Minimally Invasive Video-Assisted Thyroidectomy (MIVAT) in the Era of Minimal Access Thyroid Surgery

Abstract

Background: In the era of minimal access thyroid surgery, the terms minimal access and minimally invasive are often used interchangeably and in most instances this is far from being accurate. The aim of this article is to examine the characteristics and potential of one of the first minimal access thyroid procedures described; minimally invasive video-assisted thyroidectomy (MI-VAT). Methods: The purpose of this article was obtained by almost two decades of experiences with the procedure at the authors' center, and a systemic literature review was undertaken of all available medical literature to evaluate available literature by conducting a PubMed search limited to articles originally written in English language between the years 1997 and 2016. The search was limited by using the terms: minimally invasive thyroid surgery, video-assisted, endoscopic, and robotic thyroidectomy. The procedure's design, radicality and safety, learning curve, cost, advantages and disadvantages were addressed. MIVAT's potential as a surgical tool for thyroid pathology was also addressed by evaluating its indications, contraindications, and limitations. Results: MIVAT is a gasless hybrid procedure that is comparable to conventional thyroidectomy (CT) in terms of radicality and safety, with the added advantage of reduced early postoperative voice and swallowing symptoms. MIVAT has a relatively rapid learning curve with an additional advantage over other minimal access procedures; the ability of being adopted by the low-volume surgeon at a cost and time comparable to CT, but with improved patient satisfaction. Furthermore, it is non-inferior to procedures free of a neck scar in terms of patient satisfaction. MIVAT's main drawback is that it is limited by its strict selection criteria. It is a viable treatment option for all types of thyroid pathologies. However, its role in therapeutic neck dissection remains to be validated. Conclusions: MIVAT is a safe and effective procedure which is obviously described in its name "minimally invasive". It seems that in the era of innovative technologies and scarless-in-the neck thyroid surgery, MIVAT is here to stay.

Minimally Invasive Video-Assisted Thyroidectomy: Analysis of Complications From a Systematic Review

“…12 For these reasons, MIVAT still remains a reliable and easily reproducible technique that allows performing, in selected cases, a thyroidectomy through a very small (1.5-2.5 cm) skin incision. 17 Moreover, this minimally invasive procedure follows the course of conventional procedure, and the video assistance is limited to very few steps, such as laryngeal nerves and parathyroid glands and section of upper thyroid pedicle. For this reason, it can be performed by a surgeon skilled in thyroid surgery without special difficulties.…”

“…[10][11][12] In the past 20 years, several overviews and systematic reviews discussed different aspects of MIVAT. [13][14][15][16][17] Three meta-analysis studies concerning overall results of MIVAT have been published. [18][19][20] All of them included a relatively small number of articles; moreover, the latest study was published 3 years ago and the item of complication rate has not been specifically discussed yet.…”

Minimally invasive video-assisted thyroidectomy and transoral video-assisted thyroidectomy: A comparison of two systematic reviews

“…Minimally invasive video-assisted thyroidectomy (MIVAT), a partly endoscopic procedure, is currently the most widely used MATS method. [ 1 ]…”