What is the Evidence for Endoscopic Thyroidectomy in the Management of Benign Thyroid Disease? View Full Text


Ontology type: schema:ScholarlyArticle      Open Access: True


Article Info

DATE

2008-07

AUTHORS

E. Th. Slotema, F. Sebag, J. F. Henry

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. More... »

PAGES

1325-1332

References to SciGraph publications

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  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s00268-008-9505-0

    DOI

    http://dx.doi.org/10.1007/s00268-008-9505-0

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1007159089

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/18327525


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    250 schema:name 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
    251 rdf:type schema:Organization
     




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