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Minimally invasive video-assisted thyroidectomy: an analysis of results and a revision of indications

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Abstract

Background

The first report of minimally invasive video-assisted thyroidectomy (MIVAT) was published in 1999, and the indications were progressively implemented: from cytologically undetermined thyroid nodules to intermediate-risk differentiated thyroid cancers. The aim of this study was to review the entire series of patients who underwent a MIVAT, critically analyzing its indications and contraindications and trying to figure out how the indications might be extended.

Methods

From 1998 to 2009, a total of 1,946 patients (1,659 females, 287 males; mean age = 40.2 years) underwent MIVAT in our department. Inclusion criteria were benign thyroid nodules <35 mm, malignant nodules <20 mm, and an ultrasonographically estimated thyroid volume (ETV) <25 cc. The presence of suspicious or metastatic lymph nodes and the presence of severe thyroiditis were considered a contraindication for MIVAT.

Results

A total thyroidectomy was performed in 1,435 patients (72.3%). A total lobectomy was performed in 511 cases (26.3%), and a central neck node sampling was associated with total thyroidectomy in 104 cases. Final histology revealed benign disease in 979 cases (51.5%) and a malignancy was diagnosed in 915 cases (48.5%). Unexpected thyroiditis was found on final histology in 17.9% of the patients with benign disease and 30.9% of patients with malignancy. The incidence of thyroiditis was significantly different in these two populations (p < 0.0001).

Conclusion

Our data confirm the validity of the traditional indications for MIVAT: low-risk differentiated thyroid cancer (DTC), cytologically undetermined nodules, and small-volume benign thyroid disease. The indications may be further and safely extended to those patients with associated thyroiditis and those with intermediate-risk DTC. MIVAT can be proposed on a much larger scale than it was at its onset and cannot be considered an option for only a limited number of patients.

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Disclosure

Drs. Michele N. Minuto, Piero Berti, Mario Miccoli, Clara Ugolini, Valeria Matteucci, Manuela Moretti, Fulvio Basolo, and Paolo Miccoli have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy

    Michele N. Minuto, Piero Berti, Clara Ugolini, Valeria Matteucci, Manuela Moretti, Fulvio Basolo & Paolo Miccoli

  2. Department of Experimental Pathology, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy

    Mario Miccoli

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  1. Michele N. Minuto
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  2. Piero Berti
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  3. Mario Miccoli
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  4. Clara Ugolini
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  5. Valeria Matteucci
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  6. Manuela Moretti
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  7. Fulvio Basolo
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  8. Paolo Miccoli
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Correspondence to Michele N. Minuto.

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Minuto, M.N., Berti, P., Miccoli, M. et al. Minimally invasive video-assisted thyroidectomy: an analysis of results and a revision of indications. Surg Endosc 26, 818–822 (2012). https://doi.org/10.1007/s00464-011-1958-9

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  • DOI: https://doi.org/10.1007/s00464-011-1958-9

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