Video-assisted neck surgery (VANS) using a gasless lifting procedure for thyroid and parathyroid diseases: “The VANS method from A to Z”

Abstract

Purpose To describe and evaluate our video-assisted neck surgery (VANS) method for thyroid and parathyroid diseases. Methods We describe in detail the VANS method for enucleation, lobectomy, total (nearly total) thyroidectomy, and lymph node dissection for malignancy and Graves' disease. In collaboration with the Japan Society of Endoscopic Surgery (JSES), we evaluated several aspects of this method. The JSES evaluated the method for working-space formation and surgical complications, whereas we examined the learning curve of the surgeons, and the cosmetic satisfaction of the patients and the degree of numbness and pain they experienced. We also asked patients who underwent conventional surgery whether they would have selected VANS had it been available. Results The working space for 81.5% of the procedures in Japan was created using the gasless lifting method. The learning curve, considering both blood loss and operating time, decreased after 30 cases. Both factors improved for tumors smaller than 5 cm in diameter. Over 60% of the patients who underwent conventional surgery stated that they would have selected VANS, had it been available. Postoperative pain was worse after conventional surgery than after VANS, but neck numbness after VANS was more frequent than expected. Conclusions The VANS method is a feasible, safe, and cost-effective procedure with clear cosmetic advantages over conventional surgery.

Learning Curve for Endoscopic Thyroidectomy Using Video-Assisted Neck Surgery: Retrospective Analysis of a Surgeon's Experience with 100 Patients

“…This is because this approach: 1) is closer to the neck than other approaches and relatively easy to perform; 2) is less invasive in terms of the extent of skin flap creation than other approaches; and 3) does not need air insufflation and does not show complications such as CO2 embolism or subcutaneous emphysema. In addition, as mentioned in our previous report 7 , the level of satisfaction with the scar is higher among younger patients, especially those in their 20s and 30s, compared to the conventional approach.…”

“…The operative method was based on a previous report 7 . In summary, a 30-to 35mm skin incision (depending on the size of the tumor) was placed in the subclavian area on the affected side, and a lifting technique using a lifting retractor with an aspirator was applied.…”

Definition of learning curve for thyroidectomy: systematic review on the different approaches

“…The techniques investigated for remote-access thyroidectomy in the selected studies were: transoral endoscopic thyroidectomy trans-vestibular approach) (9 reports (TOETVA) ( 30 - 38 ), breast approach (5 reports) ( 39 - 43 ), transaxillary (3 reports) ( 44 - 46 ), BABA (2 reports) ( 47 , 48 ), subclavian (2 reports) ( 49 , 50 ), retroauricular (1 report) ( 51 ). Bleeding, hypocalcemia and RNL injuries were compared before and after proficiency achievement in eight papers ( 36 , 40 - 43 , 45 , 47 , 50 ) with other trials considering the overall postoperative complication rate.…”

“…Two retrospective studies in the current literature evaluate LC for endoscopic thyroidectomy with a subclavian approach ( 49 , 50 ). Neither author used the CUSUM and in both papers proficiency was established at 30 procedures for a single surgeon.…”

Lateral approach contributes to shortened surgical time in video-assisted neck surgery (VANS) for thyroid nodule

“…Maegawa et al also took 183 minutes (range: 121–329) by the same midline approach in VANS for hemithyroidectomy, which is a longer operation time than that by the conventional open thyroidectomy in their institute [ 17 ]. Elsewhere, Shimizu et al performed hemithyroidectomy by lateral approach in VANS [ 9 , 18 ]. The gold standard approach for thyroid in VANS is therefore still a matter of controversy.…”