Jiao Liu1, Turun Song, Mingqing Xu. 1. Department of Liver and Vascular Surgery, West China Hospital, Sichuan University, Guoxue Xiang #37, Chengdu, 610041, Sichuan, People's Republic of China.
Abstract
PURPOSE: Minimally invasive video-assisted thyroidectomy (MIVAT) is now emerging as a novel and less invasive procedure for thyroid diseases. This study conducted a systematic review of the available data to evaluate the safety and efficacy of this new technique over conventional procedure. METHODS: A systematic literature search was performed on Medline, Embase, and The Cochrane Library. Randomized controlled trials comparing the MIVAT with open thyroidectomy were selected and meta-analyzed. RESULTS: Nine RCTs involving 730 patients were included and all were restricted to patients with a thyroid nodule no larger than 4 cm and surgery did not involve lymph node dissection. Both procedures were of similar efficacy in nodule resection. Open surgery had a 1.6 times higher rate of postoperative complications than the novel technique, with no significant difference (P = 0.08), especially in transient recurrent nerve palsy (OR = 0.93, P = 0.87). Although longer operative time was required for MIVAT (MD = 15.0 min, P < 0.00001), patients experienced less postoperative pain, especially in the early postoperative period (MD = -11.52, P = 0.0003). There was also a shorter incision length (MD = -2.36 cm, P < 0.00001), better cosmetic results and greater patient satisfaction in the novel technique group (WD = 2.59; P < 0.00001). CONCLUSIONS: MIVAT is a feasible, practical, and safe alternative with better cosmetic benefits, and it can be performed with an ease of manipulation that is similar to that of conventional neck surgery.
PURPOSE: Minimally invasive video-assisted thyroidectomy (MIVAT) is now emerging as a novel and less invasive procedure for thyroid diseases. This study conducted a systematic review of the available data to evaluate the safety and efficacy of this new technique over conventional procedure. METHODS: A systematic literature search was performed on Medline, Embase, and The Cochrane Library. Randomized controlled trials comparing the MIVAT with open thyroidectomy were selected and meta-analyzed. RESULTS: Nine RCTs involving 730 patients were included and all were restricted to patients with a thyroid nodule no larger than 4 cm and surgery did not involve lymph node dissection. Both procedures were of similar efficacy in nodule resection. Open surgery had a 1.6 times higher rate of postoperative complications than the novel technique, with no significant difference (P = 0.08), especially in transient recurrent nerve palsy (OR = 0.93, P = 0.87). Although longer operative time was required for MIVAT (MD = 15.0 min, P < 0.00001), patients experienced less postoperative pain, especially in the early postoperative period (MD = -11.52, P = 0.0003). There was also a shorter incision length (MD = -2.36 cm, P < 0.00001), better cosmetic results and greater patient satisfaction in the novel technique group (WD = 2.59; P < 0.00001). CONCLUSIONS: MIVAT is a feasible, practical, and safe alternative with better cosmetic benefits, and it can be performed with an ease of manipulation that is similar to that of conventional neck surgery.
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