Table_2_Outcomes of Minimally Invasive Thyroid Surgery – A Systematic Review and Meta-Analysis.docx

PurposeConventional 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.
MethodsA 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.
ResultsOut 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.
ConclusionsThis 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.

研究背景：常规甲状腺切除术是手术治疗甲状腺结节的标准治疗方案。为满足美容需求，学界已开发出多种微创及远程入路手术方式。目前临床应用最为广泛的机器人辅助与内镜甲状腺切除术入路包括：微创视频辅助甲状腺切除术（minimally invasive video assisted thyroidectomy, MIVAT）、双侧腋乳入路内镜甲状腺切除术（bilateral axillo-breast approach endoscopic thyroidectomy, BABA-ET）、双侧腋乳入路机器人甲状腺切除术（bilateral axillo-breast approach robotic thyroidectomy, BABA-RT）、经前庭入路经口内镜甲状腺切除术（transoral endoscopic thyroidectomy via vestibular approach, TOETVA）、耳后入路内镜甲状腺切除术（retro-auricular endoscopic thyroidectomy, RA-ET）、耳后入路机器人甲状腺切除术（retro-auricular robotic thyroidectomy, RA-RT）、无气腋路内镜甲状腺切除术（gasless transaxillary endoscopic thyroidectomy, GTET）以及机器人辅助经腋手术（robot assisted transaxillary surgery, RATS）。本系统综述旨在评估微创甲状腺手术技术是否不劣于传统甲状腺切除术。
研究方法：本研究在Medline、Embase及Web of Science数据库中开展系统性检索，筛选出探讨上述各类微创甲状腺手术术式的手术时长、住院时长以及喉返神经损伤、低钙血症相关并发症发生率的原创性研究。
研究结果：在初步检索得到的569篇文献中，共有98项研究符合纳入标准，其中大部分为回顾性研究。本系统综述的结果存在一定异质性。其中31项研究被纳入荟萃分析。与传统甲状腺切除术这一标准治疗方案相比，荟萃分析结果显示，除BABA-ET术后住院时长更长外，其余微创术式的住院时长无显著差异；喉返神经损伤与低钙血症的发生率亦无显著差异。正如预期，多数微创术式的手术时长显著更长。
研究结论：本研究是首个针对目前临床最常用的8种微创甲状腺手术术式，分别与传统甲状腺切除术进行对比的系统性综述与荟萃分析。研究结果表明，微创甲状腺手术技术并不会增加并发症发生率或延长住院时长，因此其疗效并不劣于传统甲状腺切除术。