Clinical Benefits of Minimally Invasive Techniques in Thyroid Surgery

Perigli, Giuliano; Cortesini, C; Qirici, Etleva; Boni, Daniele; Cianchi, Fabio

doi:10.1007/s00268-007-9259-0

Cited by 56 publications

(72 citation statements)

References 36 publications

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“…Some authors require a total thyroid volume of 20 to 30 mL or less before advocating a video-assisted technique. 2,5 In this series, our ultrasonographers did not document thyroid volume but instead measured the nodule and lobe in three dimensions. This simple method of thyroid measurement may allow the surgeon to better plan the incision length compared with an estimated volume recording of the thyroid gland.…”

Section: Discussionmentioning

confidence: 99%

“…Other than an aesthetically pleasing scar, patients have been shown to suffer less pain compared with longer incisions with no difference in complication rate. 2,5,6 Minimally invasive nonendoscopic techniques are more easily achieved and reproduced for the majority of surgeons with less access to sophisticated equipment and less staff than those able to perform endoscopic approaches. Postoperative care of the scar, such as avoidance of direct sunlight on the incision, application of moisturizing creams, meticulous wound cleaning, and application of Silastic (Dow Corning, Auburn, Michigan) (or similar) dressings, also contributes to a well-healed and aesthetically pleasing incision, and this care should also be discussed with the patient.…”

Section: Discussionmentioning

confidence: 99%

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What Can Determine the Length of an Open Nonendoscopic Thyroidectomy Incision?

Vasan

Collins

2016

Surg J

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Thyroidectomy is a common operation performed by several disciplines. The usual technique requires a midline transverse anterior cervical incision to access the thyroid gland. The length of the incision varies depending on the thyroid lesion and the patient's habitus, as well as the surgeon's comfort level. As patients' expectations regarding aesthetic appearance following surgical procedures have increased, surgeons have begun to dramatically reduce the length of the thyroidectomy incision to minimize the scar.To improve cosmesis, minimally invasive video-assisted thyroidectomy was first described by Miccoli and colleagues. 1,2 With this specialized endoscopic technique, an incision length of 1.5 cm was used to remove nodules less than 35 mm in largest diameter in a thyroid gland that was less than 20 mL in volume as determined by ultrasound. 2 Obviously, only a small percentage of patients with very small nodules can be treated in this manner.Robotic thyroidectomy to avoid an anterior neck scar is popular in Asia but has not been widely practiced within North America, and open approaches remain commonplace.This study evaluated the association between patient weight, nodule size, maximum thyroid diameter, and incision length of an open non-video-assisted thyroidectomy for 32 consecutive patients. Keywords► head and neck surgery ► endocrine surgery ► thyroid gland ► advocacy AbstractObjectives Surgeons are now utilizing small incisions when performing thyroidectomy. This study evaluated the association between patient weight, nodule size, and maximum thyroid diameter and the length of an open thyroidectomy incision. Study Design Retrospective analysis of 32 consecutive patients. Subjects and Methods Patient demographics, clinical exam, ultrasound findings, operative findings, and pathology were recorded. Results Of the 32 patients (81% women), 27 underwent a hemithyroidectomy. The mean patient weight was 194 lbs. The mean clinical nodule diameter was 3.46 cm, and the mean maximum thyroid diameter was 5.91 cm. The mean incision size was 5.13 cm. Independently, patient weight, maximum thyroid diameter, and maximum nodule diameter were shown in regression models to be statistically significant predictors of incision size. In stepwise regression analysis that included all three listed variables, maximum thyroid diameter was the most significant predictor of incision size (p < 0.0001). Conclusions Surgeons may determine the length of the incision using clinical and radiologic parameters, but most probably use their subconscious clinical judgment and the challenge of utilizing a very small incision for this operation. This study has shown that maximum thyroid diameter is the most significant determinant for the incision but that nodule size and patient weight are also significant factors. This study is evidencebased medicine level III.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

What Can Determine the Length of an Open Nonendoscopic Thyroidectomy Incision?

Vasan

Collins

2016

Surg J

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“…These lengths were chosen as previous studies have defined minimally invasive approaches as having incision lengths of 2.5-4.0 cm and conventional approaches as having incision lengths of 5.0-10.0 cm. 4,[10][11][12][13][14] The minimum limits of these ranges were chosen for the simulated scars' lengths as it was felt that this would be a more useful comparison than the upper limits or averages of these ranges.…”

Section: Experimental Designmentioning

confidence: 99%

“…[1][2][3][4] The major proposed benefit of the endoscopic approach is that it yields superior cosmetic results when compared to the open approach in select patients. [5][6][7][8][9] Despite this benefit, open thyroidectomy, through an anterior cervical incision, remains the predominant surgical approach in most centres.…”

Section: Introductionmentioning

confidence: 99%

A paired comparison analysis of third-party rater thyroidectomy scar preference

et al. 2016

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Objective: To determine the length and position of a thyroidectomy scar that is cosmetically most appealing to naïve raters.Methods: Images of thyroidectomy scars were reproduced on male and female necks using digital imaging software. Surgical variables studied were scar position and length. Fifteen raters were presented with 56 scar pairings and asked to identify which was preferred cosmetically. Twenty duplicate pairings were included to assess rater reliability. Analysis of variance was used to determine preference.Results: Raters preferred low, short scars, followed by high, short scars, with long scars in either position being less desirable ( p < 0.05). Twelve of 15 raters had acceptable intra-rater and inter-rater reliability.Conclusion: Naïve raters preferred low, short scars over the alternatives. High, short scars were the next most favourably rated. If other factors influencing incision choice are considered equal, surgeons should consider these preferences in scar position and length when planning their thyroidectomy approach.

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“…MIS is performed using long instruments to enter the patient body through small incisions and leads to direct advantages including less pain, hemorrhaging and trauma, reduced risk of infections, shortened hospital stay, and hence less burden for both the patient and social health care system [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

Hunt–Crossley model based force control for minimally invasive robotic surgery

Pappalardo

Albakri

Liu

et al. 2016

Biomedical Signal Processing and Control

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a b s t r a c tIn minimally invasive surgery (MIS) the continuously increasing use of robotic devices allows surgical operations to be conducted more precisely and more efficiently. Safe and accurate interaction between robot instruments and living tissue is an important issue for both successful operation and patient safety. Human tissue, which is generally viscoelastic, nonlinear and anisotropic, is often described as purely elastic for its simplicity in contact force control design and online computation. However, the elastic model cannot reproduce the complex properties of a real tissue. Based on in vitro animal tissue relaxation tests, we identify the Hunt-Crossley viscoelastic model as the most realistic one to describe the soft tissue's mechanical behavior among several candidate models. A force control method based on Hunt-Crossley model is developed following the state feedback design technique with a Kalman filter based active observer (AOB). Both simulation and experimental studies were carried out to verify the performance of developed force controller, comparing with other linear viscoelastic and elastic model based force controllers. The studies and comparisons show that the Hunt-Crossley model based force controller ensures comparable rise time in transient response as the controller based on Kelvin-Boltzmann model which is reported as the most accurate description for robot-tissue interaction in recent literature, but it causes much less overshoot and remains stable for tasks with faster response time requirements.

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Clinical Benefits of Minimally Invasive Techniques in Thyroid Surgery

Abstract: When compared with conventional treatment, VAT and MIT provided significant benefit in terms of cosmetic results and postoperative pain. Nevertheless, the main limiting factor for minimally invasive thyroid surgery still remains the size of the thyroid.

Cited by 56 publications

References 36 publications

What Can Determine the Length of an Open Nonendoscopic Thyroidectomy Incision?

What Can Determine the Length of an Open Nonendoscopic Thyroidectomy Incision?

A paired comparison analysis of third-party rater thyroidectomy scar preference

Hunt–Crossley model based force control for minimally invasive robotic surgery

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