Minimally invasive, video-assisted thyroidectomy: first experience from the United Kingdom

INTRODUCTION Minimally-invasive, video-assisted thyroidectomy (MIVAT) was developed to reduce scarring/trauma associated with cervical incisions used in open thyroidectomy. Results from various centres have been published internationally but none from the UK. This study reports the first results from the UK and compares them with other centres. We also aim to compare the results of a single-surgeon experience in a small/moderately-sized hospital to those of larger tertiary centres. PATIENTS AND METHODS Retrospective analysis of a single surgeon experience in a district general hospital RESULTS The cohort was 55 patients (52 female, 3 male), mean age 48 years (range, 21-77 years) who had 64 MIVAT procedures. There were 49 hemithyroidectomies (HTs), 2 isthmusectomy, 4 total thyroidectomies (TTs) and 9 completion thyroidec-tomies (CTs) with median operating time of 86 min (IQR 66-110 min). Individual operating times were HT 85 min (IQR 60-110 min); TT 130 min (IQR 100-140 min) and CT 77 min (IQR 70-98 min). Median operating time was shorter in the second half of this series (76 min vs 92 min; P < 0.001). Length of stay was < 1 day in 92%. Conversions occurred in 6.3% with no haematoma or re-operation. Transient voice change was present in 7 (11%), permanent unilateral recurrent laryngeal nerve palsy in 2 (3%), and transient hypocalcaemia in 2 (3%). CONCLUSIONS The first results from the UK are similar to those of other international centres. A single-surgeon practice can obtain results comparable to larger tertiary centres provided there is sufficient case-load. MIVAT is safe and effective, but has a steep learning curve with rapid improvement observed within first 30 cases. Future studies should focus on objective assessment of scar/cosmesis and cost-effectiveness. MIVAT is an acceptable alternative to open surgery in highly selected patients.

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Minimally Invasive Video-assisted Thyroidectomy vs Conventional Open Hemithyroidectomy in Asian Patients

World Journal of Endocrine Surgery ◽

10.5005/jp-journals-10002-1189 ◽

2016 ◽

Vol 8 (3) ◽

pp. 189-192

Author(s):

Reyaz M Singaporewalla ◽

Anil D Rao ◽

Arunesh Majumder

Keyword(s):

Postoperative Pain ◽

Minimally Invasive ◽

Pain Score ◽

Open Surgery ◽

Operating Time ◽

Incision Length ◽

Video Assisted ◽

Asian Patients ◽

Significant Difference ◽

Conventional Open Surgery

ABSTRACT Introduction Although the technique of minimally invasive video assisted thyroidectomy (MIVAT) is well established in continental Europe, data on it's role in Asian patients is limited. We compared the results of MIVAT with conventional open hemithyroidectomy in Asian patients. Materials and methods Over a 1-year period, patients undergoing hemithyroidectomy for benign symptomatic goiters were selected. Inclusion criteria for MIVAT were benign colloid goiters, recurrent cysts or follicular lesions and neoplasms with lobe volume of less than 40 cc or nodule diameter less than 35 mm. Larger goiters underwent conventional open surgery. Patients with previous neck surgery and proven malignancy were excluded. Operative time, complications, postoperative pain score, incision length and cosmetic satisfaction at 6 months were recorded. Results Thirty-six patients (MIVAT-21, Conventional-15) were included. Both groups were comparable in terms of demographic profile and co-morbidities. The mean operating time for both groups showed no significant difference (MIVAT = 111.67 ± 19.4 min, Conventional = 112.40 ± 25.06 min; p = 0.925). Minimally invasive video assisted thyroidectomy patients had significantly less pain in the immediate postoperative period (mean pain score 2.38 vs 4.8, p < 0.001). Mean incision length at end of surgery was significantly smaller in the MIVAT group (2.58 vs 6.3 cm; p < 0.001). Neck scar satisfaction at 6 months was excellent in 71.4% of MIVAT cases vs 26.6% of conventional hemithyroidectomy cases. There were no complications in any of the treatment groups. Conclusion In selected cases, MIVAT is as safe as conventional open surgery with distinct advantages of better postoperative pain control and cosmesis. How to cite this article Rao AD, Singaporewalla RM, Majumder A. Minimally Invasive Video-assisted Thyroidectomy vs Conventional Open Hemithyroidectomy in Asian Patients. World J Endoc Surg 2016;8(3):189-192.

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Assessment of the learning curve of video-assisted thoracoscopic sympathectomy in a single neurosurgical trainee: a cumulative summation analysis

Egyptian Journal of Neurosurgery ◽

10.1186/s41984-021-00122-0 ◽

2021 ◽

Vol 36 (1) ◽

Author(s):

Hazem M. Alkosha ◽

Yasser M. Elkiran

Keyword(s):

Blood Loss ◽

Learning Curve ◽

Hospital Stay ◽

Operating Time ◽

Rapid Improvement ◽

Surgical Performance ◽

Common Procedure ◽

Thoracoscopic Sympathectomy ◽

Video Assisted ◽

Or Team

Abstract Background Video-assisted thoracoscopic sympathectomy (VATS) is a common procedure unusually practiced by neurosurgeons due to lack of training. Objective To evaluate the learning curve for VATS in a young neurosurgeon with no previous experience in open sympathectomy techniques or extracranial endoscopic procedures. Methods This is a retrospective review and analysis of prospectively collected data in 50 consecutive cases admitted to our facility with the diagnosis of essential palmar and axillary hyperhidrosis operated by a neurosurgical trainee under strict supervision of 2 experienced mentors. After an initial training phase, cumulative sum mation (CUSUM) analysis was used to evaluate the surgical performance of the trainee in terms of operating time, blood loss, hospital stay and failures. Results Improvement in operating time was noticed after the first 20 cases with significant affection by changes in OR team. The blood loss was significantly improved after the first 10 cases with less sensitivity to changes in OR team. Hospital stay and failures were steady and within expected values throughout the study. Conclusion An average of 20 cases may be enough for a neurosurgeon with basal knowledge to attain technical competence in VATS sympathectomy. Mentored surgical training on VATS sympathectomy is a safe and effective training method with failures within expected limits. The experience of the OR team plays an important role in the rapid improvement and consistency of performance.

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Video-assisted isolated percutaneous hernia sac suturing in children with inguinal hernia (VIPS)

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care ◽

10.17816/psaic661 ◽

2021 ◽

Vol 10 (2) ◽

pp. 157-164

Author(s):

Pavel M. Pavlushin ◽

Alexey V. Gramzin ◽

Artyom A. Tratonin ◽

Nikolai V. Krivosheenko ◽

Yuri Yu. Koinov ◽

...

Keyword(s):

Minimally Invasive ◽

Operating Time ◽

Subcutaneous Fat ◽

Oblique Muscle ◽

Hernia Sac ◽

Video Assisted ◽

Minimally Invasive Surgical ◽

Inguinal Hernias ◽

Minimally Invasive Surgical Treatment ◽

Internal Oblique

Background. Inguinal hernias in children are a common problem. They occur in 520 cases of 1000 newborns, with the prevalence in males of about 10 times. Therefore, they present a very important problem in pediatric surgery. Materials and methods. This prospective study was performed from 2019 to 2020 and included 30 patients with diagnosed inguinal hernias. Video-assisted percutaneous hernia sac ligation was performed in all patients. Results. The mean operating time was 10.3 2.7 min in patients with unilateral inguinal hernias and 14.7 1.6 min in patients with the bilateral variant. No complications or recurrences were observed during the six-month follow-up period. In one case, an additional 3 mm port setting was performed in an eight-month-old child. The main reason for doing this was the fibrous transformation of the parietal peritoneum because of the existence of incarcerations in the anamnesis. Conclusion. This technique garners all the advantages of a minimally invasive surgical treatment of inguinal hernias using the Tuohy needle. However, the conductor application allows us to create the same approach using a Touhy needle. This means that we can perform an isolated hernia sac ligation without getting under the preperitoneal tissue ligature, parts of the internal oblique and transverse muscles, aponeurosis of the external oblique muscle, and subcutaneous fat. This presented video-assisted percutaneous hernia sac ligation method seems like a potential minimally invasive way to treat inguinal hernias in children.

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Video-assisted percutaneous hernia sac suturing: a new technique of inguinal hernia repair in children

Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care ◽

10.17816/psaic704 ◽

2020 ◽

Vol 10 (4) ◽

pp. 411-418

Author(s):

Pavel M. Pavlushin ◽

Alexey V. Gramzin ◽

Nikolai V. Krivosheenko ◽

Yuri Y. Koinov ◽

Yuri V. Chikinev

Keyword(s):

Inguinal Hernia ◽

Minimally Invasive ◽

Premature Infants ◽

Operating Time ◽

Minimal Invasive ◽

Bilateral Hernia ◽

Hernia Sac ◽

Hernial Sac ◽

Video Assisted ◽

A New Technique

Background. Inguinal hernias are very important problem in pediatric surgery. It appears in 520 cases in every 1000 newborns, approximately 10 times prevalence in males. However, the incidence of inguinal hernia is bigger by 1.52 times in group of premature infants. Materials and methods. In prospective study, that was performed in 20192020, 90 pediatric patients diagnosed inguinal hernia were included. All patients had open herniotomy (Duhamel method), subcutaneous endoscopic-assisted ligation of inguinal hernia using Tuohy needle, or video-assisted percutaneous hernial sac suturing (VIPS). Results. The mean operating time in VIPS group was 13 13.46 min in patients with unilateral inguinal hernia and 20 6.12 min in patients with bilateral variant. In the 6-month follow-up period, any complications or recurrences were not observed. VIPS group included two extremely premature infant with uni- and bilateral inguinal hernia. Minimally invasive herniotomy was performed in 50 weeks post-conceptual age, with unremarkable postoperative period. A difference was found in the operating time between groups of minimally invasive herniotomy and group of Duhamel repair. No difference was found in the operating time of bilateral hernia between all groups. Conclusion. Considered all things, assuming that announced method of video-assisted percutaneous hernial sac ligation to be a perspective minimal invasive way of treatment for inguinal hernia in children is reasonable. However, for final conclusions, further study of this surgical technique, also in a cohort of premature infants, is required, with the possible organization of multicenter clinical trials.

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Video assisted thoracoscopic thyroidectomy for retrosternal goitre

Annals of The Royal College of Surgeons of England ◽

10.1308/003588414x14055925058634 ◽

2014 ◽

Vol 96 (8) ◽

pp. 606-608 ◽

Cited By ~ 7

Author(s):

P Gupta ◽

KKW Lau ◽

I Rizvi ◽

S Rathinam ◽

DA Waller

Keyword(s):

Thoracoscopic Surgery ◽

Recurrent Laryngeal Nerve Palsy ◽

Operating Time ◽

Surgical Excision ◽

Invasive Approach ◽

Video Assisted ◽

Pain Scores ◽

Cervical Incision ◽

Great Vessels ◽

Median Diameter

Introduction Thyroidectomy for retrosternal goitre is usually carried out through a cervical incision. Around 4–12% of patients, however, require an extracervical approach, usually by sternotomy. Anatomically, the thyroid extends deep behind the great vessels in the pretracheal fascia. A sternotomy is therefore not only a substantial incision but this anterior approach is also not ideal for exposure. We report the use of video assisted thoracoscopic surgery (VATS) instead of a sternotomy or thoracotomy in conjunction with a transverse cervical incision for these patients. Methods A retrospective descriptive study was carried out of seven patients with retrosternal goitre who underwent a VATS thyroidectomy. Results Twenty-one patients with retrosternal goitre were referred to our institution for surgical excision with the anticipation of requiring an extracervical incision. Of these, seven (median age: 68 years, range: 58–73 years) underwent a VATS thyroidectomy. The median operating time was 218 minutes (range: 120–240 minutes). The median diameter of the retrosternal goitre was 70mm (range: 40–145mm). Only one patient required conversion to a manubriotomy to deliver the bulky thyroid and one patient suffered a transient right recurrent laryngeal nerve palsy. The median postoperative pain scores for days 0 and 1 were 1 (range: 0–5) and 0 (range: 0–3) respectively. The median length of stay was 5 days (range: 3–7 days). Conclusions The use of VATS in thyroidectomy for retrosternal goitre offers a minimally invasive approach resulting in less morbidity while affording excellent exposure.

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Comparison of Two Techniques of Minimally Invasive Parathyroidectomy: Video-Assisted (MIVAP) and open (OMIP)

Polish Journal of Surgery ◽

10.2478/v10035-007-0109-4 ◽

2007 ◽

Vol 79 (11) ◽

Author(s):

Marcin Barczyński ◽

Stanisław Cichoń ◽

Aleksander Konturek ◽

Wojciech Cichoń ◽

Wojciech Wierzchowski

Keyword(s):

Minimally Invasive ◽

Minimally Invasive Parathyroidectomy ◽

Invasive Parathyroidectomy ◽

Video Assisted

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Faculty Opinions recommendation of Randomized clinical trial comparing open with video-assisted minimally invasive parathyroid surgery for primary hyperparathyroidism.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1869956.1415054 ◽

2010 ◽

Author(s):

Tobias Carling

Keyword(s):

Clinical Trial ◽

Primary Hyperparathyroidism ◽

Minimally Invasive ◽

Randomized Clinical Trial ◽

Parathyroid Surgery ◽

Video Assisted

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Endoscopic Pan/Tilt Camera for Thorax Interventions – Design and first results

Current Directions in Biomedical Engineering ◽

10.1515/cdbme-2019-0130 ◽

2019 ◽

Vol 5 (1) ◽

pp. 517-519

Author(s):

Alexander Mrokon ◽

Peter P. Pott ◽

Volker Steger

Keyword(s):

Minimally Invasive ◽

Inclination Angle ◽

Magnetic Circuit ◽

Mechanical Stability ◽

Fem Simulation ◽

Camera System ◽

Design Changes ◽

First Results ◽

Set Up ◽

Future Work

AbstractMinimally invasive surgery in some cases suffers from a limited view because certain areas are obscured by others. In this paper, a system is described, which can be used in minimally invasive procedures as an addition to a standard endoscope to improve the range of view. Through FEM simulation a magnetic circuit was designed to position the camera head. Subsequently, a camera positioning system was set up that includes an extracorporeal and an intracorporeal unit. The first controls the intracorporeal system. The latter has a camera inclination angle of up to 65° and an additional vertically downward viewing angle when aligned in parallel (inclination angle 0°). The panning angle is 360°. The camera system was evaluated in lab and cadaver trials. It has been found that the size of the intracorporeal system (16 × 10 × 150 mm) represents a major problem. Future work will focus of the reduction of the system’s size, the improvement of the camera image quality, and design changes considering mechanical stability.

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