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Ding Y, Qiu C, Zhu C, Li Y, Geng X, Lv G, Yan X, Ju F, Wang S, Wu W. Comparison of gasless transaxillary endoscopic thyroidectomy, endoscopic thyroidectomy via areola approach and conventional open thyroidectomy in patients with unilateral papillary thyroid carcinoma. World J Surg Oncol 2024; 22:148. [PMID: 38840176 PMCID: PMC11151600 DOI: 10.1186/s12957-024-03433-2] [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: 02/27/2024] [Accepted: 06/01/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Gasless transaxillary endoscopic thyroidectomy (GTET) and endoscopic thyroidectomy via the areola approach (ETA) have emerged as minimally invasive surgical techniques for managing papillary thyroid carcinoma (PTC). This study aimed to assess the surgical efficacy of endoscopic thyroidectomy (ET) as compared to conventional open thyroidectomy (COT) in PTC patients. METHODS Between 2020 and 2022, 571 PTC patients underwent unilateral thyroidectomy accompanied by ipsilateral central lymph node dissection. This cohort comprised 72 patients who underwent GTET, 105 ETA, and 394 COT. The analysis encompassed a comprehensive examination of patient clinicopathologic characteristics and postoperative complaints. Furthermore, the learning curve of GTET was evaluated using the cumulative summation (CUSUM) method. RESULTS Patients in the ET group exhibited a lower mean age and a higher proportion of female individuals. Operation time in the ET group was significantly longer. No significant differences were observed in the incidence of postoperative complications among the three groups. With regard to postoperative complaints reported three months after surgery, GTET demonstrated superior alleviation of anterior chest discomfort and swallowing difficulties. Patients who underwent ET reported significantly higher cosmetic satisfaction levels. Additionally, the learning curve of GTET was 27 cases, and the operation time during the mature phase of the learning curve exhibited a significant reduction when compared to ETA. CONCLUSIONS The findings of this study affirm the safety and feasibility of employing GTET and ETA for the surgical management of PTC. GTET presents an attractive surgical option, particularly for patients with unilateral PTC who place a premium on cosmetic outcomes.
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Affiliation(s)
- Yu Ding
- Department of Thyroid Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou Jiangsu, 213000, China
| | - Chenjie Qiu
- Department of General Surgery, Changzhou Hospital of Traditional Chinese Medicine, Changzhou Jiangsu, 213000, China
| | - Chunfu Zhu
- Department of Thyroid Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou Jiangsu, 213000, China
| | - Yuan Li
- Department of Thyroid Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou Jiangsu, 213000, China
| | - Xiang Geng
- Department of Thyroid Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou Jiangsu, 213000, China
| | - Guojun Lv
- Department of Thyroid Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou Jiangsu, 213000, China
| | - Xiaoyi Yan
- Department of Thyroid Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou Jiangsu, 213000, China
| | - Feng Ju
- Department of Thyroid Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou Jiangsu, 213000, China
| | - Shijia Wang
- Department of Thyroid Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou Jiangsu, 213000, China
| | - Wenze Wu
- Department of Thyroid Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou Jiangsu, 213000, China.
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Woods AL, Campbell MJ, Graves CE. A scoping review of endoscopic and robotic techniques for lateral neck dissection in thyroid cancer. Front Oncol 2024; 14:1297972. [PMID: 38390267 PMCID: PMC10883677 DOI: 10.3389/fonc.2024.1297972] [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: 09/20/2023] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
Introduction Lateral neck dissection (LND) in thyroid cancer has traditionally been performed by a transcervical technique with a large collar incision. With the rise of endoscopic, video-assisted, and robotic techniques for thyroidectomy, minimally invasive LND is now being performed more frequently, with better cosmetic outcomes. Methods The purpose of this paper is to review the different minimally invasive and remote access techniques for LND in thyroid cancer. A comprehensive literature review was performed using PubMed and Google Scholar search terms "thyroid cancer" and "lateral neck dissection" and "endoscopy OR robot OR endoscopic OR video-assisted". Results There are multiple surgical options now available within each subset of endoscopic, video-assisted, and robotic LND. The approach dictates the extent of the LND but almost all techniques access levels II-IV, with variability on levels I and V. This review provides an overview of the indications, contraindications, surgical and oncologic outcomes for each technique. Discussion Though data remains limited, endoscopic and robotic techniques for LND are safe, with improved cosmetic results and comparable oncologic and surgical outcomes. Similar to patient selection in minimally invasive thyroidectomy, it is important to consider the extent of the LND and select appropriate surgical candidates.
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Affiliation(s)
- Alexis L Woods
- Department of Surgery, University of California, Davis Medical Center, Sacramento, CA, United States
| | - Michael J Campbell
- Department of Surgery, University of California, Davis Medical Center, Sacramento, CA, United States
| | - Claire E Graves
- Department of Surgery, University of California, Davis Medical Center, Sacramento, CA, United States
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Yang Y, Sun D, Yang J, Chen J, Duan Y. Endoscopic Thyroidectomy in Anterior Chest Approach Versus Open Thyroidectomy for Patients with Papillary Thyroid Carcinomas, a Retrospective Study. J Laparoendosc Adv Surg Tech A 2020; 30:488-494. [PMID: 32182158 DOI: 10.1089/lap.2019.0694] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: To compare the endoscopic thyroidectomy (ET) with the open thyroidectomy (OT) for patients with papillary thyroid carcinomas and share our experience of central lymph nodes dissection and recurrent laryngeal nerve exposure. Materials and Methods: From January 2015 to July 2017, 197 patients were enrolled in our hospital. Among them, 85 underwent ET and 112 underwent OT. The mean age of the patients was 38.15 ± 11.72 years in ET group and 47.79 ± 10.51 years in OT group. Unilateral thyroidectomy was performed in 47 patients of ET group and 63 patients of OT group. Bilateral thyroidectomy was performed in 38 patients of ET group and 49 patients of OT group. Intraoperative information, including operation time, hemorrhage, tumor size, capsular invasion, central LN metastasis, number of retrieved lymph nodes, hospital stay, cost, postoperative complication, and cosmetic satisfaction, was compared between the two groups. Results: The operation time of ET group was significantly longer (P < .05). There were no significant differences between the two groups in postoperative complications (P > .05). The patients in ET group were more satisfied with the cosmetic effects (P < .05). Conclusion: ET was a safe and effective alternative operation method for selected patients with papillary thyroid carcinomas.
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Affiliation(s)
- Yu Yang
- Department of General Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Donglin Sun
- Department of General Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Junsheng Yang
- Department of General Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jing Chen
- Department of General Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yunfei Duan
- Department of General Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
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Video-assisted neck surgery (VANS) using a gasless lifting procedure for thyroid and parathyroid diseases: "The VANS method from A to Z". Surg Today 2019; 50:1126-1137. [PMID: 31728730 PMCID: PMC7501127 DOI: 10.1007/s00595-019-01908-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 09/04/2019] [Indexed: 12/20/2022]
Abstract
Purpose To describe and evaluate our video-assisted neck surgery (VANS) method for thyroid and parathyroid diseases. Methods We describe in detail the VANS method for enucleation, lobectomy, total (nearly total) thyroidectomy, and lymph node dissection for malignancy and Graves’ disease. In collaboration with the Japan Society of Endoscopic Surgery (JSES), we evaluated several aspects of this method. The JSES evaluated the method for working-space formation and surgical complications, whereas we examined the learning curve of the surgeons, and the cosmetic satisfaction of the patients and the degree of numbness and pain they experienced. We also asked patients who underwent conventional surgery whether they would have selected VANS had it been available. Results The working space for 81.5% of the procedures in Japan was created using the gasless lifting method. The learning curve, considering both blood loss and operating time, decreased after 30 cases. Both factors improved for tumors smaller than 5 cm in diameter. Over 60% of the patients who underwent conventional surgery stated that they would have selected VANS, had it been available. Postoperative pain was worse after conventional surgery than after VANS, but neck numbness after VANS was more frequent than expected. Conclusions The VANS method is a feasible, safe, and cost-effective procedure with clear cosmetic advantages over conventional surgery.
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Nakajo A, Arima H, Hirata M, Yamashita Y, Shinden Y, Hayashi N, Kawasaki Y, Arigami T, Uchikado Y, Mori S, Mataki Y, Sakoda M, Kijima Y, Uenosono Y, Maemura K, Natsugoe S. Bidirectional Approach of Video-Assisted Neck Surgery (BAVANS): Endoscopic complete central node dissection with craniocaudal view for treatment of thyroid cancer. Asian J Endosc Surg 2017; 10:40-46. [PMID: 27650915 DOI: 10.1111/ases.12312] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/05/2016] [Accepted: 06/19/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Endoscopic thyroidectomy is a well-established surgical technique that is mainly performed for benign thyroid disease. We considered that endoscopic surgery could also be widely indicated for the treatment of thyroid cancer. We herein describe our new bidirectional approach of video-assisted neck surgery (BAVANS) for complete central node dissection in endoscopic thyroid cancer surgery. METHODS BAVANS involves two different directional pathways to the cervical lesion. Before lymph node dissection, we perform endoscopic thyroidectomy via a conventional gasless precordial or axillary approach. After thyroidectomy, the surgeon repositions by the head of the patient and inserts three ports in front of the upper neck lesion in the submandibular area to approach the paratracheal lesion from an overhead-to-caudal direction. RESULTS BAVANS allows for an excellent craniocaudal view and easy access to the peritracheal lymph nodes. Sixteen patients with papillary thyroid cancer underwent BAVANS and progressed satisfactorily after surgery. Of those patients, eight underwent total or near total thyroidectomy, and five patients underwent bilateral central node dissection. The average number of retrieved lymph nodes with unilateral central node dissection was nine, which was higher than that achieved with conventional open surgery. All patients began oral intake within 5 h after surgery. Postoperative Horner syndrome occurred in one patient. No other complications were noted. CONCLUSIONS BAVANS is a very effective surgical procedure that many endoscopic surgeons can perform safely and easily. It has both a cosmetic advantage and excellent curability in endoscopic thyroid cancer surgery.
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Affiliation(s)
- Akihiro Nakajo
- Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, Kagoshima City, Japan
| | - Hideo Arima
- Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, Kagoshima City, Japan
| | - Munetsugu Hirata
- Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, Kagoshima City, Japan
| | - Yoshie Yamashita
- Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, Kagoshima City, Japan
| | - Yoshiaki Shinden
- Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, Kagoshima City, Japan
| | - Naoki Hayashi
- Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, Kagoshima City, Japan
| | - Yota Kawasaki
- Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, Kagoshima City, Japan
| | - Takaaki Arigami
- Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, Kagoshima City, Japan
| | - Yasuto Uchikado
- Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, Kagoshima City, Japan
| | - Shinichiro Mori
- Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, Kagoshima City, Japan
| | - Yuko Mataki
- Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, Kagoshima City, Japan
| | - Masahiko Sakoda
- Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, Kagoshima City, Japan
| | - Yuko Kijima
- Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, Kagoshima City, Japan
| | - Yoshikazu Uenosono
- Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, Kagoshima City, Japan
| | - Kosei Maemura
- Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, Kagoshima City, Japan
| | - Shoji Natsugoe
- Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, Kagoshima City, Japan
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Tai DKC, Chick WK, Chan PCM, Lau CH, Tang DLC. Experience of endoscopic thyroidectomy in a single-centre institution. SURGICAL PRACTICE 2016. [DOI: 10.1111/1744-1633.12216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Dora KC Tai
- Department of Surgery; Queen Elizabeth Hospital; Hong Kong
| | | | - Peter CM Chan
- Department of Surgery; Queen Elizabeth Hospital; Hong Kong
| | - Chi-Hung Lau
- Department of Surgery; Queen Elizabeth Hospital; Hong Kong
| | - Donald LC Tang
- Department of Surgery; Queen Elizabeth Hospital; Hong Kong
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Total endoscopic versus conventional open thyroidectomy for papillary thyroid microcarcinoma. J Craniofac Surg 2015; 26:464-8. [PMID: 25692899 DOI: 10.1097/scs.0000000000001449] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The objective of this study was to conduct a meta-analysis to assess the safety and efficacy of total endoscopic thyroidectomy (TET) versus conventional open thyroidectomy (COT) for papillary thyroid microcarcinoma with regard to short-term clinical outcomes. METHODS MEDLINE, EMBASE, Science Citation Index Expanded, and the Cochrane Central Register of Controlled Trials in the Cochrane Library between January 1996 and July 2014 were searched to identify relevant comparative studies. Pooled weighted mean differences (WMD) or odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using either fixed or random-effects models. The perioperative outcomes were evaluated. RESULTS Five eligible nonrandomized studies were included, involving 1004 patients: 475 were TET and 529 were COT. Meta-analysis results revealed that TET group had a significantly longer operative time (WMD, 48.15; 95% CI, 27.54-68.75; P < 0.00001), compared with the COT group. While analyzing the number of removed lymph nodes, 4 studies were included. The TET group had a less number of removed lymph nodes (WMD, -0.68; 95% CI, -1.20 to -0.15; P = 0.01). There were no significant differences in terms of hospital stay, transient recurrent laryngeal nerve palsy, permanent recurrent laryngeal nerve palsy, transient hypocalcemia, and permanent hypocalcemia. CONCLUSIONS Total endoscopic thyroidectomy appears to be a much feasible safe surgical procedure for papillary thyroid microcarcinoma in selected patients.
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Igarashi T, Shimizu K, Yakubouski S, Akasu H, Okamura R, Sugitani I, Jikuzono T, Danilova L. Introduction and use of video-assisted endoscopic thyroidectomy for patients in Belarus affected by the Chernobyl nuclear disaster. Asian J Endosc Surg 2013; 6:298-302. [PMID: 23992375 DOI: 10.1111/ases.12058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 06/08/2013] [Accepted: 06/16/2013] [Indexed: 11/29/2022]
Abstract
INTRODUCTION We developed video-assisted neck surgery (VANS) - a feasible, simple, and safe endoscopic thyroid procedure with cosmetic benefits - in 1998. To date, we have performed this procedure 633 times. We have also introduced the VANS method in Belarus, a country that was left contaminated by the Chernobyl nuclear disaster. METHODS From a mass screening, nine Belarusian patients, including two with papillary carcinoma of the thyroid, were selected to undergo an operation using the VANS method, performed by a single surgeon (author Shimizu). We compared indicating factors for minimally invasive surgery, specifically the operating time and blood loss, between the Belarusian cases and the 33 most recent cases performed at our institute in Tokyo. RESULTS The procedures in Belarus were performed under very different working conditions than in Japan. However, operating time and blood loss improved for the Belarusian cases as the surgeon gained experience in this environment; all the cosmetic outcomes were excellent. Subsequently, over a 2-year period, surgeons in Belarus performed the VANS method, with modification, for 29 cases of thyroid tumor. CONCLUSION The VANS method is easily learned by inexperienced surgeons without major technical problems.
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Affiliation(s)
- Takehito Igarashi
- Department of Endocrine Surgery, Nippon Medical School, Tokyo, Japan
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Lee H, Lee J, Sung KY. Comparative study comparing endoscopic thyroidectomy using the axillary approach and open thyroidectomy for papillary thyroid microcarcinoma. World J Surg Oncol 2012; 10:269. [PMID: 23234462 PMCID: PMC3544716 DOI: 10.1186/1477-7819-10-269] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 11/26/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Endoscopic thyroidectomy has been applied prudently to malignant thyroid tumors. The purpose of our study was to compare the surgical outcomes of endoscopic thyroidectomy (ET) and conventional open thyroidectomy (COT) for micropapillary thyroid carcinoma. METHODS From October 2002 to December 2008, 78 patients underwent unilateral lobectomy and isthmectomy with central lymph node dissection for papillary thyroid microcarcinoma. Of these, 37 patients underwent ET and 41 patients COT. Surgical outcomes, including operation time, number of retrieved lymph nodes, postoperative complication rate and patients' satisfaction with the cosmetic results, were analyzed. RESULTS The mean age of the patients was 42.3 ± 7.6 years in the ET group and 49.0 ± 10.8 years in the OT group (P = 0.003). The operation time was shorter in the COT group (112.3 ± 14 min) than in the ET group (138.4 ± 36.9 min, P< 0.01). However, there were no significant differences in tumor size (0.5 ± 0.231 vs. 0.41 ± 0.264 cm, P = 0.116), number of retrieved lymph nodes (3.63 ± 2.1 vs. 3.82 ± 3.28, P = 0.78) or postoperative hospital stay (3.35 ± 0.94 vs. 3.17 ± 1.16 days, P = 0.457). Patients in the ET group experienced more pain than those in the COT group at 1 and 7 days after the operation as evaluated by a visual analog scale (P = 0.037, 0.026). Cosmetically, patients in the ET group were very satisfied with the operative procedure according to the questionnaire we used (1.43 ± 0.55 vs. 3.21 ± 0.72, P< 0.001). The mean follow-up period was 54.3 months in the ET group and 47.4 months in the COT group, and each group exhibited one case of tumor recurrence detected at the other thyroid lobe within 2 years. CONCLUSIONS Large series of prospective studies and long-term follow-up are needed, but the results of ET using the axillary approach for micropapillary thyroid carcinoma were not inferiortothose using COT, and it might be a safe and feasible procedure with good cosmetic results.
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Affiliation(s)
- Hayemin Lee
- Department of Surgery, Bucheon St, Mary's Hospital, The Catholic University of Korea, Sosa-dong, Wonmi-Gu, Bucheon City, Kyunggi-Do, 420-717, Korea
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Lee S, Ryu HR, Park JH, Kim KH, Kang SW, Jeong JJ, Nam KH, Chung WY, Park CS. Early surgical outcomes comparison between robotic and conventional open thyroid surgery for papillary thyroid microcarcinoma. Surgery 2012; 151:724-30. [DOI: 10.1016/j.surg.2011.12.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 12/09/2011] [Indexed: 10/14/2022]
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Systematic comparison of cervical and extra-cervical surgical approaches for endoscopic thyroidectomy. Surg Today 2011; 42:835-41. [PMID: 22183049 DOI: 10.1007/s00595-011-0100-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Accepted: 07/27/2011] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate the clinical application of different surgical approaches for endoscopic thyroidectomy and provide more rational treatment criteria. METHODS Collect all randomized controlled trials, multi-center studies, clinical controlled trials, clinical trials and other comparative studies of endoscopic thyroidectomy with a large sample size in different databases through an established search strategy, make a systematic analysis of all the included literature. RESULTS This study selected 12 publications for analysis from more than 800 articles: these included six publications describing cervical thyroidectomy (A) and six publications describing extra-cervical thyroidectomy (B). Conversion to open surgery occurred in 29 patients in group A and only 4 in group B (p < 0.001). The patients in group A experienced shorter hospital stays than patients in group B (1.90 ± 0.80 vs. 4.03 ± 0.99 days, p < 0.001), and there was shorter operating time in group A (p < 0.001). Hemorrhage occurred in 3 cases in group A and 8 cases in group B (p = 0.04), Seroma occurred in 25 cases in group B but in no cases in group A (p < 0.001). Postoperative cosmetic results evaluated by verbal response scales (VRS) registered showed: group A (3.35 ± 0.60) and group B (3.74 ± 0.50; p < 0.001). Other complications such as recurrent laryngeal nerve injury and hypocalcemia showed no significant differences. CONCLUSIONS Evaluation of the different surgical approaches for endoscopic thyroidectomy shows that the incidence of hemorrhage and seroma are higher in the extra-cervical group, but the rate of conversion to conventional open surgery is significantly higher in the cervical group. Furthermore, patients who undergo extra-cervical endoscopic thyroidectomy are associated with longer operating time and hospital stays; however, these studies suggest that the extra-cervical surgical approach for endoscopic thyroidectomy is preferable for dealing with more kinds of thyroid tumor and leaving no scars on neck.
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Excellence in robotic thyroid surgery: a comparative study of robot-assisted versus conventional endoscopic thyroidectomy in papillary thyroid microcarcinoma patients. Ann Surg 2011; 253:1060-6. [PMID: 21587112 DOI: 10.1097/sla.0b013e3182138b54] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To confirm the merits of robotic thyroid surgery by comparing the surgical outcomes of robotic-assisted and conventional endoscopic thyroidectomy in papillary thyroid microcarcinoma (PTMC) patients. BACKGROUND Robot-assisted surgical techniques are widely utilized, and substantially, overcome the limitations of conventional endoscopic surgery. Furthermore, recently, robotic procedures were introduced to the thyroidectomy field. METHODS From November 2001 to July 2009, 1150 patients with PTMC underwent endoscopic thyroidectomy using a gasless, trans-axillary approach. Of these patients, 580 underwent a robotic procedure (the robotic group; RG) and 570 a conventional endoscopic procedure (the conventional endoscopic group; EG). These 2 groups were retrospectively compared in terms of their clinicopathologic characteristics, early surgical outcomes, and surgical completeness. RESULTS Total thyroidectomy was performed more frequently in the RG. Although mean operation times were not statistically different, the mean number of central nodes retrieved was greater in the RG than in the EG. Mean tumor size were not significantly different in the 2 groups, but the RG showed more frequent central node metastasis and capsular invasion. Tumor and nodal statuses in the RG were more advanced than in the EG. Regarding postoperative complications, transient hypocalcemia was more frequent in the RG, but other complication frequencies were not significantly different in the 2 groups. Postoperative serum thyroglobulin levels were similar in 2 groups, and short-term follow-up (1 year) revealed no recurrence by sonography and no abnormal uptake during radioactive iodine therapy in either group. CONCLUSIONS The application of robotic technology to endoscopic thyroidectomy could overcome the limitations of conventional endoscopic surgery during the surgical management of PTMC.
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Shimizu K. [Therapeutic guidelines--the current status and problems. 3. Management of thyroid cancer]. NIHON NAIKA GAKKAI ZASSHI. THE JOURNAL OF THE JAPANESE SOCIETY OF INTERNAL MEDICINE 2010; 99:747-754. [PMID: 20578361 DOI: 10.2169/naika.99.747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Kim YE, Kwak HN, Kim JH, Choi YJ, Yun JS, Son BH, Park YL. 10 Year-Experience of Endoscopic Thyroidectomy for Papillary Thyroid Microcarcinoma in Single Institution: Breast Approach and Gasless Transaxillary Approach. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2010. [DOI: 10.4174/jkss.2010.79.5.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Yeoung-Eun Kim
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ha-Na Kwak
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Ho Kim
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon Jung Choi
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Sup Yun
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung Ho Son
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong-Lai Park
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Koh YW, Park JH, Kim JW, Lee SW, Choi EC. Endoscopic hemithyroidectomy with prophylactic ipsilateral central neck dissection via an unilateral axillo-breast approach without gas insufflation for unilateral micropapillary thyroid carcinoma: preliminary report. Surg Endosc 2009; 24:188-97. [PMID: 19688395 DOI: 10.1007/s00464-009-0646-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Revised: 03/17/2009] [Accepted: 05/01/2009] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recently, various endoscopic approaches have been applied to thyroid surgery. However, few specific data exist on endoscopic thyroidectomy with central neck dissection (CND) for micropapillary thyroid carcinoma. This study aimed to evaluate the feasibility and safety of endoscopic hemithyroidectomy (HT) plus CND. METHODS In this study, 29 consecutive patients underwent endoscopic HT with ipsilateral CND via a unilateral axillo-breast approach (endo group), and 30 matched control patients underwent conventional open HT with ipsilateral CND (open group). The following variables were compared between these two groups: perioperative complications, surgery-related outcomes, and pathologic outcomes. RESULTS The operating time in the endo group was longer than in the open group (p = 0.012). In terms of parathyroid gland (PTG) preservation, there were no statistically significant differences between the two groups. The mean numbers of dissected central lymph nodes and metastatic central lymph nodes were similar in the two groups (p = 0.506 vs. 0.975). The endo group had a significantly longer mean hospital stay (6.21 +/- 0.94 days) than the open group (4.30 +/- 1.02 days; p = 0.000). No significant difference was observed in the overall perioperative complications between the two groups. CONCLUSIONS This study demonstrates that the endoscopic approach of CND plus HT is feasible for selected unilateral, intrathyroidal, micropapillary carcinomas. In the future, prospective and comparative studies on the surgical techniques of total thyroidectomy and CND are needed to verify their oncologic safety.
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Affiliation(s)
- Yoon Woo Koh
- Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea
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16
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Moon BI. Endoscopic Thyroidectomy. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2007. [DOI: 10.5124/jkma.2007.50.8.736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Byung In Moon
- Department of Surgery, Ewha Womans University College of Medicine, Korea.
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17
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Maeda S, Uga T, Hayashida N, Ishigaki K, Furui J, Kanematsu T. Video-assisted subtotal or near-total thyroidectomy for Graves' disease. Br J Surg 2006; 93:61-6. [PMID: 16323164 DOI: 10.1002/bjs.5173] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Surgery remains the treatment of choice for patients with Graves' disease. The purpose of the present study was to assess the usefulness and efficacy of video-assisted subtotal or near-total thyroidectomy in patients with Graves' disease. METHODS Between March 2000 and December 2004, 63 patients with Graves' disease underwent video-assisted subtotal, near-total or total thyroidectomy. Fifty-three patients (84 per cent) were considered for surgery after failure of antithyroid drug and radioiodine therapy, whereas the other ten patients were initially selected for surgical treatment based on their own preference. Treatment outcome was evaluated, including surgical complications, thyroid function, quality of life and patient satisfaction with the surgical result. RESULTS All patients were operated on using a video-assisted technique, with some modifications depending on time and experience. There were no conversions to open surgery. Three patients (5 per cent) had temporary recurrent laryngeal nerve palsy that recovered spontaneously. Most patients were satisfied with the surgical results, particularly regarding the placement of the surgical scars. CONCLUSION Video-assisted subtotal or near-total thyroidectomy is a safe and effective procedure for treatment of Graves' disease.
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Affiliation(s)
- S Maeda
- Division of Endocrine Surgery, Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
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18
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Gosnell JE, Sackett WR, Sidhu S, Sywak M, Reeve TS, Delbridge LW. Minimal access thyroid surgery: technique and report of the first 25 cases. ANZ J Surg 2004; 74:330-4. [PMID: 15144252 DOI: 10.1111/j.1445-1433.2004.02982.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Minimal access thyroid surgery, using various techniques, is increasingly being reported. The present study reviews our experience with thyroid surgery using a lateral focused mini-incision approach, and assesses its safety and feasibility. METHODS The study group comprised all patients undergoing minimal access thyroid surgery (MATS) during the period May 2002-May 2003. Data were prospectively gathered, including patient demographics, indication for surgery, operation performed, nodule size, final pathology, and complications. Exclusion criteria for this procedure included: family history of thyroid cancer, previous neck irradiation or surgery, carcinoma on fine needle aspiration, presence of significant thyroiditis, multinodular goitre, and nodule size >3 cm. The operation was carried out through a 2.5-cm lateral incision placed directly over the nodule, with exposure gained by dissecting the plane between the sternomastoid muscle and the lateral edge of the strap muscles. RESULTS Twenty-five patients underwent MATS, 22 women and three men. Nineteen patients underwent hemithyroidectomy, five underwent isthmectomy, and one underwent local nodule excision. The average measured incision size was 2.63 cm at the end of the procedure. The average nodule size was 2.2 cm, and the average thyroid lobe resected measured 4.7 cm in maximal length. Final pathology revealed benign nodules in 21 patients and four thyroid cancers (two follicular and two papillary). There was one wound infection and two patients had temporary recurrent laryngeal nerve neuropraxia. CONCLUSION Minimal access thyroid surgery is a safe and feasible alternative to open thyroid surgery in selected cases.
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Affiliation(s)
- Jessica E Gosnell
- University of Sydney Endocrine Surgical Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia
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19
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Lombardi CP, Raffaelli M, Princi P, Lulli P, Rossi ED, Fadda G, Bellantone R. Safety of video-assisted thyroidectomy versus conventional surgery. Head Neck 2004; 27:58-64. [PMID: 15459914 DOI: 10.1002/hed.20118] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Thyroid gland manipulation, surgical stress response, and postoperative outcome in cases of video-assisted thyroidectomy (VAT) and conventional thyroidectomy were compared to verify the safety of VAT. METHODS Twenty consenting patients were randomly assigned to undergo VAT or conventional thyroidectomy. Serum thyroglobulin levels were monitored as indicators of thyroid manipulation, and C-reactive protein and white blood cell count were monitored to assess surgical stress response. Thyroid capsule integrity and the presence of spilled cells in the thyroid bed were verified. RESULTS No significant differences were found in the indicators of thyroid gland manipulation and surgical stress response between groups. No thyroid capsules ruptured, and no spilled thyroid cells were found. Patients who had VAT experienced less pain, required fewer analgesics, and were more satisfied with the cosmetic result and the surgical outcome. CONCLUSIONS VAT is as safe as conventional thyroidectomy and is characterized by a less painful postoperative course and by better cosmetic results and postoperative outcome.
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Affiliation(s)
- Celestino Pio Lombardi
- Divisione di Endocrinochirurgia, Istituto di Clinica Chirurgica, Dipartimento di Scienze Chirurgiche, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168 Rome, Italy
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20
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Bellantone R, Lombardi CP, Raffaelli M, Alesina PF, De Crea C, Traini E, Salvatori M. Video-assisted thyroidectomy for papillary thyroid carcinoma. Surg Endosc 2003; 17:1604-8. [PMID: 12874681 DOI: 10.1007/s00464-002-9220-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2002] [Accepted: 03/21/2003] [Indexed: 11/27/2022]
Abstract
BACKGROUND In patients with small papillary thyroid carcinomas (PTC), we evaluated the operative feasibility and safety of video-assisted thyroidectomy (VAT) and the completeness of the surgical resection. METHODS Video-assisted thyroidectomy was attempted in 24 patients with thyroid malignancy. Total thyroid resection for PTC was achieved completely by VAT in 20 of them, who were included in this study. RESULTS In this study, 12 total thyroidectomies and 8 lobectomies followed by completion thyroidectomies were performed. Eight patients also underwent central neck lymph node dissection. Mean postoperative serum thyroglobulin was 0.2 ng/ml for patients receiving LT4 suppressive treatment and 4.2 ng/ml for patients after LT4 withdrawal. Postoperative ultrasonography showed no residual thyroid tissue. The mean radioiodine uptake at postoperative scintiscan was 2.2%. CONCLUSIONS In the case of PTC, VAT is feasible and safe. The completeness of the surgical resection seems comparable with that reported for conventional surgery. Nevertheless, larger series and longer follow-up evaluation are necessary for definitive conclusions to be drawn about its oncologic validity.
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Affiliation(s)
- R Bellantone
- Division of Endocrine Surgery, Department of Surgery, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
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21
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Abstract
Since 1997, successful attempts at endoscopic thyroidectomy have led to controversies. The procedure has, as yet, no alarming operative complication, but its benefits to patients are debatable. By means of very individualized and ingeniously designed approaches, the procedure has proven to be feasible and safe in trained hands. Cautious trials and evaluations of endoscopic thyroid surgery are now in progress internationally at expert centres. The technique itself is undergoing progressive evolution and larger studies are underway. Although endoscopic thyroidectomy has little chance of acquiring the same popularity as open thyroidectomy due to its inherently higher technical demand, it may become a practical and safe alternative option for selected suitable patients.
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22
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Kitagawa W, Shimizu K, Akasu H, Tanaka S. Endoscopic neck surgery with lymph node dissection for papillary carcinoma of the thyroid using a totally gasless anterior neck skin lifting method. J Am Coll Surg 2003; 196:990-4. [PMID: 12788440 DOI: 10.1016/s1072-7515(03)00130-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Wataru Kitagawa
- Division of Endocrine Surgery, Department of Surgery II, Nippon Medical School, Tokyo, Japan
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23
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Maeda S, Shimizu K, Minami S, Hayashida N, Kuroki T, Furuichi A, Sugiyama N, Ishigaki K, Suto R, Furui J, Kanematsu T. Video-assisted neck surgery for thyroid and parathyroid diseases. Biomed Pharmacother 2003; 56 Suppl 1:92s-95s. [PMID: 12487261 DOI: 10.1016/s0753-3322(02)00236-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Endoscopic surgery has now become a well-established modality for the treatment of various organ diseases. In the present study, we analyzed the surgical results achieved by video-assisted neck surgery (VANS) in thyroid and parathyroid diseases. METHODS From January 2000 to April 2002, 87 patients (eight males and 79 females) with a mean age of 49 years underwent VANS. The preoperative diagnoses of these patients included 37 benign thyroid tumors, 30 Graves' diseases, 17 parathyroid adenomas and three thyroid cancers. RESULTS The mean operative time of VANS was 165 min for a hemithyroidectomy, 287 min for a subtotal thyroidectomy, and 157 min for a parathyroidectomy. The mean intraoperative blood loss was 60, 183 and 23 g for a hemithyroidectomy, subtotal thyroidectomy and parathyroidectomy, respectively. No conversion from VANS to conventional surgery was experienced. Three patients (3.4%) had temporary palsy of the recurrent laryngeal nerve. Otherwise, the postoperative courses were uneventful. CONCLUSIONS VANS for thyroid and parathyroid diseases was found to be safe and effective. From a cosmetic point of view, a high degree of patient satisfaction was obtained. VANS is thus considered to be an excellent option for selected patients with thyroid and parathyroid diseases.
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Affiliation(s)
- Shigeto Maeda
- Division of Endocrine Surgery, Department of Surgery, Nagasaki University, Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8102, Japan.
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24
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Shimizu K, Kitagawa W, Akasu H, Hirai K, Tanaka S. Video-assisted minimally invasive endoscopic thyroid surgery using a gasless neck skin lifting method--153 cases of benign thyroid tumors and applicability for large tumors. Biomed Pharmacother 2003; 56 Suppl 1:88s-91s. [PMID: 12487260 DOI: 10.1016/s0753-3322(02)00239-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Endoscopic surgery is often considered to be 'minimally invasive surgery' in the light of recent developments. In particular, endoscopic endocrine neck surgery is desirable from a cosmetic viewpoint. Here we compared the usefulness of our original endoscopic method of video-assisted neck surgery (the VANS method) with conventional surgery when challenged with the removal of thyroid tumors measuring more than 5 cm in diameter, based on our experience with 167 cases (162 thyroid tumors, five parathyroid tumors). The percentage of patients who underwent the VANS method of the total number of patients who underwent neck surgery was determined and the operative procedures used in the different surgeries were analyzed. The operating time and blood loss for 153 benign thyroid tumors were statistically compared between the small-tumor group (n = 130, < 5 cm) and the large-tumor group (n = 23, > or = 5 cm). More than 60% of the benign and 5.3% of the malignant thyroid tumors were operated on by the VANS method. Near- or subtotal lobectomy was the most common procedure (64.1%) for benign tumors. Malignancy was defined as papillary carcinoma less than 1 cm in diameter. Total lobectomy with lymph node clearance was performed for all malignant tumors. Although the operating time and the blood loss were statistically greater in the large-tumor group than the small-tumor group, with increased experience it was possible to remove tumors of up to 7.4 cm safely. Our findings support the idea that the VANS method is feasible, practical, and safe, and has great cosmetic benefits, even for the removal of large benign tumors.
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Affiliation(s)
- Kazuo Shimizu
- Department of Surgery, Nippon Medical School, 1-1-5 Sendagi Bunkyo-ku, Tokyo 113-8603, Japan.
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25
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Nakano S, Kijima Y, Owaki T, Shirao K, Baba M, Aikou T. Anterior chest wall approach for video-assisted thyroidectomy using a modified neck skin lifting method. Biomed Pharmacother 2003; 56 Suppl 1:96s-99s. [PMID: 12487262 DOI: 10.1016/s0753-3322(02)00233-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Neck endoscopic surgery is likely to prove less invasive and more cosmetically advantageous than conventional methods. The surgical procedure used for 42 consecutive patients undergoing video-assisted thyroidectomy by the anterior chest wall approach is described herein. A 3-4 cm incision was made at the anterior chest wall 2 cm below the clavicle on the tumor side. Two Kirshner wires connected to a winching device were horizontally inserted beneath the skin in order to lift the neck skin. Specially made retractors were passed through the chest wall wound to the lateral neck bilaterally. Strap muscle on the tumor side was retracted laterally and the thyroid tumor was retracted medially. A suitable working space was thus created using this modified neck lifting method without gas insufflation. All patients underwent video-assisted thyroidectomy utilizing an anterior chest wall approach without conversion to open thyroidectomy. Mean operative time from incision to removal of the tumor was 145 min. Mean tumor size was 4.1 cm (range: 2.0-7.5 cm). The advantage of our approach is that the scar below the clavicle is invisible under normal clothing. In addition, conventional instruments for open thyroidectomy can be used. In our method, the thyroid tumor and trachea are palpable and some parts of the operation can be conducted under direct visualization if the assistant retracts the anterior chest wall wound upward. Video-assisted thyroidectomy utilizing an anterior chest wall approach is cosmetically less invasive, particularly for women who are frequently nervous about operative scars on the neck.
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Affiliation(s)
- Shizuo Nakano
- The First Department of Surgery, Faculty of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, 890-8520, Japan.
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26
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Abstract
Endoscopic surgery has become widely used, so much so that recent technical and mechanical advances have led to "endoscopic surgery" being synonymous with "minimally invasive surgery". In particular, endoscopic thyroid surgery has developed rapidly and been increasingly refined in recent years. The incidence of thyroid diseases is markedly higher in women than in men, and operations for these diseases result in a scar on the anterior neck that is exposed when open-necked clothing is worn. Therefore, a technique for endoscopic endocrine neck surgery that results in a better cosmetic appearance is desirable. We have developed a totally gasless endoscopic surgical technique using an anterior neck-skin lifting method for thyroid and parathyroid diseases. This technique is called the video-assisted neck surgery (VANS) method. Since our original report, we have treated more than 200 cases of thyroid and parathyroid disease using this technique. In cases of benign thyroid tumours, near total lobectomy was the most common procedure followed by total lobectomy. The maximum resected tumour size was 7.4 cm in diameter. For malignant tumours, the indication for the VANS method was limited to thyroid papillary microcarcinomas measuring less than 1 cm in diameter. Total lobectomy and prophylactic neck dissection were performed in all 10 of these cases. A subtotal thyroidectomy was performed for only a few cases of Graves' disease. The operating time and the amount of bleeding were statistically significantly reduced, as the surgeon gained experience with the technique. In conclusion, the VANS method is a feasible, practical and safe procedure, with excellent cosmetic benefits.
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Affiliation(s)
- Kazuo Shimizu
- Department of Surgery II, Nippon Medical School, Tokyo, Japan.
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27
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Sackett WR, Barraclough BH, Sidhu S, Reeve TS, Delbridge LW. Minimal access thyroid surgery: is it feasible, is it appropriate? ANZ J Surg 2002; 72:777-80. [PMID: 12437686 DOI: 10.1046/j.1445-2197.2002.02558.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Reports of minimal access thyroid surgery (MATS) using various techniques have recently appeared. This study examined the feasibility of MATS using either a lateral 'focused' or endoscopically assisted approach. METHODS The study group comprised all patients undergoing minimally invasive parathyroidectomy (MIP) during the period May 1998 to April 2002 in whom a concomitant thyroid procedure was undertaken. All procedures were performed either through a 2-cm lateral cervical incision (n = 19) or endoscopically (n = 7). RESULTS Twenty-six patients underwent thyroid surgery, consisting of either local excision of a thyroid nodule (n = 25) or hemi-thyroidectomy (n = 1). In 13 patients the nodule was incidentally discovered, in four patients removal of the parathyroid necessitated partial thyroidectomy, and in nine patients the lesion identified by preoperative parathyroid localization proved to be a thyroid nodule. There were no permanent complications in the study group. Two patients required drainage of a haematoma. The final pathology of all 26 cases revealed benign nodular thyroid disease. CONCLUSION Thyroid surgery can safely be performed as a minimally invasive procedure. Minimal access thyroid surgery is therefore a feasible option for selected patients. The question remains to be answered as to whether this surgical approach is appropriate treatment for nodular thyroid disease.
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Affiliation(s)
- Wendy R Sackett
- University of Sydney Endocrine Surgical Unit, Royal North Shore Hospital, Australia
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28
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Abstract
The advancement of video-assisted minimally invasive surgery in this decade fostered the successful attempt at endoscopic thyroidectomy in 1997. This technically demanding surgery is now being evaluated in a small number of specialized centers. The procedure earned the most attention in Japan and is performed in more than 20 centers; a conference dedicated to the technique was held in Japan in 2001. By retrieving information from published or presented articles and direct personal communications, we report on the multitude of surgical strategies designed by different experts to enable relocalization of the surgical wounds to optimize cosmesis to the patient while complying with the gold standard of thyroid surgery.
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Affiliation(s)
- Gustus H C Yeung
- Department of Surgery, Yan Chai Hospital, Tsuen Wan, Hong Kong, China
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29
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Shimizu K, Kitagawa W, Akasu H, Tanaka S. Video-assisted endoscopic endocrine neck surgery with a benefit of cosmesis: a new technique using a totally gasless anterior neck skin lifting method. J NIPPON MED SCH 2002; 69:2-3. [PMID: 11847502 DOI: 10.1272/jnms.69.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Kazuo Shimizu
- Department of Surgery II, Nippon Medical School, Tokyo, Japan
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