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Campagnoli M, Dell'Era V, Rosa MS, Negri F, Malgrati E, Garzaro M, Valletti PA. Patient's Scar Satisfaction after Conventional Thyroidectomy for Differentiated Thyroid Cancer. J Pers Med 2023; 13:1066. [PMID: 37511679 PMCID: PMC10381783 DOI: 10.3390/jpm13071066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 06/20/2023] [Accepted: 06/26/2023] [Indexed: 07/30/2023] Open
Abstract
Differentiated thyroid carcinoma (DTC) is the most frequent endocrine neoplasm. Its treatment is based on surgery with consequent impact on patients' quality of life (QoL) and aesthetic implication. The aim of the present study is to assess scar satisfaction in patients affected by DTC who underwent total or partial thyroidectomy. A comparison was also made between scar satisfaction with different subcuticular suture. Validated questionnaires have been employed during a 3-month follow-up: Patient and Observer Scar Assessment Scale (POSAS) and the Patient Scar Assessment Questionnaire (PSAQ). Eventually, the impact of thyroid cancer on QoL of patients was performed in the studied population employing the Thyroid-related patient-reported outcome questionnaire (ThyPRO) and European Organisation for Research Additionally, Treatment of Cancer-Quality of Life questionnaire-C30 (EORTC QLQ-C30). It was conducted in a single center observational study considering 74 patients respecting inclusion criteria. Overall scar satisfaction was found to improve during follow-up, reaching the best scores at 3 months from surgery. Subcuticular suture does not seem to influence the scar satisfaction. In our study male patients seem to be more satisfied, on the other hand age does not seem to influence satisfaction. Overall, the ThyPRO questionnaire and EORTC QLQ-C30 scores did not statistically differ between preoperative and postoperative suggesting a small impact of DTC in QoL.
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Affiliation(s)
| | - Valeria Dell'Era
- ENT Department Maggiore della Carità Hospital, 28100 Novara, Italy
| | | | - Fabiola Negri
- ENT Department Maggiore della Carità Hospital, 28100 Novara, Italy
| | - Eric Malgrati
- ENT Department Maggiore della Carità Hospital, 28100 Novara, Italy
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Papachristos AJ, Glover A, Sywak M, Sidhu SB. Thyroidectomy in Australia 2022: lessons from 21,000 consecutive cases. ANZ J Surg 2022; 92:1626-1630. [PMID: 35689169 DOI: 10.1111/ans.17783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 11/30/2022]
Abstract
In this article, we aim to describe our modern-day approach to total thyroidectomy, detailing the subtle refinements of our technique, as it has evolved over three decades and 21 000 cases. Since Delbridge's seminal paper in 2003, the major changes to our approach include a retrograde approach to the recurrent laryngeal nerve that allows dissection of the distal RLN from fascial bands within the ligament of Berry before medialisation of the thyroid lobe. Routine use of intraoperative nerve monitoring systems has increased our awareness of temporary neuropraxia, facilitated a reduction in the risk of bilateral RLN palsy and improved our identification and preservation of the external branch of the superior laryngeal nerve. The increasing use of advanced energy devices has been associated with a reduction in post-operative haematoma rates. We adopt a low threshold to parathyroid auto-transplantation, unless all glands are assessed to be clearly not at risk, and routinely supplement patients with Caltrate in the immediate post-operative period to minimize the risk of symptomatic hypocalcaemia. Ultimately, when we reflect on the subtle refinements that have contributed to improved outcomes, the fundamental principles of exposure and dissection that have evolved over decades remain the basis of our surgical approach and must continue to do so.
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Affiliation(s)
- Alexander James Papachristos
- Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia.,Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Anthony Glover
- Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia.,Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Endocrine Cancer Program, The Kinghorn Cancer Centre and St. Vincent's Clinical School, Faculty of Medicine, Garvan Institute of Medical Research, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Sywak
- Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia.,Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Stan B Sidhu
- Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia.,Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Kudpaje A, Subash A, Subramaniam N, Palme CE, US VR, Arakeri G. Remote Access Thyroid Surgery: A Review of Literature. Indian J Surg Oncol 2022; 13:191-198. [PMID: 35462662 PMCID: PMC8986942 DOI: 10.1007/s13193-021-01364-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 06/01/2021] [Indexed: 11/26/2022] Open
Abstract
Since the first description of endoscopic thyroid lobectomy in 1997, a variety of techniques have been developed to avoid the visible cervical scar conventionally been associated with thyroidectomy. These "remote access" approaches, which typically use either endoscopic or robotic instrumentation, have successfully avoided the anterior neck scar, which has a measurable impact on the patient's quality of life (Graves and Suh Surgery 168(5):845-850, 2020; Sakorafas World J Surg 34(8):1793-1804, 2010). The main advantage of these techniques is better cosmesis compared to conventional transcervical approaches (Graves and Suh Surgery 168(5):845-850, 2020) However, these techniques have failed to gain widespread acceptance in the surgical community because of the technical challenges, scepticism about oncological safety and cost factors. This review presents an overview of the various methods of remote access thyroid surgery (RATS) and also evaluates the selection criteria, oncological efficacy, training requirements and key advantages of this technique.
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Affiliation(s)
- Akshay Kudpaje
- Department of Head and Neck Surgical Oncology, HCG Cancer Centre, Bengaluru, Karnataka India
| | - Anand Subash
- Department of Head and Neck Surgical Oncology, HCG Cancer Centre, Bengaluru, Karnataka India
| | - Narayana Subramaniam
- Department of Head and Neck Surgical Oncology, Mazumdar Shaw Cancer Centre, Narayana Health, Bengaluru, Karnataka India
| | - Carsten E. Palme
- Department of Head and Neck Surgery, The Sydney Head and Neck Cancer Institute, Chris O’Brien Lifehouse, Sydney, Australia
| | - Vishal Rao US
- Department of Head and Neck Surgical Oncology, HCG Cancer Centre, Bengaluru, Karnataka India
| | - Gururaj Arakeri
- Department of Head and Neck Surgical Oncology, HCG Cancer Centre, Bengaluru, Karnataka India
- Department of Oral and Maxillofacial Surgery, Novodaya Dental College and Hospital, Raichur, India
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Imran M, Mehmood Z, Baloch MN, Altaf S. Endoscopic thyroid lobectomy vs Conventional open thyroid lobectomy. Pak J Med Sci 2020; 36:831-835. [PMID: 32494283 PMCID: PMC7260891 DOI: 10.12669/pjms.36.4.1604] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/05/2019] [Accepted: 04/08/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Surgical managements for these suspicious nontoxic swellings requires open conventional method of thyroidectomy by neck incisions that can result in prominent scars and immediate risk usually hemorrhage. However new technological innovations came into practiced that include video assisted minimal invasive endoscopy by axillo-breast approach that gives very promising results with excellent cosmesis. In this study, we compared conventional open surgery with minimal invasive endoscopic techniques and associate various complaints and complications that were encountered in surgery. METHODS Sixty patients were enrolled in this comparative study. It was conducted from period February 2018 to February 2019. The patients were randomized alternatively in two groups. Group-I patients underwent conventional lobectomy while Group-II patients were operated endoscopically, Patients having nodules less than 3cm and Thy 1 and 2 were included in this study. Patient having nodules greater than 3cm, Multinodular goiter, recurrent nodule and Thy 3-6 were excluded from the study. RESULTS Patients who underwent endoscopic lobectomy were much more satisfied about scar marks whereas some developed post-operative complications. It included hoarseness of voice in Three (13.62%) patients, two patients developed seroma (9.08%), three patients (13.62%) erythema, whereas no postoperative complications were seen in patients who underwent open thyroid lobectomy. No signs of hypocalcemia noted in both approaches. CONCLUSIONS The complications with endoscopic approaches are higher but they are minor and resolved spontaneously within maximum period of six weeks. However scar mark satisfaction was much higher in endoscopic lobectomy group.
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Affiliation(s)
- Mariam Imran
- Dr. Mariam Imran, Department of Surgery Ward 25, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Zahid Mehmood
- Dr. Zahid Mehmood, FCPS FRCS FACS. Department of Surgery Ward 25, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Muhammad Naseem Baloch
- Dr. Muhammad Naseem Baloch, FCPS FACS. Department of Surgery Ward 25, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Sehrish Altaf
- Dr. Sehrish Altaf, Department of Surgery Ward 25, Jinnah Postgraduate Medical Center, Karachi, Pakistan
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Lee K, Ward N, Oremule B, Mani N. Optimal wound closure techniques for thyroid and parathyroid surgery: A systematic review of cosmetic outcomes. Clin Otolaryngol 2019; 44:905-913. [PMID: 31145548 DOI: 10.1111/coa.13382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/14/2019] [Accepted: 05/28/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Cosmesis after surgical wound closure is an important outcome. This is relevant after thyroid and parathyroid surgery as anterior neck scars are visible and often of concern to patients. We aimed to investigate whether wound closure method influences cosmetic outcome in thyroid and parathyroid surgery, in particular using sutures, staples, steri-strips and glue. DESIGN We performed a systematic review of MEDLINE, PubMed, EMBASE, CINAHL and Cochrane focusing on wound cosmesis following thyroid and parathyroid surgery. Searches were conducted using combinations of the search terms: thyroid/parathyroid surgery, wound/skin closure and suture, staples, clips, glue and steri-strips, using appropriate MESH terms and Boolean operators. MAIN OUTCOME MEASURES Primary outcome was wound cosmesis. Secondary measures were also extracted. RESULTS Initial search found 304 papers and after systematic review, a total of 10 studies compared different closure methods and cosmetic outcomes. There were nine randomised controlled trials and one cohort study, with a total of 712 patients. Three studies compared staples vs glue; three compared sutures vs clips; two compared suture vs steri-strips and two studies for suture vs glue. In general, short-term cosmesis was better with subcuticular sutures compared to glue or clips, long-term cosmetic outcomes were not influenced by closure method. CONCLUSIONS We found closure with subcuticular suture or steri-strips produced superior short-term cosmetic outcomes. Although long-term cosmetic outcome is not influenced by closure method, given the superior cosmetic outcome and advantage of not needing removal, we recommend subcuticular sutures should be performed for wound closure in thyroid and parathyroid surgery.
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Affiliation(s)
- Kristina Lee
- Department of Otolaryngology and Head and Neck Surgery, Manchester Royal Infirmary, Manchester, UK
| | - Nicholas Ward
- Department of Otolaryngology, Royal Bolton Hospital, Manchester, UK
| | - Babatunde Oremule
- Department of Otolaryngology, Fairfield General Hospital, Manchester, UK
| | - Navin Mani
- Department of Otolaryngology and Head and Neck Surgery, Manchester Royal Infirmary, Manchester, UK
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Lee KH, Kim EY, Park CH, Park YL, Yun JS, Lee GY. Assessing cosmetic results after conventional thyroidectomy using the EASY-EYE_C: a double-blind randomized controlled trial. Ann Surg Treat Res 2017; 93:231-239. [PMID: 29184875 PMCID: PMC5694713 DOI: 10.4174/astr.2017.93.5.231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 04/01/2017] [Accepted: 04/25/2017] [Indexed: 11/30/2022] Open
Abstract
Purpose The incidence of thyroid cancer is relatively high, especially in young women, and postoperative scarring after thyroidectomy is an important problem for both patients and clinicians. Currently, there is no available product that can be used for wound protection during thyroid surgery. We used the EASY-EYE_C, a new silicone-based wound protector. Methods We conducted a double-blind randomized controlled trial to assess the efficacy of the EASY-EYE_C with surgical scars. We studied 66 patients who underwent conventional total thyroidectomy or hemithyroidectomy performed by a single surgeon from August 2015 to June 2016. At 6-week follow-up, a single blinded physician observed the wounds to make clinical assessments using the Patient and Observer Scar Assessment Scale (POSAS), the Vancouver Scar Scale (VSS), and a modified Stony Brook Scar Evaluation Scale (SBSES). Results There were no significant differences by sex, age, type of surgery, body mass index, length of wound, incision site (from sternal notch), or thyroid weight, but the duration of operation was significantly shorter in the experimental group (E group). The e-group also had better POSAS scores than the control group (C group), with means of 43.2 (standard deviation [SD], ±15.9) versus 68.3 (SD, ±21.5), respectively (P < 0.05). The modified SBSES and VSS scores were similar to those from the POSAS. Conclusion In this study, all scores for evaluating outcomes were higher in the E group than in the C group. In addition, the operation time was significantly shorter in the E group. Therefore, the EASY-EYE_C may be useful for improving the cosmetic outcomes of conventional thyroid surgery.
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Affiliation(s)
- Kwan Ho Lee
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Young Kim
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chan Heun Park
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Lai Park
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Sup Yun
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ga Young Lee
- Department of Dermatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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The advantages of extended subplatysmal dissection in thyroid surgery-the "mobile window" technique. Langenbecks Arch Surg 2017; 402:257-263. [PMID: 28050728 DOI: 10.1007/s00423-016-1545-6] [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: 06/17/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Minimal access thyroidectomy, using various techniques, is widely known, but respective data on thyroidectomy for thyroid cancer with lymphadenectomy is scarce. The present study aims to evaluate the feasability of extended subplatysmal dissection in combination with a small incision ("mobile window" technique). METHODS A retrospective study was performed analysing data from 93 patients. All patients suffered from thyroid carcinoma and underwent (total) thyroidectomy, bilateral cervico-central (levels VI and VII) and functional lateral neck dissection (levels II to V) on the side of the malignancy. In group A, consisting of 47 patients, the operation was performed by a traditional Kocher incision (minimal range 6-7 cm), in 46 patients (group B) a mini-incision (≤4 cm) was made. Intra- and postoperative morbidity as well as oncological accuracy were assessed. RESULTS There was no significant difference between the two groups comparing postoperative pathological diagnosis, intra- and postoperative complications and the number of removed lymph nodes. However, operating time was slightly longer in group A and thyroid weight was heavier in group B. CONCLUSIONS Extended subplatymsal dissection allows thyroidectomy and even lateral lymphadenectomy for thyroid carcinoma via "mobile" mini-incision. The procedure is safe, of equivalent oncological accuracy compared to traditional incision and the cosmetic results are excellent.
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Choi Y, Lee JH, Kim YH, Lee YS, Chang HS, Park CS, Roh MR. Impact of postthyroidectomy scar on the quality of life of thyroid cancer patients. Ann Dermatol 2014; 26:693-9. [PMID: 25473220 PMCID: PMC4252665 DOI: 10.5021/ad.2014.26.6.693] [Citation(s) in RCA: 155] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 01/27/2014] [Accepted: 02/20/2014] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Surgical scars are crucial cosmetic problem, especially when in exposed areas such as the anterior neck following thyroidectomy. OBJECTIVE To evaluate the impact of post-thyroidectomy scars on quality of life (QoL) of thyroid cancer patients and identify the relationship between scar characteristics and QoL. METHODS Patients with post-thyroidectomy scars on the neck were recruited. QoL was measured using the Dermatology Life Quality Index (DLQI). Scar characteristics were graded according to Vancouver scar scale (VSS) score. RESULTS Ninety-seven patients completed a battery of questions at the time of enrollment. Post-thyroidectomy scars were classified according to morphology as linear flat scars, linear bulging scars, hypertrophic scars or adhesive scars. There were 32 patients (33.0%), 9 patients (9.3%), 41 patients (42.3%) and 15 patients (15.5%), respectively, in each group. The mean total DLQI score was 9.02. Domain 2 (daily activities, 2.87 points), which includes questions about clothing, was the most greatly impacted among patients. The total DLQI scores of patients who have experienced scar-related symptoms were significantly higher than those of patients without symptoms (p<0.05). The VSS scores were 3.09 for linear flat scars, 6.89 for linear bulging scars, 6.29 for hypertrophic scars and 5.60 for adhesive scars. However, the DLQI scores did not significantly differ among scar types or VSS scores. CONCLUSION Post-thyroidectomy scars on the neck affect the QoL of thyroid cancer patients regardless of scar type. Therefore, clinicians should pay attention to the psychological effects of scars on patients and take care to minimize post-thyroidectomy scar.
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Affiliation(s)
- Yuri Choi
- Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hye Lee
- Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | | | - Yong Sang Lee
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hang-Seok Chang
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Cheong Soo Park
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Ryung Roh
- Department of Dermatology, Gangnam Severance Hospital, Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Minimally invasive surgery with spotlight work channel system in the treatment of lumbar disc herniation: a retrospective study of 21 cases. Cell Biochem Biophys 2014; 71:243-8. [PMID: 25129385 DOI: 10.1007/s12013-014-0190-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A group of lumbar discherniation cases was treated with posterior discectomy and decompression with Spotlight working channel. We retrospectively studied these patients. To study and analyze the clinical efficacy and technical features of discectomy which is carried out with the Spotlight channel technology. The development of the minimally invasive spine surgery technology promotes new instruments and materials. For minimally invasive spine surgery in channel technology, the newly launched Depuy(Spine) working channel-Spotlight, which is a new generation of wide viewing angle, single-hole device for minimally invasive spine operations, has good prospects for clinical application. From March 2011 to March 2012, 21 patients who were diagnosed with lumbar disc herniation were treated with posterior discectomy and decompression with Spotlight working channel, then the lumbar and leg pain visual analogue scale (VAS) scores of before and after surgery and that of the follow-ups and the Oswestry Disability Index were analyzed. All patients were successfully operated, and also they received follow-ups for more than 1 year. The postoperative lumbar and leg pain VAS scores improved significantly compared with the preoperative ones (P < 0.05) and can effectively maintain (P > 0.05). The three time points of lumbar pain VAS were 7.80 ± 0.49, 1.51 ± 0.52 and 1.47 ± 0.59. The leg pain VAS were 7.53 ± 0.50, 1.58 ± 0.58 and 1.49 ± 0.67. During the follow-ups of the cases in this group, no case of disc herniation relapsed. Patients were satisfied with that. The Spotlight channel system is one of the surgical approaches to "minimally invasive spine technology with direct vision". It has a good range of surgical indications. It can be carried out flexibly and used widely, which means it will be easier for the surgeons to master.
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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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Chen N, Stephenson LA, Jorgensen JB, Zitsch RP. Stretch of the Minimally Invasive Incision during Thyroid and Parathyroid Surgery. Otolaryngol Head Neck Surg 2014; 151:582-5. [DOI: 10.1177/0194599814544453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Identify and quantify changes in length of the skin incision following minimally invasive thyroid and parathyroid surgery and determine whether these changes persist postoperatively. Study Design Cohort study. Setting Tertiary care teaching hospital. Subjects and Methods Between July 2012 and June 2013, a prospective, nonrandomized study was performed on 44 consecutive patients undergoing open cervical minimally invasive thyroidectomy (incision approximately 6 cm or less) or minimally invasive parathyroidectomy (incision approximately 3 cm or less). Incision length was measured following initial incision, immediately after wound closure, and on postoperative follow-up at 2-week and 14-week visits. Results Thirty-one patients underwent minimally invasive thyroidectomy or parathyroidectomy with initial incision lengths ranging from 20 mm to 60 mm. Seven patients (21%) underwent total thyroidectomy with a mean length of 45 ± 8 mm, 15 patients (44%) underwent unilateral thyroid lobectomy with a mean length of 37 ± 5 mm, and 9 patients (26%) underwent parathyroidectomy with a mean length of 28 ± 2 mm. On average, the skin incision lengthened by 3.0 ± 0.9 mm during surgery representing an intraoperative stretch of 8.0% ( P < .0001). Incision lengths decreased by an average of 0.3 mm at 2-week postoperative follow-up ( ns) and 6.3 mm at 14-week postoperative follow-up ( P < .0001). Conclusion Significant intraoperative incision stretch is likely to occur during minimally invasive thyroid and parathyroid surgery. Postoperative follow-up data suggest that the increase in incision length is not permanent and resolves upon postoperative follow-up.
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Affiliation(s)
- Nan Chen
- University of Missouri School of Medicine, Columbia, Missouri, USA
| | | | - Jeffrey B. Jorgensen
- Department of Otolaryngology–Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA
| | - Robert P. Zitsch
- Department of Otolaryngology–Head and Neck Surgery, University of Missouri School of Medicine, Columbia, Missouri, USA
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12
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Minimally invasive video-assisted versus minimally invasive nonendoscopic thyroidectomy. BIOMED RESEARCH INTERNATIONAL 2014; 2014:450170. [PMID: 24800227 PMCID: PMC3996987 DOI: 10.1155/2014/450170] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 03/18/2014] [Indexed: 02/08/2023]
Abstract
Minimally invasive video-assisted thyroidectomy (MIVAT) and minimally invasive nonendoscopic thyroidectomy (MINET) represent well accepted and reproducible techniques developed with the main goal to improve cosmetic outcome, accelerate healing, and increase patient's comfort following thyroid surgery. Between 2007 and 2011, a prospective nonrandomized study of patients undergoing minimally invasive thyroid surgery was performed to compare advantages and disadvantages of the two different techniques. There were no significant differences in the length of incision to perform surgical procedures. Mean duration of hemithyroidectomy was comparable in both groups, but it was more time consuming to perform total thyroidectomy by MIVAT. There were more patients undergoing MIVAT procedures without active drainage in the postoperative course and we also could see a trend for less pain in the same group. This was paralleled by statistically significant decreased administration of both opiates and nonopiate analgesics. We encountered two cases of recurrent laryngeal nerve palsies in the MIVAT group only. MIVAT and MINET represent safe and feasible alternative to conventional thyroid surgery in selected cases and this prospective study has shown minimal differences between these two techniques.
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Quality of scar after total thyroidectomy: a single blinded randomized trial comparing octyl-cyanoacrylate and subcuticular absorbable suture. ISRN SURGERY 2013; 2013:270953. [PMID: 24324898 PMCID: PMC3845629 DOI: 10.1155/2013/270953] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 09/26/2013] [Indexed: 12/14/2022]
Abstract
Objective. To compare the quality of resulting scar at 6 weeks after total thyroidectomy with the use of the tissue adhesive octyl-cyanoacrylate or subcuticular absorbable suture for the closure of cervicotomy. Material and Methods. There are 50 patients undergoing a cervicotomy for total thyroidectomy. Twenty-five patients were randomly assigned to closure with tissue adhesive and 25 with subcuticular absorbable suture. At week 6 the scar was evaluated by blinded assessors with the Italian version of POSAS questionnaire, a validated wound scale composed of an observer's and a patient's subscale. Results. Assessment of scar appearance showed a statistically significant difference (p = 0. 038) in favor of subcuticular suture with respect to tissue adhesive on observer's assessment. The difference on patients' self-assessment was not significant. A multivariate analysis of six qualitative features of scars showed a significant influence on assessment for hyperpigmentation and relief of scar. The Italian version of POSAS proved to be reliable. Conclusion. Though tissue adhesive represents a valid method of skin closure, subcuticular absorbable suture provides a better aesthetic outcome in small cervical incisions in the early phase after thyroid surgery.
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14
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Yang YL, Xiang YY, Jin LP, Pan YF, Zhou SM, Zhang XH, Qu JM. Closure of skin incision after thyroidectomy through a supraclavicular approach: a comparison between tissue adhesive and staples. Scand J Surg 2013; 102:234-40. [PMID: 24056141 DOI: 10.1177/1457496913490610] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The objective of this study was to compare the effectiveness and cosmetic results of tissue adhesive or surgical staples in thyroidectomy through a supraclavicular incision. Methods: This was a prospective, randomized study of consecutive patients undergoing thyroidectomy by a supraclavicular approach. Eligible patients were randomized into two groups: one group had the incision closed with tissue adhesive (the experimental group) and the other with surgical staples (the control group). The main outcomes included operative time, early postoperative pain measured by Visual Analog Scale, incidence of wound dehiscence and infection, perceived cosmetic outcome, and overall patient satisfaction by using Patient Satisfaction Assessment Form. Results: There were 151 consecutive patients assessed for eligibility, and 132 patients were enrolled over 22 months. The clinical characteristics of the patients in the two groups were similar. Main outcomes were assessed in the first 24 h postoperatively, the first month, and the third month postoperatively. Operation time was longer in the experimental group ( P = 0.027). Mean Visual Analog Scale scores for pain were lower in the experimental group in the early postoperative period ( P < 0.001). No patients developed surgical site infections or wound dehiscence. Lower scores for scar assessment and higher overall satisfaction levels at the first month after surgery were found in the experimental group compared to the control group ( P < 0.001). There was no significant difference between the two groups at the third month postoperatively in perceived cosmetic result ( P = 0.052) or overall satisfaction ( P = 0.059). Conclusions: Tissue adhesive is effective and reliable in skin closure for thyroid surgery. While this closure may take somewhat longer to perform, it leads to less postoperative pain, more acceptable wound cosmesis, and higher patient satisfaction levels in short postoperative follow-up.
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Affiliation(s)
- Y.-L. Yang
- Department of Breast Surgery, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, People’s Republic of China
- Department of Surgical Oncology, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, People’s Republic of China
| | - Y.-Y. Xiang
- Department of Surgical Oncology, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, People’s Republic of China
| | - L.-P. Jin
- Department of Surgical Oncology, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, People’s Republic of China
| | - Y.-F. Pan
- Department of Surgical Oncology, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, People’s Republic of China
| | - S.-M. Zhou
- Department of Surgical Oncology, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, People’s Republic of China
| | - X.-H. Zhang
- Department of Surgical Oncology, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, People’s Republic of China
| | - J.-M. Qu
- Department of Surgical Oncology, The First Affiliated Hospital of Wenzhou Medical College, Wenzhou, People’s Republic of China
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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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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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O'Leary DP, Clover A, Galbraith JG, Mushtaq M, Shafiq A, Redmond H. Adhesive strip wound closure after thyroidectomy/parathyroidectomy: A prospective, randomized controlled trial. Surgery 2013; 153:408-12. [DOI: 10.1016/j.surg.2012.08.063] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 08/30/2012] [Indexed: 11/28/2022]
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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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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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Minimally invasive thyroidectomy: A comprehensive appraisal of existing techniques. Surgery 2011; 150:17-24. [DOI: 10.1016/j.surg.2011.02.018] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 02/17/2011] [Indexed: 11/18/2022]
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Herrera MF, Zárate X. [Impact of minimally invasive techniques in endocrine surgery]. Cir Esp 2011; 89:337-9. [PMID: 21496790 DOI: 10.1016/j.ciresp.2011.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 02/02/2011] [Indexed: 11/20/2022]
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Chen ZQ, Wang L, Li T, Hu SY, Zhi XT. Supraclavicular Lateral Collar Incision Versus Conventional Approach for Thyroidectomy: Supplement for Minimally Invasive Techniques with Extended Indications. J Laparoendosc Adv Surg Tech A 2011; 21:45-50. [PMID: 21029025 DOI: 10.1089/lap.2010.0236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Zhi-qiang Chen
- Minimally Invasive Surgery Centre of Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Lei Wang
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, China
| | - Tao Li
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, China
| | - San-yuan Hu
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, China
| | - Xu-ting Zhi
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan, China
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Henry JF, Thakur A. Minimal access surgery - thyroid and parathyroid. Indian J Surg Oncol 2010; 1:200-6. [PMID: 22930635 DOI: 10.1007/s13193-010-0033-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Accepted: 04/03/2010] [Indexed: 10/18/2022] Open
Abstract
The concept of surgical invasiveness cannot be limited to the length or to the site of the skin incision. It must be extended to all structures dissected during the procedure. Therefore, MIT or MIP should properly be defined as operations through a short and discrete incision that permits direct access to the thyroid or parathyroid gland, resulting in a focused dissection.Parathyroid glands are particularly suitable for minimally invasive surgery as most parathyroid tumors are small and benign. MIP are performed through a limited or discrete incision when compared to classic open transverse cervical incision and are targeted on one specific parathyroid gland. The concept of these limited explorations is based on the fact that 85% of patients will have single-gland disease. MIP must be proposed only for patients with sporadic hyperparathyroidism in whom a single adenoma has been clearly localized by preoperative imaging studies.The minimal access approaches to the thyroid gland may be broadly classified into three groups: the mini-open lateral approach via a small incision, minimally invasive video-assisted thyroidectomy via the midline and various endoscopic techniques. Endoscopic extracervical approaches have the main advantage of leaving no scar in the neck but cannot reasonably be described as minimally invasive as they require more dissection than conventional open surgery.Initially the indications for MIT were a solitary thyroid nodule of less than 3 cm in diameter in an otherwise normal gland. Today, MIT are also proposed in patients with small nodular goiters, Graves's diseases and low risk papillary thyroid cancers. Some concern remains about the radicality of MIT in this latter group but preliminary results are comparable to those of conventional surgery both in terms of I-131 uptake and serum thyroglobuline levels.Demonstrating the advantages of MIT and MIP over conventional surgery is not easy. Main complications, such as nerve injury, hypoparathyroidism, or hemorrhage, are the same as in conventional surgery. Several studies comparing conventional surgery with minimally invasive techniques using a cervical access have shown a diminution of postoperative pain, and better cosmetic results with minimally invasive techniques. MIP and MIT seem overall to be an advance but only randomized studies will demonstrate the real benefit.
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Gharib H, Papini E, Paschke R, Duick DS, Valcavi R, Hegedüs L, Vitti P. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and EuropeanThyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules. Endocr Pract 2010; 16 Suppl 1:1-43. [PMID: 20497938 DOI: 10.4158/10024.gl] [Citation(s) in RCA: 362] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Polyzos SA, Anastasilakis AD. Infectious thyroiditis as a complication of fine-needle biopsy: a systematic review. Expert Rev Endocrinol Metab 2010; 5:673-679. [PMID: 30764021 DOI: 10.1586/eem.10.50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Thyroid fine-needle biopsy (FNB) is a simple, reliable and inexpensive procedure for the diagnosis of thyroid malignancy. Furthermore, it is a useful tool for the identification of the causative pathogen in cases of acute suppurative thyroiditis. However, it can also cause infectious thyroiditis, as bacterial seeding can occur. Post-FNB thyroid infection is a rare complication. Gram-positive bacteria predominate but other bacteria have also been isolated, especially in immunocompromised patients. Preventive measures include iodine skin preparation and alcohol cleansing of the skin before FNB and adequate aseptic conditions. The prognosis of post-FNB infectious thyroiditis depends on prompt recognition and treatment. The treatment of choice is antibiotics and pus drainage, but thyroid resection may be required in cases of persistent infection.
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Affiliation(s)
- Stergios A Polyzos
- a Second Medical Clinic, Medical School, Aristotle University of Thessaloniki, Ippokration Hospital, Thessaloniki, Greece.
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Abstract
The head and neck region poses a challenging arena for oncologic surgery. Diseases and their treatment can affect a myriad of functions, including sight, hearing, taste, smell, breathing, speaking, swallowing, facial expression, and appearance. This review discusses several areas where refinements in surgical techniques have led to improved patient outcomes. This includes surgical incisions, neck lymphadenectomy, transoral laser microsurgery, minimally invasive thyroid surgery, and the use of vascularized free flaps for oromandibular reconstruction.
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Affiliation(s)
- Jeffrey C. Liu
- Fellow, Head and Neck Service, Memorial Sloan-Kettering Cancer Center
| | - Jatin P. Shah
- Check, Head and Neck Service, Memorial Sloan-Kettering Cancer Center
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Abstract
PURPOSE OF REVIEW To review the literature regarding the safety and feasibility of outpatient thyroid surgery. RECENT FINDINGS Outpatient thyroidectomy is increasingly reported especially for hemithyroidectomy. Meta-analysis of 11 randomized trials comparing routine drain with no drains found no significant difference in respiratory distress or wound reexploration but found an increased length of stay with drain usage. In addition to risk from delayed hematoma formation, risk of hypocalcemia developing from hypoparathyroidism has traditionally challenged outpatient total or completion thyroidectomy. Routine calcium and vitamin D supplementation has been shown to reduce the risk of hypocalcemia. A meta-analysis of rapid postoperative parathyroid hormone (PTH) measurement confirmed a significantly increased risk of hypocalcemia for PTH less than 15 pg/ml. SUMMARY Outpatient thyroidectomy is increasingly performed and reported. The senior author currently offers outpatient thyroidectomy for patients not requiring drain placement (smaller goiters without significant blood loss) and with postanesthesia care unit PTH levels of at least 30 pg/ml or with postanesthesia care unit PTH levels of at least 20 pg/ml with oral calcium supplementation.
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Randomized trial of tissue adhesive vs staples in thyroidectomy integrating patient satisfaction and Manchester score. Otolaryngol Head Neck Surg 2009; 140:703-8. [DOI: 10.1016/j.otohns.2009.01.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2008] [Revised: 12/11/2008] [Accepted: 01/05/2009] [Indexed: 11/20/2022]
Abstract
Objective: Closure of skin incision of minimally invasive thyroidectomy with tissue adhesive is compared with surgical staples for 1) cosmetic appearance, 2) patient pain score, and 3) patient satisfaction score. Study Design: Prospective single-blinded randomized study. Subjects and Methods: Seventy-two patients undergoing minimally invasive thyroid surgery using video-assisted thyroidectomy (VAT) and minimal incision thyroidectomy (MIT) techniques were randomized for skin closure into two groups, one using staples and the other using tissue adhesive. Patients evaluated their pain on the first and tenth postoperative days. Scars were assessed using the Manchester scar assessment tool, and patients completed a satisfaction assessment form. Results: Sixty out of the 72 patients were followed up for three months postoperatively. Assessment of wound cosmesis revealed no statistical difference; however, there was a statistical difference in ability to shower and overall satisfaction in the tissue adhesive group ( P = 0.017). Conclusion: Tissue adhesive is an excellent alternative for skin incision closure, having the added advantage of ability to shower on the same day, avoidance of the anxiety associated with staple removal, and no General Practitioner (GP) visit required for wound care. The use of tissue adhesive achieves higher patient satisfaction levels and enhances the perception of minimally invasive thyroid surgery (MITS) techniques among patients and surgeons alike.
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Dionigi G. Evidence-based review series on endoscopic thyroidectomy: real progress and future trends. World J Surg 2009; 33:365-6. [PMID: 19034568 DOI: 10.1007/s00268-008-9834-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Current world literature. Curr Opin Otolaryngol Head Neck Surg 2009; 17:132-41. [PMID: 19363348 DOI: 10.1097/moo.0b013e32832ad5ad] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dionigi G, Bacuzzi A, Bertocchi V, Carrafiello G, Boni L, Rovera F, Dionigi R. Safe incorporation of new technologies in thyroid surgery. Expert Rev Med Devices 2009; 5:747-58. [PMID: 19025350 DOI: 10.1586/17434440.5.6.747] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The history of thyroid surgery starts with Billroth, Kocher and Halsted, who developed the technique for thyroidectomy between the years of 1873 and 1910. In general the essential objectives for thyroidectomy are: sparing the parathyroid glands, avoidance of injury to the laryngeal nerves, an accurate hemostasis and an excellent cosmesis. In the last 10 years, major improvements and new technologies have been proposed and applied in thyroid surgery. These include mini-invasive thyroidectomy, new devices for achieving hemostasis and dissection, regional anesthesia, intraoperative neuromonitoring, parathyroid hormone assay technology and genetic screening. This paper reviews the relevant medical literature published on the influence of these new technologies on the quality of thyroid surgery, as well as prevention of postoperative morbidity and mortality. Searches were last updated in April 2008.
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Affiliation(s)
- Gianlorenzo Dionigi
- Center of Endocrine Surgery, Department of Surgical Sciences, University of Insubria, Azienda Ospedaliero-Universitario, Fondazione Macchi, Varese, Italy.
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Dionigi G, Rovera F, Boni L, Dionigi R. Video-assisted thyroidectomy performed in a one-day surgery setting. Int J Surg 2008; 6 Suppl 1:S4-6. [PMID: 19167939 DOI: 10.1016/j.ijsu.2008.12.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND AIM Evidence base data have demonstrated that video-assisted thyroidectomy (VAT) has good results regarding safety, morbidity, patient cure rate, pain and cosmesis. Aim of this study was to evaluate the performance of VAT in an ambulatory setting (i.e. one-day surgery, <24-h stay). MATERIALS AND METHODS Between September 2007 and July 2008, 43 patients underwent VAT in a one-day surgery division. Patient selection criteria for VAT were: thyroid nodules <30 mm, gland volume <20 ml, no history of thyroiditis or neck surgery or irradiation, "low risk" papillary carcinoma and absence of enlarged lymph nodes. One-day surgery patient selection criteria were medical and social logistic (Materazzi G, et al. Eur Surg Res 2007;39:182-8). Intraoperative neuromonitoring (IONM) was used for RLN identification. Intact parathyroid hormone (iPTH) levels were determined early postoperatively at +6-h. Postoperative complications, conversion rate were analyzed. RESULTS No cases required conversion to open surgery or ordinary recovery (i.e. >24h). Incidence of temporary hypoparathyroidism was 11.6% (5/43) with no case of symptomatic hypocalcemia. Incidence of temporary RLN injury was 2.3% (1 patient) with no case of permanent or bilateral RLN injury. All patients were satisfied with the type of recovery. CONCLUSIONS This preliminary report is an example of the safe incorporation between new technologies (IONM, early iPTH measurement) with improvement of the quality and safety of VAT performed in a one-day surgery setting.
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Affiliation(s)
- G Dionigi
- Endocrine Surgery Research Center, Department of Surgical Sciences, University of Insubria, Viale Borri 57, 21100 Varese, Italy.
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Dionigi G, Rovera F, Boni L. Commentary on transoral access for endoscopic thyroid resection : Witzel K, von Rahden BH, Kaminski C, Stein HJ (2008) Transoral access for endoscopic thyroid resection. Surg Endosc 22(8):1871-1875. Surg Endosc 2008; 23:454-5; discussion 456. [PMID: 19067050 DOI: 10.1007/s00464-008-0241-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Accepted: 09/22/2008] [Indexed: 02/07/2023]
Affiliation(s)
- Gianlorenzo Dionigi
- Endocrine Surgery Research Center, Department of Surgical Sciences, University of Insubria, Via Guicciardini, Varese, 21100, Italy.
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Dionigi G, Boni L, Rovera F, Bacuzzi A, Dionigi R. Neuromonitoring and video-assisted thyroidectomy: a prospective, randomized case-control evaluation. Surg Endosc 2008; 23:996-1003. [PMID: 18806939 DOI: 10.1007/s00464-008-0098-3] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Revised: 06/19/2008] [Accepted: 07/13/2008] [Indexed: 01/09/2023]
Abstract
INTRODUCTION This study evaluates the role of intraoperative neuromonitoring (IONM) in video-assisted thyroidectomy (VAT) with emphasis given to the identification of recurrent laryngeal nerve (RLN) and external branch of superior laryngeal nerve (EBSLN). METHODS The study was based on a prospectively randomized series comprising 72 standard VAT gasless approaches. In the control group (N = 36), the laryngeal nerves were identified by 30 degrees 5-mm endoscope magnification solely. The standard technique of the IONM group (N = 36) consisted of localizing and monitoring EBSLN, both vagus and RLNs, before and after thyroid resection to prove nerve integrity. Surgical outcomes were mean operative time, nerve representation, incision length, and morbidity. RESULTS All procedures were performed successfully. There were no instances of equipment malfunction or interference. No permanent complications occurred in either group. The incidences of temporary RLN injury were 2.7% (1 patient) and 8.3% (3 patients) in the IONM and control group, respectively. The EBSLN was identified better in the IONM group: 83.6% versus 42% (p < 0.05). In the IONM group, a negative electromyography (EMG) response indicated an altered function of RLN and stage thyroidectomy was scheduled. CONCLUSIONS This is the first VAT series with a standardized IONM technique. The technical feasibility and safety of IONM in selected patients seem acceptable. Neuromonitoring during VAT is effective in providing identification and function of laryngeal nerves. IONM enables surgeons to feel more comfortable with their approach to VAT. A reduction of rates for postoperative complications could not be demonstrated in the present study. Larger series are needed for further evaluation.
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Affiliation(s)
- Gianlorenzo Dionigi
- Department of Surgical Sciences, Endocrine Surgery Research Center, University of Insubria, Varese, Italy.
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Henry J. Minimally invasive thyroid and parathyroid surgery is not a question of length of the incision. Langenbecks Arch Surg 2008; 393:621-6. [DOI: 10.1007/s00423-008-0406-3] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Accepted: 07/29/2008] [Indexed: 11/27/2022]
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