Abstract
Background
This prospective, randomized study was designed to objectively demonstrate that minimally invasive video-assisted thyroidectomy (MIVAT) improves postoperative pain compared with standard thyroidectomy, via the dosage of biochemical mediators measured before and after surgery.
Methods
Forty-nine patients undergoing total thyroidectomy were allotted to MIVAT (n = 23) or traditional thyroidectomy (OPEN) (n = 26) groups. At hospitalization (T0), interleukin (IL)-1, -2, -4, -6, -10, -3, tumor necrosis factor (TNF)-α, TGF-β, and MCP-1 were measured. The basal pain tolerance also was evaluated by VAS. Blood samples for interleukin measurement and VAS evaluations were obtained from all patients in the recovery room (T1) and 24 h after surgery (T2).
Results
At T0, the MIVAT and the OPEN groups were not different in terms of basal pain tolerance and biochemical profile. At T1, VAS scores were significantly higher (p = 0.04), whereas TGF-β (p = 0.03) and MCP-1 (p = 0.03) levels were significantly lower in the OPEN than in the MIVAT group. No significant difference was demonstrated for other interleukins. A significant inverse relationship between VAS and TGF-β was demonstrated and confirmed through the correlation (p = 0.003) and regression (p = 0.003, p < 0.0001, R 2 = 0.172) coefficients; the stepwise regression also demonstrated that TGF was the most predictive factor of postoperative pain (p = 0.0038) through an inverse relationship. No statistically significant difference has been demonstrated at T2.
Conclusions
TGF-β serum levels immediately after surgery seem to correlate with pain evaluation, confirming that reduced postoperative distress is an objective outcome of MIVAT. This result confirms the results of studies based only on subjective pain evaluations.
Similar content being viewed by others
References
Miccoli P, Berti P, Raffaelli M, Materazzi G, Baldacci S, Rossi G (2001) Comparison between minimally invasive video-assisted thyroidectomy and conventional thyroidectomy: a prospective randomized study. Surgery 130:1039–1043
Lombardi CP, Raffaelli M, Princi P, Lulli P, Rossi ED, Fadda G, Bellantone R (2005) Safety of video-assisted thyroidectomy versus conventional surgery. Head Neck 27(1):58–64
Ikeda Y, Takami H, Sasaki Y, Takayama J, Niimi M, Kan S (2002) Comparative study of thyroidectomies. Endoscopic surgery versus conventional open surgery. Surg Endosc 16(12):1741–1745
Ujiki MB, Sturgeon C, Denham D, Yip L, Angelos P (2006) Minimally invasive video-assisted thyroidectomy for follicular neoplasm: is there an advantage over conventional thyroidectomy? Ann Surg Oncol 13(2):182–186
Shehata M, Schwarzmeier JD, Hilgarth M, Demirtas D, Richter D, Hubmann R, Boeck P et al (2006) Effect of combined spa-exercise therapy on circulating TGF-beta1 levels in patients with ankylosing spondylitis. Wien Klin Wochenschr 118(9–10):266–272
Bolke E, Jehle PM, Graf M, Baier A, Wiedeck H, Steinbach G, Storck M et al (2001) Inflammatory response during abdominal and thyroid surgery: a prospective clinical trial on mediator release. Shock 16(5):334–339
Jansson K, Redler B, Truedsson L, Magnuson A, Matthiessen P, Andersson M, Norgren L (2004) Intraperitoneal cytokine response after major surgery: higher postoperative intraperitoneal versus systemic cytokine levels suggest the gastrointestinal tract as the major source of the postoperative inflammatory reaction. Am J Surg 187(3):372–377
Buvanendran A, Kroin JS, Berger RA, Hallab NJ, Saha C, Negrescu C, Moric M et al (2006) Upregulation of prostaglandin E2 and interleukins in the central nervous system and peripheral tissue during and after surgery in humans. Anesthesiology 104(3):403–410
Annes JP, Munger JS, Rifkin DB (2003) Making sense of latent TGF-beta activation. J Cell Sci 116:217–224
Disclosures
Paolo Miccoli, Rocco Rago, Marco Massi, Erica Panicucci, Maria Rita Metelli, Piero Berti, and Michele N. Minuto have no conflicts of interest or financial ties to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Miccoli, P., Rago, R., Massi, M. et al. Standard versus video-assisted thyroidectomy: objective postoperative pain evaluation. Surg Endosc 24, 2415–2417 (2010). https://doi.org/10.1007/s00464-010-0964-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-010-0964-7