Abstract
Objectives:
1) Review complication profiles among various thyroidectomy techniques, including conventional, minimally invasive non-endoscopic, minimally invasive video-assisted (MIVAT), and robotic approaches. 2) Analyze factors contributing to the safety profile of MIVAT. 3) Describe potential steps to implement MIVAT in a surgical practice.
Methods:
The largest single series of MIVAT in North America was reviewed to explore its safety profile. An institutional review board (IRB)-approved prospectively maintained database was queried for all patients undergoing thyroid surgery by a single surgeon from 2003 to 2011. Demographic information, surgical and pathologic data, and post-operative outcomes were analyzed.
Results:
A total of 1,132 consecutive thyroidectomies were identified. MIVAT was incorporated beginning in 2005. There were 249 MIVATs (164 hemi, 85 total), 399 minimally invasive non-endoscopic thyroidectomies, 441 conventional thyroidectomies, and 43 robotic thyroidectomies. Two hundred twenty-eight MIVATs were accomplished on an outpatient basis. MIVAT patients were predominantly young (46.8 ± 14.8 years old) and female (89%). The mean incision length was 2.3 ± 0.4 cm. No cases of permanent hypoparathyroidism or permanent true vocal fold paralysis occurred. Observed complications included transient vocal fold dysfunction (n = 10; 4.0%), cellulitis (n = 1, 0.4%), and temporary hypocalcemia (n = 5; 2.0%). The overall complication rate for MIVAT was lower than the combined overall complication rate for minimally invasive non-endoscopic, conventional, and robotic thyroidectomy (6.8% vs. 14.8%; P = 0.001).
Conclusions:
MIVAT can be performed safely with a low complication profile in a high-volume practice. The safety of MIVAT represented by this experience may support expanded implementation.
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