Related Experiment Videos
Minimally invasive video-assisted thyroidectomy: multiinstitutional experience
Paolo Miccoli1, Rocco Bellantone, Michel Mourad
1Dipartimento di Chirurgia, Università degli Studi di Pisa, Via Roma 67, Italy.
Abstract:
Minimally invasive video-assisted thyroidectomy (MIVAT) was described in 1998. In this study we collected the experience of four third-level referral centers that adopted this technique. A total of 336 patients (279 females, 57 males) were selected for MIVAT. Selection criteria were thyroid volume <15 ml, nodules not exceeding 3.5 cm of diameter, and an absence of thyroiditis, previous neck surgery, or previous irradiation. The procedure, totally gasless, is carried out through a 15 mm central incision above the sternal notch. Dissection is performed under endoscopic vision using conventional and endoscopic instruments. The mean operating time was 69.4 +/- 30.6 minutes for lobectomy (range 20-150 minutes) and 87.4 +/- 43.5 minutes for total thyroidectomy (range 30-220 minutes). The mean postoperative stay was 1.9 +/- 0.8 days. Postoperative complications were 7 transient and 1 definitive recurrent nerve palsies and 11 cases of hypoparathyroidism (9 transient, 2 definitive). Conversion to open surgery was necessary in 15 patients (4.5%). This study confirms in a large number of cases the safety and feasibility of MIVAT, even in different surgical settings where similar results were achieved. The complication rate was not different from that of standard thyroidectomy. Although the operating time appears longer than with conventional procedures, the learning curve demonstrates a sharp decrease with increasing experience and the introduction of new technologies. The number of patients eligible for this approach remains low, thereby limiting its use, but it should be considered a valid option in selected surgical centers, offering some advantages to patients in terms of cosmetic results and postoperative distress.
Insights
Minimally invasive video-assisted thyroidectomy (MIVAT) is safe and feasible across multiple centers. This technique offers cosmetic benefits and reduced distress for selected patients, with complication rates comparable to standard thyroidectomy.
Area of Science:
- Endocrine Surgery
- Minimally Invasive Surgery
- Surgical Oncology
Background:
- Minimally invasive video-assisted thyroidectomy (MIVAT) was introduced in 1998.
- MIVAT offers potential cosmetic and patient comfort advantages over traditional open thyroidectomy.
- Adoption of MIVAT has varied, necessitating multi-center experience evaluation.
Purpose of the Study:
- To evaluate the safety and feasibility of MIVAT.
- To assess complication rates and outcomes in a large cohort of MIVAT patients.
- To compare MIVAT outcomes with standard open thyroidectomy.
Main Methods:
- Retrospective analysis of 336 MIVAT procedures across four referral centers.
- Strict patient selection criteria: thyroid volume <15 ml, nodules ≤3.5 cm, no prior neck surgery or irradiation.
- Gasless endoscopic procedure via a 15 mm incision, using conventional and endoscopic instruments.
Main Results:
- Mean operative time: 69.4 min (lobectomy), 87.4 min (total thyroidectomy).
- Mean postoperative stay: 1.9 days.
- Complications: 7 transient/1 definitive recurrent nerve palsies, 11 hypoparathyroidism (9 transient/2 definitive). Conversion to open surgery in 4.5% of cases.
Conclusions:
- MIVAT is a safe and feasible thyroidectomy approach with comparable complication rates to open surgery.
- While operative time may be longer initially, it decreases with experience and technological advancements.
- MIVAT is a valid option for selected patients, offering improved cosmetic results and reduced postoperative distress.