Outcomes of Minimally Invasive Thyroid Surgery – A Systematic Review and Meta-Analysis

PurposeConventional thyroidectomy has been standard of care for surgical thyroid nodules. For cosmetic purposes different minimally invasive and remote-access surgical approaches have been developed. At present, the most used robotic and endoscopic thyroidectomy approaches are minimally invasive video assisted thyroidectomy (MIVAT), bilateral axillo-breast approach endoscopic thyroidectomy (BABA-ET), bilateral axillo-breast approach robotic thyroidectomy (BABA-RT), transoral endoscopic thyroidectomy via vestibular approach (TOETVA), retro-auricular endoscopic thyroidectomy (RA-ET), retro-auricular robotic thyroidectomy (RA-RT), gasless transaxillary endoscopic thyroidectomy (GTET) and robot assisted transaxillary surgery (RATS). The purpose of this systematic review was to evaluate whether minimally invasive techniques are not inferior to conventional thyroidectomy.MethodsA systematic search was conducted in Medline, Embase and Web of Science to identify original articles investigating operating time, length of hospital stay and complication rates regarding recurrent laryngeal nerve injury and hypocalcemia, of the different minimally invasive techniques.ResultsOut of 569 identified manuscripts, 98 studies met the inclusion criteria. Most studies were retrospective in nature. The results of the systematic review varied. Thirty-one articles were included in the meta-analysis. Compared to the standard of care, the meta-analysis showed no significant difference in length of hospital stay, except a longer stay after BABA-ET. No significant difference in incidence of recurrent laryngeal nerve injury and hypocalcemia was seen. As expected, operating time was significantly longer for most minimally invasive techniques.ConclusionsThis is the first comprehensive systematic review and meta-analysis comparing the eight most commonly used minimally invasive thyroid surgeries individually with standard of care. It can be concluded that minimally invasive techniques do not lead to more complications or longer hospital stay and are, therefore, not inferior to conventional thyroidectomy.

Conventional thyroidectomy vs thyroid thermal ablation on postoperative quality of life and satisfaction for patients with benign thyroid nodules

Objective The complications and treatment effects of conventional thyroidectomy and thyroid thermal ablation should be compared in order to identify the best intervention for patients with benign thyroid nodules. Methods Patients (18–50 years old) who had benign thyroid nodules and were eligible for both thyroidectomy and thyroid thermal ablation were randomly allocated (1:1) to either conventional thyroidectomy group or thyroid thermal ablation group. Patients’ satisfaction and condition-specific quality of life were measured with the Thyroid-Specific Quality-of-Life Questionnaire Scale (QoL) at the 15th post-randomization month and were set as the co-primary outcome. Results A total of 450 patients were enrolled and randomized (225 patients in each group). At the 15th month after randomization, more patients in the thyroid thermal ablation group were satisfied with the treatment effects compared to those in the conventional thyroidectomy group. More patients in the thyroid thermal ablation group have a QoL score of 410 (QOL scores ranges from 0 to 410) than patients in conventional thyroidectomy. Eight (4%) of the 209 patients in conventional thyroidectomy group and 6 (3%) of the 208 patients in thyroid thermal ablation group had at least one severe postoperative complication. The time to achieve volume reduction was longer in the thermal ablation group. Conclusion Thyroid thermal ablation is superior to conventional thyroidectomy in terms of patients satisfaction, post-operative quality of life, and shorter hospital stay but takes longer to achieve BTNs volume reduction. The complication rates between the two groups were similar.

A comparative study between harmonic scalpel hemostasis and conventional hemostasis in total thyroidectomy

Background: Thyroidectomy is the most commonly performed procedure in endocrine surgery. Since the thyroid gland is highly vascular, therefore, rapid and absolute hemostasis is extremely required. Conventional thyroidectomy is commonly used with acceptable outcomes, however, it is time‑consuming and resulted in significant intraoperative blood loss with the possible risk of postoperative hemorrhage, injury to parathyroid glands and laryngeal nerves. The advent of focus harmonic devices was encouraging for improving safety, effectiveness, and reduction of operative time, especially in thyroid surgery. Aim of this study: The purpose of this study was to analyze the effectiveness and surgical outcomes of using ultrasonic harmonic scalpel for thyroid surgery compared to conventional techniques.Methods: This was a prospective, randomized study in which 60 patients with various types of goiters presented for thyroidectomy. The patients were divided into two comparable groups. Group A (30 patients) included patients who had focus harmonic thyroidectomy and Group B (30 patients) included patients who underwent conventional thyroidectomy.Results: Focus harmonic thyroidectomy showed a significant reduction in operative time, intraoperative blood loss, volume of postoperative fluid drainage and meantime for hospital stay compared with conventional thyroidectomy. There were no significant differences in the incidence of postoperative hypocalcemia, seroma, hematoma, wound infection and laryngeal nerve injury between both groups.Conclusions: Focus harmonic thyroidectomy was a safe, effective, faster, and appealing alternative to conventional technique since it reduced the operative time, intraoperative blood loss, postoperative drainage and hospital stay with comparable postoperative complications.

Feasibility of using minimal incision in thyroidectomy operation

Background: The conventional technique of thyroidectomy requires long skin incision, not satisfying patient and surgeon in terms of cosmesis and endoscopic thyroid surgery requires expertise. The aim of this study was to compare the clinical outcomes of patients undergoing minimal-incision thyroidectomy with those undergoing conventional thyroidectomy for benign thyroid diseases.Methods: Prospective randomized study that was carried on 50 patients who were undergone thyroidectomy at the department of surgery-Menoufia University from June 2018 to June 2019. The patients were divided into two groups. Group A included 25 patients who were operated upon using minimal incision thyroidectomy technique and group B included 25 patients who were undergone traditional thyroidectomy incision.Results: The length of skin incision was significantly shorter in the minimal-incision thyroidectomy than that in the conventional thyroidectomy group. Operative time was shorter in minimal incision technique. The incidence of postoperative complications was higher in conventional thyroidectomy group but didn’t reach to significant level. Patients undergone minimal-incision thyroidectomy experienced significantly less postoperative pain and were more satisfied with the cosmetic result than patients who underwent conventional thyroidectomy.Conclusions: Thyroid surgery can safely be performed as a minimally invasive procedure. Minimal access thyroid surgery is therefore a feasible and safe option for selected patients with excellent cosmetic outcome, with minimal learning curve.