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Systematic review with meta-analysis of prospective randomized trials comparing minimally invasive video-assisted thyroidectomy (MIVAT) and conventional thyroidectomy (CT)

  • Systematic Reviews and Meta-analyses
  • Published:
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Abstract

Background

Minimally invasive video-assisted thyroidectomy (MIVAT) has gained acceptance among surgeons as its feasibility has been well documented. The aim of this systematic review with meta-analysis has been to assess and validate the safety and feasibility of MIVAT when compared to conventional thyroidectomy (CT) and to verify other potential benefits and drawbacks.

Methods

A literature search for prospective randomized trials comparing MIVAT and CT was performed. Trials were reviewed for the primary outcome measures: overall morbidity, recurrent laryngeal nerve palsy, postoperative hypocalcemia, and postoperative hematoma; and for the secondary outcome measures: operative time, conversion to standard procedure, intraoperative blood loss, intraoperative drain insertion, nodule size and thyroid weight, postoperative pain evaluation, length of hospital stay, patient satisfactory score, and cosmetics results. Standardized mean difference (SMD) was calculated for continuous variables and odds ratio for qualitative variables.

Results

Nine prospective randomized studies comparing MIVAT and CT were analyzed. Overall, 581 patients were randomized to either MIVAT (289, 49.7 %) or CT (292, 50.3 %). The primary outcome measures of MIVAT were comparable with those of CT without statistically significant difference. Patients who underwent MIVAT experienced significantly less pain than those operated on conventionally during the whole postoperative period. Patient satisfactory score significantly favored MIVAT (9.0 vs. 6.8, SMD = −3.388, 95 % CI = −5.720 to −1.057). Operative time was significantly longer in MIVAT (75.2 vs. 59.2 min, SMD = 1.246, 95 % CI = 0.227–2.266).

Conclusions

MIVAT is a safe and feasible alternative for the removal of small-volume benign thyroid disease and low-risk papillary thyroid carcinomas showing better cosmetics results and less postoperative pain but significantly longer operative time when compared to CT. New multicenter randomized studies are needed to evaluate the technique in more complex circumstances such as intermediate-risk thyroid cancer, lymph node removal, thyroiditis, and Graves’ disease.

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Acknowledgments

This study was supported by a grant from the University of Cagliari, Italy (CAR 2012).

Conflicts of interest

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Authors and Affiliations

  1. Department of Surgery, Clinica Chirurgica, University of Cagliari, Monserrato, Italy

    Adolfo Pisanu, Mauro Podda, Isabella Reccia, Giulia Porceddu & Alessandro Uccheddu

  2. Clinica Chirurgica, University of Cagliari Azienda Ospedaliero–Universitaria Presidio Policlinico di Monserrato, Blocco G SS 554 km 4,500, 09042, Monserrato, CA, Italy

    Adolfo Pisanu

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  1. Adolfo Pisanu
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  2. Mauro Podda
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  3. Isabella Reccia
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Correspondence to Adolfo Pisanu.

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Pisanu, A., Podda, M., Reccia, I. et al. Systematic review with meta-analysis of prospective randomized trials comparing minimally invasive video-assisted thyroidectomy (MIVAT) and conventional thyroidectomy (CT). Langenbecks Arch Surg 398, 1057–1068 (2013). https://doi.org/10.1007/s00423-013-1125-y

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  • DOI: https://doi.org/10.1007/s00423-013-1125-y

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