Is minimally invasive, video-assisted thyroidectomy feasible in Graves’ disease?

• Published in: Surgery Vol. 149; no. 4; pp. 556 - 560
• Main Authors: Alesina, Pier F., MD, Singaporewalla, Reyaz M., MD, Eckstein, Anja, Lahner, Harald, MD, Walz, Martin K
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.04.2011; Elsevier
• Subjects: Adult; Biological and medical sciences; Endocrinopathies; Feasibility Studies; Female; General aspects; Graves Disease - surgery; Humans; Male; Medical sciences; Middle Aged; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Retrospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of endocrine glands; Thyroid. Thyroid axis (diseases); Thyroidectomy - methods; Treatment Outcome; Video-Assisted Surgery; Endocrinopathy; Medicine; Immunopathology; Treatment; Hyperthyroidism; Surgery; Thyroid diseases; Graves disease; Autoimmune disease; Thyroidectomy; Video recording
• ISSN: 0039-6060; 1532-7361
• DOI: 10.1016/j.surg.2010.11.018

Background Although the safety and advantages of minimally invasive, video-assisted thyroidectomy (MIVAT) are well documented in nodular thyroid disease, its role in Graves’ disease is controversial. We compared the outcomes of patients undergoing MIVAT with those undergoing conventional thyroidectomy for Graves’ disease. Methods Of the 497 patients with Graves’ disease referred for surgery (1999–2009), 157 (31.6%) patients underwent the MIVAT procedure (video-assisted group). As a control group, 340 patients undergoing conventional thyroidectomy (conventional thyroidectomy group) were included in the current analysis. MIVAT was proposed if the thyroid volume was ≤30 mL. The data were obtained through a prospectively maintained surgical database. Results Most patients in both groups underwent total thyroidectomy (98% in the MIVAT group and 96.5% in the conventional group). Three (1.9%) conversions to open surgery occurred in the video-assisted group. Hospital stay was significantly shorter ( P = .008) in the video-assisted group (2.1 ± 0.4 days) compared with the conventional thyroidectomy group (2.4 ± 1.4 days). The mean operative time was shorter (84 ± 29 min; range, 15–240) for the video-assisted group compared with the conventional thyroidectomy group (94 ± 43 min; range, 20–360), although this difference was not statistically significant ( P = .05). Postoperative transient hypocalcemia occurred in 14 (8.9%), transient recurrent laryngeal nerve palsy occurred in 2 (1.3%), and postoperative hematoma occurred in 5 (3.2%) patients in the video-assisted group compared with 23 (6.8%), 11 (3.2%), and 8 (2.3%) patients in the conventional thyroidectomy group, respectively ( P = ns). Conclusion In selected patients with Graves’ disease, MIVAT is feasible and can be performed safely with results comparable with open surgery.