference concerning overall skin complication, and a single trial highlighted hypocalcemia significantly increased in MIVAT, concerning serologic value only. No difference concerning symptomatic nor definitive hypocalcemia was found. We can confirm that MIVAT is a safe technique. It should be adopted in mean-high-volume surgery centers for thyroidectomy, if a strict compliance with indication was applied.

Factors Affecting Long-Term Cosmetic Results after Minimally Invasive Video-Assisted Thyroidectomy and Conventional Thyroid Surgery

Approximately 90,000 thyroid operations are performed in Germany each year. Minimally invasive video-assisted thyroidectomy (MIVAT) accounts for 5 - 10% of these operations. There are few data that compare long-term cosmetic results after MIVAT to those after conventional surgery. Current systematic reviews show no advantage for MIVAT. The goal of this study was to analyse the long-term postoperative results in both procedures and the evaluation of relevant factors. The analysis of the long-term results is based on follow-up examinations using a validated method for scar appraisal (POSAS). Cohort analysis was performed on MIVAT operations in our hospital between 2004 and 2011 and conventional thyroid operations in 2011. Follow-up examination data were analysed from 117 patients from the MIVAT group and 102 patients from the conventional group. The follow-up examination was performed with a mean of 23.1 vs. 23.6 months postoperatively (MIVAT vs. conventional). The Friedman Test showed that scar pigmentation (mean rank 4.79) and scar surface structure (mean rank 3.62) were the deciding factors influencing the long-term cosmetic results. Both MIVAT and conventional surgery gave very good long-term cosmetic results. From the patient's perspective, there is no significant advantage with conventional surgery. The evaluation of the long-term results largely depends on factors such as scar pigmentation and surface structure that can only be influenced to a limited extent by the surgical procedure.

MIVAT: the last 2 years experience, tips and techniques after more than 10 years.

Minimally invasive video-assisted thyroidectomy (MIVAT) has been introduced into clinical practice by Miccoli in the late 1990s (Miccoli et al., Am J Surg 181(6):567-570, 2001) and it has become a widespread technique used and welcomed worldwide. In this paper, we present our experience of the last 2 years; we also describe tips and techniques derived from over 460 cases performed in the last 10 years by the same surgical team with the same single operator. In the last 10 years, we did about 460 MIVAT procedures. In the last 2 years, we performed MIVAT on 156 consecutive patients at Sant'Andrea University Hospital of Rome "Sapienza" University. of 156 cases performed, we were able to monitor the follow-up in 110 patients. On 110 cases, the mean surgical time was 74 ± 7.2min. In our data, we reported: transitory hypoparathyroidism 11 (10%), definitive hypoparathyroidism 4 (3.60%) (this value is inclusive of patients treated with central neck dissection. The value referred only to MIVAT is 1.05%), 2 (1.81%) transitory monolateral nerve palsy, 16 (14.50%) transitory, and 1 (0.9%) definitive nerve palsy. 4 (3.60%) cases of transitory dysphagia and 0 (0%) cases of definitive dysphagia (Table4). We also had 1 (0.9%) case of surgical scar infection, 0 (0%) postoperative bleeding, and 2 (1.81%) cases of subcutaneous surgical adhesion. Cosmetic results were: 0 (0%) insufficient, 0 (0%) sufficient, 6 (6.30%) passable, 17 (15.50%) good. and 86 (78.20%) excellent. Conversion rate 0 (0%). MIVAT is a good and safe technique, with similar short-term outcomes and similar costs compared to traditional total thyroidectomy. We hope that the tips and techniques reported in this paper as well as the advices in the use of instruments in MIVAT and open surgery will be useful to improve the skills of young surgeons and make thyroid surgery less invasive.