Minimally Invasive Thyroidectomy and Intraoperative Neuromonitoring (IONM): is MIVAT the better surgical option?

Minimally Invasive Thyroidectomy and Intraoperative Neuromonitoring (IONM): is MIVAT the better surgical option?

Authors

  • Elena Bonati Department of Medicine and Surgery, General Surgery Unit, Parma University Hospital
  • Tommaso Loderer Department of Medicine and Surgery, General Surgery Unit, Parma University Hospital
  • Lorenzo Viani Department of Medicine and Surgery, General Surgery Unit, Parma University Hospital
  • Valentina Donato Department of Medicine and Surgery, General Surgery Unit, Parma University Hospital
  • Flavia De Gennaro Department of Medicine and Surgery, General Surgery Unit, Parma University Hospital
  • Paolo Del Rio Department of Medicine and Surgery, General Surgery Unit, Parma University Hospital

Keywords:

IONM, MIVAT, thyroidectomy, lobectomy, minimally invasive thyroid surgery

Abstract

Background: In the last two decades, many new techniques have been introduced in thyroid surgery. Minimally invasive video-assisted thyroidectomy (MIVAT) has benefited from technological advances and the use of intraoperative neuromonitoring (IONM) has improved surgical outcomes, with a small cervical incision. Methods: We retrospectively analyzed the use of IONM in patients undergoing MIVAT, from 2015 to 2020, at the Operative Unit of the General Surgical Clinic of the University Hospital of Parma, Italy. We compared our data with a control group from 2011 to 2014 treated with the same minimally invasive technique but without using IONM. The aim of our study was to evaluate the use of IONM in patients undergoing MIVAT, and we compared data of the two groups, routinary use or non-use of the IONM, to assess if there was a different incidence of postoperative complications and a significant difference in surgical operative time. Results: We collected data on 328 cases, divided into two groups according to the routinary use or non-use of the IONM. The incidence of serological hypocalcemia was lower in group 2 (p <0.0001). We did not register differences in the incidence of wound infection, postoperative seroma, or hemorrhage. We did not register statistically significant differences in the surgical procedure time between the groups and the incidence of dysphonia was higher in group 1 but without statistical significance (p=ns). Conclusions: MIVAT is a feasible and safe technique with good esthetic outcomes and the combined use of IONM presents a better outcome in terms of postoperative dysphonia. 

References

Dionigi G, Dralle H, Materazzi G, Kim HY, Miccoli P. Happy 20th birthday to minimally invasive video-assisted thyroidectomy! J Endocrinol Invest. 2020 Mar;43(3):385-388. doi: 10.1007/s40618-019-01119-1.

Applewhite MK, White MG, James BC, et al. Ultrasonic, bipolar, and integrated energy devices: comparing heat spread in collateral tissues. J Surg Res. 2017 Jan;207:249-254. doi: 10.1016/j.jss.2016.06.077.

Canu GL, Medas F, Podda F, Tatti A, Pisano G, Erdas E, Calò PG. Thyroidectomy with energy-based devices: surgical outcomes and complications-comparison between Harmonic Focus, LigaSure Small Jaw and Thunderbeat Open Fine Jaw. Gland Surg. 2020 Jun;9(3):721-726. doi: 10.21037/gs.2020.03.31.

Yu X, Liu C, Yan M, Gong W, Wang Y. Hyperthermal liquid, spray, and smog may be potential risk factors for recurrent laryngeal nerve thermal injury during thyroid surgeries. Endocrine. 2021 Apr;72(1):198-207. doi: 10.1007/s12020-020-02451-w.

Del Rio P, Bonati E, Loderer T, Rossini M, Cozzani F. Can we routinely identify the external branch of the superior laryngeal nerves with neural monitoring?: a prospective report on 176 consecutive nerves at risk. Updates Surg. 2021 Dec;73(6):2275-2281. doi: 10.1007/s13304-021-01084-6.

Medas F, Ansaldo GL, Avenia N, et al. The THYCOVIT (Thyroid Surgery during COVID-19 pandemic in Italy) study: results from a nationwide, multicentric, case-controlled study. Updates Surg. 2021 Aug;73(4):1467-1475. doi: 10.1007/s13304-021-01051-1.

Zhang D, Fu Y, Liang N, et al. Thyroid surgery during coronavirus-19 pandemic phases I, II and III: lessons learned in China, South Korea, Iran and Italy. J Endocrinol Invest. 2021 May;44(5):1065-1073. doi: 10.1007/s40618-020-01407-1.

Giuffrida M, Cozzani F, Rossini M, Bonati E, Del Rio P. How COVID-19 pandemic has changed elective surgery: the experience in a general surgery unit at a COVID-hospital. Acta Biomed. 2021 Nov 5;92(5):e2021304. doi: 10.23750/abm.v92i5.10296.

Rottoli M, Gori A, Pellino G, et al. Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy. JAMA Netw Open. 2022 Nov 1;5(11):e2243119. doi: 10.1001/jamanetworkopen.2022.43119.

Giuliani G, Guerra F, Messinese S, et al. The COVID - AGICT study: COVID-19 and advanced gastro-intestinal cancer surgical treatment. A multicentric Italian study on the SARS-CoV-2 pandemic impact on gastro-intestinal cancers surgical treatment during the 2020. Analysis of perioperative and short-term oncological outcomes. Surg Oncol. 2023 Apr;47:101907. doi: 10.1016/j.suronc.2023.101907.

Medas F, Dobrinja C, Al-Suhaimi EA et al. Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study. Lancet Diabetes Endocrinol. 2023 Apr 28:S2213-8587(23)00094-3. doi: 10.1016/S2213-8587(23)00094-3.

Giuliani G, Coletta D, Guerra F, et al. The MIS-COVID-AGICT Study: Trend of Minimally Invasive Surgery for Gastrointestinal Cancer Treatment During the First Waves of the COVID-19 Pandemic in Italy. Subgroup Analysis from the COVID-AGICT Study: COVID-19 and Advanced Gastrointestinal Cancer Surgical Treatment. J Laparoendosc Adv Surg Tech A. 2023 May 2. doi: 10.1089/lap.2023.0058.

Miccoli P, Berti P, Conte M, Bendinelli C, Marcocci C. Minimally invasive surgery for thyroid small nodules: preliminary report. J Endocrinol Invest. 1999 Dec;22(11):849-51. doi: 10.1007/BF03343657.

Del Rio P, Arcuri MF, Pisani P, De Simone B, Sianesi M. Minimally invasive video-assisted thyroidectomy (MIVAT): what is the real advantage? Langenbecks Arch Surg. 2010 Apr;395(4):323-6. doi: 10.1007/s00423-009-0589-2.

Bellotti C, Capponi MG, Cinquepalmi M, et al. MIVAT: the last 2 years experience, tips and techniques after more than 10 years. Surg Endosc. 2018 May;32(5):2340-2344. doi: 10.1007/s00464-017-5929-7.

Chen WH, Chen CY. Postoperative quality of life and cosmetic outcome between minimally invasive video-assisted thyroidectomy and bilateral axillo-breast approach robotic thyroidectomy: a single center retrospective cohort study. Updates Surg. 2021 Aug;73(4):1459-1465. doi: 10.1007/s13304-021-01035-1.

Randolph GW, Dralle H. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Laryngoscope. 2011 Jan;121 Suppl 1:S1-16. doi: 10.1002/lary.21119.

Del Rio P, Maestroni U, Sianesi M, et al. Minimally invasive video-assisted thyroidectomy for papillary thyroid cancer: a prospective 5-year follow-up study. Tumori. 2015 Mar-Apr;101(2):144-7. doi: 10.5301/tj.5000223.

Rossini M, Cozzani F, Loderer T, Bonati E, Giuffrida M, Del Rio P. Intraoperative Neuromonitoring, Nerves at Risk and Staged Thyroidectomy, our Experience on 377 Consecutive Cases. Acta Biomed. 2022 May 11;93(2):e2022040. doi: 10.23750/abm.v93i2.11178.

Ji YB, Ko SH, Song CM, et al. Feasibility and efficacy of intraoperative neural monitoring in remote access robotic and endoscopic thyroidectomy. Oral Oncol. 2020 Apr;103:104617. doi: 10.1016/j.oraloncology.2020.104617.

Munshi R, Mankowski N, Souza S, et al. The Effect of Patient Positioning on Intraoperative Neuromonitoring During Thyroid and Parathyroid Surgery. Am Surg. 2021 Dec 3:31348211061103. doi: 10.1177/00031348211061103.

Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016 Jan;26(1):1-133. doi: 10.1089/thy.2015.0020.

Pacini F, Basolo F, Bellantone R, et al. Italian consensus on diagnosis and treatment of differentiated thyroid cancer: joint statements of six Italian societies. J Endocrinol Invest. 2018 Jul;41(7):849-876. doi: 10.1007/s40618-018-0884-2.

Zhang D, Wang C, Wang T, et al. Clinical Experience of Use of Percutaneous Continuous Nervemonitoring in Robotic Bilateral Axillo-Breast Thyroid Surgery. Front Endocrinol (Lausanne). 2022 Feb 8;12:817026. doi: 10.3389/fendo.2021.817026.

Melfa G, Siragusa G, Cocorullo G, et al. Effects of Intraoperative Nerve Monitoring Techniques on Voice and Swallowing Disorders after Uncomplicated Thyroidectomy: Preliminary Report of a Bi-Institutional Prospective Study. J Clin Med. 2022 Dec 30;12(1):305. doi: 10.3390/jcm12010305.

Downloads

Published

28-08-2024

Issue

Section

ORIGINAL CLINICAL RESEARCH

How to Cite

1.
Bonati E, Loderer T, Viani L, Donato V, De Gennaro F, Del Rio P. Minimally Invasive Thyroidectomy and Intraoperative Neuromonitoring (IONM): is MIVAT the better surgical option?. Acta Biomed [Internet]. 2024 Aug. 28 [cited 2024 Oct. 5];95(4):e2024046. Available from: https://mail.mattioli1885journals.com/index.php/actabiomedica/article/view/14711