What is the efficacy of minimally invasive video-assisted thyroidectomy (MIVAT) in reducing complications?

Updated: Jan 25, 2018
  • Author: Pramod K Sharma, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

The development of videolaparoscopic surgery in the last decade has allowed several operations to be performed with minimally invasive techniques. After the first parathyroidectomy procedure was performed endoscopically in 1996, this minimally invasive approach was applied to thyroid surgery.

Minimally invasive video-assisted thyroidectomy (MIVAT) was described in 1998. The technique was described using a central access with a 1.5-cm incision and external retraction. Video-assisted thyroidectomy was tested successfully in animals and has been performed safely in human patients. Postoperative morbidity rates in patients seem to be equivalent to those of patients who have undergone conventional surgery.

Chao et al (2004) prospectively compared video-assisted thyroid lobectomy and conventional lobectomy in 116 patients with thyroid nodules. [14] No deaths, hematomas, wound infections, cases of hypothyroidism, or RLN palsies were reported. Damage to the SLN occurred in 6 (10.2%) patients after conventional surgery and in no patients in the video-assisted group. Transient RLN palsy occurred in 5 (8.5%) patients who underwent conventional surgery versus 3 (5.8%) patients in the video-assisted group; the difference was not significant. Patients in both groups were discharged home on the second postoperative day.

In a 5-year study, Miccoli et al (2004) selected 579 patients to undergo MIVAT. [15] The operation consisted of total thyroidectomy in 312 patients and lobectomy in 267. The mean operative time was 41 minutes (range, 15-120 min) for lobectomy and 51.6 minutes (range, 30-140 min) for total thyroidectomy. The postoperative hospital stay was 24 hours (overnight discharge) for all patients. Complications included postoperative bleeding (0.1%), recurrent nerve palsy (1.3%), and definitive hypoparathyroidism (0.2%). Some have suggested that pain following VAT is less when compared with conventional thyroidectomy because of limited dissection, retraction, and injury to tissues.


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