Clinical Contrast Between Miccoli's Thyroidectomy And Conventional Thyroidectomy

Conventional thyroid surgery is an effective and safe treatment for thyroid nodule, however," minimally invasive surgery" has been known widely. Patients, especially young female patients, prefer the kinds of minimally invasive methods to conventional ones if they can.Miccoli's thyroid surgery is a kind of minimally invasive video assisted thyroid surgery which was described by Miccoli and his colleagues in 1998, and it's usually used to resolve benign problems. Though Miccoli's doesn't have the cosmetic effect as other video endoscopic thyroid surgeries do, it's similar to conventional thyroid surgery having no use for establishing operation space by carbon dioxide perfusion. So it not only saves operation time, but also avoids many complications like subcutaneous emphysema,air embolism,skin infarction et al. We decided to choose Miccoli's thyroid surgery as our new treatment method, and wanted to evaluate it through contrasting between Miccoli's and conventional thyroid surgery.In this study we collect 237 cases from 20th Jul 2006 to 31st Mar 2008, Miccoli's operation has 117 cases while conventional operation has 120 cases. All thyroid nodules were diagnosed as benign focuses. There are 93 female patients (79%) and 24 male patients whose mean age is 43.90±11.52 years in Miccoli's team; there are 86 female patients (72%) and 34 male patients whose mean age is 46.01±11.05 years in convention team. The mean diameter of nodule in the Miccoli's team and convention team is 22mm and 26mm respectively.The procedure of Miccoli's team, totally gasless, is carried out through a 20-30mm central incision above the sternal notch. Dissection is performed under endoscopic vision using conventional and endoscopic instruments. All nodules were required to undergo pathology examine in the operations.There are 4 cases underwent conventional operation in Miccoli's team because of the pathology examine reporting malignant results, and 4 another patients underwent endoscopic thyroid surgery although the malignant pathology results. Partial thyroidectomy was performed in 99 cases, subtotal thyroidectomy in 6 cases, total lobectomy and subtotal contrlobectomy in 4 case, 56 cases were adenoma, 23 cases were nodular goiter, 30 cases were thyroid adenoma and nodular goiter in Miccoli's team; There are 5 cases underwent operation for thyroid carcinoma, partial thyroidectomy was performed in 107 cases, subtotal thyroidectomy in 2 cases, total lobectomy and subtotal contrlobectomy in 6 case, 54 cases were adenoma, 25 cases were nodular goiter, 36 cases were thyroid adenoma and nodular goiter in convention team. One patient experienced temporary cracked symptom in Miccoli's team; two patients represented hypoparathyroidism. The mean operating time of Miccoli's team is a little longer than convention team (74.04±29.67 vs. 59.97±23.55, P<0.05), but the blood loss in operation of Miccoli's team is less, postoperation hospital stay is shorter, and cosmetic results is more cheering. Similar results about age, complication and recrudesce rate were achieved in these two teams.Although the operating time appears longer than conventional procedures, the learning curve demonstrates a sharp decrease with increasing experience and the introduction of new technologies. The blood loss of Miccoli's team is less because of not only amplificatory effect of endoscope equipments, but also the harmonic scalpel used in operation. The minimal injury, mild postoperative pain and no need of outflow tube might result in shorter postoperation hospital stay.Recurrent nerve palsy resulting in temporary cracked symptom was exhibited in Miccoli's team, and we considered that the nerve might be injured by heat conduction of harmonic scalpel. To avoid this complication, it is important not only to avoid excessive dissociation but also a cautious use of the harmonic scalpel and unipolar cautery when dissecting close to the recurrent nerve. There is no question that the minimally invasive and cosmetic result with Miccoli's is better than with conventional surgery.It reveals that Miccoli's thyroid surgery should be considered a valid option, and human will resolve the problems which restrict the development of minimally invasive surgery, and we'll have to collect more cases to evaluate the new method.