Mini-invasive video-assisted surgery of the thyroid and parathyroid glands: A 2011 update

Abstract

Thyroid surgery during the last century was characterized by a development of Kocher's concepts: through a relentless work of surgeons from all over the world thyroidectomy reached a standard of quality in terms of overall results which was unimaginable in the first half of the XX century. The flattering data collected in the literature until the 90's were all concordant in assuming that there would be little space for a real improvement in the quality standard of thyroid surgery. The introduction of laparoscopic surgery, though, changed very quickly the attitude of surgeons towards their operative behavior and countless new mini-invasive techniques were soon proposed for almost any field of surgery. In 1994, Gagner published the first series of laparoscopic adrenalectomies. Soon after, parathyroid adenomas seemed to offer an ideal field of application of these new surgical concepts. The first report of an endoscopic parathyroidectomy was in 1996. One year later other videoscopic procedures were described whose results seemed quite encouraging so as to push surgeons to try the same access and the same technique also for operations on thyroid. During the following decade several endoscopic or video-assisted approaches were proposed for the removal of thyroid gland. This paper aims to evaluate the results of minimally invasive thyroid and parathyroid surgery through an extensive review of the literature, in particular as far as minimally invasive video-assisted thyroidectomy is concerned.

Morbidity from minimally invasive video-assisted thyroidectomy: a general review

“…The literature seems consistent with a better postoperative outcome of MIVAT (17). In particular, during the whole postoperative period, it has been found that patients take less pain medications.…”

“…Recently, Miccoli et al (17) showed that the rate of complications involving the RLN is substantially similar to that already described in the literature; however, the study indicates that in tertiary referral centers, the incidence may prove slightly higher because of the large number of patients who undergo MIVAT, and of the frequently malignant nature of the underlying disease. Paradoxically, the use of advanced surgical instruments might further increase such rate, for instance due to heat transmission caused by the ultrasound scalpel that some surgeons use for coagulating and dividing vessels.…”

“…In particular, during the whole postoperative period, it has been found that patients take less pain medications. For patients who undergo conventional surgery, the trauma, edema, the size of the surgical wound, represent some of the main causes of postoperative pain; this clearly represents an advantage of MIVAT (15,17). It is also obvious that from an aesthetic point of view, the patient prefers a smaller surgical incision (MIVAT 2-2.5 cm vs. CT 5-6 cm) (14) (Figure 1).…”

Video-Assisted Thyroidectomy for Selected Cases of Differentiated Thyroid Carcinoma. Initial Experience in Colombia

“…However, the appearance of minimally invasive techniques for head and neck conditions opened a new possibility of treatment for thyroid cancer. The first attempt was the minimally invasive video-assisted thyroidectomy designed by Miccoli et al [22]. Soon, other surgical techniques as breast-access minimally invasive thyroidectomy [23], axillary robotic-assisted thyroidectomy [24] and face-lift robotic assisted thyroidectomy [25] has also been suggested as minimally invasive.…”

Frozen Tissue Examination: Is It really no Longer of Use in Parathyroid Surgery? Single-center Retrospective Study on 97 Patients treated by minimally Invasive Approach

“…1 However, the imaging tests, the treatment, and the intraoperative control arrangements are still being debated. There are two different surgical strategies: Exploratory cervicotomy with visualisation of the four glands or focused minimally invasive surgical approach 2,3 enabling the visualization of one or two glands. However, the lack of visualization of the four glands makes it impossible to rule out multiglandular involvement and, in particular, the rare case of double adenomas, and because of that, some authors recommend systematic intraoperative PTH assays (intraoperative assay of the PTH or tissue PTH).…”