Comparison Of Minimally Invasive Video-Assisted Thyroidectomy And Conventional Thyroidectomy On Clinical Efficacy: A Systematic Review

Objective: 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 thyroidectomy (CT) in dealing with patients with thyroid neoplasm, and provide a more rational and scientific treatment measures for thyroidectomy.Methods: Formulate strict included and exclusion criteria, retrieval Medline Pubmed, the Cochrane Controlled Trials Register (Issue 3, 2010), CBMdisc (1996-2010), CNKI (1996-2010), Chongqing VIP data (1996-2010) and Wangfang data (1996-2010). Collect randomized controlled trials from 1996 to 2010 which related MIVAT versus CT for thyroid neoplasm according to an established search strategy. Data were extracted by two reviewers using the designed extraction form, and adopt RevMan 4.2 to compare the duration of operation, estimated blood loss, post-operative pain, post-operative cosmetic results and peri-operative complications of the two different operative approaches.Results: Shorter operation time (WMD and 95% CI= 22.66 [15.53, 29.79]) was statistically significant (p<0.00001) in favor of conventional open thyroidectomy. WMD of blood loss was less with CT than with MIVAT (WMD=-1.38, 95 % CI=[-3.36 , 0.88]), but it did not reached significance between procedures (p=0.23). Comparisons between two procedures concerning pain score of 6, 24 and 48 hours, respectively, depicted statistically significant differences in favor of the MIVAT but only in the random effects model (WMD=-1.72, 95%CI=[-2.40, -1.05],Z=5.00,p<0.00001). Post-operative cosmetic results were evaluated by both the verbal response scale (VRS) and the numeric scale (NS), MIVAT was associated with better cosmetic results (WMD and 95%CI=0.90[0.40, 1.40] and 2.15[0.78, 3.51] respectively, p=0.0004 and 0.002 respectively). No significant difference was found for the gross complication rate, but damage to the external branch of the superior laryngeal nerve occurred in 8 (10.2%) patients after conventional thyroidectomy, but in no patients after minimally video-assisted thyroidectomy (Fisher exact test, p=0.006). Conclusion: Similar to conventional thyrodectomy, MIVAT is a safe and effective procedure. MIVAT was also equal to open thyroidectomy as far as short-term outcomes (gross complications and estimated blood loss) were concerned, but associated with better cosmetic results and less pain. As far as the surgery itself was concerned, it needs a longer operative time to be accomplished.