Comparison between minimally invasive video-assisted thyroidectomy and conventional thyroidectomy: is there any evidence-based information?
BACKGROUND
The aim of this study was to test the hypothesis that minimally invasive video-assisted thyroidectomy (MIVAT) affords comparable safety and efficacy as to the open conventional surgery in dealing with patients with small thyroid nodules.


METHODS
Randomized controlled trials comparing the MIVAT with open thyroidectomy were ascertained by methodical search using Medline, Embase, Pubmed, and The Cochrane Library. Primary meta-analysis outcomes were adverse events (laryngeal nerve palsy and hypoparathyroidism), and cosmesis and secondary outcomes were operative time, blood loss, and early and late postoperative pain.


RESULTS
Operative time was significantly less with open thyroidectomy than with MIVAT, while MIVAT was associated with less pain at 6 hours postoperatively. Blood loss did not reached significance between procedures. Comparisons between two procedures concerning pain score of 24 and 48 hours, respectively, depicted statistically significant differences in favor of the MIVAT but only in the fixed effects model. MIVAT was associated with less scarring. There were no statistically significant differences for the presence of transient recurrent laryngeal nerve palsy and the presence of transient hypoparathyroidism.


CONCLUSIONS
MIVAT is a safe procedure that produces outcomes; in view of short-term adverse events, similar to those of open thyroidectomy, it needs a longer operative time to be accomplished and is superior in terms of immediate postoperative pain and cosmetic results.
Sgourakis
George
G
Department of General and Abdominal Surgery, Johannes Gutenberg University Hospital, Mainz, Germany. ggsgourakis@yahoo.gr
Sotiropoulos
Georgios C
GC
Neuhäuser
Markus
M
Musholt
Thomas J
TJ
Karaliotas
Constantine
C
Lang
Hauke
H
D019317:Evidence-Based Medicine; D006801:Humans; D007011:Hypoparathyroidism / Q000209:etiology; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D010149:Postoperative Pain / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D016606:Thyroid Nodule / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D020535:Video-Assisted Surgery / Q000009:adverse effects / Q000379:methods*; D014826:Vocal Cord Paralysis / Q000209:etiology