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Del Rio P, Polistena A, Chiofalo MG, De Pasquale L, Dionigi G, Docimo G, Graceffa G, Iacobone M, Medas F, Pezzolla A, Sorrenti S, Spiezia S, Calò PG. Management of surgical diseases of thyroid gland indications of the United Italian Society of Endocrine Surgery (SIUEC). Updates Surg 2023; 75:1393-1417. [PMID: 37198359 PMCID: PMC10435599 DOI: 10.1007/s13304-023-01522-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/23/2023] [Indexed: 05/19/2023]
Abstract
A task force of the United Italian society of Endocrine Surgery (SIUEC) was commissioned to review the position statement on diagnostic, therapeutic and health‑care management protocol in thyroid surgery published in 2016, at the light of new technologies, recent oncological concepts, and tailored approaches. The objective of this publication was to support surgeons with modern rational protocols of treatment that can be shared by health-care professionals, taking into account important clinical, healthcare and therapeutic aspects, as well as potential sequelae and complications. The task force consists of 13 members of the SIUEC highly trained and experienced in thyroid surgery. The main topics concern clinical evaluation and preoperative workup, patient preparation for surgery, surgical treatment, non-surgical options, postoperative management, prevention and management of major complications, outpatient care and follow-up.
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Affiliation(s)
- P Del Rio
- Unit of General Surgery, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - A Polistena
- Department of Surgery Pietro Valdoni, University of Rome Sapienza, Rome, Italy
| | - M G Chiofalo
- Department Head and Neck, Thyroid Surgery Unit, Istituto Nazionale Tumori IRCCS Fondazione G. Pascale, Naples, Italy
| | - L De Pasquale
- Thyroid and Parathyroid Service, Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - G Dionigi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- Division of Surgery, Istituto Auxologico Italiano Instituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - G Docimo
- Division of Thyroid Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | - G Graceffa
- Department of Surgical Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - M Iacobone
- Endocrine Surgery Unit, Department of Surgery, Oncology and Gastroenterology, Padova University Hospital, Padova, Italy
| | - Fabio Medas
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy.
| | - A Pezzolla
- Division of Videolaparoscopic Surgery, Department of Emergency and Organ Transplanatation, University of Bari "A. Moro", Bari, Italy
| | - S Sorrenti
- Department of Surgery, "Sapienza" University of Rome, Rome, Italy
| | - S Spiezia
- Department of Endocrine and Ultrasound-guided Surgery, Ospedale del Mare, Naples, Italy
| | - P G Calò
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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Ji X, Sun W, Lv C, Huang J, Zhang H. Meta-analysis of the efficacy and safety of thermal ablation for treating large benign thyroid nodules. Clin Endocrinol (Oxf) 2022; 97:654-663. [PMID: 35170792 DOI: 10.1111/cen.14695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/17/2022] [Accepted: 02/10/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Many large benign thyroid nodules have symptoms and cosmetic problems. This study consisted of a meta-analysis to accurately assess the effect of thermal ablation on these nodules. METHODS The PubMed, Embase, Web of Science, and Scopus databases were systematically searched for retrospective or prospective studies of thermal ablation since June 1, 2021. The weighted mean differences of the measures were analysed before and after treatment. RESULTS A total of 10 eligible studies were included. By comparing the initial nodule volume with the nodular volume after thermal ablation, we found that the volume reduction rate was increased significantly after 1 month (SMD = 0.453, 95% CI: 0.323-0.583, p < .001), 3 months (SMD = 0.655, 95% CI: 0.563-0.747, p < .001), 6 months (SMD = 0.691, 95% CI: 0.607-0.774, p < .001), and 12 months (SMD = 0.694, 95% CI: 0.583-0.803), p < .001). The nodular volume was also found to decrease significantly, after 1 month (SMD = 2.381, 95% CI: 1.278-3.485, p < .001), 3 months (SMD = 5.071, 95% CI: 2.386-7.756, p < .001), 6 months (SMD = 5.363, 95% CI: 2.765-7.962, p < .001), and 12 months (SMD = 8.194, 95% CI: 2.113-14.274), p < .001). Symptom score (SMD = 4.419, 95% CI: 2.573-6.265, p < .001)and cosmetic score (SMD = 4.245, 95% CI: 2.566-5.359, p < .001) were reduced after thermal ablation. CONCLUSIONS Thermal ablation could become an alternative to manage large benign thyroid nodules.
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Affiliation(s)
- Xiaoyu Ji
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Wei Sun
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Chengzhou Lv
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Jiapeng Huang
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Hao Zhang
- Department of Thyroid Surgery, The First Hospital of China Medical University, Shenyang, China
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Vu DL, Pham MT, Nguyen VB, Le TM. Efficacy and Safety of Radiofrequency Ablation for the Treatment of Autonomously Functioning Thyroid Nodules: A Long-Term Prospective Study. Ther Clin Risk Manag 2022; 18:11-19. [PMID: 35023921 PMCID: PMC8747785 DOI: 10.2147/tcrm.s344464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/11/2021] [Indexed: 12/05/2022] Open
Abstract
Objective This study aims to evaluate the efficacy and safety of RFA in the AFTN treatment after 2 years of follow-up and to find the factors related to treatment responses through TSH level and VRR. Materials and Methods This long-term prospective study was conducted from September 2017 to April 2021 on 17 AFTNs treated with RFA. Clinical evaluations, thyroid function tests, thyroid scintigraphy, and ultrasonography examinations were performed at 1 month, 3 months, 6 months, and 24 months after ablation. The primary endpoint was the success rate of RFA in restoring the euthyroidism stage after 24 months of follow-ups; secondary outcomes were VRR and improvements of US parameters, clinical examinations, and complications. The Spearman rank correlation test was used to determine related factors with treatment response variables. Results At the 24 months after the procedure, symptom score, cosmetic score, vascularity grade, and nodule volume significantly decreased. The VRR reduced approximately 42.77%, 63.13%, 78.3%, and 95.65% after 1 month, 3 months, 6 months, and 24 months follow-up. All 17 patients were restored euthyroid state without taking ATDs. No major complications were collected. The last TSH level was significantly correlated with the age of patients (Spearman rho = −0.637, p = 0.008). The VRR was significantly correlated with age of patients (Spearman rho = 0.566, p = 0.018) and initial TSH (Spearman rho = 0.485, p = 0.048). Conclusion RFA was demonstrated as a safe and effective option for AFTN treatment in long-term follow-up. It can be used as an alternative treatment with encouraging results.
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Affiliation(s)
- Dang Luu Vu
- Bach Mai Radiology Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Minh Thong Pham
- Bach Mai Radiology Center, Bach Mai Hospital, Hanoi, Vietnam
| | - Van Bang Nguyen
- Center of Endocrinology and Diabetes, Family Hospital, Da Nang, Vietnam
| | - Thi My Le
- Radiology Department, Vinmec Times City International Hospital, Hanoi, Vietnam
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Kumar C, Lohani KR, Kataria K, Ranjan P, Dhar A, Srivastava A. Endoscopic thyroidectomy: Which one is the better technique for the beginners? J Minim Access Surg 2021; 17:337-341. [PMID: 32964885 PMCID: PMC8270042 DOI: 10.4103/jmas.jmas_184_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: Endoscopic thyroidectomy is an advanced procedure and has a long learning curve. Most commonly employed approach is combined axillary-breast approach (ABA). Recently, transoral endoscopic thyroidectomy vestibular approach (TOETVA) is being popularised as a scarless procedure. However, it is not established whether TOETVA or ABA approach is better to begin with. Purpose: The purpose of the study was to compare the initial experience of TOETVA and ABA with respect to difficulties and outcomes. Methodology: A prospective non-randomised interventional study was conducted including the initial ten patients in each group who underwent hemithyroidectomy for benign solitary thyroid nodule. Sigma plot version 12.3 was used for the statistical analysis. Results: All the patients were female and comparable with respect to age (33.2 vs. 28.2 years) and size of nodule (2.7 vs. 3 cm) (TOETVA vs. ABA). The operative time (121 vs. 138.5 min, P = 0.34) and blood loss (50 vs. 60 ml, P = 0.9) were similar in both the groups. Even though the flap raising time was significantly less with TOETVA group (29.3 vs. 47.2 min, P < 0.001), it was associated with more difficulty in approaching upper pole (P = 0.02) and lower pole (P < 0.001), more intra-operative events (30% vs. 10%, P = 0.58) and conversions to open (20% vs. 10%, P = 1). Similarly, post-operative pain scoring was more with TOETVA (3 vs. 2, P = 0.04). Hospital stay was similar in both the groups (2.5 vs. 3 days, P = 1). Patients in both the groups had both overall and cosmetic satisfaction. Conclusions: Axillary-breast approach should be preferred to start learning the endoscopic thyroidectomy, as it is easier and safer than transoral endoscopic vestibular approach.
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Affiliation(s)
- Chitresh Kumar
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Kush Raj Lohani
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Kamal Kataria
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Piyush Ranjan
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Dhar
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Anurag Srivastava
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
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Nguyen VB, Nguyen TX, Nguyen VVH, Nguyen HT, Nguyen DT, Le CV. Efficacy and Safety of Single-Session Radiofrequency Ablation in Treating Benign Thyroid Nodules: A Short-Term Prospective Cohort Study. Int J Endocrinol 2021; 2021:7556393. [PMID: 34552630 PMCID: PMC8452432 DOI: 10.1155/2021/7556393] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/15/2021] [Accepted: 09/02/2021] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE The aims of this study are to evaluate the safety and efficacy of RFA in the treatment of benign thyroid nodule(s) and to find independent factors related to the volume reduction rate of the nodule(s). MATERIALS AND METHODS This short-term prospective study from a single medical center was conducted on 93 benign thyroid nodules in 93 patients treated with RFA. Two basic techniques were used: the trans-isthmic approach and moving-shot technique. Clinical and ultrasonography examinations were performed at 1- and 3-month follow-up after the treatment session. Primary outcomes included volume reduction ratio (VRR) at 1-month and 3-month follow-ups; secondary outcomes were therapeutic success rate and complications. Multiple linear regression analysis was used to determine independent factors associated with VRR. RESULTS A final sample of 78 patients with 78 nodules, given participant rate 83.8% (including 60 solid nodules, 16 predominantly cystic nodules, and 2 thyroid cysts), was followed up for 3 months. The mean volume reduction ratio was 41.47% and 64.72% after 1-month and 3-month follow-ups, respectively. The therapeutic success rate was 30.8% at 1-month and 84.6% at 3-month follow-ups. Symptom score and cosmetic score improved significantly. There was no change in thyroid function tests. Two minor complications (transient voice change) were found. The multiple linear regression analysis showed that the internal component of the nodules significantly related to the VRR during the 3-month follow-up (β = 23.00; 95%CI (7.59-38.45)). CONCLUSION RFA was demonstrated as a safe and effective option for benign thyroid nodules treatment. It can be used as an alternative treatment with encouraging results.
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Affiliation(s)
- Van Bang Nguyen
- Center of Endocrinology and Diabetes, Family Hospital, Da Nang, Vietnam
| | - Thi Xuan Nguyen
- Center of Endocrinology and Diabetes, Family Hospital, Da Nang, Vietnam
| | - Van Vy Hau Nguyen
- Center of Endocrinology and Diabetes, Family Hospital, Da Nang, Vietnam
| | - Hai Thuy Nguyen
- Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Dinh Toan Nguyen
- Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
| | - Chi Van Le
- Department of Internal Medicine, Hue University of Medicine and Pharmacy, Hue University, Hue City, Vietnam
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Moreno Llorente P, A Gonzales Laguado E, Alberich Prats M, Francos Martínez JM, García Barrasa A. Surgical approaches to thyroid. Cir Esp 2020; 99:267-275. [PMID: 33069356 DOI: 10.1016/j.ciresp.2020.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 01/03/2023]
Abstract
Thyroidectomy is the most frequent procedure in endocrine surgery. The conventional approach through a collar incision, as described by Kocher in XIXth century, has become the "gold standard". It is continuously evolving in spite of, many years ago, it showed to be safe and efficient with quality standards difficult to beat. Endoscopic and robotic surgery have developed "new approaches" to thyroid in order to improve the cosmetic results, looking even for invisible scars. We have done a thoughtful review of most of them trying to understand their benefits and drawbacks. Currently none of these "new approaches" have been shown to be better than conventional open thyroidectomy beyond offering a better cosmetic result. Besides, only a small percentage of patients can benefit of them. However, most of these approaches will remain if they treat the diseased thyroid and also improve the quality of life of our patients.
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Affiliation(s)
- Pablo Moreno Llorente
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, España.
| | - Erick A Gonzales Laguado
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, España
| | - Marta Alberich Prats
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, España
| | - José Manuel Francos Martínez
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, España
| | - Arantxa García Barrasa
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, España
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Vuong NL, Dinh LQ, Bang HT, Thuy TTM, Bac NH, Vy TT. Radiofrequency Ablation for Benign Thyroid Nodules: 1-Year Follow-Up in 184 Patients. World J Surg 2019; 43:2447-2453. [PMID: 31165252 DOI: 10.1007/s00268-019-05044-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Benign thyroid nodules are common, and must be treated when symptomatic. Non-surgical minimally invasive modalities, including radiofrequency ablation (RFA), have been widely used with good results. The factors related to the efficacy of RFA are still debated. This study was to evaluate the safety, efficacy and related factors of RFA in the treatment of benign thyroid nodules. METHODS A retrospective single-center study was conducted on 251 benign thyroid nodules in 184 patients treated with RFA. The procedure was performed under ultrasound (US) guidance using the trans-isthmic approach and the moving-shot technique. Clinical and US examinations were performed at 1, 3, 6, 12 months, and then at 6 month intervals. Study outcomes were volume reduction ratio (VRR) and complications. RESULTS There were 153 women and 31 men included in the study. The mean age was 43.9 years. The median initial largest diameter and volume of nodules were 30 mm and 6.18 ml. The median length of follow-up was 12 months. Two minor complications were found. The mean VRR was 66.8; 74.3; and 81% after 3, 6, and 12 months, respectively. Initial solidity was a factor related to the efficacy: cystic nodules had higher VRR compared to solid ones. CONCLUSIONS RFA is safe, effective and can be used as a routine treatment for benign thyroid nodules. More prospective multicenter studies with long-term follow-up are required to improve the safety and efficacy of RFA.
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Affiliation(s)
- Nguyen Lam Vuong
- Department of Medical Statistics and Informatics, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
- Thoracic and Vascular Department, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Le Quang Dinh
- Thoracic and Vascular Department, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Ho Tat Bang
- Thoracic and Vascular Department, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tran Thi Mai Thuy
- Department of Medical Imaging, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Nguyen Hoang Bac
- University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Tran Thanh Vy
- Thoracic and Vascular Department, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam.
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Musholt TJ, Bockisch A, Clerici T, Dotzenrath C, Dralle H, Goretzki PE, Hermann M, Holzer K, Karges W, Krude H, Kussmann J, Lorenz K, Luster M, Niederle B, Nies C, Riss P, Schabram J, Schabram P, Schmid KW, Simon D, Spitzweg C, Steinmüller T, Trupka A, Vorländer C, Weber T, Bartsch DK. [Update of the S2k guidelines : Surgical treatment of benign thyroid diseases]. Chirurg 2019; 89:699-709. [PMID: 29876616 DOI: 10.1007/s00104-018-0653-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Thyroid resections represent one of the most common operations with 76,140 interventions in the year 2016 in Germany (source Destatis). These are predominantly benign thyroid gland diseases. Recommendations for the operative treatment of benign thyroid diseases were last published by the CAEK in 2010 as S2k guidelines (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V. [AWMF] 003/002) against the background of increasingly more radical resection procedures. Hemithyroidectomy and thyroidectomy are routinely performed for benign thyroid disease in practice. The operation-specific risks show a clear increase with the extent of the resection. Therefore, weighing-up of the risk-indications ratio between unilateral lobectomy or thyroidectomy necessitates an independent evaluation of the indications for both sides. This principle in particular has been used to update the guidelines. In addition, the previously published recommendations of the CAEK for correct execution and consequences of intraoperative neuromonitoring were included into the guidelines, which in particular serve the aim to avoid bilateral recurrent laryngeal nerve paralysis. Moreover, the recommendations for the treatment of postoperative complications, such as hypoparathyroidism and postoperative infections were revised. The updated guidelines therefore represent the current state of the science as well as the resulting surgical practice.
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Affiliation(s)
- T J Musholt
- Sektion Endokrine Chirurgie der Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes Gutenberg Universität Mainz, Langenbeckstr. 1, 55101, Mainz, Deutschland.
| | - A Bockisch
- Klinik für Nuklearmedizin, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - T Clerici
- Klinik für Chirurgie, Kantonsspital St. Gallen, 9007, St. Gallen, Schweiz
| | - C Dotzenrath
- Klinik für endokrine Chirurgie, Helios Universitätsklinikum Wuppertal, Heusnerstr. 40, 42283, Wuppertal, Deutschland
| | - H Dralle
- Sektion Endokrine Chirurgie, Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - P E Goretzki
- Chirurgische Klinik, Campus Charite Mitte/Campus Virchow Klinikum, Endokrine Chirurgie, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - M Hermann
- 2. Chirurgische Abteilung, Krankenanstalt Rudolfstiftung, Märzstr. 80, 1150, Wien, Österreich
| | - K Holzer
- Sektion Endokrine Chirurgie der Viszeral‑, Thorax- u. Gefäßchirurgie, Universitätsklinikum Marburg, Baldingerstr., 35043, Marburg, Deutschland
| | - W Karges
- Sektion Endokrinologie und Diabetologie - Medizinische Klinik III, Universitätsklinikum Aachen, RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - H Krude
- Klinik für Pädiatrie mit Schwerpunkt Endokrinologie und Diabetologie, Charité Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - J Kussmann
- Klinik für Endokrine Chirurgie, Schön Klinik Hamburg-Eilbeck, Dehnhaide 120, 22081, Hamburg, Deutschland
| | - K Lorenz
- Klinik u. Poliklinik f. Allgem.-, Viszeral- u. Gefäßchirurgie, Universitätsklinikum Halle, Ernst-Grube-Str. 40, 06120, Halle, Deutschland
| | - M Luster
- Nuklearmedizin, Universitätsklinikum Gießen und Marburg, GmbH, Standort Marburg, Baldingerstrass, 35041, Marburg, Deutschland
| | - B Niederle
- Sektion Endokrine Chirurgie, Franziskus Spital, Nikolsdorfergasse 32, 1050, Wien, Österreich
| | - C Nies
- Klinik für Allg.- u. Viszeralchirurgie, Marienhospital Osnabrück, Bischofsstr. 1, 49074, Osnabrück, Deutschland
| | - P Riss
- Chirurgische Universitätsklinik, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - J Schabram
- Klinik für Endokrine Chirurgie, Asklepios Klinik Lich, Goethestr. 4, 35423, Lich, Deutschland
| | - P Schabram
- Anwaltskanzlei Ratajczak & Partner, Heinrich-von-Stephan-Str. 25, 79100, Freiburg im Breisgau, Deutschland
| | - K W Schmid
- Pathologie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - D Simon
- Klinik f. Allg.- u. Viszeralchirurgie, Ev. Bethesda Krankenhaus Duisburg GmbH, Heerstr. 219, 47053, Duisburg, Deutschland
| | - Ch Spitzweg
- Medizinische Klinik und Poliklinik II, LMU Klinikum der Universität München - Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland
| | - Th Steinmüller
- Chirurgische Abteilung, Zentrum f. Allg.- u. Viszeralchirurgie, DRK-Kliniken Westend, Spandauer Damm 130, 14050, Berlin, Deutschland
| | - A Trupka
- Chirurgische Klinik, Klinikum Starnberg GmbH, Oßwaldstr. 1, 82319, Starnberg, Deutschland
| | - C Vorländer
- Endokrine Chirurgie, Bürgerhospital Frankfurt am Main, Nibelungenallee 37-41, 60318, Frankfurt am Main, Deutschland
| | - T Weber
- Klinik für Endokrine Chirurgie, Katholisches Klinikum Mainz, An der Goldgrube 11, 55131, Mainz, Deutschland
| | - D K Bartsch
- Klinik für Visceral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Gießen und Marburg, GmbH, Standort Marburg, Baldingerstrass, 35041, Marburg, Deutschland
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Vidal O, Saavedra-Perez D, Vilaça J, Pantoja JP, Delgado-Oliver E, Lopez-Boado MA, Fondevila C. Cirugía endocrina cervical mínimamente invasiva. Cir Esp 2019; 97:305-313. [DOI: 10.1016/j.ciresp.2019.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/15/2019] [Accepted: 03/18/2019] [Indexed: 01/29/2023]
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10
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Juarez MC, Ishii L, Nellis JC, Bater K, Huynh PP, Fung N, Darrach H, Russell JO, Ishii M. Objectively measuring social attention of thyroid neck scars and transoral surgery using eye tracking. Laryngoscope 2019; 129:2789-2794. [DOI: 10.1002/lary.27933] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 02/17/2019] [Accepted: 02/25/2019] [Indexed: 12/31/2022]
Affiliation(s)
| | - Lisa Ishii
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
- Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
| | - Jason C. Nellis
- Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
| | - Kristin Bater
- Johns Hopkins School of Medicine Baltimore Maryland U.S.A
| | | | - Nicholas Fung
- Johns Hopkins School of Medicine Baltimore Maryland U.S.A
| | - Halley Darrach
- Johns Hopkins School of Medicine Baltimore Maryland U.S.A
| | - Jonathon O. Russell
- Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
| | - Masaru Ishii
- Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
- Division of Rhinology, Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
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Tae K, Ji YB, Song CM, Ryu J. Robotic and Endoscopic Thyroid Surgery: Evolution and Advances. Clin Exp Otorhinolaryngol 2018; 12:1-11. [PMID: 30196688 PMCID: PMC6315214 DOI: 10.21053/ceo.2018.00766] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 08/03/2018] [Indexed: 12/13/2022] Open
Abstract
To minimize surgical morbidity and neck scarring, minimally invasive thyroidectomy and robotic/endoscopic thyroidectomy via cervical, axillary, anterior chest, breast, postauricular or transoral approaches have been developed over the past 20 years. In this article, we review the evolution of robotic and endoscopic thyroid surgery and recent advances. Among remote access approaches, the gasless transaxillary approach, bilateral axillo-breast approach, postauricular facelift approach, and transoral vestibular approach are in common use today. Each procedure has its own advantages and disadvantages. Therefore, we need to understand these advantages and limitations, and to select the appropriate method for each patient. The most significant advantage of remote access thyroidectomy is its excellent cosmesis. The complication rate is similar in patients undergoing a remote access approach and those undergoing conventional surgery if the former is performed by experienced surgeons. Operative time is significantly longer in remote access thyroidectomy. In conclusion, remote access thyroidectomy is feasible and its outcomes are comparable to those of conventional transcervical thyroidectomy in highly selected patients.
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Affiliation(s)
- Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Yong Bae Ji
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Chang Myeon Song
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Junsun Ryu
- Department of Otolaryngology-Head and Neck Surgery, Center for Thyroid Cancer, National Cancer Center, Goyang, Korea
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12
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Abstract
PURPOSE Visualization and precise dissection of the parathyroid glands are a crucial step of thyroidectomy. Moreover, identification of parathyroid adenoma in patients with primary hyperparathyroidism can be challenging due to the possible abnormal location of the enlarged parathyroid. Near-infrared fluorescence (NIR) can be adopted during video-assisted neck surgery in addition to standard endoscopic magnification to enhance the visualization of the parathyroid tissue. METHODS Between July and August 2017, five patients (one male, four females) underwent video-assisted neck surgery at our hospital. One patient suffered from primary hyperparathyroidism. The four remaining patients underwent thyroidectomy for multinodular goiter or Graves' disease. The parathyroid glands were firstly identified by the video-assisted approach and then confirmed by the NIR visualization of the endogenous autofluorescence of the parathyroid tissue. Low-dose (2.5 mg/ml) indocyanine green was administered to visualize the vascular supply during and/or after the dissection. The standard dose of 2.5 mg (1 ml per injection) was used to allow repeated injection during the same procedure. RESULTS An endogenous parathyroid autofluorescence could be visualized by the NIR camera in all patients. The right upper parathyroid adenoma could be detected prior to fully dissection of the gland from the surrounding tissue. Twelve out of 16 parathyroid glands have been visually identified during four total thyroidectomies. Eleven glands showed an autofluorescence prior to indocyanine green (ICG) injection. Further, ICG injection has been used for guiding the dissection of the gland in three cases and for confirmation of the vascular supply at the end of the procedure in the remaining cases. There were neither intraoperative nor postoperative complications. CONCLUSION The 5-mm 30° NIR camera allows for enhanced visualization of the parathyroid tissue during video-assisted thyroidectomy. This promising tool can become standard for video-assisted neck surgery.
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13
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Hiperparatiroidismo primario. Med Clin (Barc) 2018; 150:226-232. [DOI: 10.1016/j.medcli.2017.07.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 07/20/2017] [Accepted: 07/24/2017] [Indexed: 11/21/2022]
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Endoscopic Thyroid Surgery Through Trans-oral Vestibular Approach (TOVA): A Case Series and Review of Literature. Indian J Otolaryngol Head Neck Surg 2018; 70:162-166. [PMID: 29456963 DOI: 10.1007/s12070-017-1174-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 07/18/2017] [Indexed: 10/19/2022] Open
Abstract
Endoscopic surgery is now standard of care for different Endocrine Disorders; the endoscopic thyroid surgery is becoming more popular and different approaches has been practice by many thyroid surgeon worldwide. Trans-orovestibular approach, based on the principle of natural orifice transluminal surgery is truly scar free thyroid surgery and has minimal dissection. We are presenting here three cases of benign solitary thyroid nodule operated endoscopically through trans-oro-vestibular approach in one male and two female patients. Described about the approach, challenges during surgery and outcome. These surgeries documented very few in literatures in live human patients. Transoral endoscopic thyroid surgery through vestibular approach is shortest and direct remote access approach. The need of limited dissection in this approach provides less complication and excellent cosmetic outcome in strictly selected patients.
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Shulutko AM, Semikov VI, Osmanov EG, Gryaznov SE, Gorbacheva AV, Patalova AR, Mansurova GT, Kazaryan AM. Evaluation Criteria and Surgical Technique for Transoral Access to the Thyroid Gland: Experimental Study. J INVEST SURG 2018; 32:421-427. [DOI: 10.1080/08941939.2018.1424271] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Alexander M. Shulutko
- Department of Surgery №2, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Vasiliy I. Semikov
- Department of Surgery №2, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Elkhan G. Osmanov
- Department of Surgery №2, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Sergey E. Gryaznov
- Department of Surgery №2, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Anna V. Gorbacheva
- Department of Surgery №2, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Alla R. Patalova
- Department of Surgery №2, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Gaukhar T. Mansurova
- Department of Surgery №2, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Department of Plastic Surgery, Clinic Sirius, Moscow, Russia
| | - Airazat M. Kazaryan
- Department of Gastrointestinal Surgery, Akershus University Hospital, Lørenskog, Norway
- Department of Surgery N1, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia
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16
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Sivakumar T, Amizhthu RA. Transoral endoscopic total thyroidectomy vestibular approach: A case series and literature review. J Minim Access Surg 2018; 14:118-123. [PMID: 29067943 PMCID: PMC5869970 DOI: 10.4103/jmas.jmas_3_17] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Conventional open thyroidectomy is often associated with post-operative complications including nerve damage, voice disturbances, paraesthesias, adhesions and prominent scarring. Several endoscopic surgical techniques have been reported as alternatives to conventional thyroidectomy. Natural orifice transluminal endoscopic surgery is a promising approach which leaves no scar, produces few complications and affords faster discharge from care. Several studies have explored its utility in total thyroidectomy in patients with benign or malignant thyroid disease. Herein, we present a case series on the successful application of transoral endoscopic total thyroidectomy vestibular approach (TOETVA) in benign and malignant diseases of the thyroid. We performed TOETVA in 11 patients presenting with benign or malignant thyroid nodules in our hospital, between 1st January 2015 and 30th June 2016. The surgery was completed successfully in all patients with a pre-operative diagnosis of multinodular goitre. The surgery was performed under general anaesthesia and the mean operative time was 130 min. The mean blood loss was 2–3 cc. No incidence of recurrent laryngeal nerve injury, damage to mental nerve, parathyroid damage or peri-incisional adhesion occurred in the study participants. No visible scarring occurred in the patients following surgery. The patients had an uneventful recovery after the surgery and were discharged after 4 days. TOETVA is safe and effective in the surgical management of multinodular goitre and offers a scar-free alternative to conventional surgery.
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Affiliation(s)
- T Sivakumar
- Associate Professor in Fellowship of Minimal Access Surgey, Siva Hospital, Institute of Minimal Access Surgery, Kanyakumari, Tamil Nadu, India
| | - R A Amizhthu
- Associate Professor in Fellowship of Minimal Access Surgey, Siva Hospital, Institute of Minimal Access Surgery, Kanyakumari, Tamil Nadu, India
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Papavramidis TS, Anastasiou O, Pliakos I, Kotsovolis G, Panidis S, Michalopoulos A. PARATHYROID FUNCTION AFTER TOTAL THYROIDECTOMY: A RANDOMIZED CLINICAL TRIAL CONCERNING THE INFLUENCE OF THE SURGICAL TECHNIQUE. Endocr Pract 2017; 24:150-155. [PMID: 29144799 DOI: 10.4158/ep-2017-0100] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Thyroidectomy impairs parathyroid function, even if it does not necessarily lead to postoperative clinical hypocalcemia. This study was prospective and evaluated the parathyroid hormone (PTH) function in nonclinically symptomatic patients after total thyroidectomy performed by two different techniques. METHODS Prospective randomized clinical trial including 269 patients undergoing classic or harmonic scalpel total thyroidectomy. Pre-operatively and at 48 hours, biochemical analysis was performed. Simultaneously, a sodium bicarbonate test (SBT) was performed. RESULTS Calcium and PTH were altered for both groups ( P<.001). During SBT at 3 minutes after infusion, PTH rose and reached its maximum for both groups ( P<.001) and then decreased at 5 minutes ( P<.001 and P = .004) and at 10 minutes ( P = .006 and P = .043) before returning to baseline levels. At 5 and 10 minutes of the SBT, some differences were observed between the groups. The difference in clinically obvious parathyroid dysfunction between groups was not significant, but there was a difference in the peak PTH levels after bicarbonate stimulation. Similarly, total secretion during the test, as well as total secretion for the first 10 minutes, was practically the same for the two groups. Additionally, partial subclinical postoperative hypoparathyroidism was clearly more common in the harmonic scalpel thyroidectomy group ( P<.001). CONCLUSION SBT demonstrated more impairment in the harmonic scalpel group, as parathyroid function was altered after thyroidectomy. ABBREVIATIONS HSTT = harmonic scalpel total thyroidectomy PTH = parathyroid hormone SBIT = sodium bicarbonate infusion test.
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18
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Sui WF, Li JY, Fu JH. Percutaneous laser ablation for benign thyroid nodules: a meta-analysis. Oncotarget 2017; 8:83225-83236. [PMID: 29137336 PMCID: PMC5669962 DOI: 10.18632/oncotarget.17928] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 05/03/2017] [Indexed: 11/25/2022] Open
Abstract
Purpose To evaluate percutaneous laser ablation in treating benign thyroid nodules, we conducted a meta-analysis based on summarizing existing researches. Materials and Methods A literature search for clinical trial was performed in PubMed, Cochrane Library and Excerpt Medica Database. The qualities of included studies were evaluated. We calculated the indexes with mean difference. Heterogeneity and publication bias were tested and explored. We performed subgroup analyses and sensitivity analysis further. Results A total of 19 researches and 2137 patients were included in this meta-analysis. The pooled estimates of nodule volume were statistically significant after percutaneous laser ablation for 1 month, 3 month, 6month, 12month, 24month and 36month(P < 0.05). The pooled estimate of thyroid-stimulating hormone was statistically significant after percutaneous laser ablation for 1 and 12 month (P = 0.008 and P = 0.03). The pooled estimate of free triiodothyronine was no statistically significant after percutaneous laser ablation for all follow-up intervals. The pooled estimate of free tetraiodothyronin was statistically significant after percutaneous laser ablation1 month (P = 0.004). The pooled estimate of thyroglobulin was statistically significant after percutaneous laser ablation 24 month (P = 0.04). The heterogeneity was found and the source of heterogeneity was explored in nodule volume for 6 and 12 month. No publication bias was found. Conclusions This meta-analysis demonstrated that percutaneous laser ablation was safe and useful in shrinking benign thyroid nodules volume, improving thyroid function, relieving symptoms of pressure and esthetic, especial for hyper-vascular benign thyroid nodules. Larger number of high-quality prospective studies still needs to be performed.
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Affiliation(s)
- Wei Fan Sui
- Department of Interventional Radiology, The Affiliated Renmin Hospital of Jiangsu University, Zhenjiang, 212002, China
| | - Jian Yun Li
- Department of Interventional Radiology, The Affiliated Renmin Hospital of Jiangsu University, Zhenjiang, 212002, China
| | - Jian Hua Fu
- Department of Interventional Radiology, The Affiliated Renmin Hospital of Jiangsu University, Zhenjiang, 212002, China
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Abstract
In thyroid surgery multiple different cervical minimally invasive (partly endoscopically assisted) and extracervical endoscopic (partly robot-assisted) approaches have been developed in the last 20 years. The aim of all these alternative approaches to the thyroid gland is optimization of the cosmetic result. The indications for the use of alternative and conventional approaches are principally the same. Important requirements for the use of alternative methods are nevertheless a broad experience in conventional thyroid operations of the thyroid and adequate patient selection under consideration of the size of the thyroid and the underlying pathology. Contraindications for the use of alternative approaches are a large size of the thyroid gland including local symptoms, advanced carcinomas, reoperations and previous radiations of the anterior neck. The current article gives an overview of the clinically implemented alternative approaches for thyroid surgery. Of those the majority must still be considered as experimental. The alternative approaches to the thyroid gland can be divided in cervical minimally invasive, extracervical endosopic (robot-assisted) and transoral operations (natural orifice transluminal endoscopic surgery, NOTES). Since conventional thyroid operations are standardized procedures with low complication rates, alternative approaches to the thyroid gland are considered critically in Germany. The request for a perfect cosmetic result should not overweigh patients' safety. Only a few alternative approaches (e. g. MIVAT, RAT) can yet be considered as a safe addition in experienced hands in highly selected patients.
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Affiliation(s)
- E Maurer
- Klinik für Visceral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Gießen/Marburg GmbH, Baldingerstraße, 35043, Marburg, Deutschland.
| | - S Wächter
- Klinik für Visceral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Gießen/Marburg GmbH, Baldingerstraße, 35043, Marburg, Deutschland
| | - D K Bartsch
- Klinik für Visceral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Gießen/Marburg GmbH, Baldingerstraße, 35043, Marburg, Deutschland
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Dionigi G, Kim HY, Wu CW, Lavazza M, Materazzi G, Lombardi CP, Anuwong A, Tufano RP. Neuromonitoring in endoscopic and robotic thyroidectomy. Updates Surg 2017; 69:171-179. [DOI: 10.1007/s13304-017-0442-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 04/01/2017] [Indexed: 12/01/2022]
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21
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Shulutko AM, Semikov VI, Gryaznov SE, Gorbacheva AV, Patalova AR, Mansurova GT, Boblak YA. [Transoral approach to thyroid gland in the experiment]. Khirurgiia (Mosk) 2017:25-31. [PMID: 28303870 DOI: 10.17116/hirurgia2017225-31] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To develop minimally invasive and safe endoscopic access to thyroid gland. MATERIAL AND METHODS Transoral pre-mandibular video-assisted gas-free access to thyroid gland was developed in experimental study that included 19 human cadavers. Stereometric modeling defined the evaluation criteria including the form of basal arch of lower jaw and its height. There was no conflict of instruments in working chamber under platysma. Additional trocar was deployed to resolve the conflict between working parts of instruments during thyroid gland mobilization. The angle of operative action between the instruments is close to 90°. Trocar hole is used for drainage. RESULTS The access provides good visualization of recurrent laryngeal nerve, upper and lower thyroid arteries and parathyroid gland. It is less traumatic compared with other extra-cervical accesses to thyroid glands.
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Affiliation(s)
- A M Shulutko
- Chair of Faculty Surgery #2, Sechenov First Moscow State Medical University
| | - V I Semikov
- Chair of Faculty Surgery #2, Sechenov First Moscow State Medical University
| | - S E Gryaznov
- Chair of Faculty Surgery #2, Sechenov First Moscow State Medical University
| | - A V Gorbacheva
- Chair of Faculty Surgery #2, Sechenov First Moscow State Medical University
| | - A R Patalova
- Chair of Faculty Surgery #2, Sechenov First Moscow State Medical University
| | - G T Mansurova
- Chair of Faculty Surgery #2, Sechenov First Moscow State Medical University
| | - Yu A Boblak
- Chair of Faculty Surgery #2, Sechenov First Moscow State Medical University
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22
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Gharib H, Papini E, Garber JR, Duick DS, Harrell RM, Hegedüs L, Paschke R, Valcavi R, Vitti P. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS, AMERICAN COLLEGE OF ENDOCRINOLOGY, AND ASSOCIAZIONE MEDICI ENDOCRINOLOGI MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE DIAGNOSIS AND MANAGEMENT OF THYROID NODULES--2016 UPDATE. Endocr Pract 2016; 22:622-39. [PMID: 27167915 DOI: 10.4158/ep161208.gl] [Citation(s) in RCA: 676] [Impact Index Per Article: 84.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Thyroid nodules are detected in up to 50 to 60% of healthy subjects. Most nodules do not cause clinically significant symptoms, and as a result, the main challenge in their management is to rule out malignancy, with ultrasonography (US) and fine-needle aspiration (FNA) biopsy serving as diagnostic cornerstones. The key issues discussed in these guidelines are as follows: (1) US-based categorization of the malignancy risk and indications for US-guided FNA (henceforth, FNA), (2) cytologic classification of FNA samples, (3) the roles of immunocytochemistry and molecular testing applied to thyroid FNA, (4) therapeutic options, and (5) follow-up strategy. Thyroid nodule management during pregnancy and in children are also addressed. On the basis of US features, thyroid nodules may be categorized into 3 groups: low-, intermediate-and high-malignancy risk. FNA should be considered for nodules ≤10 mm diameter only when suspicious US signs are present, while nodules ≤5 mm should be monitored rather than biopsied. A classification scheme of 5 categories (nondiagnostic, benign, indeterminate, suspicious for malignancy, or malignant) is recommended for the cytologic report. Indeterminate lesions are further subdivided into 2 subclasses to more accurately stratify the risk of malignancy. At present, no single cytochemical or genetic marker can definitely rule out malignancy in indeterminate nodules. Nevertheless, these tools should be considered together with clinical data, US signs, elastographic pattern, or results of other imaging techniques to improve the management of these lesions. Most thyroid nodules do not require any treatment, and levothyroxine (LT4) suppressive therapy is not recommended. Percutaneous ethanol injection (PEI) should be the first-line treatment option for relapsing, benign cystic lesions, while US-guided thermal ablation treatments may be considered for solid or mixed symptomatic benign thyroid nodules. Surgery remains the treatment of choice for malignant or suspicious nodules. The present document updates previous guidelines released in 2006 and 2010 by the American Association of Clinical Endocrinologists (AACE), American College of Endocrinology (ACE) and Associazione Medici Endocrinologi (AME).
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23
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Chen F, Tian G, Kong D, Zhong L, Jiang T. Radiofrequency ablation for treatment of benign thyroid nodules: A PRISMA-compliant systematic review and meta-analysis of outcomes. Medicine (Baltimore) 2016; 95:e4659. [PMID: 27559968 PMCID: PMC5400335 DOI: 10.1097/md.0000000000004659] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 07/21/2016] [Accepted: 07/21/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Thyroid nodules (TNs) usually appearing in the general population have the potential possibility of malignant transformation and common problems of jugular oppression such as dyspnea and hoarseness. We performed this meta-analysis to evaluate the efficiency of radiofrequency ablation (RFA) for the treatment of benign TNs in accord with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statements. METHODS Published literatures were retrieved from PubMed, Embase, Web of Science, and Scopus up to January 27, 2016. Pooled standard mean difference with 95% confidence interval was estimated by fixed- or random-effects model depending on heterogeneity, which was calculated using the Cochran Q, τ, and I statistics. The quality of the articles was evaluated by the Newcastle-Ottawa scale. RESULTS Meta-analysis of data from 1090 patients with 1406 benign TNs in 20 articles showed that with the subgroup stratified by nodule volume, they were significantly decreased at 1, 3, 6, 12, and the last follow-up months, when comparing post-RFA with the initial nodule volume. In addition, the volume also notably declined by cold and hot nodules. By subgrouping into the largest diameter, symptom score, cosmetic score, thyrotropin, triiodothyronine, free thyroxine level, and vascularity, the pooled data indicated that there was a decrease in largest diameter, symptom score, cosmetic score, triiodothyronine level, and vascular scale, an unchanged free thyroxine, and an increased thyrotropin level after RFA. The publication bias for this particular study is presented in the following groups: nodule volume reduction at 6 months and last follow-up month after RFA and symptom score. CONCLUSION In summary, by pooling of these studies we recommended that RFA indeed has the advantages in improving outcomes and providing better prognosis for patients with benign TNs.
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Affiliation(s)
- Fen Chen
- Hepatobiliary and Pancreatic Intervention Center
| | - Guo Tian
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine
| | | | - Liyun Zhong
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Tian’an Jiang
- Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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24
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Rosato L, De Crea C, Bellantone R, Brandi ML, De Toma G, Filetti S, Miccoli P, Pacini F, Pelizzo MR, Pontecorvi A, Avenia N, De Pasquale L, Chiofalo MG, Gurrado A, Innaro N, La Valle G, Lombardi CP, Marini PL, Mondini G, Mullineris B, Pezzullo L, Raffaelli M, Testini M, De Palma M. Diagnostic, therapeutic and health-care management protocol in thyroid surgery: a position statement of the Italian Association of Endocrine Surgery Units (U.E.C. CLUB). J Endocrinol Invest 2016; 39:939-53. [PMID: 27059212 DOI: 10.1007/s40618-016-0455-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 03/08/2016] [Indexed: 02/08/2023]
Abstract
PURPOSE The diagnostic, therapeutic and health-care management protocol (Protocollo Gestionale Diagnostico-Terapeutico-Assistenziale, PDTA) by the Association of the Italian Endocrine Surgery Units (U.E.C. CLUB) aims to help treat the patient in a topical, rational way that can be shared by health-care professionals. METHODS This fourth consensus conference involved: a selected group of experts in the preliminary phase; all members, via e-mail, in the elaboration phase; all the participants of the XI National Congress of the U.E.C. CLUB held in Naples in the final phase. The following were examined: diagnostic pathway and clinical evaluation; mode of admission and waiting time; therapeutic pathway (patient preparation for surgery, surgical treatment, postoperative management, management of major complications); hospital discharge and patient information; outpatient care and follow-up. RESULTS A clear and concise style was adopted to illustrate the reasons and scientific rationales behind behaviors and to provide health-care professionals with a guide as complete as possible on who, when, how and why to act. The protocol is meant to help the surgeon to treat the patient in a topical, rational way that can be shared by health-care professionals, but without influencing in any way the physician-patient relationship, which is based on trust and clinical judgment in each individual case. CONCLUSIONS The PDTA in thyroid surgery approved by the fourth consensus conference (June 2015) is the official PDTA of U.E.C. CLUB.
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Affiliation(s)
- L Rosato
- Department of Surgery, ASL TO4, Ivrea Hospital, School of Medicine, Turin University, Turin, Italy
| | - C De Crea
- Endocrine and Metabolic Surgery, Policlinico Agostino Gemelli, Catholic University, Rome, Italy.
| | - R Bellantone
- Endocrine and Metabolic Surgery, Policlinico Agostino Gemelli, Catholic University, Rome, Italy
| | - M L Brandi
- Clinical Unit on Metabolic Bone Disorders, University Hospital of Florence, Florence, Italy
| | - G De Toma
- Endocrine Surgery, Department of Surgery "P. Valdoni", "La Sapienza" University, Rome, Italy
| | - S Filetti
- Department of Clinical Sciences, "La Sapienza" University, Rome, Italy
| | - P Miccoli
- Endocrine Surgery, Department of Surgery, Pisa University, Rome, Italy
| | - F Pacini
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - M R Pelizzo
- Endocrine Surgery, Department of Surgery, Padua University, Padua, Italy
| | - A Pontecorvi
- Department of Endocrinology, Catholic University, Rome, Italy
| | - N Avenia
- Department of Surgery, "S. Maria" Terni Hospital, Perugia University, Perugia, Italy
| | - L De Pasquale
- Endocrine and Breast Surgical Unit, Department of Surgery, "S. Paolo" Hospital, Milan, Italy
| | - M G Chiofalo
- Thyroid Surgery, Department of Surgery, I.N.T. "Pascale" of Naples, Naples, Italy
| | - A Gurrado
- Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, Bari University, Bari, Italy
| | - N Innaro
- Endocrine Surgery, Department of Surgery, "Mater Domini" Hospital, Catanzaro, Italy
| | - G La Valle
- Health Management, Piedmont Region, ASL TO4, School of Medicine, Turin University, Turin, Italy
| | - C P Lombardi
- Endocrine and Metabolic Surgery, Policlinico Agostino Gemelli, Catholic University, Rome, Italy
| | - P L Marini
- Endocrine Surgery, Department of Surgery, "S. Camillo-Forlanini" Hospital, Rome, Italy
| | - G Mondini
- General Surgery, Endocrine and Breast Surgical Unit, Department of Surgery, ASL TO4, Ivrea Hospital, Turin, Italy
| | - B Mullineris
- General Surgery and Endocrine Surgical Unit, Department of Surgery, Sant'Agostino-Estense NOCSAE, Modena, Italy
| | - L Pezzullo
- Thyroid Surgery, Department of Surgery, I.N.T. "Pascale" of Naples, Naples, Italy
| | - M Raffaelli
- Endocrine and Metabolic Surgery, Policlinico Agostino Gemelli, Catholic University, Rome, Italy
| | - M Testini
- Unit of Endocrine, Digestive, and Emergency Surgery, Department of Biomedical Sciences and Human Oncology, Bari University, Bari, Italy
| | - M De Palma
- Department of Surgery, A.O.R.N. "Cardarelli" Hospital, Naples, Italy
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25
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Dordea M, Aspinall SR. Short and long-term cosmesis of cervical thyroidectomy scars. Ann R Coll Surg Engl 2016; 98:11-7. [PMID: 26688393 PMCID: PMC5234393 DOI: 10.1308/rcsann.2016.0022] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2015] [Indexed: 12/14/2022] Open
Abstract
Introduction Multiple surgical approaches to the thyroid gland have been described via cervical or extracervical routes. Improved cosmesis, patient satisfaction, reduced pain (procedure dependent) and early discharge have all been reported for minimally invasive approaches with similar safety profiles and long-term outcomes to conventional surgery. This review summarises the current evidence base for improved cosmesis with minimally invasive cervical approaches to the thyroid gland compared with conventional surgery. Methods A systematic review was undertaken. The MEDLINE(®), Embase™ and Cochrane databases were searched for relevant articles. Results A total of 57 papers thyroid papers were identified. Of those, 20 reported some form of cosmetic outcome assessment. There were 6 randomised controlled trials with 412 patients (evidence level 2B), 7 cohort studies with 3,073 patients (level 3B) and 7 non-comparative case series with 1,575 patients (level 4). There was significant heterogeneity between studies in terms of wound closure technique, timing of scar assessment and scar assessment scales (validated and non-validated). Most studies performed early scar assessments, some using non-validated scar assessment tools. Conclusions Assessment of cosmesis is complex and requires rigorous methodology. Evidence from healing/remodelling studies suggests scar maturation is a long-term process. This calls into question the value of early scar assessment. Current evidence does not support minimally invasive surgical approaches to the thyroid gland if improved long-term cosmesis is the goal.
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Affiliation(s)
- M Dordea
- Northumbria Healthcare NHS Foundation Trust , UK
| | - S R Aspinall
- Northumbria Healthcare NHS Foundation Trust , UK
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Abstract
BACKGROUND Today is well known that endoscopic thyroidectomy could reach the same level of completeness as a conventional operation. We have been using minimally invasive video assisted thyroidectomy (MIVAT) as our favorite minimally invasive access to thyroid diseases from the late nineties. METHODS Our experience with MIVAT is represented by 2,413 cases between 1998 and 2014: in particular 821 patients were operated with a total thyroidectomy for a papillary carcinoma (34.0%). Furthermore 967 patients underwent a MVAT for the presence of an undetermined lesion (40.0%). RESULTS The conversion rate was very low: 24 patients (1.0%), mainly due to: unexpected posterior tracheal invasions (nine patients), involvement of lymph nodes not evident at echography (four patients), esophageal infiltration (three patients), strap muscles infiltration (three patients) and finally in five cases the presence of serious thyroiditis that had escaped to ultrasonographic evaluation. CONCLUSIONS The minimally MIVAT to treat malignant thyroid tumors has today a very clear indication for malignancies.
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Affiliation(s)
- Paolo Miccoli
- Department of Surgery, University of Pisa, Pisa, Italy
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Miccoli P, Biricotti M, Matteucci V, Ambrosini CE, Wu J, Materazzi G. Minimally invasive video-assisted thyroidectomy: reflections after more than 2400 cases performed. Surg Endosc 2015; 30:2489-95. [PMID: 26335076 DOI: 10.1007/s00464-015-4503-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 08/03/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND The minimally invasive video-assisted approach was developed for primary hyperparathyroidism in 1997 and the year after for thyroid disease. Since then, the technique has been adopted worldwide, and indications moved from the initial benign disease to low-risk and intermediate-risk carcinoma, demonstrating a level of oncologic radicality comparable to the conventional open approach when inclusion criteria are strictly respected. METHODS Between 1998 and 2014, 2412 minimally invasive video-assisted thyroidectomies (MIVAT) were performed in our department. The indication for surgery in 825 patients (34.3 %) was a malignant tumor, in particular, a papillary carcinoma in 800 patients. Among them, 528 patients operated on between 2000 and 2009 had a mean complete follow-up of 7.5 (standard deviation, 2.3) years. RESULTS A total thyroidectomy was performed in 1788 patients (74.1 %) and a hemithyroidectomy in 564 (23.4 %). Also performed was central compartment lymphadenectomy in 31 patients (1.3 %) and parathyroidectomy for the presence of a solitary parathyroid adenoma in 29 (1.2 %). Mean duration of the procedure was 41 (standard deviation, 14) minutes. After a mean follow-up of 7. 5 years, 528 patients who underwent MIVAT for low-risk or intermediate-risk papillary carcinoma presented a cure rate of 85 % (undetectable thyroglobulin), comparable with the 80 % rate reported in patients who had undergone open thyroidectomy during the same period. CONCLUSIONS After a long experience and a considerable number of procedures performed in a single center, MIVAT is confirmed as a safe operation, with a complication rate comparable with open thyroidectomy. MIVAT offers a cure rate for the treatment of low-risk and intermediate-risk malignancies that is comparable with an open procedure when inclusion criteria are strictly respected.
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Affiliation(s)
- P Miccoli
- Department of Surgery, University of Pisa, Pisa, Italy
| | - M Biricotti
- Department of Surgery, University of Pisa, Pisa, Italy
| | - V Matteucci
- Department of Surgery, University of Pisa, Pisa, Italy
| | - C E Ambrosini
- Department of Surgery, University of Pisa, Pisa, Italy.
| | - J Wu
- Asia Institute Tele-Surgery, Show-Chwan Memorial Hospital, Changhua, Taiwan
| | - G Materazzi
- Department of Surgery, University of Pisa, Pisa, Italy
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Minimally invasive video-assisted thyroidectomy for papillary thyroid cancer: a prospective 5-year follow-up study. TUMORI JOURNAL 2015; 101:144-7. [PMID: 25791536 DOI: 10.5301/tj.5000223] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Minimally invasive video-assisted thyroidectomy (MIVAT) was initially introduced for the treatment of selected patients who met certain thyroid volume, nodule size and pathological criteria. Recent studies indicate that the completeness of resection of malignant nodules is comparable to that obtained with conventional thyroidectomy. AIMS To compare the 5-year outcomes in patients with papillary thyroid carcinoma (PTC) treated with MIVAT versus conventional thyroidectomy. METHODS In this prospective cohort study conducted over 2 years (July 2005-June 2007), 172 patients with node-negative, nonmetastatic PTC underwent either MIVAT (n = 67) or conventional thyroidectomy (n = 105). Study outcomes were 1) the cumulative dose of radioactive iodine (RAI) to achieve a disease-free state, defined as a stimulated serum thyroglobulin (Tg) level <2 ng/mL with negative Tg antibody and no tumor on a whole-body scan or cross-sectional imaging, and 2) the 5-year serum Tg level. RESULTS The clinical parameters of the MIVAT and conventional thyroidectomy groups were comparable except for age (mean 43 ± 12 vs. 59 ± 17 years, respectively; p = 0.03) and operative time (mean 69 ± 24 vs. 53 ± 16 minutes, p = 0.02); the mean tumor size was similar between groups (1.3 ± 0.7 vs. 1.6 ± 0.9 cm, p = 0.14). Surgical morbidity was similar in both groups. Median follow-up was 5 years. RAI dose (mean 72 ± 38 vs. 96 ± 47 mCu, p = 0.34) and serum Tg at 5 years (mean 0.3 ± 0.2 vs. 0.5 ± 0.3 ng/mL, p = 0.30) were not significantly different between the MIVAT and conventional thyroidectomy groups. CONCLUSIONS MIVAT can be safely utilized in patients with localized PTC, providing comparable completeness of resection and oncological outcome to conventional thyroidectomy.
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Xia LY, He C, Huang XW, Xi X, Liu XK. The operation experience of endoscopic thyroidectomy by areola and axilla approach. Eur Arch Otorhinolaryngol 2014; 273:555-8. [PMID: 25480477 DOI: 10.1007/s00405-014-3424-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 11/29/2014] [Indexed: 10/24/2022]
Abstract
To explore the feasibility of endoscopic thyroidectomy via breast areola and axilla approach. The clinical data of 36 cases that underwent endoscopic thyroidectomy via breast areola and axilla approach from February 2012 to December 2013 were reviewed. All cases were completed, the mean operation time was 136.3 min (95-183 min), intraoperative blood loss was 15.8 ml (5-60 ml). The average hospitalization time was 5 days (4-6 days). There were no conversions to open surgery, no permanent nerve injuries, and no cases of hypoparathyroidism. Three patients had postoperative subcutaneous ecchymosis who were cured spontaneously after 1 month. Endoscopic thyroidectomy is safe and feasible for patients with thyroid diseases with good cosmetic results, and is worthy of being widely applied for patients who have cosmetic demand.
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Affiliation(s)
- Lai-Yang Xia
- Department of General Surgery, The People's Hospital Of Ganzhou, Ganzhou Affiliated Hospital of Nanchang University, Ganzhou, 341000, China
| | - Chun He
- Department of General Surgery, The People's Hospital Of Ganzhou, Ganzhou Affiliated Hospital of Nanchang University, Ganzhou, 341000, China
| | - Xing-Wei Huang
- Department of General Surgery, The People's Hospital Of Ganzhou, Ganzhou Affiliated Hospital of Nanchang University, Ganzhou, 341000, China
| | - Xun Xi
- Department of General Surgery, The People's Hospital Of Ganzhou, Ganzhou Affiliated Hospital of Nanchang University, Ganzhou, 341000, China
| | - Xue-Kui Liu
- Department of Head and Neck Surgery, State Key Laboratory of Oncology in South China, Cancer Center of Sun Yat-Sen University, Guangzhou, Guangdong, 510060, China.
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30
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Piniek A, Schuhmann R, Coerper S. [Minimally invasive video-assisted thyroidectomy: establishment in a thyroid center]. Chirurg 2014; 85:246-52. [PMID: 24218083 DOI: 10.1007/s00104-013-2624-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND This study retrospectively evaluated a series of patients who underwent minimally invasive video-assisted thyroidectomy (MIVAT) during the introduction stage of this surgical technique at the Martha-Maria Hospital in Nuremberg. PATIENTS AND METHODS The eligibility criteria for MIVAT were a thyroid volume < 25 ml, nodules < 30 mm, no thyroiditis, no preoperative evidence of carcinoma and no previous neck surgery. A retrospective evaluation was performed together with a control group of patients who underwent conventional thyroid surgery during the same time period and included a follow-up for general patient satisfaction and cosmetic results. RESULTS Between August 2008 and July 2009 a total of 55 patients underwent MIVAT including 8 conversions to open surgery and 45 patients who underwent conventional surgery served as matched controls. No significant differences in terms of perioperative complication rates were found (e.g. recurrent laryngeal nerve palsy, hypocalcemia or secondary hemorrhage). The mean operating time was significantly longer in the MIVAT group (96.8 ± 3.7 min vs. 69.8 ± 2.3 min, p = 0.001) whereas a significant decrease in the mean operating time for hemithyroidectomy after 5 months was observed (98.1 ± 3.77 min vs. 76.0 ± 4.98 min, p = 0.013). Patients in the MIVAT group were more satisfied with the cosmetic outcome (8.5 ± 0.3 vs. 8.2 ± 0.2, p = 0.05) as well as with the overall surgical procedure (9.0 ± 0.3 vs. 8.6 ± 0.2, p = 0.02). CONCLUSION During introduction of the MIVAT procedure a learning effect can be observed which is hallmarked by a decrease in operating time and conversion rate to open surgery. Moreover, no significant differences in terms of main postoperative complications were found so that MIVAT can be considered a safe and feasible technique under the conditions of correct eligibility criteria.
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Affiliation(s)
- A Piniek
- Chirurgisches Schilddrüsen- und Nebenschilddrüsenzentrum, Klinik für Allgemein-, Visceral- und Gefäßchirurgie, Krankenhaus Martha-Maria, Stadenstr. 58, 90491, Nürnberg, Deutschland,
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Dralle H, Machens A, Thanh PN. Minimally invasive compared with conventional thyroidectomy for nodular goitre. Best Pract Res Clin Endocrinol Metab 2014; 28:589-99. [PMID: 25047208 DOI: 10.1016/j.beem.2013.12.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Since minimally invasive thyroidectomy was introduced in 1997, different surgical approaches to the thyroid have been described: the minimal neck incision and the anterior chest, areolar breast or axillary access. Whereas conventional open thyroidectomy is suitable for any thyroid disease, minimal neck incision thyroidectomy or extracervical scarless neck thyroidectomy are limited to small-volume disease. In 11 prospective randomized studies and six systematic reviews, minimally invasive video-assisted thyroidectomy via a central or lateral neck approach afforded better cosmesis in the first 3 months than conventional open thyroidectomy, with less postoperative pain for the first 48 h. Surgical morbidity did not differ in these limited studies. No head-to-head comparison is available for extracervical scarless neck thyroidectomy and conventional open thyroidectomy. Extracervical scarless neck thyroidectomy caused more postoperative pain and gave rise to complications not seen with minimal neck incision thyroidectomy or conventional open thyroidectomy. In the absence of evidence to the contrary, conventional open thyroidectomy continues to remain the gold standard for any nodular goitre.
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Affiliation(s)
- Henning Dralle
- Department of General, Visceral and Vascular Surgery, University Hospital, Medical Faculty, University of Halle-Wittenberg, Ernst-Grube-Str. 40, D-06097 Halle/Saale, Germany.
| | - Andreas Machens
- Department of General, Visceral and Vascular Surgery, University Hospital, Medical Faculty, University of Halle-Wittenberg, Ernst-Grube-Str. 40, D-06097 Halle/Saale, Germany
| | - Phuong Nguyen Thanh
- Department of General, Visceral and Vascular Surgery, University Hospital, Medical Faculty, University of Halle-Wittenberg, Ernst-Grube-Str. 40, D-06097 Halle/Saale, Germany
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Endoscopic thyroidectomy via areola approach: summary of 1,250 cases in a single institution. Surg Endosc 2014; 29:192-201. [PMID: 24986013 DOI: 10.1007/s00464-014-3658-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 04/20/2014] [Indexed: 10/25/2022]
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Ruggiero R, Gubitosi A, Conzo G, Gili S, Bosco A, Pirozzi R, Cosenza C, Rossetti G, Fei L, Docimo G, Docimo L. Sutureless thyroidectomy. Int J Surg 2014; 12 Suppl 1:S189-93. [PMID: 24859410 DOI: 10.1016/j.ijsu.2014.05.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 05/03/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The ultrasonic scalpel is a surgical shear that uses high-frequency mechanical energy to enable simultaneous vessel sealing and tissue coagulation at the same time. We conducted a prospective study to compare the outcome of total thyroidectomy using the ultrasonic scalpel versus the device Ligasure in terms of safety, operative time, overall drainage volume, complications, hospital stay. METHODS Between January 2008 and December 2013,400 patients (260 women, 140 men; mean age 46 years) undergoing thyroidectomy were randomized into two groups: group A, where Ultracision were used, and group B, where the Ligasure device was used. RESULTS There was no significant differences between the two groups in terms of age, gender, indication for thyroidectomy, thyroid gland weight and diameter, histopathologic diagnosis, preoperative and postoperative serum calcium levels, postoperative complications and reoperative thyroid surgery, time of operation and amount of drainage. CONCLUSIONS The ultrasonic scalpel and the Ligasure ares safe, effective, useful, and time-saving alternative to the traditional suture ligation technique for thyroid surgery. They simplified total thyroidectomy, eliminating the need for clamp-and-tie maneuvers while achieving efficient hemostasis.
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Affiliation(s)
- Roberto Ruggiero
- Division of General Surgery, Department of Surgery, Second University of Naples, Italy
| | - Adelmo Gubitosi
- Division of General Surgery, Department of Surgery, Second University of Naples, Italy
| | - Giovanni Conzo
- Division of General Surgery, Department of Surgery, Second University of Naples, Italy
| | - Simona Gili
- Division of General Surgery, Department of Surgery, Second University of Naples, Italy
| | - Alfonso Bosco
- Division of General Surgery, Department of Surgery, Second University of Naples, Italy
| | - Raffaele Pirozzi
- Division of General Surgery, Department of Surgery, Second University of Naples, Italy
| | - Cosma Cosenza
- Division of General Surgery, Department of Surgery, Second University of Naples, Italy
| | - Gianluca Rossetti
- Division of General Surgery, Department of Surgery, Second University of Naples, Italy
| | - Landino Fei
- Division of General Surgery, Department of Surgery, Second University of Naples, Italy
| | - Giovanni Docimo
- Division of General Surgery, Department of Surgery, Second University of Naples, Italy.
| | - Ludovico Docimo
- Division of General Surgery, Department of Surgery, Second University of Naples, Italy
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Woo SH. Endoscope-Assisted Transoral Thyroidectomy Using a Frenotomy Incision. J Laparoendosc Adv Surg Tech A 2014; 24:345-9. [DOI: 10.1089/lap.2014.0110] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Seung Hoon Woo
- Department of Otolaryngology and Institute of Health Sciences, Gyeongsang National University, Jinju, Korea
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Cosmetic Result and Overall Satisfaction after Minimally Invasive Video-assisted Thyroidectomy (MIVAT) versus Robot-assisted Transaxillary Thyroidectomy (RATT): A Prospective Randomized Study. World J Surg 2014; 38:1282-8. [DOI: 10.1007/s00268-014-2483-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Graves disease is an autoimmune disorder characterized by goitre, hyperthyroidism and, in 25% of patients, Graves ophthalmopathy. The hyperthyroidism is caused by thyroid hypertrophy and stimulation of function, resulting from interaction of anti-TSH-receptor antibodies (TRAb) with the TSH receptor on thyroid follicular cells. Measurements of serum levels of TRAb and thyroid ultrasonography represent the most important diagnostic tests for Graves disease. Management of the condition currently relies on antithyroid drugs, which mainly inhibit thyroid hormone synthesis, or ablative treatments ((131)I-radiotherapy or thyroidectomy) that remove or decrease thyroid tissue. None of these treatments targets the disease process, and patients with treated Graves disease consequently experience either a high rate of recurrence, if receiving antithyroid drugs, or lifelong hypothyroidism, after ablative therapy. Geographical differences in the use of these therapies exist, partially owing to the availability of skilled thyroid surgeons and suitable nuclear medicine units. Novel agents that might act on the disease process are currently under evaluation in preclinical or clinical studies, but evidence of their efficacy and safety is lacking.
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Affiliation(s)
- Luigi Bartalena
- Department of Clinical and Experimental Medicine, University of Insubria, Endocrine Unit, Ospedale di Circolo, Viale Borri, 57, 21100 Varese, Italy
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37
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Pisanu A, Podda M, Reccia I, Porceddu G, Uccheddu A. Systematic review with meta-analysis of prospective randomized trials comparing minimally invasive video-assisted thyroidectomy (MIVAT) and conventional thyroidectomy (CT). Langenbecks Arch Surg 2013; 398:1057-68. [PMID: 24162166 DOI: 10.1007/s00423-013-1125-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 09/22/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Minimally invasive video-assisted thyroidectomy (MIVAT) has gained acceptance among surgeons as its feasibility has been well documented. The aim of this systematic review with meta-analysis has been to assess and validate the safety and feasibility of MIVAT when compared to conventional thyroidectomy (CT) and to verify other potential benefits and drawbacks. METHODS A literature search for prospective randomized trials comparing MIVAT and CT was performed. Trials were reviewed for the primary outcome measures: overall morbidity, recurrent laryngeal nerve palsy, postoperative hypocalcemia, and postoperative hematoma; and for the secondary outcome measures: operative time, conversion to standard procedure, intraoperative blood loss, intraoperative drain insertion, nodule size and thyroid weight, postoperative pain evaluation, length of hospital stay, patient satisfactory score, and cosmetics results. Standardized mean difference (SMD) was calculated for continuous variables and odds ratio for qualitative variables. RESULTS Nine prospective randomized studies comparing MIVAT and CT were analyzed. Overall, 581 patients were randomized to either MIVAT (289, 49.7 %) or CT (292, 50.3 %). The primary outcome measures of MIVAT were comparable with those of CT without statistically significant difference. Patients who underwent MIVAT experienced significantly less pain than those operated on conventionally during the whole postoperative period. Patient satisfactory score significantly favored MIVAT (9.0 vs. 6.8, SMD = -3.388, 95 % CI = -5.720 to -1.057). Operative time was significantly longer in MIVAT (75.2 vs. 59.2 min, SMD = 1.246, 95 % CI = 0.227-2.266). CONCLUSIONS MIVAT is a safe and feasible alternative for the removal of small-volume benign thyroid disease and low-risk papillary thyroid carcinomas showing better cosmetics results and less postoperative pain but significantly longer operative time when compared to CT. New multicenter randomized studies are needed to evaluate the technique in more complex circumstances such as intermediate-risk thyroid cancer, lymph node removal, thyroiditis, and Graves' disease.
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Affiliation(s)
- Adolfo Pisanu
- Department of Surgery, Clinica Chirurgica, University of Cagliari, Monserrato, Italy,
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38
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Lee MC, Park H, Choi IJ, Lee BC, Lee GH. Comparative study of a gasless transaxillary approach versus a bilateral axillo-breast approach for endoscopic thyroidectomy in a single institute. Head Neck 2013; 36:702-8. [PMID: 23606356 DOI: 10.1002/hed.23349] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 02/01/2013] [Accepted: 04/09/2013] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Gasless transaxillary approach (TA) and the bilateral axillo-breast approach (BABA) are 2 distinctive approaches for endoscopic thyroidectomy. The purpose of this study was to evaluate and compare these 2 procedures. METHODS From May 2008 to July 2011, we performed endoscopic hemithyroidectomy via gasless TA (83 cases) and BABA (45 cases). The following variables were evaluated: operation time, postoperative pain score, drainage amount, drainage day, postoperative complications, and cosmetic satisfaction score. RESULTS There were no significant differences between the 2 approaches in terms of clinicopathologic characteristics and surgical outcomes, except for postoperative pain and cosmetic satisfaction. As for postoperative pain and cosmetic satisfaction, the gasless TA group complained of less pain and the BABA group had a better cosmetic outcome. CONCLUSION These findings will contribute to providing guidelines for the choice of surgeons between gasless TA and BABA techniques for endoscopic thyroidectomy.
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Affiliation(s)
- Myung-Chul Lee
- Department of Otorhinolaryngology, Korea Cancer Center Hospital, Seoul, Korea
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39
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Kayaoglu HA, Yenidogan E, Okan I, Ozkan N. Novel approach to thyroid skin incision with tunnel dissection technique. SURGICAL PRACTICE 2013. [DOI: 10.1111/1744-1633.12015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Erdinc Yenidogan
- Department of General Surgery; Gaziosmanpasa University; Tokat; Turkey
| | - Ismail Okan
- Department of General Surgery; Gaziosmanpasa University; Tokat; Turkey
| | - Namik Ozkan
- Department of General Surgery; Gaziosmanpasa University; Tokat; Turkey
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40
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Zhang S, Zheng Y, Wu B, Zhou F, Zhang Q. Meta-analysis of video-assisted thyroidectomy versus conventional thyroidectomy. SURGICAL PRACTICE 2013. [DOI: 10.1111/1744-1633.12016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
| | - Yihu Zheng
- Department of General Surgery, The First Affiliated Hospital; Wenzhou Medical College; Wenzhou; China
| | - Binbin Wu
- Department of Anesthesia, The Second Affiliated Hospital; Wenzhou Medical College; Wenzhou; China
| | - Feng Zhou
- Department of General Surgery, The First Affiliated Hospital; Wenzhou Medical College; Wenzhou; China
| | - Qiyu Zhang
- Department of General Surgery, The First Affiliated Hospital; Wenzhou Medical College; Wenzhou; China
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Trans-Oral Video-Assisted Neck Surgery (TOVANS). A new transoral technique of endoscopic thyroidectomy with gasless premandible approach. Surg Endosc 2012. [PMID: 23179070 PMCID: PMC3599170 DOI: 10.1007/s00464-012-2588-6] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background Endoscopic thyroidectomy is a well-established surgical technique. We have been utilizing precordial video-assisted neck surgery (VANS) with a gasless anterior neck skin lifting method. Recently, natural orifice transluminal endoscopic surgery (NOTES) has generated excitement among surgeons as potentially scar-free surgery. We developed an innovative gasless transoral technique for endoscopic thyroidectomy that incorporated the concept of NOTES in a VANS-technique. Methods Incision was made at the vestibulum under the inferior lip. From the vestibulum to the anterior cervical region, a subplatysmal tunnel in front of the mandible was created and cervical skin was lifted by Kirschner wires and a mechanical retracting system. This method without CO2 insufflation created an effective working space and provided an excellent cranio-caudal view so that we could perform thyroidectomy and central node dissection safely. Results Beginning with our first clinical application of TOVANS in September 2009, we have performed eight such procedures. Three of the eight patients had papillary microcarcinoma and received central node dissection after thyroidectomy. All patients began oral intake 1 day after surgery. The sensory disorder around the chin persisted more than 6 months after surgery in all patients. Recurrent laryngeal nerve palsy revealed in one patient. Nobody had mental nerve palsy, and no infection developed with use of preventive antibacterial tablets for 3 days. Conclusions We developed a new method for gasless transoral endoscopic thyroidectomy with a premandible approach and anterior neck-skin lifting. TOVANS makes possible complete endoscopic radical lymphadenectomy for papillary thyroid cancer. We believe that this method is innovative and progressive and has not only a cosmetic advantage but also provides easy access to the central node compartment for dissection in endoscopic thyroid cancer surgery.
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Yu JJ, Bao SL, Yu SL, Zhang DQ, Loo WTY, Chow LWC, Su L, Cui Z, Chen K, Ma LQ, Zhang N, Yu H, Yang YZ, Dong Y, Yip AYS, Ng ELY. Minimally invasive video-assisted thyroidectomy for the early-stage differential thyroid carcinoma. J Transl Med 2012; 10 Suppl 1:S13. [PMID: 23046557 PMCID: PMC3445859 DOI: 10.1186/1479-5876-10-s1-s13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Minimally invasive video-assisted thyroidectomy (MIVAT), the modified Miccoli’s thyroid surgery, is the most widespread minimally invasive technique and has been widely used for treatment of thyroid disease. This study aimed to verify the potential benefits of the modified Miccoli’s thyroid surgery, determine the feasibility of the MIVAT for early-stage differential thyroid carcinoma and evaluate the likelihood of the surgical method as a standard operation for early malignant thyroid carcinoma. Methods A total of 135 patients were retrospectively compared which included two groups of patients: the first group underwent the conventional thyroidectomy; the other group underwent MIVAT. Patients with thyroid nodule smaller than 20 mm and without previous neck surgery were included while those with wide-ranging and distant metastases of cervical tissues, or any suspected thyroid nodal metastases were excluded for analysis. MIVAT and the central compartment (level VI) lymph nodes dissection (LND) were considered as a new treatment method for this retrospective study. In addition to the comparison of surgical outcomes between the new treatment and the conventional thyroid surgery, other surgical parameters including operative time, operative volume of hemorrhage, incisional length, postoperative volume of drainage, length of hospitalization, accidence of hoarse voice, accidence of bucking, accidence of hypocalcemia and peak angle of cervical axial rotation were also compared. Results Out of 135 patients, 111 patients underwent conventional thyroid surgery and 24 patients underwent MIVAT plus level VI LND for treatment of early-stage differential malignant carcinoma. Patients who received the new surgical treatment had significantly shorter incisional length (3.1 cm vs. 6.9 cm, p < 0.0001), shorter operative time (109 min vs. 139 min, p = 0.014) and fewer operative hemorrhage (29.5 ml vs. 69.7 ml, p < 0.0001) when compared to the conventional treatment. Postoperative peak angle of cervical axial rotation of patients treated with MIVAT was less than those treated with conventional surgery (L: 31.5° vs. 39.0°, p < 0.0001; R: 31.5° vs. 38.0°, p < 0.0001). Incisional wound infection, postoperative hoarse voice, bucking and hypocalcemia were not observed in all patients. Postoperative analgetica was not required as well. Conclusions Compared with conventional thyroid surgery for early-stage differential thyroid carcinoma, the new surgical treatment could be considered as an alternative surgical method for treatment of early-stage thyroid carcinoma since it was feasible, safe and clinically effective with better surgical and cosmetic outcomes.
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Affiliation(s)
- Jian-jun Yu
- Department of Surgical-oncology, Affiliated Tumor Hospital, Ningxia Medical University, Ningxia, PR China.
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Minimally invasive video-assisted thyroidectomy: seven-year experience with 240 cases. Wideochir Inne Tech Maloinwazyjne 2012; 7:175-80. [PMID: 23256022 PMCID: PMC3516984 DOI: 10.5114/wiitm.2011.28871] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 02/27/2012] [Accepted: 03/10/2012] [Indexed: 12/31/2022] Open
Abstract
Introduction Minimally invasive video-assisted thyroidectomy (MIVAT) has gained acceptance in recent years as an alternative to conventional thyroid surgery. Aim Assessment of our 7-year experience with MIVAT. Material and methods A retrospective study of 240 consecutive patients who underwent MIVAT at our institution between 01/2004 and 05/2011 was conducted. The inclusion criterion was a single thyroid nodule below 30 mm in diameter within the thyroid of 25 ml or less in volume. The exclusion criteria were previous thyroid or parathyroid surgery, T2 or higher thyroid cancer, N1 stage, and thyroiditis. The Miccoli technique was used. The analysis included indications, eligibility rate, operative time, morbidity and cosmetic effects. Results Of 6,574 patients referred for thyroid surgery, 240 (3.6%) were eligible for MIVAT. In the final pathology report, there were 206 follicular adenomas, 21 papillary thyroid cancers, 9 cases of Graves’ disease and 4 follicular cancers. Reasons for exclusion were as follows: thyroid volume above 25 ml in 5401 (85.3%), thyroid cancer larger than stage T1 in 392 (6.2%), thyroiditis in 358 (5.6%), and previous neck surgery in 183 patients (2.9%). Minimally invasive video-assisted thyroidectomy operations consisted of 210 lobectomies and 30 total thyroidectomies, including 15 one-stage parathyroidectomies. Mean operative time was 38.6 ±15.1 min. Transient versus permanent recurrent laryngeal nerve injury was found in 8 (3.0%) vs. 2 (0.7%) nerves at risk, respectively. Cosmetic effects were assessed after 1 and 6 months of follow-up as very good or excellent by 89.6% and 95.8% of patients, respectively. Conclusions Minimally invasive video-assisted thyroidectomy is suitable for surgeons experienced in thyroid and video-assisted surgery. It is feasible for well-selected patients including cases of T1 thyroid cancer, Graves’ disease and concomitant parathyroid adenoma.
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Paravastu SCV, Chadwick DR. Parathyroidectomy in a district general hospital: outcomes and evolution in the era of minimally invasive surgery. Int J Surg 2012; 10:373-7. [PMID: 22691548 DOI: 10.1016/j.ijsu.2012.05.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 05/15/2012] [Accepted: 05/27/2012] [Indexed: 11/19/2022]
Abstract
AIM To determine the outcomes of bilateral neck exploration (BNE) and uptake as well as outcomes of minimally invasive parathyroidectomy (MIP) for primary hyperparathyroidism in a district general hospital (DGH). METHODS Patients who underwent first-time parathyroidectomy for primary hyperparathyroidism between August 1999 and December 2010 were identified from a prospectively maintained database of a single surgeon and were analysed for outcomes of MIP and BNE. MIP was adopted in 2006 and prior to that all patients underwent BNE. Results were analysed on an intention-to-treat basis. RESULTS A total of 368 patients underwent parathyroid surgery; BNE (n = 314) and MIP (n = 54). Overall cure rate was 97%. Intention-to-treat analysis, based on surgical approach, showed cure rates of 96.5% with BNE and 96.3% with MIP (p = 1.0). Of the 92 patients assessed for MIP, localisation by ultrasound and sestamibi were noted in 60 (65%) and 65 (71%) patients respectively; however, concordance between the scans was noted in only 54 (59%) patients. Of the 54 patients who underwent MIP, 5 (9.2%) were converted to BNE. Intention-to-treat analysis, based on preoperative imaging, showed cure rates of 96% with BNE and 98% with MIP (p = 0.53). CONCLUSIONS Satisfactory cure rates for parathyroidectomy are achievable in a 'medium-volume' endocrine unit within a DGH. Preoperative localisation studies with USS and MIBI have a positive concordance rate in only 60% of those considered for MIP, thereby limiting the use of MIP and reinforcing the role of BNE in this era of minimally invasive surgery.
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Affiliation(s)
- S C V Paravastu
- Academic Vascular Unit, University of Sheffield, Sheffield S1 4DA, UK.
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Lee MC, Mo JA, Choi IJ, Lee BC, Lee GH. New endoscopic thyroidectomy via a unilateral axillo-breast approach with gas insufflation: Preliminary report. Head Neck 2012; 35:471-6. [PMID: 22514023 DOI: 10.1002/hed.22984] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2012] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Invasiveness of endoscopic thyroidectomy has been in debate. The purpose of this study was to introduce new endoscopic thyroidectomy via a unilateral axillo-breast approach (UABA) with gas insufflation to lessen invasiveness. METHODS We performed 68 cases of hemithyroidectomy via a UABA with gas insufflation from January to July 2011. The following variables were studied: operation time, pain score, drainage amount, drainage day, perioperative complications, pathological outcomes, and cosmetic satisfaction. RESULTS Mean postoperative pain visual analogue scale (VAS) scores were 2.75 ± 0.93 and 2.07 ± 0.79 at 1 and 3 days after surgery. The mean amount of drainage over the first 3 postoperative days was 144.35 ± 51.64 mL, and the mean time to drain removal was 3.75 ± 0.81 days. Two cases (2.9%) of transient vocal cord palsy and 2 cases (2.9%) of seroma were identified. All patients were satisfied with the cosmetic results. CONCLUSION Endoscopic thyroidectomy via a UABA with gas insufflation is a feasible and less invasive option for selected patients.
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Affiliation(s)
- Myung-Chul Lee
- Department of Otorhinolaryngology, Korea Cancer Center Hospital, Seoul, Korea.
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Increasing the Size Limit of Benign Thyroid Lesions Resectable by Endoscopic Thyroidectomy via a Unilateral Axillo-breast Approach Without Gas Insufflation. World J Surg 2011; 35:2203-11. [DOI: 10.1007/s00268-011-1232-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Radford PD, Ferguson MS, Magill JC, Karthikesalingham AP, Alusi G. Meta-analysis of minimally invasive video-assisted thyroidectomy. Laryngoscope 2011; 121:1675-81. [DOI: 10.1002/lary.21864] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Wound complications and clinical results of electrocautery versus a scalpel to create a cutaneous flap in thyroidectomy: A prospective randomized trial. Surg Today 2011; 41:1041-8. [DOI: 10.1007/s00595-010-4435-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Accepted: 05/10/2010] [Indexed: 10/18/2022]
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El-Labban GM. Minimally invasive video-assisted thyroidectomy versus conventional thyroidectomy: A single-blinded, randomized controlled clinical trial. J Minim Access Surg 2011; 5:97-102. [PMID: 20407568 PMCID: PMC2843132 DOI: 10.4103/0972-9941.59307] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 11/07/2009] [Indexed: 11/04/2022] Open
Abstract
UNLABELLED We aimed to test the hypothesis that Minimally Invasive Video-assisted Thyroidectomy (MIVAT) affords comparable safety and efficacy as to the open conventional surgery, when dealing with patients with unilateral thyroid nodules or follicular lesions, in terms of cosmetic results, intraoperative and postoperative complications, postoperative pain and hospital stay. MATERIALS AND METHODS This was a single-blinded randomised controlled trial comparing the MIVAT with conventional thyroidectomy. The primary endpoints of the study were measurement of postoperative pain after 24 and 48 hours from operation and self-rated patient satisfaction with cosmetic outcome three months postoperatively. The secondary outcome measures were operative time, incidence of temporary and permanent recurrent laryngeal nerve injury, postoperative haematoma formation, length of incision, and duration of hospital stay. RESULTS Operative time was significantly less with open thyroidectomy than with MIVAT, while MIVAT was associated with less pain 24 hours postoperatively. Blood loss did not reach significance between procedures. Comparisons between the two procedures with regard to pain scores after 24 and 48 hours, respectively, depicted statistically significant differences in favour of the MIVAT after 24 hours. MIVAT was associated with less scarring and more satisfactory cosmetic results. There were statistically no significant differences between both procedures for the presence of transient recurrent laryngeal nerve palsy and hypoparathyroidism. CONCLUSIONS MIVAT is a safe procedure that produces outcomes, in view of short-term adverse events, similar to those of open thyroidectomy, and is superior in terms of immediate postoperative pain and cosmetic results.
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Affiliation(s)
- Gouda M El-Labban
- Department of Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
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Hong HJ, Kim WS, Koh YW, Lee SY, Shin YS, Koo YC, Park YA, Choi EC. Endoscopic thyroidectomy via an axillo-breast approach without gas insufflation for benign thyroid nodules and micropapillary carcinomas: preliminary results. Yonsei Med J 2011; 52:643-54. [PMID: 21623608 PMCID: PMC3104441 DOI: 10.3349/ymj.2011.52.4.643] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To examine the feasibility of endoscopic thyroidectomy (ET) via an axillo- breast approach without gas insufflation for large thyroid tumors and micropapillary carcinomas. MATERIALS AND METHODS The patients in the benign group were separated into groups 1 (n=95, <4 cm in tumor diameter) and 2 (n=37, ≥4 cm in tumor diameter). Also, 57 patients in the micropapillary carcinoma group underwent an endoscopic hemithyroidectomy (HT) (group 3) and were compared with 60 patients who received conventional open HT (group 4). Postoperative functional outcome, local complications, surgical outcomes, and pathological outcomes were compared between the groups. RESULTS In the benign group, there was no significant difference in mean operating time, hospital stay, or overall perioperative complications between the two groups. In the micropapillary carcinoma group, mean operating time and hospital stay in group 3 were significantly longer than in group 4 (p=0.015 and p≤0.001). The overall perioperative complications did not differ significantly between the groups. The postoperative cosmetic result was better in groups 1-3 (endo group) than in group 4 (open group). CONCLUSION ET via a gasless axillo-breast approach seems to be a safe procedure even for benign thyroid lesions ≥4 cm and micropapillary carcinomas. Although it has the advantage of better cosmetic results over open thyroidectomy, there is room for improvement in terms of lessening its invasiveness and shortening the operative time.
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Affiliation(s)
- Hyun Jun Hong
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Won Shik Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Woo Koh
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - So Yoon Lee
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Yoo Seob Shin
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Cheol Koo
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon A Park
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Chang Choi
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
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