What are the benefits of using minimally invasive video-assisted thyroidectomy (MIVAT)?

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

Answer

MIVAT provides endoscopic magnification of nerves and vessels, potentially decreasing the risk of injury to these structures. This approach may also help improve aesthetic results. However, the cosmetic result obtained with an appropriately sized and placed conventional incision is also good. The endoscopic technique cannot be used in nodules larger than 35 mm or in goiters because the specimen is too large to retrieve through the incision. In addition, this technique is not ideal for removing carcinomas in which an intact capsule is desired for oncologic reasons and for accurate histologic assessment.

Postoperative voice and swallowing have also been shown to differ according to the method of surgery. In 2008, Lombardi et al published a study of patients undergoing total thyroidectomy who were randomized into 2 groups. Twenty-nine patients underwent VAT and 24 underwent conventional thyroidectomy. Three months postoperatively, acoustic voice analysis showed that patients who were treated with conventional thyroidectomy had significantly lower fundamental frequencies, maximum phonation time, and number of semitones. Additionally, the mean voice impairment score from a specifically designed questionnaire was higher for 3 months after surgery, and the mean swallowing impairment score was higher for one week after surgery. The authors concluded that short-term voice and swallowing outcome was improved for patients treated with VAT in their study. [16]

In summary, if the general principals of conventional thyroid surgery are followed, video assistance may help in identifying structures and in minimizing the incision. Experienced surgeons may consider using this technique when the equipment and additional surgical staff is available for patients with small follicular nodules/adenomas, or well-differentiated papillary carcinoma, or when prophylactic thyroidectomy is being performed in patients with ret protooncogene mutations.


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