Video-assisted Hemithyroidectomy Research Articles

Quality of life of patients and distinctive properties of the postoperative period after minimally invasive video-assisted hemithyroidectomy

Objective: to study indicators of the quality of life of patients and features of the course of the postoperative period after minimally invasive video-assisted hemithyroidectomy (MIVAH) in comparison with traditional open hemithyroidectomy (OH).Materials and methods: an analysis of the quality of life and postoperative results was carried out in 92 patients with benign nodular neoplasms of the thyroid gland. The study group included 45 patients who underwent MIVAH. The control group included 47 patients who underwent OH.Results: pain levels were lower in the MIVAH group throughout the evaluation period. At the same time, the statistical significance of the differences (p<0.05) in the level of pain was noted at 24–-48 hours after the operation. Swallowing disorders were noted by patients less frequently in the MIVAH group (by 14.0% 1 month after surgery and by 8.0% after 6 months). Analysis of quality of life indicators on the SF-36 scale demonstrated that at 1 month after surgery, patients in the MIVAH group had higher values of the Physical Functioning (92.7±10.2 versus 83.1±15.3 points; p<0.05), Role-Physical Functioning (86.1±11.7 versus 63.0±14.8 points; p<0.01) and Social Functioning (82.4±13.9 versus 72.6±14.8 points; p<0.05). 6 months after surgery, all SF-36 scale indicators showed leveling off between the comparison groups.Conclusions: the MIVAH technique, compared with traditional open surgery, is characterized by an improvement in a number of indicators of the postoperative period. After MIVAH, the quality of life of patients is significantly higher in the early postoperative period, but in the long-term postoperative period, the quality of life shows comparable indicators both after MIVAH and after OH.

Complications and technical aspects of safe tissue dissection in endoscopic hemithyroidectomy

To analyze the complications following endoscopic hemithyroidectomy and to develop the principles of tissue dissection for safe surgical intervention. The results of surgical treatment of 136 patients were studied. The main group consisted of 44 patients who underwent endoscopic hemithyroidectomy through a «gasless» axillary approach (EH group). The first control group consisted of 45 patients who underwent minimally invasive video-assisted hemithyroidectomy (MIVAH group). The second control group consisted of 47 patients who underwent open hemithyroidectomy (OH group). Verall complication rate was significantly higher in the EH group (20.5% vs. 6.4% in the OH group and 4.4% in the MIVAH group; p<0.05). In the EH group, Clavien-Dindo grade I complications occurred in 11.4% of cases. There were no similar complications in the control groups (p<0.05). Clavien-Dindo grade II complications occurred in 9.1% of patients in the EH group, 4.3% in the OH group and no similar events were identified in the MIVAH group (p>0.05). Clavien-Dindo grade III complications occurred in 1 (2.1%) case in the OH group and 2 (4.4%) cases in the MIVAH group. There were no Clavien-Dindo grade III complications in the EH group. Thus, minor complications prevailed in the EH group. Their incidence decreased along with accumulation of experience. Moreover, endoscopic procedure is safer regarding the risk of severe complications. Endoscopic hemithyroidectomy is safe, and the proposed principles of tissue dissection can further increase surgical safety.

Comparative evaluation of postoperative results after endoscopic and video-assisted hemithyroidectomy

Comparative evaluation of postoperative results after endoscopic and video-assisted hemithyroidectomy

Features of achieving experience in minimally invasive video-assisted hemithyroidectomy

Features of achieving experience in minimally invasive video-assisted hemithyroidectomy

Joint work of surgeon and assistant in minimally invasive video-assisted hemithyroidectomy and its effect on duration of surgeries and learning period

To analyze assistants` influence on duration of surgery and learning period in minimally invasive video-assisted hemithyroidectomy. The same surgeon performed 67 minimally invasive video-assisted hemithyroidectomies. Duration of surgery was analyzed in assistants with various number of interventions. Learning curves were designed using logarithmic function. Eight specialists with the same professional skill assisted to surgeon. Each of these specialists performed certain number of operations. Learning period made up 19, 26 and 44 procedures for mean numbers of assistances 21, 8 and 3, respectively. Duration of surgery in the group with 21 assistances was 63.96±2.94 min, for 3 assistances - 80.53±7.07 min in each of 6 assistants (z= -2.38; p<0.017). Constant surgeon`s assistants is a factor reducing surgery time. Higher number of operations with the same assistant has a reliable inverse correlation with surgery time and duration of learning period.

Comparative analysis of conventional and video-assisted surgeries on thyroid and parathyroid glands

Aim. A comparative analysis of conventional and video-assisted operations effectiveness.Methods. The study included 80 patients were operated from 2010 to 2015 for thyroid and parathyroid glands diseases. The first (main) group included 35 patients who underwent video-assisted surgery. The second group (comparison group) included 45 patients who were operated conventionally. Surgery for thyroid gland diseases included hemithyroidectomy, for diseases of the parathyroid glands - parathyroidectomy in patients with tertiary hyperparathyroidism and adenoma resection in patients with primary hyperparathyroidism.Results. In video-assisted hemithyroidectomy, mean surgery duration was 42.2±3.6 min, compared to 34.4±2.8 min (p=0.086) in conventional method. Recurrent laryngeal nerve and parathyroid glands were identified in 73% of cases at conventional surgery, compared to 96% at video-assisted hemithyroidectomy (p=0.012). At video-assisted surgeries, no phonation disorders were recorded, while at conventional surgeries they were diagnosed in 7 patients (14.0%, p=0.041). Transient hypocalcemia according to the results of laboratory tests was observed in 1 (3.3%) patients after video-assisted and in 3 (6.0%) patients after conventional surgery (p=0.998). The average length of hospital stay after conventional surgery was 8.1±1.8 days, and after video-assisted surgery - 2.6±1.6 days (p=0.040). Postoperative scar size in the group of video-assisted surgery not exceeded 3 cm, in the group of conventional surgery - up to 7 cm.Conclusion. With proper selection of patients, particularly with parathyroid gland diseases, are video-assisted surgery might be a method of choice. Using video-assisted surgery in treating patients with thyroid gland diseases allows to identify anatomical structures of the neck in detail.

Video-assisted loboisthmectomy by the subclavicular approach. A case report.

The main advantage of minimally invasive thyroidectomy is a good cosmetic effect. Minimally invasive video-assisted thyroidectomy (MIVAT) is performed without gas insufflation in contrast to endoscopic thyroidectomy. In general, MIVAT is carried out through an incision in the middle part of the neck, not covered with clothes. The MIVAT thyroid lobectomy can also be done through the subclavicular approach. We describe a case of a 19-year-old female patient with a tumour of the left side of the neck. Thyroid ultrasound scan (UST) with thyroid fine-needle aspiration and cytological examination (FNAC) were performed. Thyroid-stimulating hormone (TSH), free triiodothyronine (FT3) and anti-tyreoperoxidase (ATPO) were checked. Video-assisted hemithyroidectomy was performed through an incision below the left clavicle. Intraoperative pathology examination of the specimen was carried out. The UST showed a solitary 13 mm × 23 mm nodule in the left lobe of the thyroid, the FNAC showed benign pathology. Thyroid function tests were normal (TSH 0.90 mIU/l; FT3 4.70 pmol/l). Video-assisted hemithyroidectomy was done through the incision below the left clavicle. Histopathological examination proved thyroid hyperplasia nodosum. There were no intra- or postoperative complications. The patient was discharged on the second day. Clinical and cosmetic outcomes 2 months after surgery were good. Minimally invasive video-assisted thyroid lobectomy performed via the subclavicular area is feasible and provides good cosmetic outcomes.

Video-assisted neck surgery for thyroid tumor: Gasless lateral approach

A 27-year-old woman with a thyroid tumor underwent right hemithyroidectomy to rule out malignancies such as follicular carcinoma of thyroid. A subplatysmal skin flap was dissected after making an incision in the anterior aspect of the neck, and the thyroid gland was exposed through the avascular space between the heads of the sternocleidomastoid muscle. After the insertion of the original retractor, video-assisted hemithyroidectomy was performed using ultrasonic surgical devices and conventional endoscopic forceps. Pathological examination of the resected specimen revealed follicular adenoma, and the postoperative course was uneventful. A lateral gasless approach for video-assisted thyroidectomy enables visualization of an adequate operative field and appears to be a safe and effective method.

Video-assisted thyroid lobectomy through a small wound in the submandibular area

Background: Endoscopic thyroidectomy has not gained wide acceptance because of the expertise required, the long operation time, the wide dissection, and the extra cost of specialized instruments. We developed a video-assisted hemithyroidectomy procedure that requires only one small incision at the upper neck. Methods: Hemithyroidectomy was performed through a 25 to 30 mm transverse incision made in the upper lateral neck for the treatment of benign thyroid nodule. No gas or external lift dissection was needed. Results: The mean age of 39 patients was 33.8 years. The tumor size ranged from 1.9 to 5.5 cm (mean 3.1 cm). All patients underwent total lobectomy without conversion to traditional cervicotomy. The mean operation time was 56 minutes (range 36 to 90). Follicular adenoma was the final pathologic diagnosis in 25 patients and adenomatous goiter in 14. Transient recurrent laryngeal nerve palsy was seen in 1 patient. Conclusions: Our technique is safe, minimally invasive, less time consuming, and cosmetically excellent.

顎下部からのアプローチでの内視鏡補助下甲状腺片葉切除術

顎下部からのアプローチでの内視鏡補助下甲状腺片葉切除術

Minimally invasive video-assisted surgery of the thyroid: a preliminary report.

Endoscopic thyroidectomy has not yet met the favor of most endocrine surgeons. We evaluated the technical feasibility of a video-assisted approach to thyroid surgery. The study group comprised 22 females and 5 males, all with a single thyroid nodule. The nodule was "hot" in 4 patients, microfollicular in 17 and with Hürthle cell cytology in 6. A 15-mm skin incision was made above the sternal notch. The midline was opened and a 12-mm trocar inserted into the thyro-tracheal groove. It was inflated with CO2 for 3 min. The trocar was then removed and the procedure performed using external retractors and needlescopic instruments. The upper pedicle was dissected. Identification of recurrent nerve and parathyroid glands was facilitated by endoscopic magnification. The upper gland portion was then retracted out of the operative cavity; inferior veins were ligated and the lobe entirely extracted and dissected. Frozen section was obtained for "cold" nodules. Video-assisted hemithyroidectomy was accomplished in 24 patients; 1 underwent video-assisted total thyroidectomy (positive frozen section). Cervicotomy was required once to achieve hemostasis and once to perform total thyroidectomy (positive frozen section). Mean operative time was 82 min (range 60-120 min). No complications were registered. The cosmetic result was excellent. Video-assisted thyroid surgery is feasible and may improve cosmetic outcome; total thyroidectomy can be accomplished through the same access point.