Limits...
What is the evidence for endoscopic thyroidectomy in the management of benign thyroid disease?

Slotema ET, Sebag F, Henry JF - World J Surg (2008)

Bottom Line: Cosmetic outcome in extracervical approach is less troubled by size of the resected specimen compared with direct cervical approach.Long-term cosmetic outcome comparisons with conventional thyroidectomy have not been published.Currently it is not possible to recommend the application of ET based on evidence.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrine Surgery University Hospital Marseille, Service de Chirurgie Générale et Endocrinienne, CHU-Hôpital de la Timone, 264 Rue Saint-Pierre, 13385, Marseille cedex 05, France. e.t.slotema@lumc.nl

ABSTRACT

Background: Endoscopic thyroidectomy (ET) is a demanding surgical technique in which dissection of the gland is entirely performed with an endoscope, in a closed area maintained by insufflation or mechanical retraction. ET by direct cervical approach (anterior or lateral) is minimally invasive, but ET using an extracervical access (chest wall, breast, or axillary) is not. No technique seems to be universally accepted yet. This review was designed to clarify the existing evidence for performing endoscopic thyroid resections in the management of benign thyroid nodules.

Methods: A database search was conducted in PubMed and Embase from which summaries and abstracts were screened for relevant data, matching our definition. Publications were further assessed and assigned their respective levels of evidence. Additional data derived from our own unit's experience with endoscopic thyroidectomy were included.

Results: Thirty mainly retrospective cohort studies have been published in which morbidity, such as unilateral vocal cord palsy, is poorly evaluated. ET takes from 90 to 280 minutes for lobectomy by cervical access and total thyroidectomy by chest wall approach, respectively. Cosmetic outcome in extracervical approach is less troubled by size of the resected specimen compared with direct cervical approach. Extracervical approach avoids a neck scar but implies invasiveness in terms of dissection and postoperative discomfort. Long-term cosmetic outcome comparisons with conventional thyroidectomy have not been published.

Conclusions: Currently it is not possible to recommend the application of ET based on evidence. Reported complications stress the importance of advanced endoscopic skills. ET should only be offered to carefully selected patients and, therefore, a high volume of patients requiring thyroid surgery is needed. Superiority of endoscopic to conventional thyroidectomy has yet to be demonstrated. Possible advantages of endoscopic thyroid techniques and our patient's desire for the highest cosmetic outcome possible justify further development of ET in expert hands of endocrine surgeons.

Show MeSH

Related in: MedlinePlus

Lateral direct approach by Inabnet
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC2480507&req=5

Fig4: Lateral direct approach by Inabnet

Mentions: Another lateral approach has been described by Inabnet et al. [8]. The surgery begins with a 10–15-mm incision at the superior lateral area of the neck. Once sufficient working space is created, three additional trocars (two 3 mm and one 5 mm) are inserted under direct vision (Fig. 4). The specimen is extracted in a retrieval bag through the 1-cm superolateral incision.Fig. 4


What is the evidence for endoscopic thyroidectomy in the management of benign thyroid disease?

Slotema ET, Sebag F, Henry JF - World J Surg (2008)

Lateral direct approach by Inabnet
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2480507&req=5

Fig4: Lateral direct approach by Inabnet
Mentions: Another lateral approach has been described by Inabnet et al. [8]. The surgery begins with a 10–15-mm incision at the superior lateral area of the neck. Once sufficient working space is created, three additional trocars (two 3 mm and one 5 mm) are inserted under direct vision (Fig. 4). The specimen is extracted in a retrieval bag through the 1-cm superolateral incision.Fig. 4

Bottom Line: Cosmetic outcome in extracervical approach is less troubled by size of the resected specimen compared with direct cervical approach.Long-term cosmetic outcome comparisons with conventional thyroidectomy have not been published.Currently it is not possible to recommend the application of ET based on evidence.

View Article: PubMed Central - PubMed

Affiliation: Department of Endocrine Surgery University Hospital Marseille, Service de Chirurgie Générale et Endocrinienne, CHU-Hôpital de la Timone, 264 Rue Saint-Pierre, 13385, Marseille cedex 05, France. e.t.slotema@lumc.nl

ABSTRACT

Background: Endoscopic thyroidectomy (ET) is a demanding surgical technique in which dissection of the gland is entirely performed with an endoscope, in a closed area maintained by insufflation or mechanical retraction. ET by direct cervical approach (anterior or lateral) is minimally invasive, but ET using an extracervical access (chest wall, breast, or axillary) is not. No technique seems to be universally accepted yet. This review was designed to clarify the existing evidence for performing endoscopic thyroid resections in the management of benign thyroid nodules.

Methods: A database search was conducted in PubMed and Embase from which summaries and abstracts were screened for relevant data, matching our definition. Publications were further assessed and assigned their respective levels of evidence. Additional data derived from our own unit's experience with endoscopic thyroidectomy were included.

Results: Thirty mainly retrospective cohort studies have been published in which morbidity, such as unilateral vocal cord palsy, is poorly evaluated. ET takes from 90 to 280 minutes for lobectomy by cervical access and total thyroidectomy by chest wall approach, respectively. Cosmetic outcome in extracervical approach is less troubled by size of the resected specimen compared with direct cervical approach. Extracervical approach avoids a neck scar but implies invasiveness in terms of dissection and postoperative discomfort. Long-term cosmetic outcome comparisons with conventional thyroidectomy have not been published.

Conclusions: Currently it is not possible to recommend the application of ET based on evidence. Reported complications stress the importance of advanced endoscopic skills. ET should only be offered to carefully selected patients and, therefore, a high volume of patients requiring thyroid surgery is needed. Superiority of endoscopic to conventional thyroidectomy has yet to be demonstrated. Possible advantages of endoscopic thyroid techniques and our patient's desire for the highest cosmetic outcome possible justify further development of ET in expert hands of endocrine surgeons.

Show MeSH
Related in: MedlinePlus