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Coccolini F, Shander A, Ceresoli M, Moore E, Tian B, Parini D, Sartelli M, Sakakushev B, Doklestich K, Abu-Zidan F, Horer T, Shelat V, Hardcastle T, Bignami E, Kirkpatrick A, Weber D, Kryvoruchko I, Leppaniemi A, Tan E, Kessel B, Isik A, Cremonini C, Forfori F, Ghiadoni L, Chiarugi M, Ball C, Ottolino P, Hecker A, Mariani D, Melai E, Malbrain M, Agostini V, Podda M, Picetti E, Kluger Y, Rizoli S, Litvin A, Maier R, Beka SG, De Simone B, Bala M, Perez AM, Ordonez C, Bodnaruk Z, Cui Y, Calatayud AP, de Angelis N, Amico F, Pikoulis E, Damaskos D, Coimbra R, Chirica M, Biffl WL, Catena F. Strategies to prevent blood loss and reduce transfusion in emergency general surgery, WSES-AAST consensus paper. World J Emerg Surg 2024; 19:26. [PMID: 39010099 PMCID: PMC11251377 DOI: 10.1186/s13017-024-00554-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 07/01/2024] [Indexed: 07/17/2024] Open
Abstract
Emergency general surgeons often provide care to severely ill patients requiring surgical interventions and intensive support. One of the primary drivers of morbidity and mortality is perioperative bleeding. In general, when addressing life threatening haemorrhage, blood transfusion can become an essential part of overall resuscitation. However, under all circumstances, indications for blood transfusion must be accurately evaluated. When patients decline blood transfusions, regardless of the reason, surgeons should aim to provide optimal care and respect and accommodate each patient's values and target the best outcome possible given the patient's desires and his/her clinical condition. The aim of this position paper was to perform a review of the existing literature and to provide comprehensive recommendations on organizational, surgical, anaesthetic, and haemostatic strategies that can be used to provide optimal peri-operative blood management, reduce, or avoid blood transfusions and ultimately improve patient outcomes.
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Affiliation(s)
- Federico Coccolini
- General Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisia, 56124, Pisa, Italy.
| | - Aryeh Shander
- Anesthesiology and Critical Care, Rutgers University, Newark, NJ, USA
| | - Marco Ceresoli
- General Emergency and Trauma Surgery Department, Monza University Hospital, Monza, Italy
| | - Ernest Moore
- Ernest E. Moore Shock Trauma Center, University of Colorado, Denver, CO, USA
| | - Brian Tian
- General Emergency and Trauma Surgery Department, Cesena Hospital, Cesena, Italy
| | - Dario Parini
- General Surgery Department, Rovigo Hospital, Rovigo, Italy
| | | | - Boris Sakakushev
- General Surgery Department, University Hospital St George, Medical University, Plovdiv, Bulgaria
| | - Krstina Doklestich
- Clinic of Emergency Surgery, University Clinical Center of Serbia, Belgrade, Serbia
| | - Fikri Abu-Zidan
- The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Tal Horer
- Vascular and Trauma Surgery, Orebro Hospital, Orebro, Sweden
| | - Vishal Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Timothy Hardcastle
- Department of Trauma and Burns, Inkosi Albert Luthuli Central Hospital and Department of Surgical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Elena Bignami
- Anesthesia Department, Parma University Hospital, Parma, Italy
| | - Andrew Kirkpatrick
- General, Acute Care, Abdominal Wall Reconstruction, and Trauma Surgery Foothills Medical Centre, Calgary, AB, Canada
| | - Dieter Weber
- Department of General Surgery, Royal Perth Hospital, Perth, Australia
| | - Igor Kryvoruchko
- Department of Surgery No. 2, Kharkiv National Medical University, Kharkiv, Ukraine
| | - Ari Leppaniemi
- General Surgery Department, Melahiti Hospital, Helsinki, Finland
| | - Edward Tan
- Emergency Surgery Department, Radboud Medical Centre, Nijmegen, The Netherlands
| | - Boris Kessel
- Hillel Yaffe Medical Center, Rappaport Medical School, Haifa, Israel
| | - Arda Isik
- Division of General Surgery, School of Medicine, Istanbul Medeniyet University, Kadikoy, Istanbul, Turkey
| | - Camilla Cremonini
- General Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisia, 56124, Pisa, Italy
| | | | - Lorenzo Ghiadoni
- Emergency Medicine Department, Pisa University Hospital, Pisa, Italy
| | - Massimo Chiarugi
- General Emergency and Trauma Surgery Department, Pisa University Hospital, Via Paradisia, 56124, Pisa, Italy
| | - Chad Ball
- Trauma and Acute Care Surgery, Foothills Medical Center, Calgary, AB, Canada
| | - Pablo Ottolino
- Unidad de Trauma y Urgencias, Hospital Dr. Sótero del Río, Santiago de Chile, Chile
| | - Andreas Hecker
- Department of General, Thoracic and Transplant Surgery, University Hospital of Giessen, Giessen, Germany
| | - Diego Mariani
- General Surgery Department, Legnano Hospital, Legnano, Italy
| | - Ettore Melai
- ICU Department, Pisa University Hospital, Pisa, Italy
| | - Manu Malbrain
- First Department of Anesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland
| | - Vanessa Agostini
- Medicina Trasfusionale, IRCCS-Ospedale Policlinico San Martino, Genoa, Italy
| | - Mauro Podda
- Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Yoram Kluger
- General, Emergency and Trauma Surgery Department, Rambam Medical Centre, Tel Aviv, Israel
| | | | - Andrey Litvin
- Department of Surgical Diseases No. 3, University Clinic, Gomel State Medical University, Gomel, Belarus
| | - Ron Maier
- Harborview Medical Center, University of Washington, Seattle, WA, USA
| | | | - Belinda De Simone
- Department of Digestive and Emergency Surgery, Infermi Hospital, Rimini, Italy
| | - Miklosh Bala
- Trauma and Acute Care Surgery Unit Department of General Surgery, Hadassah Medical Center, Jerusalem, Israel
| | - Aleix Martinez Perez
- Faculty of Health Sciences, Valencian International University (VIU), Valencia, Spain
| | - Carlos Ordonez
- Division of Trauma and Acute Care Surgery, Department of Surgery, Fundación Valle del Lili, Cali, Colombia
| | - Zenon Bodnaruk
- Hospital Information Services for Jehovah's Witnesses, Tuxedo Park, NY, USA
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | | | - Nicola de Angelis
- General Surgery Department, Ferrara University Hospital, Ferrara, Italy
| | - Francesco Amico
- Discipline of Surgery, The University of Newcastle, Newcastle, Australia
| | - Emmanouil Pikoulis
- 3rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | | | - Raul Coimbra
- General Surgery Department, Riverside University Health System Medical Center, Loma Linda, CA, USA
| | - Mircea Chirica
- General Surgery Department, Grenoble University Hospital, Grenoble, France
| | - Walter L Biffl
- Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Fausto Catena
- General Emergency and Trauma Surgery Department, Cesena Hospital, Cesena, Italy
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Nguyen M, Foreman A, Lockwood C. Effectiveness of fibrin sealants in head and neck surgery: a systematic review protocol. JBI Evid Synth 2024; 22:1151-1160. [PMID: 38015095 DOI: 10.11124/jbies-23-00142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
OBJECTIVE This review will investigate the effectiveness of fibrin sealants in adult patients who underwent head and neck surgery. INTRODUCTION Controlling bleeding is important in head and neck surgery. Complications involving nearby vital structures increase the risk of morbidity and mortality. Surgical tissue adhesives are used in addition to other traditional hemostatic methods to reduce surgical site bleeding. Fibrin sealants have shown some success compared with other tissue adhesives, but individual studies have been inconclusive. INCLUSION CRITERIA We will include studies comparing fibrin sealants with placebo or usual care in patients 18 years or older who have undergone soft tissue surgery of the head and neck with drain placement. Primary outcomes include wound complications and time to surgical drain removal. Secondary outcomes include length of hospital stay, drain volume output, surgical management of postoperative hematoma, rate of blood transfusions, and adverse reactions. METHODS We will search electronic databases (PubMed, Embase, Cochrane Central Register of Controlled Trials CINAHL, Scopus, Web of Science) for studies published from 1975 onwards. Sources to be search for unpublished literature will include ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, MedNar, and ProQuest Dissertations and Theses. Titles, abstracts, and full-text papers will be assessed against the inclusion criteria by 2 independent reviewers. Study screening and selection will be performed, and critical appraisal conducted using the standardized JBI appraisal tools. Data will be extracted by 2 independent reviewers. Meta-analysis will be conducted for all outcomes where appropriate, with weighted mean differences for continuous data. Risk ratios will be used for dichotomous data. Certainty will be reported using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. REVIEW REGISTRATION PROSPERO CRD42023412820.
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Affiliation(s)
- Marie Nguyen
- JBI, School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
- Department of Otorhinolaryngology, Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Andrew Foreman
- Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
- Department of Otorhinolaryngology, Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Craig Lockwood
- JBI, School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
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3
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von Ahnen T, von Ahnen M, Militz-Müller S, Süß A, Schardey J, Schopf S, Schardey HM, Wirth U. Efficacy of four different hemostatic agents in thyroid surgery in reducing the amount of post-operative fluid collection. BMC Surg 2023; 23:303. [PMID: 37794384 PMCID: PMC10552291 DOI: 10.1186/s12893-023-02172-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/25/2023] [Indexed: 10/06/2023] Open
Abstract
PURPOSES Postoperative bleeding remains a life-threatening complication in thyroid surgery. The aim was to assess the efficacy of four different hemostatic agents, Collagen-Fibrinogen-Thrombin Patch (CFTP) in two sizes (3 × 2.5 cm and 9.5 × 4.8 cm), polysaccharide particles (1 g) and Cellulose Gauze (2.5 × 5 cm) on postoperative drainage volume (DV) compared to a control group. METHODS We included from October 2007 until Mai 2011, 150 patients (30 per group) for this monocentric, retrospective case-controlled study. Patients were scheduled for a hemithyroidectomy or thyroidectomy. The primary endpoint was the postoperative DV within the first 24 h, secondary the incidence of adverse events. RESULTS There were no difference in demographic parameters. The mean DV (± SD) was 51.15 (± 36.86) ml in the control, 50.65 (± 42.79) ml in small (3 × 2.5 cm), 25.38 (± 23.99) ml in large CFTP (9.5 × 4.8 cm), 53.11 (± 39.48) ml in the polysaccharide particles and 48.94 (± 30.59) ml in the cellulose gauze group. DV was significantly reduced with the large CFTP (p < 0.05) compared to all other groups. There were no adverse events. CONCLUSIONS We were able to demonstrate a significant reduction in the DV for the large CFTP group compared to the other collectives. Although this as being associated with not inconsiderable costs and we would only recommend its use for high-risk patients only.
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Affiliation(s)
| | | | | | - Anna Süß
- Krankenhaus Agatharied GmbH, Hausham, Germany
| | | | | | | | - Ulrich Wirth
- Ludwig-Maximilians-Universität München, München, Germany
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4
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Masoudi M, Wiseman J, Wiseman SM. A contemporary systematic review of the complications associated with SURGICEL. Expert Rev Med Devices 2023; 20:741-752. [PMID: 37526076 DOI: 10.1080/17434440.2023.2242776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/27/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND This review aims to summarize the findings from recent literature (2010-2022) reporting on complications that resulted from the surgical use of SURGICEL for intraoperative hemostasis. METHODS A literature search was conducted using the MEDLINE (OVID), Embase, and Cochrane Central Register of Controlled Trials - CENTRAL (OVID) databases. The studies were sorted into case reports and other study types for data extraction. Covidence was used for data extraction and statistics were descriptive. RESULTS Of the total 560 articles screened, 73 papers were selected for a full-text review and 70 studies were included in this review. A total of 7,242 participants were included in the studies (case studies n = 93, others n = 7149). 67/70 of the included studies reported complications when SURGICEL was used intraoperatively. Reported complications included: SURGICEL induced masses (granulomas, abscesses, hematomas, cysts) (n = 25), hemorrhagic complications (n = 12), masses misdiagnosed as tumors, cardiovascular, nervous system, and hepatobiliary complications, pain, and infections. Other complications included: fistulas, erectile dysfunction, chorioamnionitis, swelling, urinary leak, renal failure, and anaphylaxis. CONCLUSIONS Publications reporting on complications associated with the use of SURGICEL intraoperatively have continued to emerge. Future studies should compare how the types and rates of complications compare between SURGICEL and alternative hemostatic agents.
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Affiliation(s)
- Matthew Masoudi
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacob Wiseman
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada
| | - Sam M Wiseman
- Department of Surgery, St. Paul's Hospital & University of British Columbia, Vancouver, British Columbia, Canada
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5
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Guerin C, Van Den Heede K, Deguelte S, Najah H, Donatini G. Prevention and management of post-thyroidectomy cervical haematoma. Recommendations of the AFCE (Association francophone de chirurgie endocrinienne) with the SFE (Société française d'endocrinologie) and the SFMN (Société française de médecine nucléaire). J Visc Surg 2023:S1878-7886(23)00081-4. [PMID: 37208220 DOI: 10.1016/j.jviscsurg.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Post-thyroidectomy cervical haematoma (PTCH) requiring reoperation occurs in fewer than 5% of patients but can be fatal or leave severe neurological sequelae if compressive. Risk factors besides anticoagulant treatments are discussed. Preoperative prevention complies with the recommendations of the French Society of Anaesthesia and Resuscitation (SFAR) for the management of antiaggregants and anticoagulants before and after the operation. Intraoperative prevention is centred on careful haemostasis, sometimes aided by coagulation tools and haemostatic agents, although there is no firm evidence of their effectiveness against the occurrence of PTCH. Systematic drainage of the thyroid cavity is no longer standard practice for the prevention of PTCH. Postoperatively, maintenance of normal blood pressure is essential to prevent PTCH, together with control of pain, coughing, nausea and vomiting. To reduce the risk of serious complications, medical and paramedical teams must be trained to recognise a haematoma and manage it so that it can be evacuated as a matter of extreme urgency, if necessary bedside, and then treated for its cause in the operating theatre.
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Affiliation(s)
- Carole Guerin
- Department of General, Endocrine and Metabolic Surgery, CHU La Conception, AP-HM, Aix-Marseille University, 147, boulevard Baille, 13005 Marseille, France.
| | - Klaas Van Den Heede
- Department of General, Visceral and Endocrine Surgery, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, Paris, France
| | - Sophie Deguelte
- Department of endocrine, digestive and oncological surgery, Robert-Debré university hospital, Reims, France
| | - Haythem Najah
- Department of digestive and endocrine surgery, Haut Leveque Hospital, university hospital of Bordeaux, Bordeaux University, Bordeaux, France
| | - Gianluca Donatini
- Department of Visceral and Endocrine Surgery, CHU of Poitiers, University of Poitiers, Poitiers, France
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6
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Dolcetti V, Lori E, Fresilli D, Del Gaudio G, Di Bella C, Pacini P, D'Andrea V, Frattaroli FM, Vallone GG, Liberatore P, Pironi D, Canu GL, Calò PG, Cantisani V, Sorrenti S. US Evaluation of Topical Hemostatic Agents in Post-Thyroidectomy. Cancers (Basel) 2023; 15:cancers15092644. [PMID: 37174110 PMCID: PMC10177612 DOI: 10.3390/cancers15092644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/17/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND the aim of this study was to describe the ultrasound appearance of topical hemostatics after thyroidectomy. METHODS we enrolled 84 patients who were undergoing thyroid surgery and were treated with two types of topical hemostats, 49 with an absorbable hemostat of oxidized regenerated cellulose (Oxitamp®) and 35 with a fibrin glue-based hemostat (Tisseel®). All patients were examined using B-mode ultrasound. RESULTS In 39 patients of the first group (approximately 80%), a hemostatic residue was detected and in some cases confused with a native gland residue, or with cancer recurrence in oncological patients. No residue was detected in patients in the second group. The main ultrasound characteristics of the tampon were analyzed and arranged according to predefined patterns, and suggestions to recognize it and avoid wrong diagnoses were provided. A part of the group of patients with tampon residue was re-evaluated after 6-12 months, ensuring that the swab remained for months after the maximum resorption time declared by the manufacturer. CONCLUSIONS with equal hemostatic effectiveness, the fibrin glue pad is more favorable in the ultrasound follow-up because it creates reduced surgical outcomes. It is also important to know and recognize the ultrasound characteristics of oxidized cellulose-based hemostats in order to reduce the number of diagnostic errors and inappropriate diagnostic investigations.
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Affiliation(s)
- Vincenzo Dolcetti
- Department of Radiological, Anatomo-Pathological Sciences, "Sapienza" University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Eleonora Lori
- Department of Surgery, "Sapienza" University of Rome, 00161 Rome, Italy
| | - Daniele Fresilli
- Department of Radiological, Anatomo-Pathological Sciences, "Sapienza" University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Giovanni Del Gaudio
- Department of Radiological, Anatomo-Pathological Sciences, "Sapienza" University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Chiara Di Bella
- Department of Radiological, Anatomo-Pathological Sciences, "Sapienza" University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Patrizia Pacini
- Department of Radiological, Anatomo-Pathological Sciences, "Sapienza" University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
| | - Vito D'Andrea
- Department of Surgery, "Sapienza" University of Rome, 00161 Rome, Italy
| | - Fabrizio Maria Frattaroli
- Department of Surgery "P. Stefanini", Faculty of Medicine, "Sapienza" University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Giulia Giordana Vallone
- Department of Surgery "P. Stefanini", Faculty of Medicine, "Sapienza" University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Piero Liberatore
- Department of Surgery "P. Stefanini", Faculty of Medicine, "Sapienza" University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Daniele Pironi
- Department of Surgery, "Sapienza" University of Rome, 00161 Rome, Italy
| | - Gian Luigi Canu
- Department of Surgical Sciences, University of Cagliari, 09042 Monserrato (Cagliari), Italy
| | - Pietro Giorgio Calò
- Department of Surgical Sciences, University of Cagliari, 09042 Monserrato (Cagliari), Italy
| | - Vito Cantisani
- Department of Radiological, Anatomo-Pathological Sciences, "Sapienza" University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
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7
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Scerrino G, Richiusa P, Graceffa G, Lori E, Sorrenti S, Paladino NC. Editorial: Recent Advances in Thyroid Surgery. J Clin Med 2022; 11:jcm11237233. [PMID: 36498807 PMCID: PMC9740206 DOI: 10.3390/jcm11237233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
Thyroid surgery has been, since its earliest application, one of the most notable fields in medicine, illustrated by the fact that the Nobel Prize in Medicine was won, for the first time, for thyroid surgery by Emil Theodor Kocher (1841-1917) in 1909, for his contributions to thyroid physiology, pathology, and surgery [...].
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Affiliation(s)
- Gregorio Scerrino
- Unit of Endocrine Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy
- Correspondence:
| | - Pierina Richiusa
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), Section of Endocrinology, University of Palermo, Via Del Vespro 129, 90127 Palermo, Italy
| | - Giuseppa Graceffa
- Unit of General and Oncology Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”, University of Palermo, Via Liborio Giuffré 5, 90127 Palermo, Italy
| | - Eleonora Lori
- Department of Surgery, “Sapienza” University of Rome, Viale Del Policlinico 155, 00161 Rome, Italy
| | - Salvatore Sorrenti
- Department of Surgery, “Sapienza” University of Rome, Viale Del Policlinico 155, 00161 Rome, Italy
| | - Nunzia Cinzia Paladino
- Department of General Endocrine and Metabolic Surgery, Conception Hospital, Aix-Marseille University, 147, Boulevard Baille, 13005 Marseille, France
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8
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Menegaux F, Baud G, Chereau N, Christou N, Deguelte S, Frey S, Guérin C, Marciniak C, Paladino NC, Brunaud L, Caiazzo R, Donatini G, Gaujoux S, Goudet P, Hartl D, Lifante JC, Mathonnet M, Mirallié E, Najah H, Sebag F, Trésallet C, Pattou F. SFE-AFCE-SFMN 2022 consensus on the management of thyroid nodules: Surgical treatment. ANNALES D'ENDOCRINOLOGIE 2022; 83:415-422. [PMID: 36309207 DOI: 10.1016/j.ando.2022.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The SFE-AFCE-SFMN 2022 consensus deals with the management of thyroid nodules, a condition that is a frequent reason for consultation in endocrinology. In more than 90% of cases, patients are euthyroid, with benign non-progressive nodules that do not warrant specific treatment. The clinician's objective is to detect malignant thyroid nodules at risk of recurrence and death, toxic nodules responsible for hyperthyroidism or compressive nodules warranting treatment. The diagnosis and treatment of thyroid nodules requires close collaboration between endocrinologists, nuclear medicine physicians and surgeons, but also involves other specialists. Therefore, this consensus statement was established jointly by 3 societies: the French Society of Endocrinology (SFE), French-speaking Association of Endocrine Surgery (AFCE) and French Society of Nuclear Medicine (SFMN); the various working groups included experts from other specialties (pathologists, radiologists, pediatricians, biologists, etc.). This section deals with the surgical management of thyroid nodules.
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Affiliation(s)
- Fabrice Menegaux
- Service de Chirurgie Générale, Viscérale et Endocrinienne, GH Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France.
| | - Gregory Baud
- Service de Chirurgie Générale et Endocrinienne, CHRU de Lille, Université de Lille, Lille, France
| | - Nathalie Chereau
- Service de Chirurgie Générale, Viscérale et Endocrinienne, GH Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Niki Christou
- Service de Chirurgie Digestive, Endocrinienne et Générale, CHU de Limoges, Limoges, France
| | - Sophie Deguelte
- Service de Chirurgie Digestive et Endocrinienne, Hôpital Robert-Debré, Université de Champagne Ardennes, Reims, France
| | - Samuel Frey
- Service de Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, CHU de Nantes, Université de Nantes, Nantes, France
| | - Carole Guérin
- Service de chirurgie Générale, Endocrinienne et Métabolique, CHU La Conception, AP-HM, Aix Marseille Université, Marseille, France
| | - Camille Marciniak
- Service de Chirurgie Générale et Endocrinienne, CHRU de Lille, Université de Lille, Lille, France
| | - Nunzia Cinzia Paladino
- Service de chirurgie Générale, Endocrinienne et Métabolique, CHU La Conception, AP-HM, Aix Marseille Université, Marseille, France
| | - Laurent Brunaud
- Département de Chirurgie Viscérale, Métabolique et Cancérologique, Université de Lorraine, CHRU Nancy, Hôpital Brabois Adultes, Vandœuvre les Nancy, France
| | - Robert Caiazzo
- Service de Chirurgie Générale et Endocrinienne, CHRU de Lille, Université de Lille, Lille, France
| | - Gianluca Donatini
- Service de Chirurgie Viscérale et Endocrinienne, CHU-Poitiers, Poitiers Université, Poitiers, France
| | - Sebastien Gaujoux
- Service de Chirurgie Générale, Viscérale et Endocrinienne, GH Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Pierre Goudet
- Département de Chirurgie Générale et Endocrinienne, CHU de Dijon, Université de Bourgogne, Dijon, France
| | - Dana Hartl
- Département d'Anesthésie, de Chirurgie et de Radiologie Interventionnelle, Unité de Chirurgie Thyroïdienne, Institut Gustave Roussy, Villejuif, France
| | - Jean-Christophe Lifante
- Service de Chirurgie Endocrinienne, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Muriel Mathonnet
- Service de Chirurgie Digestive, Endocrinienne et Générale, CHU de Limoges, Limoges, France
| | - Eric Mirallié
- Service de Chirurgie Cancérologique, Digestive et Endocrinienne, Institut des Maladies de l'Appareil Digestif, CHU de Nantes, Université de Nantes, Nantes, France
| | - Haythem Najah
- Service de Chirurgie Digestive et Endocrinienne, Hôpital Haut Lévêque, CHU de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Frederic Sebag
- Service de chirurgie Générale, Endocrinienne et Métabolique, CHU La Conception, AP-HM, Aix Marseille Université, Marseille, France
| | - Christophe Trésallet
- Service de Chirurgie Digestive, Bariatrique et Endocrinienne, HU Paris Seine-Saint-Denis, AP-HP, Hôpital Avicenne, Bobigny, France
| | - Francois Pattou
- Service de Chirurgie Générale et Endocrinienne, CHRU de Lille, Université de Lille, Lille, France
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9
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Uranues S, Fingerhut A, Levin E, Spazierer D, Rahimi N, Baumgartner B. Effectiveness of Hemopatch® versus Surgicel® Original to control mild and moderate liver bleeding. BMC Surg 2022; 22:316. [PMID: 35965336 PMCID: PMC9375927 DOI: 10.1186/s12893-022-01747-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background Adjunct hemostats can be of use in certain surgical settings. We compared the effectiveness of two hemostats, Hemopatch® and Surgicel® Original in controlling bleeding from liver lesions in an experimental model. Methods Control of grades 1 (mild) and 2 (moderate) bleeding (according to the Validated Intraoperative Bleeding [VIBe] SCALE) was assessed for 10 min after Hemopatch® (n = 198) or Surgicel® Original (n = 199) application on 397 liver surface lesions. The primary endpoint was hemostatic success (reaching VIBe SCALE grade 0 at 10 min). The secondary endpoint was time to hemostasis (time to reach and maintain grade 0). A generalized linear mixed model and an accelerated failure time model were used to assess the primary and secondary endpoints, respectively. Results The overall hemostatic success rate of Hemopatch® was statistically significantly superior to that of Surgicel® Original (83.8% versus 73.4%; p = 0.0036; odds ratio [OR] 2.38, 95% confidence interval [CI] 1.33–4.27) and time to hemostasis was reduced by 15.9% (p = 0.0032; 95% CI 0.749–0.944). Grade 2 bleeds treated with Hemopatch® had statistically significantly higher hemostatic success (71.7% versus 48.5%; p = 0.0007; OR 2.97, 95% CI 1.58–5.58) and shorter time to hemostasis (49.6% reduction, p = 3.6 × 10–8); differences for grade 1 bleeds (hemostatic success rate or time to hemostasis) were not statistically significant. Conclusions Hemopatch® provided better control of VIBe SCALE bleeding compared to Surgicel® Original for Grade 2 bleeds in this porcine model, highlighting the importance of choosing a suitable hemostat to optimize control of bleeding during surgery.
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10
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Li H, Li Z, He X, Zhang F, OuYang Z, Wu G, Liu P, Yang S, Dong L, Zhen M, Xu L. Prospective, randomized, controlled, noninferiority clinical trial to evaluate the safety and efficacy of absorbable macroporous polysaccharide composites as adjunct to hemostasis during open surgery. J Card Surg 2022; 37:3060-3069. [PMID: 35842821 DOI: 10.1111/jocs.16726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND To address intraoperative bleeding in cardiac surgery, reducing blood transfusion requirements, is mandatory to achieve effective hemostasis. Hemostatic agents may limit localized persistent bleeding. The introduction of carboxymethyl-chitosan component into the hemostatic agent and the application of the radiation crosslinking technique maintain its capacity for achieving intraoperative hemostasis, thus increasing the clinical utility. METHODS A prospective, noninferiority and randomized controlled clinical trial to compare the safety and efficacy of absorbable macroporous polysaccharide composites (AMPC, treatment group) with compound microporous polysaccharide hemostatic powder (CMPHP, control group) (2:1 ratio) as adjuncts to hemostasis in open surgery. The main indication was used for hemostasis in various traumatic hemorrhage areas, including cardiothoracic, vascular, and general surgery. The primary endpoint was success rate of hemostasis within 300 s (at a 10% noninferiority margin). The secondary endpoint was hemostasis time. Both endpoints were assessed in the modified intention-to-treat (MITT) population. Safety parameters were assessed. This study is fully compliant with the CONSORT statement. RESULTS Randomized patients in AMPC and CMPHP groups were 168 and 84, respectively. In MITT population, the success rates of hemostasis within 300 s were 98.8% (163 of 165) in AMPC and 94.0% (78 of 83) in CMPHP (treatment difference 4.8% [95% CI -0.57% to 10.20%]). AMPC was thus noninferior to CMPHP. Hemostasis time (median [interquartile range]) with AMPC (87 [52.5, 180] s) was better than CMPHP (110 [54.5, 181] s). Changes in laboratory parameters over time and shifts to abnormal values were typical of surgeries and similar between two groups. No noticeable adverse effects associated with AMPC or CMPHP were observed. CONCLUSIONS AMPC is well tolerated as topical hemostatic agent, noninferior to commercial CMPHP, and exhibits excellent safety. This study provides a novel hemostatic agent which appears to offer significant clinical advantage in various hemorrhage areas.
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Affiliation(s)
- Hongwei Li
- State Key Laboratory of Molecular Immunology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Zhifei Li
- General Surgery, Peking University Third Hospital, Beijing, China
| | - Xianghui He
- General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Fuxin Zhang
- General Surgery, Breast Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Zhong OuYang
- General Surgery, Breast Surgery, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Guoyang Wu
- General Surgery, Hepatopancreatobiliary Surgery, Breast Surgery, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, China
| | - Pingguo Liu
- General Surgery, Hepatopancreatobiliary Surgery, Breast Surgery, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, China
| | - Sumei Yang
- General Surgery, Hepatopancreatobiliary Surgery, Breast Surgery, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, China
| | - Liyan Dong
- General Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Maochuan Zhen
- General Surgery, Hepatopancreatobiliary Surgery, Breast Surgery, Zhongshan Hospital Affiliated to Xiamen University, Xiamen, China
| | - Ling Xu
- State Key Laboratory of Molecular Immunology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
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11
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Del Rio P, Cozzani F, Rossini M, Loderer T, Bignami E, Bonati E. Mini-invasive thyroidectomy and intraoperative neuromonitoring: a high-volume single-center experience in 215 consecutive cases. Minerva Surg 2020; 76:160-164. [PMID: 32456402 DOI: 10.23736/s2724-5691.20.08339-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Endocrine surgery recent evolution has been characterized by introduction of mini-invasive video-assisted technique. When a new technique is introduced in surgical use the rate of adverse events must be the same of previous standardized technique. In MIVAT procedure complication rate and in particular nerve injury risk is associated surgeon's experience. The new approach is the intraoperative neuro-monitoring (IONM) use in MIVAT in order to reduce the laryngeal nerve injury rate in a more technically difficult surgical procedure. METHODS We analyzed clinical and surgical data regarding 215 patients treated with MIVAT technique and simultaneous IONM utilization from September 2014 to December 2019 in a single high-volume surgical center. We recorded data regarding age, gender, preoperative diagnosis, surgical time, early postoperative hypocalcemia, hematoma and vocal cord palsy. We compared these data to our first 211 cases of MIVAT (July 2005 to June 2009) at the beginning of the learning curve, performed without using IONM. We tried to highlight the impact of MIVAT and IONM simultaneous use on surgical outcome comparing results to our previous studies, also highlighting the learning curve effect. RESULTS We detected a postoperative transitory clinical hypocalcemia in 14 patients (6.5%). No postoperative hematoma was recorded. Using I-IONM during thyroidectomy, we recorded in five cases a loss of signal; in three cases (1.4%) we experienced a temporary postoperative vocal cord palsy, only one case of definitive palsy. We did not observe any significant differences in surgical complications rate between the first 211 cases and these last 215 cases. We have not found any statistically significative difference regarding IONM use during MIVAT procedure related to MIVAT performed without IONM. In our previous experience cases series of MIVAT the percentage of transitory nerve palsy reported was 2.4% (non-significant P value). Surgical indication has changed. CONCLUSIONS In our experience we report that the use of IONM in MIVAT is as helpful to improve the safe of procedure. The risk of nerve palsy in literature associated to MIVAT is the same of the related one to classic technique (CT). We have not found statistical positivity to use IONM in MIVAT related to MIVAT without IONM. In our previous experience cases series of MIVAT the percentage of transitory nerve palsy reported was 2.4% (non-significant P value). The most important IONM effect, in our opinion is the "safety feeling" experienced by the surgeon using IONM in a more challenging procedure. As a University Hospital, training surgery residents, we also identified the IONM as a very useful teaching support.
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Affiliation(s)
- Paolo Del Rio
- Unit of General Surgery, Department of Medicine and Surgery, Parma University Hospital, Parma, Italy
| | - Federico Cozzani
- Unit of General Surgery, Department of Medicine and Surgery, Parma University Hospital, Parma, Italy -
| | - Matteo Rossini
- Unit of General Surgery, Department of Medicine and Surgery, Parma University Hospital, Parma, Italy
| | - Tommaso Loderer
- Unit of General Surgery, Department of Medicine and Surgery, Parma University Hospital, Parma, Italy
| | - Elena Bignami
- Division of Anesthesiology and Critical Care, Department of Medicine and Surgery, Parma University Hospital, University of Parma, Parma, Italy
| | - Elena Bonati
- Unit of General Surgery, Department of Medicine and Surgery, Parma University Hospital, Parma, Italy
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12
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Scaroni M, von Holzen U, Nebiker CA. Effectiveness of hemostatic agents in thyroid surgery for the prevention of postoperative bleeding. Sci Rep 2020; 10:1753. [PMID: 32019979 PMCID: PMC7000666 DOI: 10.1038/s41598-020-58666-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 01/14/2020] [Indexed: 12/28/2022] Open
Abstract
Postoperative bleeding remains one of the most frequent, but rarely life-threatening complications in thyroid surgery. Although arterial bleeding is the main cause of postoperative hemorrhage, most often no actively bleeding vessel can be found during revision. Therefore, the coagulation technique for larger vessels may play a minor role, and hemostatic agents could be of higher importance. In this descriptive, retrospective study, data of 279 patients with thyroid surgery (total of 414 thyroid lobectomies) were collected. We reviewed the electronic medical record by analyzing the histological, operative, laboratory and discharge reports in regards to postoperative bleeding. Of the 414 operated thyroid lobes, 2.4% (n = 10) bled. 1.4% (n = 6) needed reoperation while the other 1.0% (n = 4) could be treated conservatively. Hemostatic patches were applied 286 (69.1%) times. Of the 128 (30.9%) patch-free operated sides, 4.7% (n = 6) suffered postoperative bleeding. Tachosil® alone was used 211 (51.0%) times and bleeding occurred in 1.4% (n = 3). Without statistical significance (p = 0.08) the use of Tachosil® seems to help preventing postoperative bleeding. The combination with other patches doesn’t appear to be more efficient.
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Affiliation(s)
- Martino Scaroni
- Department of Anesthesiology, Cantonal Hospital of Grisons, Löestrasse 170, 7000, Chur, Switzerland
| | - Urs von Holzen
- Indiana University School of Medicine South Bend, Goshen Center for Cancer Care, 200 High Park Ave., Goshen, IN, 46526, USA
| | - Christian A Nebiker
- Department of General Surgery, Cantonal Hospital of Aarau, Tellstrasse, Haus 3, 5000, Aarau, Switzerland.
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13
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Shah A, Palmer AJR, Klein AA. Strategies to minimize intraoperative blood loss during major surgery. Br J Surg 2020; 107:e26-e38. [DOI: 10.1002/bjs.11393] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 09/12/2019] [Indexed: 12/19/2022]
Abstract
Abstract
Background
Reducing operative blood loss improves patient outcomes and reduces healthcare costs. The aim of this article was to review current surgical, anaesthetic and haemostatic intraoperative blood conservation strategies.
Methods
This narrative review was based on a literature search of relevant databases up to 31 July 2019 for publications relevant to reducing blood loss in the surgical patient.
Results
Interventions can begin early in the preoperative phase through identification of patients at high risk of bleeding. Directly acting anticoagulants can be stopped 48 h before most surgery in the presence of normal renal function. Aspirin can be continued for most procedures. Intraoperative cell salvage is recommended when anticipated blood loss is greater than 500 ml and this can be continued after surgery in certain situations. Tranexamic acid is safe, cheap and effective, and routine administration is recommended when anticipated blood loss is high. However, the optimal dose, timing and route of administration remain unclear. The use of topical agents, tourniquet and drains remains at the discretion of the surgeon. Anaesthetic techniques include correct patient positioning, avoidance of hypothermia and regional anaesthesia. Permissive hypotension may be beneficial in selected patients. Promising haemostatic strategies include use of pharmacological agents such as desmopressin, prothrombin complex concentrate and fibrinogen concentrate, and use of viscoelastic haemostatic assays.
Conclusion
Reducing perioperative blood loss requires a multimodal and multidisciplinary approach. Although high-quality evidence exists in certain areas, the overall evidence base for reducing intraoperative blood loss remains limited.
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Affiliation(s)
- A Shah
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
- Nuffield Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - A J R Palmer
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - A A Klein
- Department of Anaesthesia and Intensive Care, Royal Papworth Hospital, Cambridge, UK
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