Clinical Benefits of Minimally Invasive Techniques in Thyroid Surgery

Background Recently there has been a strong impetus to develop minimally invasive techniques in endocrine neck surgery. This study was designed to investigate the potential benefits of two minimally invasive thyroidectomy procedures, namely video-assisted and open minimal-incision thyroidectomy (VAT and MIT, respectively) when compared with conventional thyroidectomy. Methods Between May 2000 and June 2006, a prospective, nonrandomized study was performed on 957 consecutive patients undergoing thyroid surgery. Fifty-six (5.8%) patients underwent VAT, 214 (22.4%) underwent MIT, and 687 (71.8%) underwent a conventional procedure. Results Patients were selected for VAT when total thyroid volume was ≤30 ml and for MIT when total thyroid volume was >30 but ≤80 ml as determined by ultrasonography. The length of the central neck skin incision was 1.5–2 cm for VAT, 2.5–3.5 cm for MIT, and 6–10 cm for the conventional operation. The incidence of definitive hypoparathyroidism or recurrent laryngeal palsy after VAT or MIT was comparable with that occurring after conventional treatment. Patients having VAT or MIT experienced significantly less postoperative pain than patients undergoing conventional treatment. Less pain was also registered in the VAT patient cohort when compared with the MIT cohort. Patients having VAT or MIT were more satisfied with the cosmetic result than patients who underwent conventional treatment, but no significant differences in patient satisfaction were found between the VAT and MIT groups. Conclusions When compared with conventional treatment, VAT and MIT provided significant benefit in terms of cosmetic results and postoperative pain. Nevertheless, the main limiting factor for minimally invasive thyroid surgery still remains the size of the thyroid. This study was supported by grants from the Italian Ministry of University, Scientific and Technological Research.     

Benefits and limits of minimally invasive techniques in thyroid surgery

The present study was designed to investigate the potential benefits and limits of two minimally invasive thyroidectomy procedures, namely minimally invasive video-assisted thyroidectomy (MIVAT) and open minimal-incision thyroidectomy (MIT). From May 2000 to June 2006, a prospective, non-randomised study was performed on 957 consecutive patients undergoing thyroid surgery. Fifty-six (5.8%) underwent MIVAT, 214 (22.4%) MIT and 687 (71.8%) conventional thyroidectomy (CT). Patients were selected for MIVAT when total thyroid volume was < or = 30 mL and for MIT when total thyroid volume was > 30 but < or = 80 mL, as determined by ultrasonography. The length of the central neck skin incision was 1.5-2 cm for MIVAT, 2.5-3.5 cm for MIT and 6-10 cm for CT. The incidence of definitive hypoparathyroidism or recurrent laryngeal palsy after MIVAT or MIT was comparable to that occurring after CT. Patients undergoing MIVAT or MIT experienced significantly less postoperative pain than those undergoing CT. Less pain was also registered in the MIVAT patient cohort as compared to the MIT group. Patients undergoing MIVAT or MIT were more satisfied with the cosmetic result as compared to those undergoing CT, whereas no significant differences were found between the MIVAT and MIT groups. As compared to CT, MIVAT and MIT provided a significant improvement in terms of cosmetic results and postoperative pain. Nevertheless, the main limiting factor for minimally invasive thyroid surgery still remains the size of the thyroid.     

Cosmesis and Body Image after Minimally Invasive or Open Thyroid Surgery

Background  

Minimally invasive techniques, such as laparoscopic appendectomy or minimally invasive thyroid surgery, are thought to produce better cosmetic results. However, cosmesis in thyroid surgery was rarely investigated using a standardized approach. The objectives of this study were to evaluate body image and cosmesis in patients who had either minimally invasive (MI) or conventional open (CO) thyroid surgery.     

Modified version of minimally invasive open thyroidectomy using an unilateral incision

Background/objectiveOpen thyroidectomy has been the standard approach for patients undergoing thyroidectomy. However, this approach leads to prominent scars, hypesthesia, paresthesia, and uncomfortable sensations. We aimed to describe our modified technique of minimally invasive open thyroidectomy (MIT) and to compare the results with those of conventional thyroidectomy.MethodsThis study included 880 patients who underwent surgery between January 2016 and December 2016. Modified MIT was performed in 249 patients (28.3%), and conventional thyroidectomy was performed in the remaining 631 patients.ResultsLobectomy was performed in the majority of cases (MIT 204 [81.9%] vs. conventional 429 [67.9%]). There were no significant differences in complications between the two approaches (6 [2.4%] vs. 8 [1.3%]). Patients who underwent surgery using the minimally invasive approach had a shorter operative time (77.99 ± 34.5 vs. 91.23 ± 36.58 min) and were discharged earlier (2.4 ± 0.8 vs. 3.2 ± 0.8) than those who underwent conventional thyroidectomy.ConclusionModified MIT is a safe alternative to standard open thyroidectomy and allows the performance of bilateral total thyroidectomy with proper central compartment neck dissection.Level of evidence2b.     

Minimal access thyroid surgery: Is it feasible,is it appropriate?

Background: Reports of minimal access thyroid surgery (MATS) using various techniques have recently appeared. This study examined the feasibility of MATS using either a lateral ‘focused’ or endoscopically assisted approach. Methods: The study group comprised all patients undergoing minimally invasive parathyroidectomy (MIP) during the period May 1998 to April 2002 in whom a concomitant thyroid procedure was undertaken. All procedures were performed either through a 2‐cm lateral cervical incision (n = 19) or endoscopically (n = 7). Results: Twenty‐six patients underwent thyroid surgery, consisting of either local excision of a thyroid nodule (n = 25) or hemi­thyroidectomy (n = 1). In 13 patients the nodule was incidentally discovered, in four patients removal of the parathyroid necessitated partial thyroidectomy, and in nine patients the lesion identified by preoperative parathyroid localization proved to be a thyroid nodule. There were no permanent complications in the study group. Two patients required drainage of a haematoma. The final pathology of all 26 cases revealed benign nodular thyroid disease. Conclusion: Thyroid surgery can safely be performed as a minimally invasive procedure. Minimal access thyroid surgery is therefore a feasible option for selected patients. The question remains to be answered as to whether this surgical approach is appropriate treatment for nodular thyroid disease.     

Minimally invasive parathyroidectomy and thyroidectomy--current concepts.

The introduction of various techniques for minimally invasive parathyroidectomy (MIP) and minimally invasive thyroid surgery (MITS) have changed both the conceptual and surgical approach to parathyroid disease and single thyroid nodules. Perceived advantages of minimally invasive surgery both among clinicians and patients, have been a major factor in the development of new surgical techniques, as well as refinement in preoperative localisation techniques. Worldwide the number of patients being operated on using MIP or MITS has steadily increased. At some major centres as many as 70% of patients with primary hyperparathyroidism have their operation using MIP. In this review we discuss the underlying pathology and investigative procedures, as well as the various techniques used, all of which now have excellent outcomes at a minimal cost and with minimal complications. Based on our own experience we recommend the use of a lateral focused mini-incision for both MIP and MIT since they both use standard equipment and standard dissection techniques familiar to all experienced endocrine surgeons.     

Minimally invasive thyroid surgery for diagnostic excision of solitary thyroid nodules

OBJECTIVE: Various techniques for minimally invasive thyroid surgery (MITS), including endoscopic and video-assisted procedures, have now been described. Based on our units experience with minimally invasive parathyroidectomy via a lateral incision, a similar technique for minimally invasive thyroid lobectomy has been developed and assessed. METHODS: The last 203 consecutive thyroid procedures using the MITS technique, performed between July 2002 and June 2006, comprised the study group. Inclusion criteria for initial surgery were: initial nodule < 3.0 cm; no preoperative evidence of malignancy; absence of clinical multinodular change. A 2.5-cm lateral incision, using a headlight illumination, provided optimal exposure. RESULTS: A total of 202 patients underwent 203 MITS procedures over the 4-year period, with one patient undergoing bilateral MITS. The procedures included 155 thyroid lobectomies and 48 nodule excisions; 31 of the patients underwent a minimally invasive parathyroidectomy (MIP) during which an ipsilateral thyroid nodule was removed. The mean tumour size was 17.3 mm, but the mean size of the thyroid lobe removed was 39.5 mm. Final diagnoses included benign multinodular goitre (26%), follicular adenoma (22%) and carcinoma (20%). The complication rate was low, with one permanent recurrent laryngeal nerve (RLN) palsy (anterior division only) (0.5%), four RLN neuropraxias which recovered (2%), and one haematoma not requiring re-operation (0.5%). The rate of complications was not significantly different from 819 conventional open hemithyroidectomies performed over the same period. CONCLUSION: MITS is a safe and feasible alternative to open thyroid surgery in appropriately selected cases. It offers a valuable option for diagnostic excision biopsy in patients with thyroid nodules demonstrating an atypical fine-needle biopsy whilst avoiding the need for a standard cervical "collar" incision.     

Minimal-access splenectomy: a viable alternative to laparoscopic splenectomy in massive splenomegaly.

BACKGROUND: Laparoscopic splenectomy of normal-sized spleens or in moderate splenomegaly is performed with increasing frequency. By using a modification of the open laparotomy, minimal-access splenectomy is an attractive alternative in severe splenomegaly. METHODS: Between September 2002 and October 2003, 9 patients (mean age, 58.8 years; range, 41 to 72) with severe splenomegaly (mean length, 27.9 cm; range, 23 to 32) underwent minimal-access splenectomy. Indications for splenectomy were non-Hodgkin's lymphoma in 5 cases and idiopathic myelofibrosis in 4. RESULTS: Minimal-access splenectomy was successfully completed in all patients. Mean operative time was 124 minutes (range, 75 to 165). Postoperative complications occurred in 2 cases; one perioperative death occurred in a patient with idiopathic myelofibrosis as a consequence of a secondary blast crisis. Median postoperative hospital stay was 9.1 days (range, 6 to 15). CONCLUSIONS: Minimal-access splenectomy seems to be a viable alternative to laparoscopic splenectomy in cases of severe splenomegaly. It combines the advantages of hand assistance like shorter operative times and increased safety of the procedure to the classical benefits of minimally invasive surgery.     

Video-assisted endoscopic thyroidectomy

BACKGROUND: Several experimental and clinical reports concerning endoscopic parathyroid surgery have appeared. However, reports concerning minimally invasive surgery for thyroid remains rare. Herein we present a new method, called video-assisted endoscopic thyroidectomy (VAET), for the management of various benign thyroid diseases. METHODS: In all, 16 consecutive patients who underwent VAET for benign thyroid diseases were retrospectively studied. The study group included nodular hyperplasia in 8 patients, follicular adenoma in 6, and Hurthle's tumor and simple cyst in 1 each. A 2 to 3 cm transverse incision was made on the suprasternal notch. The wound was deepened to expose the underlying trachea from which the plane of the thyroid fascia was accessed directly, and the working space was established with lifting method using conventional instrument. All surgical procedures could be manipulated and monitored under laparoscopy without gas insufflation. The ultrasonically activated scalpel was the principal instrument used for VAET. RESULTS: All 16 patients underwent VAET successfully without conversion to open thyroidectomy. The surgical procedures included lobectomy in 13 and extirpation in 3. The operation time ranged from 28 minutes to 5 hours (mean 1 hour, 42 minutes). For the 5 most recent cases, lobectomy took an average of 2 hours, whereas extirpation less than 40 minutes. The tumor size ranged from 3.5 cm to 8.0 cm (mean 5.8 cm). There were no surgical complications. All patients but 1 were discharged on postoperative day 2. During follow-up, all patients demonstrated euthyroid function and satisfactory cosmetic results. CONCLUSIONS: VAET emerges as a promising minimally invasive surgical technique replacing conventional thyroidectomy for benign thyroid diseases in selected cases, with the advantage of satisfactory cosmetic results.     

The minimally invasive surgical approach in thyroid diseases

AIM: The targets of minimally invasive thyroidectomy could be summarised by: achievement of the same results as those obtained with traditional surgery, better postoperative course and improved cosmetic RESULTS: In minimally invasive surgical approach the skin incision should not exceed 30 mm in length. In our experience this limit may be extended of 5 mm for thyroid between 25 and 50 mL in volume. This way allows more patients, excluded before, to take the advantages of minimally invasive approach. The aim of this work has been to demonstrate that the central neck minimally invasive approach is safe, less painful, better for cosmetic results and easily reproducible in surgical practice. METHODS: From January 2003 to June 2007, 75 patients have been selected for minimally invasive thyroidectomy. The procedure was carried out through a central skin incision performed 'high' between the cricoid and jugular notch. Our 'modified Miccoli-procedure' consists in five-easily repeatable steps. In the postoperative stay, all patients were asked to evaluate the pain that feel and the cosmetic result by means of a numeric scale. RESULTS: The skin incision performed was from 25 to 30 mm (mean 27.39 +/- 2.6 mm). We obtained in all cases excellent results about patients cure rate and comfort, few postoperative pain and attractive cosmetic RESULTS: CONCLUSION: In this study we demonstrate that the central neck minimally invasive approach is safe, less painful, better for cosmetic results, with less paresthetic consequences and easily reproducible in surgical practice. In our opinion a longer incision (up to 35 mm), does not affect negatively the advantages of minimally invasive procedure. This way allows more patients to take the advantages of minimally invasive approach.     

“Scarless” (in the Neck) Endoscopic Thyroidectomy (SET): An Evidence-based Review of Published Techniques

BACKGROUND: Excision of the thyroid through a skin crease incision in the anterior neck provides good direct exposure to facilitate safe dissection and a quick operation with low morbidity and minimal mortality. However, these patients still have a scar in the neck. Technologic innovations have allowed surgeons to remove the thyroid gland from a remote site, providing a scarless outcome in the neck. This study was designed to assess the different techniques of scarless (in the neck) endoscopic thyroidectomy (SET) by reviewing the current literature. METHODS: A computer-assisted search of the Medline database through September 2007 was undertaken. The combination of terms used included the following: endoscopic thyroidectomy; minimally invasive thyroidectomy; minimally invasive endocrine surgery; thyroidectomy via the axillary approach; thyroidectomy via the anterior approach; and thyroidectomy via the breast approach. Additional data were provided based on previously unpublished experience from our own unit with SET. RESULTS: There were seven studies that involved 186 patients in whom the thyroid was excised via the axillary method and five published series that involved 169 patients who had thyroidectomies performed via the anterior approach. There were four published series of thyroidectomies performed via a hybrid approach, which is a combination of both the anterior and axillary approach, involving 180 patients. Four studies compared SET and another approach for a thyroidectomy. In our unpublished series of SET, we performed 20 cases during a 2-year period comprising 11 cases via the axillary approach and 9 cases via the anterior/breast approach. Nineteen cases were lobectomies and one case was an isthmusectomy. SET was associated with a longer operative time and increase postoperative pain. Patients who had SET were satisfied with the aesthetic outcome of the procedure. CONCLUSION: Scarless (in the neck) endoscopic thyroidectomy is not a minimally invasive technique but a maximally invasive one that involves a longer operative time and greater postoperative pain. What it does provide is a safe excision of the thyroid pathology with the absence of a scar in the neck. However, there is a steep learning curve. With experience and newer surgical instruments, the operative time and postoperative pain might decrease.     

Thyroid pathology associated with primary hyperparathyroidism

BACKGROUND: Thyroid carcinoma and benign thyroid disease associated with primary hyperparathyroidism (PHPT) have been well described. With the developing trend toward minimally invasive parathyroidectomy without intra-operative thyroid gland palpation, thyroid pathology may be missed. The authors consider it timely to revisit the issue of thyroid pathology found at neck exploration for PHPT. METHODS: A retrospective review of all cases of neck exploration for PHPT between 1993 and 1998 at Liverpool Hospital was undertaken. RESULTS: There were 65 patients in the study group (44 women, 21 men; mean age: 59 years). The most common indication for surgery was asymptomatic hypercalcaemia. The mean pre-operative calcium level was 2.9 mmol/L and the mean parathyroid hormone (PTH) level was 17 pmol/L. There were 26 cases (40%) of coexistent thyroid pathology. Ten cases (15%) were of mild multinodular change, seven cases (11%) were of severe multinodular change requiring thyroidectomy, three cases (4%) were nodules secondary to Hashimoto's thyroiditis and six cases (10%) were suspicious nodules that proved to be either adenomas (n = 3) or carcinomas (n = 3) following excision. There were four papillary carcinomas detected in the present series with a mean metastases, age, completeness of excision, invasion size (MACIS) score of 4.92. CONCLUSION: A 25% association of significant thyroid pathology with PHPT is reported. Despite pre-operative tests there were two cases (4%) of thyroid carcinoma where the decision to resect the thyroid gland was made following intra-operative thyroid gland palpation. One of these two papillary carcinoma patients would have fulfilled criteria for minimally invasive parathyroid surgery. When evaluating results of minimally invasive parathyroid surgery one must be aware of the potential for missed thyroid pathology.     

Minimally invasive approach of the cervical endocrine glands

Improved preoperative functional and topographic diagnostic techniques and availability of intra-operative hormone monitoring, stimulated the introduction of video-assisted minimally invasive operations in parathyroid and thyroid surgical pathology. The first cases of such pathology operated on in our clinic are presented. The first one is a 62 year old man with renal hyperparathyroidism consecutive to a chronic renal insufficiency and hemodialysis from five and three years respectively. The technique of a minimally invasive gapless resection of all four "adenomised" parathyroid glands using laparoscopic and classic instruments is described. Fragments of one gland are implanted in the left forearm musculature. The second case was a 48 year old woman with a three cm diameter right toxic adenoma. With a lateral 15 mm incision, dissociation of the musculature and adequate moving of the retractors the excision of the thyroid nodule was done in 25'. The video-assisted minimally invasive approach allows magnification and adequate identification and removal of endocrine secreting tissues in thyroid and parathyroid pathology. The authors believe that these techniques represent a feasible and attractive alternative to conventional surgery.     

Minimally invasive, totally gasless video-assisted thyroid lobectomy.

BACKGROUND: Neck surgery is one of the newest fields of application of video-assisted surgery. We developed a technique for minimally invasive, totally gasless video-assisted thyroid lobectomy. METHODS: The procedure was accepted by a patient with a follicular nodule of the left lobe of the thyroid. We performed a left thyroid lobectomy through a single 20-mm horizontal skin incision, just above the sternal notch, after inserting a 5-mm 30 degrees laparoscope, by using both endoscopic and conventional instrumentation. RESULTS: The recurrent laryngeal nerve and the parathyroid glands were easily identified and preserved. The operating time was 2.5 hours. No complication occurred. The postoperative stay was 2 days. The cosmetic result was excellent CONCLUSIONS: We concluded that our technique is feasible and safe. This makes us optimistic about the future of minimally invasive, video-assisted thyroid surgery.     

Minimally invasive video-assisted parathyroidectomy and intraoperative parathyroid hormone monitoring. The first 36 cases and some pitfalls

Background: The success of parathyroid surgery depends on the identification and removal of all hyperactive parathyroid tissue. At this writing, bilateral cervical exploration and identification of all parathyroid glands represent the operative standard for primary hyperparathyroidism (pHPT). However, improved preoperative localization techniques and the availability of intraoperative parathyroid hormone monitoring prepare the way for minimally invasive procedures. Methods: Patients with pHPT and one unequivocally enlarged parathyroid gland on preoperative ultrasound and 99mTc-SestaMIBI scintigraphy underwent minimally invasive video-assisted parathyroidectomy by an anterior approach. Intraoperatively, a rapid chemiluminescense immunoassay was used to measure intact parathyroid hormone (iPTH) levels shortly before and then 5, 10, and 15 min after excision of the adenoma. The operation was considered successful when more than a 50% decrease in preexcision iPTH levels was observed after 5 min. Results: Between October 1999 and November 2001, 36 of 82 patients with pHPT were eligible for a minimally invasive approach. A conversion to open surgery became necessary in five patients because of technical problems. In three cases, intraoperative iPTH monitoring showed no sufficient decrease in iPTH values. In these cases, subsequent cervical exploration showed one double adenoma and two hyperplasias, respectively. In two patients we had difficulty interpreting intraoperative iPTH values, resulting in persistent pHPT. Conclusions: Despite the use of high-resolution ultrasound and 99mTc-SestaMIBI scintigraphy, the presence of multiple glandular disease cannot be ruled out completely. Intraoperative iPTH monitoring to ensure operative success is indispensible for a minimally invasive approach. Despite our problems with iPTH monitoring in two patients, we believe that in selected cases, minimally invasive parathyroidectomy represents an attractive alternative to conventional surgery.     

Endoscopic transaxillary near total thyroidectomy.

BACKGROUND: Since first reported in 1996, endoscopic minimally invasive surgery of the cervical region has been shown to be safe and effective in the treatment of benign thyroid and parathyroid disease. The endoscopic transaxillary technique uses a remote lateral approach to the thyroid gland. Because of the perceived difficulty in accessing the contralateral anatomy of the thyroid gland, this technique has typically been reserved for patients with unilateral disease. OBJECTIVES: The present study examines the safety and feasibility of the transaxillary technique in dissecting and assessment of both thyroid lobes in performing near total thyroidectomy. METHODS: Prior to this study we successfully performed endoscopic transaxillary thyroid lobectomy in 32 patients between August 2003 and August 2005. Technical feasibility in performing total thyroidectomy using this approach was accomplished first utilizing a porcine model followed by three human cadaver models prior to proceeding to human surgery. After IRB approval three female patients with histories of enlarging multinodular goiter were selected to undergo endoscopic near total thyroidectomy. RESULTS: The average operative time for all models was 142 minutes (range 57-327 min). The three patients in this study had clinically enlarging multinodular goiters with an average size of 4 cm. The contralateral recurrent laryngeal nerve and parathyroid glands were identified in all cases. There was no post-operative bleeding, hoarseness or subcutaneous emphysema. CONCLUSION: Endoscopic transaxillary near total thyroidectomy is feasible and can be performed safely in human patients with bilateral thyroid disease.     

Minimally invasive thyroid and parathyroid surgery is not a question of length of the incision

INTRODUCTION: Postoperative cosmesis in the neck is often a major concern of patients, particularly women, undergoing thyroid or parathyroid surgery. Therefore, a reduction in the length of the cervical incision, and even more so, having no scar in the neck, is particularly appealing to these patients. Over the last years, many different so-called minimally invasive procedures have been proposed for the treatment of thyroid and parathyroid diseases, the primary aim being to improve the cosmetic results. Nevertheless, the concept of surgical invasiveness cannot be limited to the length or to the site of the skin incision. It must be extended to all structures dissected during the procedure. Therefore, minimally invasive thyroidectomy or minimally invasive parathyroidectomy should properly be defined as operations through a short, less than 3 cm, and discrete incision that permits direct access to the thyroid or parathyroid gland, resulting in a focused dissection. In addition, type of anesthesia, duration of the operation, postoperative pain, complication and success rates, and long-term outcome should also be taken into account to assess surgical invasiveness. CONCLUSION: Thyroid and parathyroid operations that minimize the incision but keep it in the neck may be considered minimally invasive not only in respect of the size of the skin incision but also, and above all, in respect of the accessibility of the operative field and extent of dissection. These operations have some advantages over conventional cervicotomy in terms of postoperative pain and cosmetic results. Until now, there is no evidence to state that morbidity of these new approaches is at least equal to the conventional equivalent. Operations that employ an extracervical approach, which have the advantage of leaving no scar in the neck, cannot reasonably be described as minimally invasive, as they require more dissection than conventional open surgery.     

Management of hyperfunctioning single thyroid nodules in the era of minimally invasive thyroid surgery

Both surgical excision and radioiodine ablation are effective modalities in the management of hyperfunctioning thyroid nodules. Minimally invasive thyroid surgery (MITS) using the lateral mini‐incision approach has previously been demonstrated to be a safe and effective technique for thyroid lobectomy. As such MITS may offer advantages as a surgical approach to hyperfunctioning thyroid nodules without the need for a long cervical incision or extensive dissection associated with formal open hemithyroidectomy. The aim of the present study was to assess the safety and efficacy of MITS for the treatment of hyperfunctioning thyroid nodules. This is a retrospective case study. Data were obtained from the University of Sydney Endocrine Surgical Unit Database from 2002 to 2007. There were 86 cases of hyperfunctioning thyroid nodules surgically removed during the study period, of which 10 (12%) were managed using the MITS approach. The ipsilateral recurrent laryngeal nerve was identified and preserved in all cases with no incidence of temporary or permanent nerve palsy. The external branch of the superior laryngeal nerve was visualized and preserved in eight cases (80%). There were no cases of postoperative bleeding. There was one clinically significant follicular thyroid carcinoma in the series (10%). In nine of 10 cases (90%) normalization of thyroid function followed surgery. MITS is a safe and effective procedure, achieving the benefits of a minimally invasive procedure with minimal morbidity. As such it now presents an attractive alternative to radioiodine ablation for the management of small hyperfunctioning thyroid nodules.     

超声引导下射频消融术与腔镜微创手术治疗甲状腺良性结节的应用比较

目的比较超声引导下射频消融术与腔镜微创手术在甲状腺良性结节患者治疗中的应用。 方法收集2015年1月至2019年1月于中国人民解放军联勤保障部队第九二八医院接受手术治疗的甲状腺良性结节患者1 000例,根据手术方式分为超声引导下射频消融术组（594例）和腔镜微创手术组（406例）。比较两组患者手术时间,术中出血量,术后住院时间,手术前后6个月甲状腺功能变化情况,手术前后12 h白细胞介素6（IL-6）、C反应蛋白（CRP）、肿瘤坏死因子α（TNF-α）及术后并发症发生情况。 结果射频消融术组术后IL-6、CRP和TNF-α质量浓度水平显著低于腔镜微创手术组（t=-67.827、-117.340、32.192,均P<0.001）;射频消融术组手术时间、术后住院时间、手术出血量、术后并发症发生率均显著低于腔镜微创手术组（t=85.135、67.418、65.475,χ²=169.568,均P<0.001）。 结论超声引导下射频消融术与腔镜微创手术在甲状腺良性结节患者治疗中均对甲状腺功能损伤较小,且超声引导下射频消融术安全性好、创伤小、术后并发症较少。     

Kosmetische Spätergebnisse nach Schilddrüsenresektionen

BACKGROUND: The long-term cosmetic results following thyroid resection may soon become more relevant because minimally invasive techniques are also being promoted. PATIENTS AND METHODS: Two hundred forty-four patients were prospectively enrolled for a questionnaire regarding long-term results following thyroid resection. Ninety of these patients were clinically examined. RESULTS: The cosmetic results were judged by more than 90% of the patients as excellent or good. Women were slightly more critical about their results (P=0.06). Some kind of wound infection was reported in 4.1%, hypertrophic scar in 4.1%, and mild dysphagia in 7%. The results were not associated with the kind or extent of resection. The length of the scars was 4 cm (range 3-7) and the width 2 mm (range 1-4). The surgeons also judged the scars as good or excellent in most cases but were more critical than the patients. CONCLUSION: Since the long-term results of conventional surgery are, in most cases, so good, it seems difficult to improve the results by new minimally invasive techniques.