Study Finds Minimally Invasive Video-assisted Thyroidectomy Safe for Obese Patients

Obesity is associated with a number of medical comorbidities and is considered a risk factor for surgical complications. Since the implementation of minimally invasive video-assisted thyroidectomy (MIVAT) in American medical centers in 2005, obesity has been considered a relative contraindication for MIVAT, but its negative impact on the outcome has been debated. Moreover, no study assessing the safety and feasibility of MIVAT in the obese population has previously been published. To determine the impact of obesity on the risk of complications in patients undergoing minimally invasive video-assisted thyroidectomy—a relationship that had not been well-defined before—a team of researchers from Georgia Regents University, in Augusta, GA, performed a query of a prospectively maintained database of all thyroid surgeries performed from 2006 to 2012 to identify all cases of MIVAT.

The study authors found that the MIVAT procedure may be considered safe in patients with high body mass index (BMI). The findings of this study were presented at the 83rd Annual Meeting of the American Thyroid Association, in San Juan, Puerto Rico, on October 19, 2013.

The study authors carried out an IRB-approved review of all 238 identified cases of MIVAT from January 2006 to June 2012. The 238 MIVATs were performed on 228 patients. Patients were stratified into three BMI groups, according to the National Institutes of Health’s classification for obesity: normal (BMI≤24.9 kg/m²), overweight (BMI 25 to 29.9 kg/m²), and obese (BMI≥30 kg/m²). The total number of complications was compared among the three groups. The mean overall BMI for the study population was 25.5 kg/m².

There were 124 procedures (52%) in the normal group, 78 procedures (33%) in the overweight group, and 36 procedures (15%) in the obese group. The overall rate of MIVAT complications was 5.5%.

There were nine complications in the normal group (7.3%), four complications in the overweight group (5.1%), and no complications in the obese group. The complications recorded included one case of cellulitis, six cases of temporary hypocalcemia, and six cases of transient recurrent laryngeal nerve weakness. No patients suffered permanent hypocalcemia or a permanent recurrent laryngeal nerve injury.

Due to the low number of complications in this series, the overweight and obese groups were combined into a high-BMI group for further analysis. According to the study abstract, statistical analysis using simple logistic regression models revealed that there was no significant difference in the number of complications in patients with a high BMI compared with patients with a normal BMI (OR=0.45, CI:0.13-1.55, p=0.2).

The study authors concluded that “overweight and obese patients undergoing MIVAT in this series were not at an increased risk for surgical complications.”