Comprasion Of Video-assisted Thyroidectomy Versus Totally Endoscopic Thyroidectomy For Treatment Of Benign Thyroid Nodules

Objective To compared the differences in Operative time, intraoperative blood loss, postoperative pain, the incidence of complications, the injury rate of recurrent laryngeal nerve, and Postoperative cosmetic effect between VAT and TET and to find out the advantages and disadvantages of VAT and TET. And to provide a reference for the selection of surgical clinical work.Methods The literatures about the compare of VAT and TET published before May 2014 were searched in Wanfang database, China National Knowledge Infrastructure, The Chinese biomedical literature database, Pubmed, Medline, cochrane library in English and Chinese. According to the inclusion and deletion criteria, the outcomes we study were operative time, intraoperative blood loss, postoperative pain, the incidence of complications, the injury rate of recurrent laryngeal nerve, and Postoperative cosmetic effect. The quality of literatures were evaluated by two reviewers independently. Rev Man5.1 software package was used to perform meta-analysis.Results According to the inclusion and deletion criteria, 7 articles, a total of 590 patients which involved 327 VAT patients and 263 TET patients, 2 English literatures and 5 Chinese literatures were included. 1 The results of meta-analysis indicated that no significant differences were observed between VAT and TET in the rates of recurrent laryngeal nerve paralysis result[RR=0.85,95% CI:0.22~3.29,Z = 0.24(P> 0.05)]. 2 The operative time was shorter in the VAT group than in the TET group [SMD=-2.28,95% CI:-3.71~-0.84,Z = 3.11(P <0.05)] 3 No significant differences were observed between VAT and TET in the intraoperative blood loss [SMD=-0.72,95% CI:-1.48~0.04,Z = 1.85(P> 0.05)]. 4 The complication rate was lower in the VAT group than in the TET group [RR=0.14,95%CI:0.02~0.86,Z =2.12(P< 0.05)].5 The VAS scores for post-operative pain was lower in the VAT group than in the TET group[SMD =-1.57,95% CI:-2.28~-0.86,Z = 4.35(P < 0.05) ] 6 4 articles reported that VAT has a certain degree of cosmetic effect, 3articles reported that TET has more advantages than VAT.Conclusion Compared to TET, VAT needed less operation time, had lower The complication rate and lower VAS scores for post-operative pain, which meant that Laparoscopic-assisted thyroidectomy operation had less operation invasion. We found that there were no significant difference between VAT and TET in hemorrhage volume during operation and the damage of recurrent laryngeal nerve. Thus, there was no significant difference of operation safety between two kinds surgical methods. Meanwhile, VAT has certain effect of cosmesis but not better than TET. In summary, VET was the better surgical method which contained the advantages of beauty and minimal invasion.