Meta-analysis of minimally invasive video-assisted thyroidectomy.

OBJECTIVES: The aim of this study is to compare minimally invasive video-assisted thyroidectomy (MIVAT) to conventional thyroidectomy.

STUDY DESIGN: A systematic review of the literature and meta-analysis.

METHODS: All published prospective controlled trials that compared MIVAT to conventional thyroidectomy were identified. The trials data were extracted and statistical analyzed using Statsdirect 2.5.7.

RESULTS: Five trials were identified. The total number of patients was 318. The primary outcome measures were pain, postoperative hypocalcaemia, and postoperative recurrent laryngeal nerve palsy. There was no difference in rates of postoperative hypocalcaemia or postoperative recurrent laryngeal nerve palsy between the techniques. Reported pain scores at 24 hours were significantly lower in MIVAT compared to conventional surgery. Pooled effect size was -4.496 (95% confidence interval [CI] = -7.146 to -2.045, P = .0004). The secondary outcome measures were operative time, blood loss, and cosmesis. There was significant improvement in patient reported scores for cosmesis with MIVAT. The pooled effect size was 3.669 (95% CI 0.636-60.702, P = .0178). MIVAT was associated with a significant increase in operative time. Pooled effect size was 1.681 (95% CI 0.600-2.762, P = .0023). There was no difference in blood loss between the groups.

CONCLUSIONS: This study demonstrates that MIVAT is as safe as the existing gold standard operation. Furthermore, it has better cosmetic and pain outcomes for patients when compared to conventional surgery. MIVAT is a promising new technique, with obvious benefits over the established surgery, for small-volume thyroid disease that mainly affects a young female patient population.