Highlights from endocrine surgical history

A prospective study to assess cervical scar satisfaction following conventional open thyroidectomy for thyroid cancer

BACKGROUND

Conventional open thyroidectomy (COT) remains a common method of thyroidectomy in many parts of the world for various reasons.

METHODS

In this prospective (cross-sectional) study, we evaluated the scar satisfaction among patients and surgeons following COT using the Patient and Observer Scar Assessment Scale (POSAS) and the Patient Scar Assessment Questionnaire (PSAQ).

RESULTS

A total of 116 patients were included. The median age of the patients was 44 years and the majority were women. The median scar length overall was 12.2 cm. On POSAS, the median score for surgeon 1 was 1 (range 1-5), for surgeon 2, it was 2 (range 1-6), and for the patient, it was 1 (range 1-6) suggesting good scar satisfaction. The patient's response in the PSAQ was also echoing similar outcomes with scar satisfaction.

CONCLUSIONS

Overall, both the patients and the surgeons seem to be satisfied with the overall scar appearance following COT despite the scar length.

Radiofrequency Ablation for Benign Nodules and for Cancer, Too?

Radiofrequency ablation (RFA) is a minimally invasive procedure performed under ultrasound guidance that offers the ability to significantly reduce the size of benign thyroid nodules. Although application for benign nodules has only emerged during the past 5 to 10 years in North America, RFA has an impressive track record of nodule reduction, compressive and cosmetic symptom improvement, and excellent safety profile without the morbidity of open surgery. The role of RFA in autonomous functioning nodules, thyroid cancer, and indeterminate nodules is controversial and remains an area of investigation.

A propensity score matching analysis of gasless endoscopic transaxillary thyroidectomy with five-settlement technique versus conventional open thyroidectomy in patients with papillary thyroid microcarcinoma

BACKGROUND

In a previous study, we proposed a novel anatomy-based five-settlement method for transaxillary endoscopic thyroidectomy (fs-TAT) for patients with papillary thyroid carcinoma. The safety of this new method has been reported in a retrospective study of a single cohort. The safety and short-term oncological outcome of this method was confirmed by comparing it with conventional open surgery (COT) in patients with papillary thyroid microcarcinoma.

METHODS

The medical records of patients who underwent fs-TAT or COT by a single surgeon from February 2019 to December 2021 were reviewed retrospectively. All patients were diagnosed with papillary thyroid microcarcinoma and underwent lobectomy and ipsilateral central compartment neck dissection. Propensity score matching was used to compare the technical safety and short-term oncologic outcomes of fs-TAT and COT for the purpose of reducing potential selection bias. Reporting was consistent with the STROCSS 2021 guidelines.

RESULT

After propensity score matching, 460 (fs-TAT: 230; COT: 230) patients remained in the study population. There were no significant differences in sex, age, tumor size, Hashimoto's thyroiditis, or tumor multifocality between the groups. The operative time was longer [104.5 (90.3, 120.0) vs. 62.0 (52.0, 76.0), P < 0.001] and the total postoperative drainage volume [135(90, 210) vs. 75 (55, 115), P < 0.001] was greater in the fs-TAT group than in the COT group. However, intraoperative bleeding [3.0 (2.0, 5.0) vs. 5.0 (5.0, 7.5), P < 0.001] was greater, and the median number of lymph nodes yielded [5.0 (2.3, 8.0) vs. 7.0 (5.0, 11.0), P < 0.001] was greater in the COT group than in the fs-TAT group. The groups exhibited no significant difference in the rate of complications (fs-TAT: 2.2% vs. COT: 2.6%, P = 0.856), rate of positive lymph nodes (fs-TAT: 32.2% vs. COT: 36.5%, P = 0.377), length of postoperative hospital stay (3 days vs. 3 days, P = 0.305) or total medical costs (26,936 vs. 26,549, P = 0.144).

CONCLUSION

Compared to conventional open surgery, fs-TAT offered excellent safety and acceptable short-term oncological outcomes in a selected cohort of patients with papillary thyroid microcarcinoma.

Modern Surgical Techniques of Thyroidectomy and Advances in the Prevention and Treatment of Perioperative Complications

Thyroid cancer is the most common cancer of the endocrine system, and, in recent years, there has been a phenomenon of overdiagnosis followed by subsequent overtreatment. This results in an increasing number of thyroidectomy complications being faced in clinical practice. In this paper, we present the current state of knowledge and the latest findings in the fields of modern surgical techniques, thermal ablation, the identification and assessment of parathyroid function, recurrent laryngeal nerve monitoring and treatment and perioperative bleeding. We reviewed 485 papers, from which we selected 125 papers that are the most relevant. The main merit of this article is its comprehensive view of the subject under discussion-both general, concerning the selection of the appropriate method of surgery, and particular, concerning the selection of the appropriate method of prevention or treatment of selected perioperative complications.

Robotic transaxillary lateral neck dissection for thyroid cancer: learning experience from 500 cases

BACKGROUND

Differentiated thyroid carcinoma with lateral neck lymph node metastasis requires aggressive operative intervention, including lateral neck dissection. Although several robotic approaches have made precise surgery for thyroid cancer possible, few centers have expanded the technique for application to lateral neck dissections. This study aimed to demonstrate the technical feasibility, cosmetic effectiveness, and safety of robotic transaxillary lateral neck dissection (RTLND) using the da Vinci system.

METHODS

From January 2008 to July 2019, 500 patients diagnosed with thyroid cancer with lateral neck node metastasis underwent RTLND. The clinicopathologic characteristics and surgical outcomes were retrospectively reviewed.

RESULTS

All operations were performed successfully without open conversion. As the primary operation for thyroid cancer, 476 (95.2%) patients underwent unilateral or bilateral RTLND, including robotic total thyroidectomy. The remaining 24 patients (4.8%), all of whom had a recurrence, also underwent RTLND with additional procedures, if needed. The mean operation time for the 500 operations was 293.71 ± 67.22 min. Only five cases had recurrence and required further treatment.

CONCLUSIONS

RTLND is technically feasible and safe through the precise manipulation of robotic instruments. While this method is thorough and provides safe and effective surgical outcomes, it also offers the additional advantage of being minimally invasive.

Historical account of endocrinal disorders in Unani medicine

Hippocratic doctrine of four humors and qualities is implicated to be a pioneer of modern endocrinology because of the concept of dyscrasia. Imbalance in humors causes disease. Unani scholars were aware of endocrinological disorders like endocrinologic syndrome (i.e., association of amenorrhea and galactorrhoea in a non-pregnant woman), castration, contraceptives techniques, infertility, obesity, diabetes etc., and also their mode of remedy, albeit with a phenomenological approach. Their understanding of the symptoms and signs related to endocrinologic syndromes, which were explained in detail in the recent account of the endocrine system, is presented here with historical chronology. The survey was carried out from the literature of the Unani system of medicine, and the same was analyzed from the observations reported in various indexed journals and reputed books. The paper details the account of endocrinologic syndrome from the Greek era to the end of the medieval ages. - Description of the endocrinal disorders is mentioned in Unani Medicine for centuries, albeit with a different name for the disease category.- According to Unani Medicine, this disease arises due to abnormal quality and quantity of humour.- Renowned Unani scholars like Hippocrates (370-460 BC), Aristotle (384-322 BC), Aretaeos of Kappadokia(81-96 AD), Galen (130-200 AD), Zakaria Razi (865-925 AD), Majusi (930-994 AD), Ibn-e-Sina (980-1037 AD), Albucasis (1013-1106 AD) and Ismail Jorjani (1042-1137 AD) also treated such ailments through Unani medicine (plant, mineral and animal origin drugs).-Majusi performed surgery of Goiter and mentioned in his treatise and recommended the method of surgery.-Albucasis performed the first successful thyroidectomy under opium (Papaver somniferum L.) sedation and simple ligatures and hot cautery in the name of 'elephantiasis' of the throat (goiter).- The principles of treatment in Unani medicine may provide a guide for better management of endocrinal disorders (e.g., hypothyroidism, hyperthyroidism, diabetes etc.).- The treatment in Unani medicine for various diseases/syndromes/signs, which are now likely associated with hormone dysfunction, can open up the new field of Unani therapeutics for these diseases for the exploration of better treatment options.

Surgical outcomes of minimally invasive thyroidectomy in thyroid cancer: comparison with conventional open thyroidectomy

Background

Minimally invasive thyroidectomy (MIT) is a safe method of performing thyroidectomy with notable benefits, such as improved cosmesis and reduced postoperative pain. The objective of this retrospective study was to report our experience with the technical feasibility of MIT, and compare its early surgical outcomes with those of conventional open thyroidectomy (COT) in patients with differentiated thyroid carcinoma (DTC).

Methods

A total of 617 patients who underwent MIT and 2,674 patients who underwent COT were reviewed between March 2006 and November 2017 at Yonsei University (Seoul, Korea). The mean follow-up duration was 41.2±19.7 months.

Results

The mean age of patients with DTC was 46.1±11.2 years. The mean operation time in the MIT group was significantly shorter than that of the COT group (63.5±26.2 vs. 85.3±36.8 minutes, P<0.001). The mean hospital stay was significantly shorter in the MIT group than it was in the COT group as well (2.7±0.6 vs. 3.1±0.8 days, P<0.001). There were significantly fewer painkillers used after surgery in the MIT group than in the COT group (1.2±0.5 vs. 2.7±1.6, P<0.001). The mean number of harvested LNs in the MIT group was significantly lower than that of the COT group (3.1±2.6 vs. 5.5±4.0, P<0.001).

Conclusions

This study demonstrated that MIT is technically feasible in patients with DTC. MIT is a valuable alternative operative technique to COT with good surgical outcomes and outstanding cosmetic results.

Comparison of total endoscopic thyroidectomy with conventional open thyroidectomy for treatment of papillary thyroid cancer: a systematic review and meta-analysis

BACKGROUND

Despite the fact that thyroid surgery has evolved towards minimal incisions and endoscopic approaches, the role of total endoscopic thyroidectomy (TET) in thyroid cancer has been highly disputed. We performed a systematic review and meta-analyses of peer reviewed studies in order to evaluate the safety and effectiveness of TET compared with conventional open thyroidectomy (COT) in papillary thyroid cancer (PTC).

METHOD

Medical literature databases such as PubMed, Embase, the Cochrane Library, and Web of science were systematically searched for articles that compared TET and COT in PTC treatment from database inception until March 2019. The quality of the studies included in the review was evaluated using the Downs and Black scale using Review Manager software Stata V.13.0 for the meta-analysis.

RESULTS

The systematic review and meta-analysis were based on 5664 cases selected from twenty publications. Criteria used to determine surgical completeness included postoperative thyroglobulin (TG) levels, recurrence of the tumor after long-term follow-up. Adverse event and complication rate scores included transient recurrent laryngeal nerve (RLN) palsy, permanent RLN palsy, transient hypocalcaemia, permanent hypocalcaemia, operative time, number of removed lymph nodes, length of hospital stay and patient cosmetic satisfaction. TET was found to be generally equivalent to COT in terms of surgical completeness and adverse event rate, although TET resulted in lower levels of transient hypocalcemia (OR 1.66; p < 0.05), a smaller number of the retrieved lymph nodes (WMD 0.46; p < 0.05), and better cosmetic satisfaction (WMD 1.73; p < 0.05). COT was associated with a shorter operation time (WMD - 50.28; p < 0.05) and lower rates of transient RLN palsy (OR 0.41; p < 0.05).

CONCLUSIONS

The results show that in terms of safety and efficacy, TET was similar to COT for the treatment of thyroid cancer. Indeed, the tumor recurrence rates and the level of surgical completeness in TET are similar to those obtained for COT. TET was associated with significantly lower levels of transient hypocalcemia and better cosmetic satisfaction, and thus is the better option for patients with cosmetic concerns. Overall, randomized clinical trials and studies with larger patient cohorts and long-term follow-up data are required to further demonstrate the value of the TET.

Systematic review and meta-analysis of transaxillary robotic thyroidectomy versus open thyroidectomy

PURPOSE

It remains controversial whether the transaxillary robotic thyroidectomy (RT) is a feasible or better alternative to open thyroidectomy (OT) in thyroid surgery. We aimed to evaluate the efficacy of RT by pooling comparative studies of RT and OT in a systematic review and meta-analysis.

MATERIALS AND METHODS

Original articles comparing transaxillary RT and conventional OT for thyroid diseases, published in the English language from1990 until February 3, 2013 were systematically searched in PubMed, Embase, Medline, and the Cochrane Library. The outcomes analyzed were postoperative complications, number of retrieved lymph nodes, operative time, postoperative hospital stay, and cosmetic satisfaction.

RESULTS

Nine studies that fulfilled the eligibility criteria were included in the meta-analysis, of a total of 1615 patients (510 RT and 1105 OT). Compared with OT, RT showed a similar incidence of complications, number of retrieved lymph nodes, and length of postoperative hospital stay. The cosmetic effect of RT was superior to OT. But the operative time of RT was significantly longer than OT.

CONCLUSIONS

The available data suggest that the efficacy of RT is similar to OT in the treatment of thyroid diseases on the whole. RT has a better cosmetic effect than OT. But longer operative time is needed by RT.

Robotic thyroidectomy using bilateral axillo-breast approach: Comparison of surgical results with open conventional thyroidectomy

BACKGROUND

The aim of the present study was to compare the surgical outcomes of robotic thyroidectomy using the bilateral axillo-breast approach (BABA) with open conventional thyroidectomy.

METHODS

Database of patients who underwent thyroidectomy with cervical lymph node dissection after diagnosed as papillary thyroid carcinoma between July 2008 and February 2013 were examined. Clinicopathologic characteristics, surgical outcomes, and postoperative morbidities of robot group and open group were investigated.

RESULTS

The dominant tumor size (P=0.974), body mass index (BMI) (P=0.426), and the mean number of metastatic lymph nodes in central compartment neck dissection (P=0.269) were comparable between the two groups. The mean number of retrieved central lymph nodes was higher in the open group than in the robot group (P=0.001). Postoperative complications were comparable: hypoparathyroidism in 2 weeks (P=0.296) and 3 months (P=0.446) after the surgery; vocal cord palsy in 2 weeks (P=0.363) and 3 months (P=0.312); hematoma (P=0.162); and wound infection (P=0.421).

CONCLUSIONS

Robotic thyroidectomy using BABA may be a technically feasible and safe procedure comparable to conventional open surgery especially in node-negative patients.

Indications for the gasless transaxillary robotic approach to thyroid surgery: experience of forty-seven procedures at the american hospital of paris

BACKGROUND

Thyroid surgery is in a state of evolution from traditional open approaches to novel robotic techniques. The gasless transaxillary approach to thyroid surgery is effective in the management of thyroid cancer, and complications after robotic thyroidectomy are no higher than experienced after open or endoscopic techniques. The transaxillary robotic approach also avoids an anterior neck scar. This paper presents what the authors believe to be the largest cohort of patients reported in Europe undergoing gasless transaxillary robotic thyroid surgery, with the aim of defining the indications for this procedure.

METHODS

Forty-six patients underwent robotic thyroid surgery via the transaxillary approach and were enrolled in this study between March 2010 and September 2012. All patients were operated on by one surgeon at one clinical center. Reviewed data included patient characteristics, pathological characteristics, extent of surgery and postoperative complications. The mean follow-up time was 7.29 months.

RESULTS

Forty-six patients underwent 47 procedures, the average age of the patients was 43 years and the male to female ratio was 1:22. Undertaken were 30 lobectomies, 3 subtotal thyroidectomies, 13 total thyroidectomies and 1 totalization. One case was converted to an open procedure. The ratio of malignant to benign disease was 1:6.67 (6:40 cases) and analysis of the surgical specimens showed 6 follicular lesions, 24 follicular adenomas, 3 colloid lesions, 1 case of thyroiditis/lymphatic lesion, 3 adenomatoid lesions, 3 oncocytic adenomas, 3 papillary cancers and 3 microcapillary cancers. The overall average size of an individual specimen removed was 45.40 ± 28.95 cm(3) (range 5-160, n = 47) and the average largest diameter of the lesion removed was 3.72 ± 0.95 cm (range 1.4-6.0, n = 47). Postoperatively, there were 5 recurrent laryngeal nerve injuries (4 transient), 2 transient brachial plexopathies, 1 case of postoperative dysphagia and 1 of collection of blood at the site of surgery. There were no cases of disease recurrence at follow-up.

CONCLUSIONS

The gasless robotic transaxillary approach to thyroid surgery has been predicted to become a standard technique. It has been shown to be efficacious in the management of thyroid cancer with lateral neck metastases; however, more data relating to oncological safety in long-term follow-up is required. This intervention is also appropriate for benign thyroid disease including Graves' disease. To achieve consistently successful results, careful patient selection is fundamental in terms of patient characteristics and the anatomical aspects of the lesion. This is especially important with a geographical expansion to include North America and Europe. The excellent cosmetic results of this procedure make it ideal for patients who have esthetic concerns regarding particular difficulties with healing; however, in common with all new surgical procedures, further evidence must be sought to confirm its indications over time.

Safety of robotic thyroidectomy approaches: meta-analysis and systematic review

BACKGROUND

This study compared the efficacy of robotic thyroidectomy via a gasless, axillary approach with conventional cervical and endoscopic techniques by meta-analysis.

METHODS

Articles were identified from the following keyword searches: robotic/robot-assisted thyroidectomy/thyroid surgery. Outcomes included operative time, hospital stay, complications, and cosmetic satisfaction after surgery. Between-group outcome differences were calculated using random-effects models.

RESULTS

In all, 87 publications were identified and 9 studies met inclusion criteria, totaling 2881 patients, 1122 of whom underwent robotic thyroidectomy. Those who underwent robotic surgery reported greater cosmetic satisfaction, with a pooled net mean difference of -1.35 (95% confidence interval [CI]: -1.69, -1.09). Robotic approach operative time was longer than that of the conventional approach (95% CI: 29.23, 54.87), with a trend to be shorter than the endoscopic approaches. Robotic surgery had similar risks to open and endoscopic approaches.

CONCLUSIONS

Our meta-analysis suggests that robotic thyroidectomy is as safe, feasible, and efficacious as conventional cervical and endoscopic thyroidectomy, showing superior cosmetic satisfaction than that of conventional thyroidectomy.

Excellence in robotic thyroid surgery: a comparative study of robot-assisted versus conventional endoscopic thyroidectomy in papillary thyroid microcarcinoma patients

OBJECTIVE

To confirm the merits of robotic thyroid surgery by comparing the surgical outcomes of robotic-assisted and conventional endoscopic thyroidectomy in papillary thyroid microcarcinoma (PTMC) patients.

BACKGROUND

Robot-assisted surgical techniques are widely utilized, and substantially, overcome the limitations of conventional endoscopic surgery. Furthermore, recently, robotic procedures were introduced to the thyroidectomy field.

METHODS

From November 2001 to July 2009, 1150 patients with PTMC underwent endoscopic thyroidectomy using a gasless, trans-axillary approach. Of these patients, 580 underwent a robotic procedure (the robotic group; RG) and 570 a conventional endoscopic procedure (the conventional endoscopic group; EG). These 2 groups were retrospectively compared in terms of their clinicopathologic characteristics, early surgical outcomes, and surgical completeness.

RESULTS

Total thyroidectomy was performed more frequently in the RG. Although mean operation times were not statistically different, the mean number of central nodes retrieved was greater in the RG than in the EG. Mean tumor size were not significantly different in the 2 groups, but the RG showed more frequent central node metastasis and capsular invasion. Tumor and nodal statuses in the RG were more advanced than in the EG. Regarding postoperative complications, transient hypocalcemia was more frequent in the RG, but other complication frequencies were not significantly different in the 2 groups. Postoperative serum thyroglobulin levels were similar in 2 groups, and short-term follow-up (1 year) revealed no recurrence by sonography and no abnormal uptake during radioactive iodine therapy in either group.

CONCLUSIONS

The application of robotic technology to endoscopic thyroidectomy could overcome the limitations of conventional endoscopic surgery during the surgical management of PTMC.

Hyperthyroidism, exophthalmos, and goiter: historical notes on the orbitopathy

BACKGROUND

Exophthalmos associated with goiter and/or symptoms of hyperthyroidism have been known since antiquity. It was not until around 1800 that a number of studies described this disorder in more detail.

SUMMARY

For many years the nature of the disease remained unclear and it was appreciated as either a cardiac or neurological disease. There was no agreement on treatment. Surgery on the thyroid, orbit, autonomous nerve system, and pituitary has been employed. Medical treatment was introduced around World War II. Later, as a consequence of the discovery of long-acting thyroid stimulator, it became apparent that Graves-Basedow's disease was an autoimmune disease and so was the exophthalmos, though many details of the pathophysiology remain in doubt.

CONCLUSIONS

This article presents a brief review of the history of the exophthalmos associated with thyroid disease.

Historical perspective of parathyroid disease

This article highlights key historical developments in the understanding of parathyroid function and disease, a story that involves many clinical investigators and classic scientific debate. The current medical community is certainly indebted to the innate curiosity and perseverance of these historical figures.

[Overview of the history of thyroid surgery]

Thyroid gland surgery passed through history from the suggestions for prohibition, during middle of XIX century due to unacceptable mortality even for medieval condition, to highest vel of surgical laser, as W. Halsted sad. First thyroidectomy was done by Albucasis (El Zahrawi) in 925 a.d. and after him by Roger from Salerno. While Pierre-Joseph Dusalt in 1791 has done first operation on thyroid gland than can fulfill todays criteria, Teodor Billroth gave scientific grounds of thyroid surgery. Genius attitude and surgical talent of Theodor Kocher raised thyroid surgery o scientific level, brought surgical skills on the top of surgical art pyramid, and brought him personally to the Nobel Prize in 1909. Every important contribution to development of thyroid surgery gave its giants: Johann von Mikulic, William Halsted, Charles Mayo, George W. Crile and Rank Lahey. Thomas P. Dunhill, F.A. Coller, A.M. Boydena and many others did important contribution, too. Development of thyroid srugery was constant to nowadays, with tendention for multidisciplinary approach in specialized centres. Thyroid surgery in Serbia followed this world trends, in spite of treat problems in the area during history.