title: Minimally invasive video assisted thyroidectomy versus endoscopic thyroidectomy via the areola approach: a retrospective analysis of safety, postoperative recovery, and patient satisfaction.
abstract: OBJECTIVE
  Minimally invasive video-assisted thyroidectomy (MIVAT) and endoscopic thyroidectomy through areola (ETA) access are among the endoscopic approaches for thyroidectomy that have been perfected, but reports comparing the two are lacking. This study evaluated the safety, postoperative recovery, and patient satisfaction of MIVAT compared with ETA.
  
  
  METHODS
  This study included 119 patients undergoing MIVAT and 42 patients undergoing ETA from January 2006 to October 2009. Operative time, complications, postoperative recovery, cosmetic result, and patient satisfaction were analyzed.
  
  
  RESULTS
  The ETA group had a higher percentage of women (100% vs. 78.2%, P<0.05) and was younger (33.5 vs. 39 years, P<0.05). Thyroid volume (24.5 vs. 14.5 mL, P<0.001) and nodular diameter (26 vs. 22 mm, P<0.05) were larger in ETA group. The MIVAT group had a shorter operative time (28.2 vs. 112.8 minutes) and a lower rate of intraoperative (7.2 vs. 21.2 mL) and postoperative (0 vs. 80 mL, P<0.0001) blood loss. Rates of conversion and complications were similar. Postoperative pain at 12 hours was 1.9 in MIVAT vs. 3.1 in ETA (P<0.0001). Hospitalization was 1 day in the MIVAT group vs. 3.5 days in ETA (P<0.0001). Patient satisfaction was similar.
  
  
  CONCLUSIONS
  MIVAT and ETA showed similar results for safety, although ETA might be considered more invasive than MIVAT. Patients of both groups were equally satisfied with the cosmetic result. Differently from ETA, MIVAT allows total thyroidectomy to be performed also for malignant diseases. Although different, the two approaches were safe and reliable and both are valid options. Choice might depend on the surgeon's preference, thyroid size, type of disease, and the patient's expectation about cosmesis.
authors.affiliation: Department of General Surgery, Qilu Hospital of Shandong University, Jinan, China. husanyuan1962@hotmail.com
authors.forename: J H
authors.initials: JH
authors.lastname: Lu
authors.forename: G
authors.initials: G
authors.lastname: Materazzi
authors.forename: M
authors.initials: M
authors.lastname: Miccoli
authors.forename: A
authors.initials: A
authors.lastname: Baggiani
authors.forename: S
authors.initials: S
authors.lastname: Hu
authors.forename: P
authors.initials: P
authors.lastname: Miccoli
mesh_terms: D000328:Adult; D001940:Breast / Q000601:surgery; D004724:Endoscopy / Q000379:methods; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D010149:Postoperative Pain; D017060:Patient Satisfaction; D012189:Retrospective Studies; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome; D020535:Video-Assisted Surgery / Q000379:methods