Video-assisted Thyroid Surgery and Hypnosis in Thyroid Surgery
Condition: Surgery
Study type: Interventional

Summary: 
      The study is aimed to investigate the safety and feasibility of Video-assisted thyroidectomy
      under hypnosis in comparison to general anesthesia
    

Detailed description: 
      Summary of the project

      video-assisted thyroidectomy (MIVAT): General anesthesia (GA) versus hypnosis (HY)

      Investigators

      Prof. Michel Mourad*, Dr. Christine Watremez **, Prof. Fabienne Roelants**

      * Surgery and Abdominal Transplantation Division

      ** Department of Anesthesiology,

      Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Avenue Hippocrate 10,
      1200 Brussels, Belgium

        1. Aim

           The aim of this pilot study is to prospectively investigate, in a consecutive series of
           patients, the feasibility and safety of MIVAT under HY associated with local anesthesia,
           compared to GA.

        2. Inclusion criteria

             -  Adult patients candidates to total or partial thyroidectomy.

             -  ASA 1, 2 or 3

             -  One surgeon (MM)

             -  Informed consent

        3. Exclusion criteria

             -  Age <18 years

             -  The presence of familial medullary thyroid cancers

             -  Suspicious or metastatic lymph nodes

             -  Redo surgery

             -  ASA 4 patients

             -  Patients with chronic pain

             -  Deaf people

             -  Patients with psychiatric diseases

             -  Known recurrent nerve paralysis

        4. Outcome evaluation

             -  Primary outcomes: safety and feasibility.

             -  During surgery, considered events for analysis should include operating time (from
                skin incision to skin closure), total time in the operating room, intraoperative
                bleeding, drug consumption, Hemodynamic changes and conversion rates from MIVAT to
                a conventional approach and from HY to GA.

             -  After surgery, comparative variables for analysis should include: drug consumption,
                hospital stay, calcemia, and vocal cord abnormality on the basis of day-one
                laryngoscopy performed by an ENT doctor not involved in the study.

        5. Patients selection and study groups:

      Selection of patients for MIVAT is based on the size of the gland and nodules, provided that
      the craniocaudal axis of the lobes did not exceed 7cm and the largest transversal diameter
      was less than 3.5cm. All patients who are assigned to undergo MIVAT are instructed about the
      possibility of conversion to a conventional approach. The patients are left free to choose
      the type of anesthesia they prefere for their surgical intervention. They have to give
      informed consent before the procedure.

      A. General anesthesia group:

      Premedication:

        -  Lorazepam 0.5 mg 1 h before surgery

        -  ECG, NIBP, SaO2

        -  VVP + NaCl 0.9 % 500 mL + taradyl 0.5 mg / kg (<30 mg)

      Induction:

        -  Remifentanil 0.05 µg/kg/min

        -  Propofol 2 mg/kg

        -  Intubation with an armored endotracheal tube specially devised for neuromonitoring of
           the vocal cords.

      During surgery:

        -  Sevoflurane / Remifentanil

      B. Hypnosis group:

      Premedication:

        -  Lorazepam 0.5 mg 1 h avant l'intervention

        -  ECG, NIBP, SaO2

        -  VVP + NaCl 0.9 % 500 mL + taradyl 0.5 mg / kg (< 30 mg)

      Induction and during surgery:

        -  Remifentanil modified as requested

        -  Induction of hypnosis according to Milton Eriksson technique

        -  Midazolam (titrated 0.1 mg/0.1mg) if needed as anxiolytic.

        -  Local anesthesia mixture (lidocaine 0.5%/ropivacaine 0.25%) to be administered by the
           surgeon along the incision line 5 minutes before making the skin incision.
    

Intervention name(s): video-assisted thyroidectomy; Video-assisted thyroidectomy
Intervention type(s): Procedure; Procedure
Intervention description(s): Experimental arm: video-assisted thyroidectomy under local anesthesia and hypnosis; video-assisted thyroidectomy under general anesthesia
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Videoassited; Thyroidectomy; Minimal invasive surgery; General anesthesia; Hypnosis