Outcomes of Minimally Invasive Thyroid Surgery – A Systematic Review and Meta-Analysis

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Abstract

Purpose

Conventional thyroidectomy has been standard of care for surgical thyroid nodules. For cosmetic purposes different minimally invasive and remote-access surgical approaches have been developed. At present, the most used robotic and endoscopic thyroidectomy approaches are minimally invasive video assisted thyroidectomy (MIVAT), bilateral axillo-breast approach endoscopic thyroidectomy (BABA-ET), bilateral axillo-breast approach robotic thyroidectomy (BABA-RT), transoral endoscopic thyroidectomy via vestibular approach (TOETVA), retro-auricular endoscopic thyroidectomy (RA-ET), retro-auricular robotic thyroidectomy (RA-RT), gasless transaxillary endoscopic thyroidectomy (GTET) and robot assisted transaxillary surgery (RATS). The purpose of this systematic review was to evaluate whether minimally invasive techniques are not inferior to conventional thyroidectomy.

Methods

A systematic search was conducted in Medline, Embase and Web of Science to identify original articles investigating operating time, length of hospital stay and complication rates regarding recurrent laryngeal nerve injury and hypocalcemia, of the different minimally invasive techniques.

Results

Out of 569 identified manuscripts, 98 studies met the inclusion criteria. Most studies were retrospective in nature. The results of the systematic review varied. Thirty-one articles were included in the meta-analysis. Compared to the standard of care, the meta-analysis showed no significant difference in length of hospital stay, except a longer stay after BABA-ET. No significant difference in incidence of recurrent laryngeal nerve injury and hypocalcemia was seen. As expected, operating time was significantly longer for most minimally invasive techniques.

Conclusions

This is the first comprehensive systematic review and meta-analysis comparing the eight most commonly used minimally invasive thyroid surgeries individually with standard of care. It can be concluded that minimally invasive techniques do not lead to more complications or longer hospital stay and are, therefore, not inferior to conventional thyroidectomy.

Related collections

Most cited references 121

Record: found
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2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer.

Bryan Haugen, Erik Alexander, Keith Bible … (2016)

Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer.

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Methodological index for non-randomized studies (minors): development and validation of a new instrument.

Karem Slim, Emile Nini, Damien Forestier … (2003)

Because of specific methodological difficulties in conducting randomized trials, surgical research remains dependent predominantly on observational or non-randomized studies. Few validated instruments are available to determine the methodological quality of such studies either from the reader's perspective or for the purpose of meta-analysis. The aim of the present study was to develop and validate such an instrument. After an initial conceptualization phase of a methodological index for non-randomized studies (MINORS), a list of 12 potential items was sent to 100 experts from different surgical specialties for evaluation and was also assessed by 10 clinical methodologists. Subsequent testing involved the assessment of inter-reviewer agreement, test-retest reliability at 2 months, internal consistency reliability and external validity. The final version of MINORS contained 12 items, the first eight being specifically for non-comparative studies. Reliability was established on the basis of good inter-reviewer agreement, high test-retest reliability by the kappa-coefficient and good internal consistency by a high Cronbach's alpha-coefficient. External validity was established in terms of the ability of MINORS to identify excellent trials. MINORS is a valid instrument designed to assess the methodological quality of non-randomized surgical studies, whether comparative or non-comparative. The next step will be to determine its external validity when used in a large number of studies and to compare it with other existing instruments.

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Worldwide Thyroid-Cancer Epidemic? The Increasing Impact of Overdiagnosis

Salvatore Vaccarella, Silvia Franceschi, Freddie Bray … (2016)

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Author and article information

Contributors

Lisa H. de Vries: URI : https://loop.frontiersin.org/people/1353981

Dilay Aykan: URI : https://loop.frontiersin.org/people/1354034

Lutske Lodewijk: URI : https://loop.frontiersin.org/people/1354038

Inne H. M. Borel Rinkes: URI : https://loop.frontiersin.org/people/1354954

Menno R. Vriens: URI : https://loop.frontiersin.org/people/1354953

Journal

Journal ID (nlm-ta): Front Endocrinol (Lausanne)

Journal ID (iso-abbrev): Front Endocrinol (Lausanne)

Journal ID (publisher-id): Front. Endocrinol.

Title: Frontiers in Endocrinology

Publisher: Frontiers Media S.A.

ISSN (Electronic): 1664-2392

Publication date (Electronic): 12 August 2021

Publication date Collection: 2021

Volume: 12

Electronic Location Identifier: 719397

Affiliations

[1] ¹Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht , Utrecht, Netherlands

[2] ²Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University , Utrecht, Netherlands

Author notes

Edited by: Schelto Kruijff, University Medical Center Groningen, Netherlands

Reviewed by: Pier Francesco Alesina, Fondazione Ricerca e Cura Giovanni Paolo II, Italy; Carlotta Giani, University of Pisa, Italy

*Correspondence: Menno R. Vriens, Mvriens@ 123456umcutrecht.nl

This article was submitted to Cancer Endocrinology, a section of the journal Frontiers in Endocrinology

†These authors have contributed equally to this work and share first authorship

Article

DOI: 10.3389/fendo.2021.719397

PMC ID: 8387875

PubMed ID: 34456874

SO-VID: 983519c3-d5fb-4174-93e3-70f871a684ba

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

History

Date received : 02 June 2021

Date accepted : 26 July 2021

Page count

Figures: 8, Tables: 3, Equations: 0, References: 122, Pages: 16, Words: 4832

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