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Docimo G, Filograna Pignatelli M, Ferrandes S, Monaco A, Calisti F, Ruggiero R, Tolone S, Lucido FS, Brusciano L, Parisi S, Conzo G, Docimo L, Gambardella C. Role of Absorbable Polysaccharide Hemostatic Powder in the Prevention of Bleeding and Wound Events after Thyroid Surgery. J Clin Med 2023; 12:5684. [PMID: 37685750 PMCID: PMC10488928 DOI: 10.3390/jcm12175684] [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: 05/30/2023] [Revised: 07/06/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Bleeding is one of the most fearsome and life-threatening complications after thyroid surgery. Several medical devices and haemostatic agents have been proposed to improve haemostasis during total and hemi-thyroidectomy. Resorbable polysaccharide powder (HaemoCer™) is a plant-based polymer that is helpful in terms of the coagulation cascade becoming a gel and forming a barrier to prevent further bleeding, having tested for haemostasis in different districts. The aim of the current study was the evaluation of drain output, the presence of significant postoperative blood loss and complications in patients treated with or without resorbable polysaccharide powder during thyroid surgery. METHODS From January to December 2022, postoperative bleeding, drainage output and the postoperative wound events of patients undergoing thyroid surgery, in a tertiary centre, with haemostasis completion with resorbable polysaccharide powder (Group A) or not (Group B), were retrospectively analysed. RESULTS Eighty-one patients in Group A received a haemostasis improvement with the use of reabsorbable polysaccharide powder, and 96 patients in Group B received thyroid surgery alone. Patients in Group A presented lower drainage output (0.005), lower incidence of neck haematoma (0.005) and seroma (0.021), confirmed also by multivariate analysis. CONCLUSIONS The resorbable polysaccharide powder, in the current series, appeared to be an effective agent in achieving haemostasis in thyroidectomies, reducing the postoperative drainage output, and also neck events such as neck haematoma and seroma, improving the postoperative comfort of the patients. Further larger comparative studies are needed to address this issue.
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Affiliation(s)
- Giovanni Docimo
- Unit of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.D.); (M.F.P.); (S.F.); (A.M.); (F.C.)
| | - Marcello Filograna Pignatelli
- Unit of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.D.); (M.F.P.); (S.F.); (A.M.); (F.C.)
| | - Sonia Ferrandes
- Unit of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.D.); (M.F.P.); (S.F.); (A.M.); (F.C.)
| | - Alessandro Monaco
- Unit of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.D.); (M.F.P.); (S.F.); (A.M.); (F.C.)
| | - Francesco Calisti
- Unit of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.D.); (M.F.P.); (S.F.); (A.M.); (F.C.)
| | - Roberto Ruggiero
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (R.R.); (S.T.); (F.S.L.); (L.B.); (S.P.); (G.C.); (L.D.)
| | - Salvatore Tolone
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (R.R.); (S.T.); (F.S.L.); (L.B.); (S.P.); (G.C.); (L.D.)
| | - Francesco Saverio Lucido
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (R.R.); (S.T.); (F.S.L.); (L.B.); (S.P.); (G.C.); (L.D.)
| | - Luigi Brusciano
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (R.R.); (S.T.); (F.S.L.); (L.B.); (S.P.); (G.C.); (L.D.)
| | - Simona Parisi
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (R.R.); (S.T.); (F.S.L.); (L.B.); (S.P.); (G.C.); (L.D.)
| | - Giovanni Conzo
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (R.R.); (S.T.); (F.S.L.); (L.B.); (S.P.); (G.C.); (L.D.)
| | - Ludovico Docimo
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (R.R.); (S.T.); (F.S.L.); (L.B.); (S.P.); (G.C.); (L.D.)
| | - Claudio Gambardella
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (R.R.); (S.T.); (F.S.L.); (L.B.); (S.P.); (G.C.); (L.D.)
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Chui JN, Papachristos AJ, Mechera R, Sidhu SB, Sywak MS, Lee JC, Gundara J, Lai C, Glover AR. Unexpected deaths after endocrine surgery: learning from rare events using a national audit of surgical mortality. Br J Surg 2022; 109:1164-1171. [PMID: 35927948 PMCID: PMC10364700 DOI: 10.1093/bjs/znac276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/07/2022] [Accepted: 07/16/2022] [Indexed: 08/02/2023]
Abstract
BACKGROUND The mortality rate is low in endocrine surgery, making it a difficult outcome to use for quality improvement in individual units. Lessons from population data sets are of value in improving outcomes. Data from the Australian and New Zealand Audit of Surgical Mortality (ANZASM) were used here to understand and elucidate potential systems issues that may contribute to preventable deaths. METHODS ANZASM data relating to 30-day mortality after thyroidectomy, parathyroidectomy, and adrenalectomy from 2009 to 2020 were reviewed. Mortality rates were calculated using billing data. Thematic analysis of independent assessor reports was conducted to produce a coding framework. RESULTS A total of 67 deaths were reported, with an estimated mortality rate of 0.03-0.07 per cent (38 for thyroidectomy (0.03-0.06 per cent), 16 for parathyroidectomy (0.03-0.06 per cent), 13 for adrenalectomy (0.15-0.33 per cent)). Twenty-seven deaths (40 per cent) were precipitated by clinically significant adverse events, and 18 (27 per cent) were judged to be preventable by independent ANZASM assessors. Recurrent themes included inadequate preoperative assessment, lack of anticipation of intraoperative pitfalls, and failure to recognize and effectively address postoperative complications. Several novel themes were reiterated, such as occult ischaemic heart disease associated with death after parathyroid surgery, unexpected intraoperative difficulties from adrenal metastasis, and complications due to anticoagulation therapy after thyroid surgery. CONCLUSION This study represents a large-scale national report of deaths after endocrine surgery and provides insights into these rare events. Although the overall mortality rate is low, 27 per cent of deaths involved systems issues that were preventable following independent peer review.
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Affiliation(s)
| | | | - Robert Mechera
- Endocrine Surgery Unit, Royal North Shore Hospital, Northern Sydney Local Health District and Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Stan B Sidhu
- Endocrine Surgery Unit, Royal North Shore Hospital, Northern Sydney Local Health District and Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Mark S Sywak
- Endocrine Surgery Unit, Royal North Shore Hospital, Northern Sydney Local Health District and Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - James C Lee
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Justin Gundara
- Department of Surgery, Redland Hospital, Metro South and Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Surgery, Logan Hospital, Metro South and School of Medicine and Dentistry, Griffith University, Logan, Australia
| | - Christine Lai
- Division of Surgery, University of Adelaide, Adelaide, South Australia, Australia
- Department of Surgery, Queen Elizabeth Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Anthony R Glover
- Correspondence to: Anthony R. Glover, Royal North Shore Hospital Level 3, Endocrine and Oncology, ASB, St Leonards, New South Wales, 2065, Australia (e-mail: )
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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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van Rooijen JJ, van Trotsenburg ASP, van de Berg DJ, Zwaveling-Soonawala N, Nieveen van Dijkum EJM, Engelsman AF, Derikx JPM, Mooij CF. Complications After Thyroidectomy in Children: Lymph Node Dissection Is a Risk Factor for Permanent Hypocalcemia. Front Endocrinol (Lausanne) 2021; 12:717769. [PMID: 34659111 PMCID: PMC8511766 DOI: 10.3389/fendo.2021.717769] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 09/14/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Thyroidectomy is a treatment option in some benign thyroid disorders and the definitive treatment option for thyroid cancer. As postoperative mortality is extremely rare data on postoperative complications and long-term health consequences are important. OBJECTIVE To evaluate the frequencies of short- and long-term complications, and their risk factors in pediatric patients (0-18 years) who underwent a thyroidectomy in a tertiary children's hospital. METHODS A retrospective single center study was performed including all pediatric patients who underwent a thyroidectomy between January 2013 and February 2020. RESULTS Forty-eight patients were included in this study (mean age 14.6 years). Twenty-nine total thyroidectomies and 19 hemithyroidectomies were conducted. Thyroid carcinoma was the indication to perform a thyroidectomy in 12 patients, 36 patients underwent a thyroidectomy because of a benign thyroid disorder. Postoperative hypocalcemia was evaluated in patients who underwent a total thyroidectomy. Rapidly resolved hypocalcemia was observed in three patients (10.3%), transient hypocalcemia in 10 patients (34.5%) and permanent hypocalcemia in six patients (20.7%). Permanent hypocalcemia was only seen in patients who underwent a thyroidectomy combined with additional lymph node dissection because of thyroid carcinoma [thyroid carcinoma: OR 43.73, 95% CI (2.11-904.95); lymph node dissection: OR 76.14, 95% CI (3.49-458.98)]. Transient and permanent recurrent laryngeal nerve injury was reported in four (8.3%) and one (2.1%) of all patients, respectively. CONCLUSION Permanent postoperative complications after thyroidectomy are rare in pediatric patients undergoing a thyroidectomy without lymph node dissection. However, in this age group permanent hypocalcemia occurs more frequently after thyroidectomy with additional lymph node dissection because of thyroid cancer. With respect to quality of life, especially of pediatric thyroid cancer patients, reducing this complication is an important goal.
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Affiliation(s)
- Jesse J. van Rooijen
- Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - A. S. Paul van Trotsenburg
- Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Daniël J. van de Berg
- Department of Pediatric Surgery, Emma Children’s Hospital, Amsterdam University Medical Centers, University of Amsterdam and Vrije Universiteit, Amsterdam, Netherlands
| | - Nitash Zwaveling-Soonawala
- Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Els J. M. Nieveen van Dijkum
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam and Vrije Universiteit, Amsterdam, Netherlands
| | - Anton F. Engelsman
- Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam and Vrije Universiteit, Amsterdam, Netherlands
| | - Joep P. M. Derikx
- Department of Pediatric Surgery, Emma Children’s Hospital, Amsterdam University Medical Centers, University of Amsterdam and Vrije Universiteit, Amsterdam, Netherlands
| | - Christiaan F. Mooij
- Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
- *Correspondence: Christiaan F. Mooij,
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Energy vessel sealant devices are associated with decreased risk of neck hematoma after thyroid surgery. Updates Surg 2020; 72:1135-1141. [PMID: 32333320 DOI: 10.1007/s13304-020-00776-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 04/16/2020] [Indexed: 12/09/2022]
Abstract
Postoperative neck hematomas following thyroidectomy occur in up to 6.5% of cases. It is unclear whether the use of energy vessel sealant devices effects the rate of PNH. We hypothesized use of an EVSD to be associated with decreased risk of PNH in patients undergoing thyroidectomy. The 2016-2017 American College of Surgeons Thyroidectomy database was queried for patients undergoing thyroidectomy with and without EVSDs. A multivariable logistic regression analysis was performed to evaluate for risk of PNH. From 11,355 patients undergoing thyroidectomy, an EVSD was used for 7460 (65.7%) patients. Age distribution was similar between the two groups (52 vs. 53-years old, p = 0.467). Compared to patients without EVSD used, patients with EVSD used had higher rates of comorbid hypertension (40.6% vs. 34.8%, p < 0.001) and diabetes (14.2% vs. 11.5%, p < 0.001); however, a lower rate of PNH (1.4% vs. 2.4%, p < 0.001). After adjusting for known risk factors for PNH including age, prior neck surgery, and comorbidities, EVSD use was associated with a decreased risk of PNH (OR 0.453, 95% CI 0.330-0.620, p < 0.001). The strongest associated risk factors for PNH were hypertension (OR 1.823, 95% CI 1.283-2.591, p = 0.001) and toxic goiter (OR 1.837, 95% CI 1.144-2.949, p = 0.012). When compared to standard vessel ligation, EVSD use was associated with a lower risk of PNH in patients undergoing thyroidectomy. The strongest associated risk factor for PNH was toxic goiter. Future prospective research is needed to confirm these findings and if corroborated, then increased use of an EVSD should be employed.
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Park MW, Baek SK, Park EH, Jung KY. Long-term voice outcome after thyroidectomy using energy based devices. Auris Nasus Larynx 2018; 45:527-532. [DOI: 10.1016/j.anl.2017.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 07/31/2017] [Accepted: 08/09/2017] [Indexed: 12/12/2022]
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Aygün N, Uludağ M, İşgör A. Contribution of intraoperative neuromonitoring to the identification of the external branch of superior laryngeal nerve. Turk J Surg 2017; 33:169-174. [PMID: 28944328 DOI: 10.5152/turkjsurg.2017.3645] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 08/10/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We evaluated the contribution of intraoperative neuromonitoring to the visual and functional identification of the external branch of the superior laryngeal nerve. MATERIAL AND METHODS The prospectively collected data of patients who underwent thyroid surgery with intraoperative neuromonitoring for external branch of the superior laryngeal nerve exploration were assessed retrospectively. The surface endotracheal tube-based Medtronic NIM3 intraoperative neuromonitoring device was used. The external branch of the superior laryngeal nerve function was evaluated by the cricothyroid muscle twitch. In addition, contribution of external branch of the superior laryngeal nerve to the vocal cord adduction was evaluated using electromyographic records. RESULTS The study included data of 126 (female, 103; male, 23) patients undergoing thyroid surgery, with a mean age of 46.2±12.2 years (range, 18-75 years), and 215 neck sides were assessed. Two hundred and one (93.5%) of 215 external branch of the superior laryngeal nerves were identified, of which 60 (27.9%) were identified visually before being stimulated with a monopolar stimulator probe. Eighty-nine (41.4%) external branch of the superior laryngeal nerves were identified visually after being identified with a probe. Although 52 (24.1%) external branch of the superior laryngeal nerves were identified with a probe, they were not visualized. Intraoperative neuromonitoring provided a significant contribution to visual (p<0.001) and functional (p<0.001) identification of external branch of the superior laryngeal nerves. Additionally, positive electromyographic responses were recorded from 160 external branch of the superior laryngeal nerves (74.4%). CONCLUSION Intraoperative neuromonitoring provides an important contribution to visual and functional identification of external branch of the superior laryngeal nerves. We believe that it can not be predicted whether the external branch of the superior laryngeal nerve is at risk or not and the nerve is often invisible; thus, intraoperative neuromonitoring may routinely be used in superior pole dissection. Glottic electromyography response obtained via external branch of the superior laryngeal nerve stimulation provides quantifiable information in addition to the simple visualization of the cricothyroid muscle twitch.
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Affiliation(s)
- Nurcihan Aygün
- Department of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Mehmet Uludağ
- Department of General Surgery, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul, Turkey
| | - Adnan İşgör
- Department of General Surgery, Bahçeşehir University School of Medicine, İstanbul, Turkey
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Uludag M, Aygun N, Kartal K, Citgez B, Besler E, Yetkin G, Kaya C, Ozsahin H, Mihmanli M, Isgor A. Contribution of intraoperative neural monitoring to preservation of the external branch of the superior laryngeal nerve: a randomized prospective clinical trial. Langenbecks Arch Surg 2016; 402:965-976. [PMID: 28035477 DOI: 10.1007/s00423-016-1544-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 12/16/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the effect of intraoperative neuromonitoring (IONM) on the injury rate of the external branch of the superior laryngeal nerve (EBSLN) during thyroidectomy. METHODS A total of 133 consenting patients (98 female, 35 male; mean age, 45.6 ± 11.7 years) undergoing thyroidectomy were randomly assigned to 2 groups. In group 1 (n = 65 patients, 105 nerves), superior thyroid pole dissection was performed with no attempt to identify the EBSLN; in group 2 (n = 68 patients, 106 nerves), IONM was used to identify the EBSLN during surgery. EBSLN function was evaluated by intraoperative electromyography of the cricothyroid muscle. The EBSLN Voice Impairment Index-5 (VII-5) was conducted preoperatively and at 1, 3, and 6 months postoperatively. The primary outcome was the prevalence of EBSLN injury. The secondary outcomes were the identification rate of the EBSLN using IONM and changes in postoperative voice performance. RESULTS EBSLN injury was detected in eight (12.3%) patients and nine (8.6%) nerves in group 1 and in one (1.5%) patient and one (0.9%) nerve in group 2 (patients, p = 0.015; nerves, p = 0.010). IONM contributed significantly to visual (p < 0.001) and functional (p < 0.001) nerve identification in group 2. The VII-5 indicated more voice changes in group 1 than 2 at 1, 3, and 6 months postoperatively (p = 0.012, p = 0.015, and p = 0.02, respectively). CONCLUSION IONM contributes to visual and functional identification of the EBSLN and decreases the rate of EBSLN injury during superior pole dissection. Routine use of IONM to identify the EBSLN will minimize the risk of injury during thyroidectomy.
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Affiliation(s)
- Mehmet Uludag
- General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
| | - Nurcihan Aygun
- General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Kinyas Kartal
- General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Bulent Citgez
- General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Evren Besler
- General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Gurkan Yetkin
- General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Cemal Kaya
- General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Hamdi Ozsahin
- General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Mihmanli
- General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Adnan Isgor
- General Surgery, Bahcesehir University Medical Faculty, Istanbul, Turkey
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Advanced vessel sealing devices in total thyroidectomy for substernal goitre: A retrospective cohort study. Int J Surg 2016; 35:160-164. [DOI: 10.1016/j.ijsu.2016.09.092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/31/2016] [Accepted: 09/24/2016] [Indexed: 02/03/2023]
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10
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Ambe PC, Wassenberg DR. Is sutureless thyroid surgery safe in the hands of surgical trainees. A single centre retrospective study. BMC Res Notes 2016; 9:118. [PMID: 26905580 PMCID: PMC4763438 DOI: 10.1186/s13104-016-1940-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 02/17/2016] [Indexed: 12/14/2022] Open
Abstract
Background The safety and efficacy of sutureless thyroid surgery have been confirmed in many series. Equally, surgical expertise has been shown to influence postoperative outcome. This study aimed at investigating the safety of sutureless thyroid surgery in the hands of surgical trainees and to find out if this technique could be safely integrated into endocrine surgical training programs. Methods A single center retrospective comparison of the outcome of surgeries performed by experienced surgical attendings and trainees was performed. The LigaSure Precise was used in all cases. Results Two hundred and eight patients were included. The trainee group comprised of 61 cases managed by surgical trainees. Surgery was performed by surgical attendings in 147 cases (consultant group). The incidences of transient and permanent hypocalcaemia were 20.7 and 0.9 % respectively, the corresponding values for recurrent nerve injury were 6.3 and 0.9 %. Postoperative bleeding occurred in 3.4 %. There was no difference amongst both groups with regard to postoperative outcome (p > 0.05). Conclusions While sutureless thyroid surgery was safely performed by surgical trainees without relevant increase in perioperative complications in our department, further larger scale studies would be needed to confirm this would be the case more widely.
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Affiliation(s)
- Peter C Ambe
- Department of General, Visceral and Thoracic Surgery, St. Remigius Hospital Opladen, 51379, Leverkusen, Germany. .,Department of Surgery II, Helios Klinikum Wuppertal, Witten-Herdecke University, Heusnerstr. 40, 42283, Wuppertal, Germany.
| | - Dirk R Wassenberg
- Department of General, Visceral and Thoracic Surgery, St. Remigius Hospital Opladen, 51379, Leverkusen, Germany.
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Butskiy O, Wiseman SM. Electrothermal bipolar vessel sealing system (LigaSure™) for hemostasis during thyroid surgery: a comprehensive review. Expert Rev Med Devices 2014; 10:389-410. [DOI: 10.1586/erd.13.6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Glover AR, Gundara JS, Lee JC, Sywak MS, Delbridge LW, Sidhu SB. Thermal sealing systems with and without tissue divider for total thyroidectomy. ANZ J Surg 2013; 84:383-5. [DOI: 10.1111/ans.12406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Anthony R. Glover
- Kolling Institute of Medical Research; Cancer Genetics Laboratory; Royal North Shore Hospital and The University of Sydney; Sydney New South Wales Australia
| | - Justin S. Gundara
- Kolling Institute of Medical Research; Cancer Genetics Laboratory; Royal North Shore Hospital and The University of Sydney; Sydney New South Wales Australia
| | - James C. Lee
- Kolling Institute of Medical Research; Cancer Genetics Laboratory; Royal North Shore Hospital and The University of Sydney; Sydney New South Wales Australia
| | - Mark S. Sywak
- Endocrine Surgical Unit; Royal North Shore Hospital and The University of Sydney; Sydney New South Wales Australia
| | - Leigh W. Delbridge
- Endocrine Surgical Unit; Royal North Shore Hospital and The University of Sydney; Sydney New South Wales Australia
| | - Stan B. Sidhu
- Kolling Institute of Medical Research; Cancer Genetics Laboratory; Royal North Shore Hospital and The University of Sydney; Sydney New South Wales Australia
- Endocrine Surgical Unit; Royal North Shore Hospital and The University of Sydney; Sydney New South Wales Australia
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Garas G, Okabayashi K, Ashrafian H, Shetty K, Palazzo F, Tolley N, Darzi A, Athanasiou T, Zacharakis E. Which hemostatic device in thyroid surgery? A network meta-analysis of surgical technologies. Thyroid 2013; 23:1138-50. [PMID: 23470035 DOI: 10.1089/thy.2012.0588] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Energy-based hemostatic devices are increasingly being used in thyroid surgery. However, there are several limitations with regard to the existing evidence and a paucity of guidelines on the subject. The goal of this review is to employ the novel evidence synthesis technique of a network meta-analysis to assess the comparative effectiveness of surgical technologies in thyroid surgery and contribute to enhanced governance in the field of thyroid surgery. METHODS Articles published between January 2000 and June 2012 were identified from Embase, Medline, Cochrane Library, and PubMed databases. Randomized controlled trials of any size comparing the use of ultrasonic coagulation (harmonic scalpel) or Ligasure either head-to-head or against the "clamp-and-tie" technique were included. Two reviewers independently critically appraised and extracted the data from each study. The number of patients who experienced postoperative events was extracted in dichotomous format or continuous outcomes. Odds ratios were calculated by a Bayesian network meta-analysis, and metaregression was used for pair-wise comparisons. Indirect and direct comparisons were performed and inconsistency was assessed. RESULTS Thirty-five randomized controlled trials with 2856 patients were included. Ultrasonic coagulation ranked first (followed by Ligasure and then clamp-and-tie) with the lowest risk of postoperative hypoparathyroidism (odds ratio 1.43 [95% confidence interval (CI) 0.77-2.67] and 0.70 [CI 0.43-1.13], ultrasonic coagulation vs. Ligasure and ultrasonic coagulation vs. clamp-and-tie, respectively), least blood loss (-0.25 [CI -0.84 to -0.35] and -1.22 [CI -1.85 to -0.59]), and drain output (0.28 [CI -0.35 to -0.91] and -0.36 [CI -0.70 to -0.03]). From a health technology viewpoint, ultrasonic coagulation was associated with the shortest operative time (-0.66 [CI -1.17 to -0.14] and -1.29 [CI -1.59 to -1.00]) and hospital stay (-0.28 [CI -0.78 to 0.22] and -0.56 [CI -1.28 to 0.15]). The only exception occurs with the clinically important complication of recurrent laryngeal nerve paralysis, where the reverse trend applies (1.36 [CI 0.25-7.46] and 1.74 [CI 0.94-3.26]). CONCLUSIONS The comparative effectiveness of ultrasonic coagulation in thyroid surgery outcomes seems superior to other techniques with the exception of recurrent laryngeal nerve injury. This network meta-analysis, one of a handful in a surgical field, offers preliminary and robust evidence to guide clinical decisions and policy makers to adopt safer thyroid operations.
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Affiliation(s)
- George Garas
- 1 Department of Otorhinolaryngology and Head & Neck Surgery, Imperial College London , London, United Kingdom
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