Henry Jean-François, Thakur Abhijit
Indian J Surg Oncol. 2010 Apr;1(2):200-6. doi: 10.1007/s13193-010-0033-7. Epub 2010 Nov 21.
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, MIT or MIP should properly be defined as operations through a short and discrete incision that permits direct access to the thyroid or parathyroid gland, resulting in a focused dissection.Parathyroid glands are particularly suitable for minimally invasive surgery as most parathyroid tumors are small and benign. MIP are performed through a limited or discrete incision when compared to classic open transverse cervical incision and are targeted on one specific parathyroid gland. The concept of these limited explorations is based on the fact that 85% of patients will have single-gland disease. MIP must be proposed only for patients with sporadic hyperparathyroidism in whom a single adenoma has been clearly localized by preoperative imaging studies.The minimal access approaches to the thyroid gland may be broadly classified into three groups: the mini-open lateral approach via a small incision, minimally invasive video-assisted thyroidectomy via the midline and various endoscopic techniques. Endoscopic extracervical approaches have the main advantage of leaving no scar in the neck but cannot reasonably be described as minimally invasive as they require more dissection than conventional open surgery.Initially the indications for MIT were a solitary thyroid nodule of less than 3 cm in diameter in an otherwise normal gland. Today, MIT are also proposed in patients with small nodular goiters, Graves's diseases and low risk papillary thyroid cancers. Some concern remains about the radicality of MIT in this latter group but preliminary results are comparable to those of conventional surgery both in terms of I-131 uptake and serum thyroglobuline levels.Demonstrating the advantages of MIT and MIP over conventional surgery is not easy. Main complications, such as nerve injury, hypoparathyroidism, or hemorrhage, are the same as in conventional surgery. Several studies comparing conventional surgery with minimally invasive techniques using a cervical access have shown a diminution of postoperative pain, and better cosmetic results with minimally invasive techniques. MIP and MIT seem overall to be an advance but only randomized studies will demonstrate the real benefit.
手术侵袭性的概念不能局限于皮肤切口的长度或部位。它必须扩展到手术过程中所解剖的所有结构。因此，微创甲状腺手术（MIT）或微创甲状旁腺手术（MIP）应恰当地定义为通过短而离散的切口进行的手术，该切口允许直接进入甲状腺或甲状旁腺，从而实现精准解剖。甲状旁腺特别适合进行微创手术，因为大多数甲状旁腺肿瘤体积小且为良性。与经典的开放横向颈部切口相比，MIP是通过有限或离散的切口进行的，并且针对一个特定的甲状旁腺。这些有限探查的概念基于这样一个事实，即85%的患者患有单腺体疾病。MIP必须仅针对术前影像学检查已明确定位单个腺瘤的散发性甲状旁腺功能亢进患者提出。甲状腺的微创入路大致可分为三组：通过小切口的迷你开放外侧入路、通过中线的微创视频辅助甲状腺切除术以及各种内镜技术。内镜颈部外入路的主要优点是颈部不留疤痕，但由于其需要比传统开放手术更多的解剖操作，因此不能合理地被描述为微创手术。最初，MIT的适应证是直径小于3厘米的孤立性甲状腺结节，且甲状腺其他方面正常。如今，MIT也被推荐用于小结节性甲状腺肿、格雷夫斯病和低风险乳头状甲状腺癌患者。对于后一组患者，人们对MIT的根治性仍存在一些担忧，但初步结果在碘-131摄取和血清甲状腺球蛋白水平方面与传统手术相当。证明MIT和MIP相对于传统手术的优势并不容易。主要并发症，如神经损伤、甲状旁腺功能减退或出血，与传统手术相同。几项比较传统手术与使用颈部入路的微创技术的研究表明，微创技术术后疼痛减轻，美容效果更好。总体而言，MIP和MIT似乎是一种进步，但只有随机研究才能证明其真正的益处。
