الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Minimally invasive thyroid surgery (MITS) has expanded in the last decade and is being considered as an alternative to the conventional thyroidectomy, simply because it reduces tissue trauma and postoperative pain, and provides excellent cosmetic results.(72) Many different techniques have been developed for MITS over a short period; these can be broadly classified into pure/or completely closed endoscopic techniques, video-assisted techniques and minimally invasive open surgery.(73-9) Major advantages of MITS techniques include reduced tissue trauma, shorter hospital stay, better cosmetic results, minimal postoperative pain, lower cost of healthcare and, above all, patient comfort.(26)
The objectives of this study are evaluation and determination of the technical differences between minimally invasive flapless thyroidectomy (MIFT) and conventional thyroidectomy in management of selected cases of benign thyroid disease. The intraoperative parameters include the incision length and bleeding. The impact of these techniques on post-operative patient conditions and cosmetic results is also a concern.
This randomized controlled prospective study included 60 consecutive patients, suffering from benign thyroid disease, with limited gland size and without retro-sternal extension. Forty eight patients were female and 12 were male, and their age ranged between 7-72 years. group A included 30 patients for conventional thyroidectomy, and group B included 30 patients for MIFT. Standard routine preoperative evaluation was applied. Conventional thyroidectomy using the standard technique was performed in group A.(117) group B patients were subjected to MIFT, with a central neck incision of 2.0-3.2 cm-length, no sub-platysmal flap created, and using metal clips for securing the upper pole vessels. A single tie was applied on the Berry’s ligament vessels on either side. No drain was inserted, and good hemostasis with layered closure was performed.
Both groups showed female predominance, and the age distribution was similar in both groups. No significant difference was found in the BMI results. Findings according to history taking and preoperative evaluation were almost identical among patients in both groups.
group A included 27 patients who had total thyroidectomy and 3 patients had hemithyroidectomy, while patients in group B who had total thyroidectomy were 28 compared to 2 patients having hemithyroidectomy (p=1).
The mean incision length was 9.08±0.91 cm in group A, but markedly shorter in group B, as it was 2.65±0.30 cm (p<0.001). The operative time reported in group A was 109.33±21.44 minutes, which was much less in group B with a mean of 87.0±33.88 minutes (p=0.002). The mean volume of intraoperative bleeding in group A was 82.5±7.51 ml, but was considerably less in group B having a mean of 58.83±15.01 ml (p<0.001).
Post-operative hospital stay in group A patients had a mean value of 1.5±0.68 days, while patients in group B were all discharged on the first post-operative day (p<0.001). Post-operative pain assessed using VAS was significantly less in group B having a mean of 5.79±1.07 than in group A with a mean of 6.91±0.83 (p<0.001). The post-operative complications developed were similar in both groups. Seroma developed in 5 and 2 patients in group A and B respectively. Wound infection was encountered in 3 patients in group A and in 2 patients in group B. Transient hypocalcemia, explained by decreased serum calcium level below 8 mg/dl, developed in 3 patients in group A and in 2 patients in group B. All patients with transient hypocalcemia were ordered oral calcium supplementation and rechecked for their serum calcium level after a one-week therapy. Temporary hoarseness of voice was experienced by only one patient in group A, and improved spontaneously through several weeks.