Introduction
Conventional thyroid surgery has stood the test of time for over a century after being described and perfected by Theodore Kocher. With experienced hands, high success rates can be achieved in 6–8 cm neck incision. After the first endoscopic parathyroidectomy performed and described by Gagner in 1996, minimally invasive techniques in thyroid surgery including various endoscopic approaches and the video-assisted technique originally described by Miccoli have been accepted in several continents. The incision length is about 2.5 cm or even less. Cosmetic results, traditional procedure and better postoperative outcome are the key points accepted by thyroid surgeons. Minimally invasive video-assisted thyroidectomy (MIVAT) has proved to be one of the most widely used techniques in Europe and Asia. From May 2008 to June 2012, about 216 consecutive MIVAT operations were performed in our general surgery department. Sixteen patients without comprehensive records were excluded. Through a small central incision (1.5–3.0 cm) and external retraction without neck insufflation, good postoperative results including cosmetic results, little pain, operative time, and shorter hospitalization were achieved.
Aim
This study tried to summarize the safety and feasibility of MIVAT performed in 200 cases in a general surgery department.
Material and methods
Between May 2008 and June 2012, 200 patients (28 male, 172 female; with an age range of 23 to 67 years, mean age 38.6 years) were selected for MIVAT. Eligibility criteria were similar to a previous study. In our hospital, the selection process is based on clinical examination and ultrasonography. Patients with thyroid nodules smaller than 35 mm in the largest diameter in thyroid glands with a volume less than 20 ml, Graves disease gland smaller than 20 ml in volume, and low risk papillary thyroid carcinoma (PTC) < 2 cm in diameter without proof of enlarged lymph nodes in the lateral neck were all enrolled. Patients with a short neck in obese patients, history of thyroiditis, previous neck surgery or irradiation were excluded. Proper patient selection is critical for a successful outcome. Complete preoperative evaluation (biochemical assessment, ultrasonography, etc.) was performed in all cases. Fine needle aspiration cytology (FNAC) was performed in 87 selected cases. Cervical enhanced computed tomography (CT) scanning was performed in patients with doubted lymph node metastasis in ultrasound inspection. Pre-operative informed consent was obtained from all patients. Clinicopathologic characteristics, postoperative pain, length of hospital stay, cosmetic results and complications were retrospectively analyzed.
Results
All patients received general anesthesia. Thyroid unilateral lobectomy was successfully accomplished in 108 cases, total thyroidectomy in 84, and partial lobectomy in 8. Conversion to standard conventional thyroidectomy was required in 6 patients (3%) because of thyroiditis and bleeding. The mean lymph node yield of the cancer specimens was 3.6 per patient. Permanent unilateral recurrent laryngeal nerve (RLN) palsy occurred in 1 case (0.5%), transient unilateral RLN palsy in 6 patients (3.0%, complete recovery after 1–6 months), and transient hypocalcemia in 7 patients (3.5%). No definitive hypocalcemia was observed. No postoperative hematomas occurred. Postoperative pain was endurable. The cosmetic result was excellent in most cases.
Conclusions
The MIVAT is feasible and safe in selected patients, with better results comparable to conventional thyroidectomy. The MIVAT can also be performed in a general surgery department.