Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, Utrecht, Netherlands.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands.
Front Endocrinol (Lausanne). 2021 Aug 12;12:719397. doi: 10.3389/fendo.2021.719397. eCollection 2021.
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 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.
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.
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.
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.
传统甲状腺切除术一直是甲状腺结节手术的标准治疗方法。出于美容目的，已经开发了不同的微创和远程手术方法。目前，最常用的机器人和内镜甲状腺切除术方法是微创视频辅助甲状腺切除术（MIVAT）、双侧腋窝-乳房入路内镜甲状腺切除术（BABA-ET）、双侧腋窝-乳房入路机器人甲状腺切除术（BABA-RT）、经口内镜甲状腺切除术 前庭入路（TOETVA）、耳后内镜甲状腺切除术（RA-ET）、耳后机器人甲状腺切除术（RA-RT）、无气经腋窝内镜甲状腺切除术（GTET）和机器人辅助经腋窝手术（RATS）。本系统评价的目的是评估微创技术是否不劣于传统甲状腺切除术。
在 Medline、Embase 和 Web of Science 中进行系统检索，以确定调查不同微创技术的手术时间、住院时间和喉返神经损伤和低钙血症并发症发生率的原始文章。
在 569 篇鉴定的手稿中，有 98 项研究符合纳入标准。大多数研究是回顾性的。系统评价的结果各不相同。31 篇文章纳入荟萃分析。与标准治疗相比，荟萃分析显示在住院时间方面没有显著差异，BABA-ET 后住院时间较长。喉返神经损伤和低钙血症的发生率没有显著差异。正如预期的那样，大多数微创手术的手术时间明显更长。
这是第一项比较八种最常用的微创甲状腺手术与标准治疗的全面系统评价和荟萃分析。可以得出结论，微创技术不会导致更多的并发症或更长的住院时间，因此并不劣于传统甲状腺切除术。
