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Padovano M, Scopetti M, Tomassi R, Manetti F, D'Errico S, Santurro A, De Toma G, Frati P, Miccoli P, Fineschi V. Mapping complications in thyroid surgery: statistical data are useful for medico-legal management of a recurrent safety issue. Updates Surg 2022; 74:1725-1732. [PMID: 36028654 PMCID: PMC9481495 DOI: 10.1007/s13304-022-01357-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/04/2022] [Indexed: 11/24/2022]
Abstract
Abstract Quality of care assessment is a crucial tool for patient safety implementation. Litigation relating to thyroid surgery is one of the most represented sectors also due to the continuous increase in the number of thyroid interventions. Given the incidence of the problem, the present study aims to outline an operational methodology for risk mapping and litigation management in thyroid surgery. The study was conducted through the analysis of data collected at Umberto I General Hospital in Rome from 2007 to 2018. All thyroid surgery claims were included and, subsequently, a descriptive statistical analysis of the categorical variables was performed with the representation of frequencies in absolute terms and as a percentage. The results obtained show that in 94% of cases (44 cases) the reported event consists of incorrect treatment. The most frequent adverse events were identified in unilateral or bilateral recurrent nerve lesions (31; 70%); incomplete removal of the thyroid gland (6; 14%), post-surgical hypoparathyroidism (4; 9%), aesthetic damage secondary to surgical scars (2; 5%), dental avulsion during intubation maneuvers (1; 2%). The experience derived from the risk mapping through management of thyroid claims proved it to be a reactive tool of considerable importance in clinical governance. The promotion of measures aimed at improving the satisfaction of some critical parameters identified in the litigation management activity such as adherence to the indications for surgery, the preoperative diagnostic path, and the adequacy of the surgical report allows to further implement the quality of care in the surgical treatment of thyroid pathology. Graphical Abstract ![]()
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Affiliation(s)
- Martina Padovano
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185, Rome, Italy
| | - Matteo Scopetti
- Department of Medical, Surgical Sciences and Translational Medicine, Sapienza University of Rome, 00189, Rome, Italy
| | - Raoul Tomassi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185, Rome, Italy
| | - Federico Manetti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185, Rome, Italy
| | - Stefano D'Errico
- Department of Medicine, Surgery and Health, University of Trieste, 34149, Trieste, Italy
| | - Alessandro Santurro
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Salerno, Italy.
| | - Giorgio De Toma
- Department of Surgery, Sapienza University of Rome, 00161, Rome, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185, Rome, Italy
| | - Paolo Miccoli
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, 56126, Pisa, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, 00185, Rome, Italy
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Liu RH, Razavi CR, Chang HY, Tufano RP, Eisele DW, Gourin CG, Russell JO. Association of Hypocalcemia and Magnesium Disorders With Thyroidectomy in Commercially Insured Patients. JAMA Otolaryngol Head Neck Surg 2021; 146:237-246. [PMID: 31917427 DOI: 10.1001/jamaoto.2019.4193] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Importance Hypocalcemia is a common complication of total thyroidectomy. Objectives To identify factors associated with hypocalcemia after total thyroidectomy and to explore the association between hypocalcemia, magnesium disorders, and costs of care. Design, Setting, and Participants A retrospective cross-sectional analysis was performed using data from the MarketScan Commercial Claim and Encounters database on 126 766 commercially insured patients younger than 65 years undergoing total thyroidectomy between January 1, 2010, and December 31, 2012. Statistical analysis was performed from January 1, 2016, to May 30, 2019. Main Outcomes and Measures Short- and long-term hypocalcemia and the costs of care were examined using multivariable regression modeling. Results Among the 126 766 patients in the study (81.6% women; mean age, 46.5 years [range, 18-64 years]), postoperative hypocalcemia was present in 19.1% of patients in the initial 30-day postoperative period and in 4.4% of patients at 1 year. Magnesium disorders were present in 2.1% of patients at the time of surgery. Short- and long-term hypocalcemia were significantly more likely in women (short-term: odds ratio [OR], 1.39 [95% CI, 1.29-1.50]; long-term: OR, 1.69 [95% CI, 1.52-1.89]), those younger than 40 years (short-term: OR for ages 40-64 years, 0.83 [95% CI, 0.78-0.87]; long-term: OR for ages 40-64 years, 0.73 [95% CI, 0.67-0.79]), those with a diagnosis of thyroiditis (short-term: OR, 1.48 [95% CI, 1.16-1.89]; long-term: OR, 1.60 [95% CI, 1.13-2.26]) or cancer (short-term: OR, 1.32 [95% CI, 1.05-1.67]; long-term: OR, 1.17 [95% CI, 0.83-1.63]), vitamin D deficiency (short-term: OR, 1.96 [95% CI, 1.74-2.21]; long-term: OR, 3.72 [95% CI, 3.30-4.18]), concurrent lateral neck dissection (short-term: OR, 1.51 [95% CI, 1.37-1.66]; long-term: OR, 1.95 [95% CI, 1.69-2.26]), concurrent central neck dissection (short-term: OR, 1.15 [95% CI, 1.07-1.24]; long-term: OR, 1.25 [95% CI, 1.12-1.40]), intraoperative parathyroid (short-term: OR, 1.58 [95% CI, 1.46-1.71]; and long-term: OR, 2.05 [95% CI, 1.82-2.31]) or recurrent laryngeal nerve injury (short-term: OR, 1.49 [95% CI, 1.27-1.74]; long-term: OR, 2.04 [95% CI, 1.64-2.54]), and magnesium disorders (short-term: OR, 8.40 [95% CI, 7.21-9.79]; long-term: OR, 25.23 [95% CI, 19.80-32.17]). Compared with the initial postoperative period, the odds of hypocalcemia decreased by 90.0% (OR, 0.10 [95% CI, 0.09-0.11]) at 6 months and 93.0% (OR, 0.07 [95% CI, 0.06-0.08]) at 1 year. After controlling for all other variables, magnesium disorders were associated with the highest odds of short- and long-term postoperative hypocalcemia. Hypocalcemia ($3392) and magnesium disorders ($14 314) were associated with increased mean incremental 1-year costs of care. Conclusions and Relevance Hypocalcemia is common after total thyroidectomy but resolves in most patients by 1 year. Magnesium disorders are significantly independently associated with short- and long-term hypocalcemia and are associated with greater costs of care. These data suggest a potentially modifiable target to reduce the incidence and cost of long-term hypocalcemia at patient and systemic levels.
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Affiliation(s)
- Rui Han Liu
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Christopher R Razavi
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Hsien-Yen Chang
- Department of Health Policy and Management, the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ralph P Tufano
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - David W Eisele
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Christine G Gourin
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Jonathon O Russell
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Kamel AAF, Amin OAI, Hassan MAMM, Elmesallamy WAEA, Hassan EM. Ultrasound prediction for vocal cord dysfunction in patients scheduled for anterior cervical spine surgeries: a prospective cohort study. J Clin Monit Comput 2020; 35:869-875. [PMID: 32556843 DOI: 10.1007/s10877-020-00546-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/08/2020] [Indexed: 11/25/2022]
Abstract
Prediction of vocal cord dysfunction is essential after anterior cervical spine surgeries. This study aimed to detect the validity of transcutaneous laryngeal ultrasonography by both anterior and novel lateral approaches for prediction of vocal cord edema and paralysis after anterior cervical spine surgeries. A prospective cohort study conducted on 90 patients scheduled for anterior cervical spine surgeries underwent consecutive pre and postoperative vocal cord examination for edema and paralysis by both anterior and lateral approaches laryngeal ultrasonography. Rigid laryngoscopy was the standard confirmatory tool. For postoperative vocal cord edema, the anterior ultrasonography approach diagnostic sensitivity = 88.2%, specificity = 78.9% with PPV = 78.9% and NPV = 88.2% and the novel lateral ultrasonography approach diagnostic sensitivity = 88.2%, specificity = 94.7% with PPV = 93.75% and NPP = 90%. While for paralysis, the anterior ultrasonography approach diagnostic sensitivity = 86.7%, specificity = 85.7% with PPV = 81.25% and NPV = 90% and the novel lateral ultrasonography approach diagnostic (sensitivity, specificity with PPV and NPP) = 100%. The diagnostic accuracy of the novel lateral approach was more correlated to rigid laryngoscopy (91.7% and 100%) compared to anterior approach for vocal cord edema and paralysis (83.3% and 80.6%). Overall incidence of vocal cord paralysis was 16.6%. Risk of vocal cord paralysis was statistically significant more in female, multiple disc herniation, lower and mixed disc levels, Langenbeck retractor, cage and plate and duration of surgery ≥ 1.5 h. Transcutaneous Laryngeal ultrasound is a valid comfortable tool for prediction of vocal cord edema and paralysis after anterior cervical spine surgeries with superiority of the novel lateral over anterior approach.
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Affiliation(s)
| | | | | | | | - Elham Magdy Hassan
- Phoniatrics at Otorhinolaryngology Department, Faculty of Medicine, Zagazig University, Alsharkia, Egypt
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Walgama E, Randolph GW, Lewis C, Tolley N, Sacks W, Chen Y, Ho AS. Cost-effectiveness of fiberoptic laryngoscopy prior to total thyroidectomy for low-risk thyroid cancer patients. Head Neck 2020; 42:2593-2601. [PMID: 32510729 DOI: 10.1002/hed.26312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 04/24/2020] [Accepted: 05/15/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Flexible fiberoptic laryngoscopy is performed prior to thyroid surgery to evaluate the function of the recurrent laryngeal nerve. We assess the cost-effectiveness of preoperative laryngoscopy prior to total thyroidectomy for a low-risk thyroid cancer patient without dysphonia. METHODS A decision tree analysis was performed from a third-party payer perspective. We assessed the cost-effectiveness of fiberoptic laryngoscopy prior to total thyroidectomy for T2N0M0 papillary thyroid carcinoma, such that an ipsilateral vocal fold paralysis alters the surgical plan to hemi-thyroidectomy, when permissible, to avoid the risk of bilateral vocal fold paralysis. RESULTS Performing preoperative laryngoscopy to assess vocal fold function has an incremental cost-effectiveness ratio (ICER) of 45 193 USD/QALY compared to no laryngoscopy. At a willingness-to-pay of 100 K/QALY, the intervention is cost-effective if the incidence of vocal fold paralysis is at least 0.57%, or when the permissible rate of hemithyroidectomy in cases of incidental paralysis is at least 41%. Probabilistic sensitivity analysis shows that laryngoscopy is cost-effective in 90.9% of cases. CONCLUSIONS Fiberoptic laryngoscopy is a cost-effective prior to total thyroidectomy in asymptomatic, low-risk thyroid cancer patients.
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Affiliation(s)
- Evan Walgama
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.,Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carol Lewis
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Neil Tolley
- Department of Otorhinolaryngology and Head & Neck Surgery, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Wendy Sacks
- Department of Medicine, Division of Endocrinology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Yufei Chen
- Department of Surgery, Division of Endocrine Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Allen S Ho
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
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5
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The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Thyroid Disease in Adults. Ann Surg 2020; 271:e21-e93. [PMID: 32079830 DOI: 10.1097/sla.0000000000003580] [Citation(s) in RCA: 222] [Impact Index Per Article: 55.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To develop evidence-based recommendations for safe, effective, and appropriate thyroidectomy. BACKGROUND Surgical management of thyroid disease has evolved considerably over several decades leading to variability in rendered care. Over 100,000 thyroid operations are performed annually in the US. METHODS The medical literature from 1/1/1985 to 11/9/2018 was reviewed by a panel of 19 experts in thyroid disorders representing multiple disciplines. The authors used the best available evidence to construct surgical management recommendations. Levels of evidence were determined using the American College of Physicians grading system, and management recommendations were discussed to consensus. Members of the American Association of Endocrine Surgeons reviewed and commented on preliminary drafts of the content. RESULTS These clinical guidelines analyze the indications for thyroidectomy as well as its definitions, technique, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Fine Needle Aspiration Biopsy Diagnosis, Molecular Testing, Indications, Extent and Outcomes of Surgery, Preoperative Care, Initial Thyroidectomy, Perioperative Tissue Diagnosis, Nodal Dissection, Concurrent Parathyroidectomy, Hyperthyroid Conditions, Goiter, Adjuncts and Approaches to Thyroidectomy, Laryngology, Familial Thyroid Cancer, Postoperative Care and Complications, Cancer Management, and Reoperation. CONCLUSIONS Evidence-based guidelines were created to assist clinicians in the optimal surgical management of thyroid disease.
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Naunheim MR, Goldberg L, Dai JB, Rubinstein BJ, Courey MS. Measuring the impact of dysphonia on quality of life using health state preferences. Laryngoscope 2020; 130:E177-E182. [DOI: 10.1002/lary.28148] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/21/2019] [Accepted: 05/31/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Matthew R. Naunheim
- Massachusetts Eye and Ear Infirmary Boston Massachusetts U.S.A
- Harvard Medical School Boston Massachusetts U.S.A
| | - Leanne Goldberg
- Icahn School of Medicine at Mount Sinai New York New York U.S.A
| | - Jennifer B. Dai
- Icahn School of Medicine at Mount Sinai New York New York U.S.A
| | | | - Mark S. Courey
- Icahn School of Medicine at Mount Sinai New York New York U.S.A
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DeVore EK, Shrime MG, Wittenberg E, Franco RA, Song PC, Naunheim MR. The health utility of mild and severe dysphonia. Laryngoscope 2019; 130:1256-1262. [DOI: 10.1002/lary.28216] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 07/03/2019] [Accepted: 07/15/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Elliana K. DeVore
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts
- Department of OtolaryngologyMassachusetts Eye and Ear Infirmary Boston Massachusetts
| | - Mark G. Shrime
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts
- Department of OtolaryngologyMassachusetts Eye and Ear Infirmary Boston Massachusetts
- Center for Global Surgery EvaluationMassachusetts Eye and Ear Infirmary Boston Massachusetts
| | - Eve Wittenberg
- Center for Health Decision ScienceHarvard T. H. Chan School of Public Health Boston Massachusetts U.S.A
| | - Ramon A. Franco
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts
- Department of OtolaryngologyMassachusetts Eye and Ear Infirmary Boston Massachusetts
| | - Phillip C. Song
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts
- Department of OtolaryngologyMassachusetts Eye and Ear Infirmary Boston Massachusetts
| | - Matthew R. Naunheim
- Department of OtolaryngologyHarvard Medical School Boston Massachusetts
- Department of OtolaryngologyMassachusetts Eye and Ear Infirmary Boston Massachusetts
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8
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Zanocco K, Kaltman DJ, Wu JX, Fingeret A, Heller KS, Lee JA, Yeh MW, Sosa JA, Sturgeon C. Cost Effectiveness of Routine Laryngoscopy in the Surgical Treatment of Differentiated Thyroid Cancer. Ann Surg Oncol 2018; 25:949-956. [PMID: 29417402 DOI: 10.1245/s10434-018-6356-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Some surgeons perform flexible fiberoptic laryngoscopy (FFL) in all patients prior to thyroid cancer operations. Given the low likelihood of recurrent laryngeal nerve (RLN) or aerodigestive invasion in clinically low-risk thyroid cancers, the value of routine FFL in this group is controversial. We hypothesized that routine preoperative FFL would not be cost effective in low-risk differentiated thyroid cancer (DTC). METHODS A decision model was constructed comparing preoperative FFL versus surgery without FFL in a clinical stage T2 N0 DTC patient without voice symptoms. Total thyroidectomy and definitive hemithyroidectomy were both modeled as possible initial surgical approaches. Outcome probabilities and their corresponding utilities were estimated via literature review, and costs were estimated using Medicare reimbursement data. Sensitivity analysis was conducted to examine the uncertainty of cost, probability, and utility estimates in the model. RESULTS When the initial surgical strategy was total thyroidectomy, routine preoperative FFL produced an incremental cost of $183 and an incremental effectiveness of 0.000126 quality-adjusted life-years (QALYs). The incremental cost-effectiveness ratio (ICER) for routine FFL prior to total thyroidectomy was $1.45 million/QALY, exceeding the $100,000/QALY threshold for cost effectiveness. Routine FFL became cost effective if the preoperative probability of asymptomatic vocal cord paralysis increased from 1.0% to 4.9%, or if the cost of preoperative FFL decreased from $128 to $27. Changing the extent of initial surgery to hemithyroidectomy produced a higher ICER for routine FFL of $1.7 million/QALY. CONCLUSION Routine preoperative FFL is not cost effective in asymptomatic patients with sonographically low-risk DTC, regardless of the initial planned extent of surgery.
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Affiliation(s)
- Kyle Zanocco
- Division of General Surgery, Department of Surgery, Section of Endocrine Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - David J Kaltman
- Department of Surgery, Section of Endocrine Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - James X Wu
- Division of General Surgery, Department of Surgery, Section of Endocrine Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Abbey Fingeret
- Department of Surgery, Section of General Surgery - Surgical Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Keith S Heller
- Department of Surgery, Section of Endocrine Surgery, NYU Langone Medical Center, New York, NY, USA
| | - James A Lee
- Department of Surgery, Section of Endocrine Surgery, Columbia University Medical Center, New York, NY, USA
| | - Michael W Yeh
- Division of General Surgery, Department of Surgery, Section of Endocrine Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Julie Ann Sosa
- Department of Surgery, Section of Endocrine Surgery, Duke University Medical Center, Durham, NC, USA
| | - Cord Sturgeon
- Department of Surgery, Section of Endocrine Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Inversini D, Liu X, Sun H, Dionigi G. IPTH cost-effectiveness in thyroid surgery. Gland Surg 2017; 6:417-419. [PMID: 28861385 DOI: 10.21037/gs.2017.03.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Davide Inversini
- 1st Division of General Surgery, Research Center for Endocrine Surgery, Department of Medicine and Surgery, ASST Sette Laghi Ospedale di Circolo e Fondazione Macchi-Polo Universitario, University of Insubria (Varese-Como), via Guicciardini 9, 21100 Varese, Italy
| | - Xiaoli Liu
- Jilin Provincial Key Laboratory of Surgical Translational Medicine, China Japan Union Hospital of Jilin University, Division of Thyroid Surgery, Changchun city, Jilin Province, China
| | - Hui Sun
- Jilin Provincial Key Laboratory of Surgical Translational Medicine, China Japan Union Hospital of Jilin University, Division of Thyroid Surgery, Changchun city, Jilin Province, China
| | - Gianlorenzo Dionigi
- 1st Division of General Surgery, Research Center for Endocrine Surgery, Department of Medicine and Surgery, ASST Sette Laghi Ospedale di Circolo e Fondazione Macchi-Polo Universitario, University of Insubria (Varese-Como), via Guicciardini 9, 21100 Varese, Italy
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Panova TN, Nazarochkin YV, Mustafin RD, Lebedeva LI, Ob'etanov AA, Malafeev IA. [The laryngeal condition in the patients presenting with euthyroid multinodular goiter as evaluated by direct laryngoscopy]. Vestn Otorinolaringol 2017; 82:38-41. [PMID: 28514362 DOI: 10.17116/otorino201782238-41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of the present study was to improve diagnostics of disturbances in the laryngeal condition of the patients presenting with euthyroid multinodular goiter with special reference to the condition of the upper respiratory passages. The preoperative characteristic of 398 patients included the description of the predominant clinical syndrome (the neoplastic and compressive variants) and specification of the morphological type of the disease to promote the decrease of operative activity with respect to colloidal proliferative goiter. Direct laryngoscopy was employed in addition to the traditional diagnostic techniques during both the surgical operation and the follow-up observation. Hoarseness developed in the postoperative period in 13.4% to 16.9% of the patients. Postoperative transient and persistent laryngeal paresis was documented in 1.5% and from 1.5% to 4.2% of the cases respectively. Direct laryngoscopy revealed the symptoms of laryngitis and laryngotracheitis as well as foci of leukoplakia, laryngeal cysts and nodules, besides disturbances in the mobility of the vocal chordae. It is concluded that the above pathological changes in the laryngeal structures should be identified during the preoperative examination of the patients presenting with euthyroid multinodular goiter while direct laryngoscopy must be included in the program of postoperative supervision.
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Affiliation(s)
- T N Panova
- Astrakhan branch of Research and Clinical Centre of Otorhinolaryngology, Russian Federal Medico-Biological Agency, Astrakhan, Russia, 414056
| | - Yu V Nazarochkin
- Astrakhan State Medical University, Russian Ministry of Health, Astrakhan, Russia, 414000; Astrakhan branch of Research and Clinical Centre of Otorhinolaryngology, Russian Federal Medico-Biological Agency, Astrakhan, Russia, 414056
| | - R D Mustafin
- Astrakhan branch of Research and Clinical Centre of Otorhinolaryngology, Russian Federal Medico-Biological Agency, Astrakhan, Russia, 414056
| | - L I Lebedeva
- Astrakhan branch of Research and Clinical Centre of Otorhinolaryngology, Russian Federal Medico-Biological Agency, Astrakhan, Russia, 414056
| | - A A Ob'etanov
- Astrakhan State Medical University, Russian Ministry of Health, Astrakhan, Russia, 414000; Astrakhan branch of Research and Clinical Centre of Otorhinolaryngology, Russian Federal Medico-Biological Agency, Astrakhan, Russia, 414056
| | - I A Malafeev
- Aleksandro-Mariinskaya Regional Clinical Hospital, Astrakhan, Russia, 414056
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Comparison of ultrasound frequency in laryngeal ultrasound for vocal cord evaluation. Surgery 2017; 161:1108-1112. [DOI: 10.1016/j.surg.2016.10.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 09/25/2016] [Accepted: 10/12/2016] [Indexed: 11/30/2022]
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12
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Abstract
BACKGROUND Laryngeal ultrasound (LUS) is a new method for vocal cord evaluation in patients with risk of vocal cord palsy (VCP). However, the previously described LUS reportedly had a high failure rate of vocal cord visualization in male patients. A novel gel pad LUS was devised to overcome the limitations of the previous method. METHODS A total of 482 (100 male) consecutive LUS and direct laryngoscopy examinations were performed in thyroidectomy and other neck surgery patients. The conventional LUS and gel pad LUS were used for all patients. Findings were independently cross-validated with direct laryngoscopy. RESULTS The conventional LUS and gel pad LUS methods had a 93.4% and 99.0% visualization rate, respectively, with a sensitivity of 98.0% for both methods, and a specificity of 99.7% and 99.8%, respectively. Among the 482 patients, 51 patients had VCP and 91 patients had diffuse thyroid cartilage calcification interrupting LUS. CONCLUSION The new gel pad LUS method significantly enhances the visualization of vocal cords in patients who have diffuse thyroid cartilage calcification interrupting LUS and, therefore, the overall efficacy of LUS as a perioperative diagnostic tool for VCP.
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Affiliation(s)
- Jung-Woo Woo
- 1 Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, South Korea
- 2 Department of Surgery, Gyeongsang National University Changwon Hospital and Gyeongsang National University School of Medicine , Changwon, Korea
| | - Seo Ki Kim
- 1 Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, South Korea
| | - Inhye Park
- 1 Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, South Korea
| | - Jun Ho Choe
- 1 Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, South Korea
| | - Jung-Han Kim
- 1 Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, South Korea
| | - Jee Soo Kim
- 1 Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul, South Korea
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Lang BHH, Wong CKH, Ma EPM. Single-session high intensity focussed ablation (HIFU) versus open cervical hemithyroidectomy for benign thyroid nodule: analysis on early efficacy, safety and voice quality. Int J Hyperthermia 2017; 33:868-874. [PMID: 28540785 DOI: 10.1080/02656736.2017.1305127] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND High intensity focussed ultrasound (HIFU) is a promising non-surgical treatment for symptomatic benign thyroid nodule. We aimed to compare early efficacy, safety and voice quality between HIFU ablation and open thyroidectomy. METHODS Consecutive patients who underwent single-session HIFU ablation or a hemithyroidectomy for symptomatic benign thyroid nodule were included. The 6-month extent of nodule shrinkage, symptom improvement score, thyroid function, hospital stay and cost were compared between the two procedures. Safety was defined by absence of major complications like recurrent laryngeal nerve injury and skin burn. Voice quality was assessed by a computerised multi-dimensional voice programme and a Voice Handicap Index (VHI) questionnaire 1-month after treatment. RESULTS Altogether, 43 patients had HIFU and 103 patients had a hemithyroidectomy. In the HIFU group, the extent of nodule shrinkage at 6-month was 51.71 ± 16.04%. No patients in the HIFU group suffered skin burn or hypothyroidism. The HIFU group had a significantly shorter length of hospital stay (0.3 vs. 1.0 day, p < 0.001), lower incidence of subclinical hypothyroidism (1/43 vs. 21/103, p = 0.008), higher symptom improvement score (p = 0.009) and was less costly (USD 1923.1 vs. USD 5384.6). Relative to HIFU, pitch quality also worsen after surgery (p < 0.05). CONCLUSIONS Relative to surgery, single HIFU ablation appeared efficacious and safe. Apart from shorter hospital stay, less subclinical hypothyroidism, being scar-less, lower cost and more symptom improvement, HIFU patients were less affected by a pitch problem in the first month. This study provides a strong argument for HIFU ablation as a treatment for symptomatic benign thyroid nodule.
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Affiliation(s)
- Brian H H Lang
- a Department of Surgery , The University of Hong Kong , Hong Kong , Hong Kong, China
| | - Carlos K H Wong
- b Department of Family Medicine and Primary Care , The University of Hong Kong , Ap Lei Chau , Hong Kong, China
| | - Estella P M Ma
- c Division of Speech and Hearing Sciences , The University of Hong Kong , Hong Kong , Hong Kong, China
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Naunheim MR, Song PC, Franco RA, Alkire BC, Shrime MG. Surgical management of bilateral vocal fold paralysis: A cost-effectiveness comparison of two treatments. Laryngoscope 2016; 127:691-697. [DOI: 10.1002/lary.26253] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 06/24/2016] [Accepted: 07/20/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Matthew R. Naunheim
- Department of Otolaryngology-Head and Neck Surgery; Massachusetts Eye and Ear Infirmary; Boston Massachusetts U.S.A
- Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts U.S.A
| | - Phillip C. Song
- Department of Otolaryngology-Head and Neck Surgery; Massachusetts Eye and Ear Infirmary; Boston Massachusetts U.S.A
- Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts U.S.A
| | - Ramon A. Franco
- Department of Otolaryngology-Head and Neck Surgery; Massachusetts Eye and Ear Infirmary; Boston Massachusetts U.S.A
- Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts U.S.A
| | - Blake C. Alkire
- Department of Otolaryngology-Head and Neck Surgery; Massachusetts Eye and Ear Infirmary; Boston Massachusetts U.S.A
- Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts U.S.A
| | - Mark G. Shrime
- Department of Otolaryngology-Head and Neck Surgery; Massachusetts Eye and Ear Infirmary; Boston Massachusetts U.S.A
- Department of Otology and Laryngology; Harvard Medical School; Boston Massachusetts U.S.A
- Department of Global Health and Population; Harvard School of Public Health; Boston Massachusetts U.S.A
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Parangi S. Editorial: Translaryngeal vocal cord ultrasound: Ready for prime time. Surgery 2016; 159:67-9. [DOI: 10.1016/j.surg.2015.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 10/14/2015] [Indexed: 10/22/2022]
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16
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A novel lateral-approach laryngeal ultrasonography for vocal cord evaluation. Surgery 2016; 159:52-6. [DOI: 10.1016/j.surg.2015.07.043] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 07/15/2015] [Accepted: 07/18/2015] [Indexed: 11/22/2022]
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Lang BHH, Wong CKH, Ma EPM. A systematic review and meta-analysis on acoustic voice parameters after uncomplicated thyroidectomy. Laryngoscope 2015; 126:528-37. [DOI: 10.1002/lary.25452] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 04/17/2015] [Accepted: 05/19/2015] [Indexed: 11/07/2022]
Affiliation(s)
| | - Carlos K. H. Wong
- Department of Family Medicine and Primary Care; 3/F Ap Lei Chau Clinic
| | - Estella P. M. Ma
- Division of Speech and Hearing Sciences; the University of Hong Kong; Hong Kong SAR the People's Republic of China
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Wong KP, Woo JW, Youn YK, Chow FCL, Lee KE, Lang BHH. The importance of sonographic landmarks by transcutaneous laryngeal ultrasonography in post-thyroidectomy vocal cord assessment. Surgery 2014; 156:1590-6; discussion 1596. [DOI: 10.1016/j.surg.2014.08.061] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Accepted: 08/20/2014] [Indexed: 10/24/2022]
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Wong KP, Lang BHH, Chang YK, Wong KC, Chow FCL. Assessing the Validity of Transcutaneous Laryngeal Ultrasonography (TLUSG) After Thyroidectomy: What Factors Matter? Ann Surg Oncol 2014; 22:1774-80. [DOI: 10.1245/s10434-014-4162-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Indexed: 11/18/2022]
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