Miccoli Paolo, Bellantone Rocco, Mourad Michel, Walz Martin, Raffaelli Marco, Berti Piero
Dipartimento di Chirurgia, Università degli Studi di Pisa, Via Roma 67, Italy.
World J Surg. 2002 Aug;26(8):972-5. doi: 10.1007/s00268-002-6627-7. Epub 2002 May 21.
Minimally invasive video-assisted thyroidectomy (MIVAT) was described in 1998. In this study we collected the experience of four third-level referral centers that adopted this technique. A total of 336 patients (279 females, 57 males) were selected for MIVAT. Selection criteria were thyroid volume <15 ml, nodules not exceeding 3.5 cm of diameter, and an absence of thyroiditis, previous neck surgery, or previous irradiation. The procedure, totally gasless, is carried out through a 15 mm central incision above the sternal notch. Dissection is performed under endoscopic vision using conventional and endoscopic instruments. The mean operating time was 69.4 +/- 30.6 minutes for lobectomy (range 20-150 minutes) and 87.4 +/- 43.5 minutes for total thyroidectomy (range 30-220 minutes). The mean postoperative stay was 1.9 +/- 0.8 days. Postoperative complications were 7 transient and 1 definitive recurrent nerve palsies and 11 cases of hypoparathyroidism (9 transient, 2 definitive). Conversion to open surgery was necessary in 15 patients (4.5%). This study confirms in a large number of cases the safety and feasibility of MIVAT, even in different surgical settings where similar results were achieved. The complication rate was not different from that of standard thyroidectomy. Although the operating time appears longer than with conventional procedures, the learning curve demonstrates a sharp decrease with increasing experience and the introduction of new technologies. The number of patients eligible for this approach remains low, thereby limiting its use, but it should be considered a valid option in selected surgical centers, offering some advantages to patients in terms of cosmetic results and postoperative distress.
微创视频辅助甲状腺切除术（MIVAT）于1998年被描述。在本研究中，我们收集了四个采用该技术的三级转诊中心的经验。共有336例患者（279例女性，57例男性）被选择进行MIVAT。选择标准为甲状腺体积<15 ml、结节直径不超过3.5 cm，且无甲状腺炎、既往颈部手术史或既往放疗史。该手术完全不使用气体，通过胸骨切迹上方15 mm的中央切口进行。在内镜视野下使用传统器械和内镜器械进行解剖。叶切除术的平均手术时间为69.4±30.6分钟（范围20 - 150分钟），全甲状腺切除术的平均手术时间为87.4±43.5分钟（范围30 - 220分钟）。术后平均住院时间为1.9±0.8天。术后并发症包括7例短暂性和1例永久性喉返神经麻痹以及11例甲状旁腺功能减退（9例短暂性，2例永久性）。15例患者（4.5%）需要转为开放手术。本研究在大量病例中证实了MIVAT的安全性和可行性，即使在不同的手术环境中也能取得相似的结果。并发症发生率与标准甲状腺切除术无异。虽然手术时间似乎比传统手术长，但学习曲线显示随着经验增加和新技术的引入，手术时间会大幅缩短。适合这种手术方法的患者数量仍然较少，从而限制了其应用，但在选定的手术中心应将其视为一种有效的选择，在美容效果和术后不适方面为患者提供一些优势。
