A Meta-Analysis of Minimally Invasive Video-Assisted Thyroidectomy

How does minimally invasive video-assisted thyroidectomy (MIVAT) compare with conventional thyroidectomy?

Background: The advantages of minimally invasive thyroid surgery include shorter hospital stays, reduced postoperative pain, and improved cosmetic results. Studies have also demonstrated functional advantages over conventional surgery with regard to voice and swallowing. MIVAT is one type of these procedures, with two others being complete endoscopic techniques and mini-incision open techniques.

Study design: A systematic review of the literature and meta-analysis.

Setting: Department of Otolaryngology-Head and Neck Surgery, St. Bartholomew’s hospital, West Smithfield, London, United Kingdom; Department of Surgery, West Middlesex University Hospital, Isleworth, Middlesex, United Kingdom; and St. George’s Hospital, Tooting, London, United Kingdom.

Synopsis: The authors included all published prospective controlled trials that compared MIVAT to conventional thyroidectomy. The primary outcome measures were patient-reported pain and postoperative hypocalcemia or recurrent laryngeal nerve palsy. The secondary outcome measures were operative time, estimated intraoperative blood loss and patient-scored postoperative cosmetic result. The authors identified five studies published between 2001 and 2009. MIVAT was performed on 156 patients and conventional thyroidectomy in 162 cases. Regarding safety, the team found no significant difference between the two groups. Of the trials that assessed postoperative pain, the MIVAT groups reported significantly lower pain. An analysis of cosmesis showed a significant advantage of MIVAT. The analysis showed that the MIVAT technique takes longer to perform than conventional surgery, but the authors felt this took into effect the learning curve for physicians new to the technique. There were also relatively high complication rates that were ascribed to the learning curve.

Bottom line: Once the surgeon has mastered the technique, MIVAT is as safe as conventional thyroidectomy and outcome measures of pain and cosmesis show better results for MIVAT. Operative time, however, is longer for MIVAT.

Citation: Radford PD, Ferguson MS, Magill JC, et al. Meta-analysis of minimally invasive video-assisted thyroidectomy. Laryngoscope. 2011;121(8):1675-1681.

-Reviewed by Sue Pondrom