Modified Miccoli's thyroid surgery for thyroid diseases

Minimally invasive video-assisted thyroidectomy (MIVAT), originally described by Miccoli, is considered to be the most widely practiced and easily reproducible procedure for selected patients with benign and/or malignant thyroid nodules. Modified techniques based on MIVAT, namely modified Miccoli's thyroid surgery (MMTS), were developed based on MIVAT. This study aimed to evaluate the preliminary results of MMTS compared with those of MIVAT. The enrolling criteria included a benign nodule <3.5 cm in diameter, a malignant tumor <2 cm, no previous neck surgery and no evidence of any suspected lymph node metastasis or local invasion. Unilateral lobectomy was considered for benign lesions and the additional dissection of central compartment (level VI) lymph nodes was applied for malignant disease. The modified techniques included carefully selecting the operative incision, expanding the operative space, embedding a drainage tube in situ and delicately suturing every layer inwards and crosswise, as well as measuring cervical motion. In addition to the comparison of surgical outcomes between MMTS and MIVAT, other surgical parameters, including operative time, blood loss, postoperative drainage, cosmetic satisfaction, peak angle of cervical rotation, length of hospitalization and complications, were retrospectively analyzed. A consecutive series of 70 patients, including 54 cases of benign and 16 cases of malignant disease, initially underwent MIVAT between April, 2008 and May, 2012, while 127 patients, including 98 benign and 29 malignant cases, subsequently underwent MMTS between September, 2011 and October, 2014. Patients who received MMTS exhibited significantly less blood loss (20.3 +/- 11.3 vs. 32.3 +/- 12.6 ml, P<0.01), lower volume of postoperative drainage (42.77 +/- 15.2 vs. 50.48 +/- 23.2 ml, P<0.01) and higher cosmetic satisfaction (94.6 +/- 3.5 vs. 88.9 +/- 2.7%, P<0.01), but a longer operative time (102 +/- 36 vs. 50.48 +/- 23.2 min, P<0.01) when compared with MIVAT. In addition, a better peak angle of cervical rotation (38.6 +/- 4.1 degrees vs. 35.3 +/- 3.8 degrees, P=0.25) and shorter length of hospitalization (4.25 +/- 1.08 vs. 4.51 +/- 1.30 days, P=0.52) was observed in the MMTS group, although the differences with the MIVAT group were not statistically significant. No complications were observed, apart from 2 cases of recurrent laryngeal nerve palsy and 1 case of transient hypocalcemia at the beginning of MIVAT. In conclusion, both MMST and MIVAT are safe and feasible methods of thyroidectomy; however, MMST is associated with less trauma and higher cosmetic satisfaction compared with MIVAT. Therefore, MMST may be used as a standard operative method and prospectively applicable for thyroidectomy, even for early-stage malignancies.