Comparative Study Between Minimally Invasive Video-assisted Thyroidectomy And Totally Endoscopic Thyroidectomy

Objective:Current endoscopic techniques are divided into Minimally invasive video-assisted thyroidectomy(MIVAT)and totally endoscopic thyroidectomy (TET) according to leaving incisions on neck or not. And totally endoscopic thyroidectomy is comprised of different approaches for example areola, chest-breast, axilla and hybrid approach. The most common approaches in our hospital are Minimally invasive video-assisted thyroidectomy and endoscopic thyroidectomy via chest-breast approach. However, Comparative study between the two approaches are lack in China, this study evaluated the safety, Trauma and the effect about cosmesis of MIVAT compared with TET to find out the advantages and disadvantages of them and help the doctors and patients to make a choice。Methods:The study included70patients undergoing MIVAT and TET at Qilu Hospital of Shandong University in2012.46patients undergoing MIVAT (MIVAT group) and24patients undergoing TET (TET group) were analyzed retrospectively. Information about gender, age, Operative data, Intraoperative and postoperative complications, length of stay, feelings of patients and patient satisfaction about cosmesis is collected and analysised, MIVAT and TET are compared in term of the safety, trauma and the effect about cosmesis。 Data were collected from patient medical records, Survey, follow-ups of outpatient and telephone。Results:No differences was noted between two groups in the term of demographic data for example gender, age, size of nodular diameter, proportion of benign and malignant. The MIVAT group has a shorter operating time than TET group (50.1±21.86min vs126.6±36.41min, P<0.05);1case in MIVAT group was converted into open surgery and no case in TET group (2.17%vs0%, P>0.05). All the recurrent laryngeal nerves (RLN) of70patients were intact and all signals of them showed no injury. Whereas the intraoperative blood loss in the MIVAT group was significantly less than those in the TET group (13.2±4.02ml vs23.5±7.67ml, P<0.05). Postoperative pain at6hours was similar, but the MIVAT group showed less Postoperative pain than the TET group at12hours and24hours (3.3±1.31vs4.4±1.61, P<0.05at12hours;1.0±0.95vs2.2±1.17, P<0.05at24hours). The MIVAT group has a low rate of postoperative bleeding (33.0±27.15ml vs134.1≈59.40ml, P<0.05) and a shorter stay time (4.0±1.42vs5.3±1.22, P<0.05) than the TET group. Temporary hoarseness occurred in one patient in each group (2.2%vs4.2%, P>0.05), no RLN permanent palsy occurred。There weren’t any other complications existed in MIVAT group, and in TET group subcutaneous pneumoderma occurred in2cases, subcutaneous hydrops occurred in1case. The two groups have similar Voice Handicap Index (VHI)(0.6±1.09vs0.7±1.09, P>0.05), The Reflux Symptom Index (RSI)(22.9±6.27vs25.1±6.90, P> 0.05) and patient satisfaction index about cosmesis (3.8±0.45vs3.9±0.28, P>0.05) after3monthes.Conclusions:The MIVAT is considered less invasive than TET, but the study showed similar results for safty, the two approaches are both safe and valid. Patients of two approaches were equally satisfied with the effect about cosmesis. We can make a choice depend on size of nodules, benign or malignant, the ability and preference of doctor, the wishes of patients and so on.