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Meta-Analysis
. 2021 Aug 12:12:719397.
doi: 10.3389/fendo.2021.719397. eCollection 2021.

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

Lisa H de Vries  1 , Dilay Aykan  1 , Lutske Lodewijk  1 , Johanna A A Damen  2 , Inne H M Borel Rinkes  1 , Menno R Vriens  1
Affiliations
Meta-Analysis

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

Lisa H de Vries et al. Front Endocrinol (Lausanne). .

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.

Keywords: bilateral axillo-breast approach endoscopic thyroidectomy (BABA-ET); bilateral axillo-breast approach robotic thyroidectomy (BABA-RT); gasless transaxillary endoscopic thyroidectomy (GTET); minimally invasive video assisted thyroidectomy (MIVAT); retro-auricular endoscopic thyroidectomy (RA-ET); retro-auricular robotic thyroidectomy (RA-RT); robot assisted transaxillary surgery (RATS); transoral endoscopic thyroidectomy via vestibular approach (TOETVA).

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Preoperatively marked patients who will undergo (A) TOETVA (7). Three incisions will be made in the oral vestibule, one for the camera and two laterally for dissection and coagulation instruments; and (B) RATS (8). The incision site is marked laterally. The dotted lines mark the borders of the surgical working space.
Figure 2
Figure 2
Flowchart of study selection using PRISMA 2020 flow diagram.
Figure 3
Figure 3
Forest plots of operating time for (A) BABA-ET, (B) BABA-RT, (C) MIVAT lobectomy, (D) MIVAT total thyroidectomy, (E) TOETVA, (F) GTET and (G) RATS.
Figure 4
Figure 4
Forests plots of hospital stay for (A) BABA-ET, (B) BABA-RT, (C) MIVAT, (D) TOETVA, (E) GTET and (F) RATS.
Figure 5
Figure 5
Forests plots of transient recurrent laryngeal nerve injury for (A) BABA-ET, (B) BABA-RT, (C) MIVAT, (D) TOETVA, (E) GTET and (F) RATS.
Figure 6
Figure 6
Forests plots of permanent recurrent laryngeal nerve injury for (A) BABA-ET, (B) BABA-RT, (C) MIVAT, (D) TOETVA, (E) GTET and (F) RATS.
Figure 7
Figure 7
Forests plots of transient hypocalcemia for (A) BABA-ET, (B) BABA-RT, (C) MIVAT, (D) TOETVA, (E) GTET and (F) RATS.
Figure 8
Figure 8
Forests plots of permanent hypocalcemia for (A) BABA-ET, (B) BABA-RT, (C) MIVAT, (D) TOETVA, (E) GTET and (F) RATS.
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