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Al-Qahtani K, Shahrani MA, Zahrani FA, Ghamdi AA, Alghamdi FA, Alshaalan ZA, Al-Saif A, Bokhari A, Al-Abdulkarim AA, Islam T. Comparing Thyroidectomy Techniques, Surgical Loupe and Neuromonitoring Between ENT and Endocrine Surgeons-an Observational Study. Indian J Otolaryngol Head Neck Surg 2023; 75:1618-1624. [PMID: 37636681 PMCID: PMC10447852 DOI: 10.1007/s12070-023-03627-2] [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: 07/05/2022] [Accepted: 02/21/2023] [Indexed: 03/28/2023] Open
Abstract
Thyroid surgery is performed by ENT head and neck (ENT-HNS), endocrine (ES) and general surgeons (GS). Each modality adopts different surgical techniques causing difference in outcome, operative time and postoperative complication. A retrospective chart review of thyroid surgeries performed by two ENT-HNS, three ES of a single tertiary center was conducted. We compared the use of neuromonitoring and surgical loupe and subsequent patient outcomes between surgeries performed by ENT-HNS versus ES, focusing on parathyroid gland identification, operative duration, vocal cord paralysis and length of hospital stay. A total of 167 patients underwent thyroid surgery. Surgical loupes were used in all the surgeries performed by ENT-HNS vs. 85% by the ES. Parathyroid glands were identified in all the surgeries performed by ENT-HNS versus 95% by ES. Neuromonitoring was used in all the surgeries performed by ENT-HNS, and none by the ES. Vocal cord paralysis developed in two patients of ES versus none in the ENT-HNS. Mean operative duration for total thyroidectomy in ENT-HN surgeries, 183.7 min vs. 151 min in the ES. The mean hospital stay of patients was 3.6 ± 1.6 days for ENT-HNS, and 5.45 ± 3 days for ES. Identification of parathyroid gland and recurrent laryngeal nerve by neuromonitoring and surgical loupes may increase operative time but decrease the rate of vocal cord paralysis and increases the chance of parathyroid gland identification.
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Affiliation(s)
- Khalid Al-Qahtani
- Department of Otolaryngology-Head & Neck Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mohammad Al Shahrani
- Department of Otolaryngology-Head & Neck Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Faisal Al Zahrani
- Department of Otolaryngology-Head & Neck Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - AbdulAziz Al Ghamdi
- Department of Otolaryngology-Head & Neck Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Fareed Al Alghamdi
- Department of Otolaryngology-Head & Neck Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Zaid Al Alshaalan
- Department of Otolaryngology-Head & Neck Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Abdulaziz Al-Saif
- Breast and Endocrine Surgery Unit, Department of Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Areej Bokhari
- Breast and Endocrine Surgery Unit, Department of Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Amal A. Al-Abdulkarim
- Breast and Endocrine Surgery Unit, Department of Surgery, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Tahera Islam
- College of Medicine and Research Center, King Saud University, P.O. Box-245, Riyadh, 11461 Kingdom of Saudi Arabia
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Christou N, Di Maria S, Mirallié E, Noullet S, Mathonnet M, Menegaux F. Ambulatory thyroidectomy. Recommendations of the Association francophone de chirurgie endocrinienne (AFCE), with the Société française d'endocrinologie (SFE) and the Société française de médecine nucléaire (SFMN). J Visc Surg 2023; 160:S119-S126. [PMID: 37211444 DOI: 10.1016/j.jviscsurg.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Before ambulatory thyroidectomy is proposed, the patient and his family and/or friends will need to be informed by the surgeon of the specificity of this procedure, the normal postoperative effects of a thyroidectomy, and potential complications. Also known as outpatient thyroid surgery, it can only be proposed by an experienced surgeon supported by an adequately trained medical and paramedical team. The healthcare establishment must be in possession of all the resources needed in ambulatory management, with continuity of care guaranteed 24h/24 7d/7 in the event of possible emergency rehospitalization. In all cases, contact the day after the operation between the healthcare facility and the patient is imperative. Ambulatory management can be proposed for lobo-isthmectomy or isthmectomy, possibly involving lymph node dissection. It is also possible for secondary totalization of thyroidectomy (following lobectomy). On the other hand, indications for single-stage total thyroidectomy must be limited and ensure proximity between the patient's home and a healthcare structure with a platform adapted to the pathology necessitating surgical intervention (non-plunging euthyroid goiter). A precise clinical pathway must be set out, including pre-, peri- and postoperative protocols having been formalized for surgery (hemostasis procedures) and for anesthesia (prevention of pain, of vomiting and of hypertension). We recommend at least 6hours of postoperative surveillance in outpatient care. When outpatient treatment is not possible or not recommended, hospitalization stay after thyroidectomy can be limited to 24hours, except in the event of postoperative complications, or a need for effectively dosed anticoagulant treatment.
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Affiliation(s)
- Niki Christou
- Digestive, Endocrine and General Surgery Department, University Hospital Center of Limoges, Limoges, France.
| | - Sophie Di Maria
- Department of Anesthesia-Resuscitation, University Hospital Center of Pitié-Salpêtrière, AP-HP, Sorbonne University, Paris, France
| | - Eric Mirallié
- Cancer, Digestive and Endocrine Surgery Department, Institut des Maladies de l'Appareil Digestif, University Hospital Center of Nantes, Nantes, France
| | - Séverine Noullet
- Department of General, Visceral and Endocrine Surgery, University Hospital Center of Pitié-Salpêtrière, AP-HP, Sorbonne University, Paris, France
| | - Muriel Mathonnet
- Digestive, Endocrine and General Surgery Department, University Hospital Center of Limoges, Limoges, France
| | - Fabrice Menegaux
- Department of General, Visceral and Endocrine Surgery, University Hospital Center of Pitié-Salpêtrière, AP-HP, Sorbonne University, Paris, France
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Lu W, Qiu Y, Wu Y, Li J, Chen R, Chen S, Lin Y, OuYang L, Chen J, Chen F, Qiu S. RADIOMICS BASED ON TWO-DIMENSIONAL AND THREE-DIMENSIONAL ULTRASOUND FOR EXTRATHYROIDAL EXTENSION FEATURE PREDICTION IN PAPILLARY THYROID CARCINOMA. ACTA ENDOCRINOLOGICA (BUCHAREST, ROMANIA : 2005) 2022; 18:407-416. [PMID: 37152886 PMCID: PMC10162833 DOI: 10.4183/aeb.2022.407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Aim To evaluate the diagnostic performance of radiomics features of two-dimensional (2D) and three-dimensional (3D) ultrasound (US) in predicting extrathyroidal extension (ETE) status in papillary thyroid carcinoma (PTC). Patients and Methods 2D and 3D thyroid ultrasound images of 72 PTC patients confirmed by pathology were retrospectively analyzed. The patients were assigned to ETE and non-ETE. The regions of interest (ROIs) were obtained manually. From these images, a larger number of radiomic features were automatically extracted. Lastly, the diagnostic abilities of the radiomics models and a radiologist were evaluated using receiver operating characteristic (ROC) analysis. We extracted 1693 texture features firstly. Results The area under the ROC curve (AUC) of the radiologist was 0.65. For 2D US, the mean AUC of the three classifiers separately were: 0.744 for logistic regression (LR), 0.694 for multilayer perceptron (MLP), 0.733 for support vector machines (SVM). For 3D US they were 0.876 for LR, 0.825 for MLP, 0.867 for SVM. The diagnostic efficiency of the radiomics was better than radiologist. The LR model had favorable discriminate performance with higher area under the curve. Conclusion Radiomics based on US image had the potential to preoperatively predict ETE. Radiomics based on 3D US images presented more advantages over radiomics based on 2D US images and radiologist.
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Affiliation(s)
- W.J. Lu
- The Second Affiliated Hospital of Guangzhou Medical University − Ultrasound
| | - Y.R. Qiu
- The Second Clinical School of Guangzhou Medical University − Department of Clinical Medicine, Guangzhou, Guangdong, China
| | - Y.W. Wu
- The Second Affiliated Hospital of Guangzhou Medical University − Ultrasound
| | - J. Li
- The Second Affiliated Hospital of Guangzhou Medical University − Ultrasound
| | - R. Chen
- The Second Affiliated Hospital of Guangzhou Medical University − Ultrasound
| | - S.N. Chen
- The Second Affiliated Hospital of Guangzhou Medical University − Ultrasound
| | - Y.Y. Lin
- The Second Affiliated Hospital of Guangzhou Medical University − Ultrasound
| | - L.Y. OuYang
- The Second Affiliated Hospital of Guangzhou Medical University − Ultrasound
| | - J.Y. Chen
- The Second Affiliated Hospital of Guangzhou Medical University − Ultrasound
| | - F. Chen
- The Second Affiliated Hospital of Guangzhou Medical University − Ultrasound
| | - S.D. Qiu
- The Second Affiliated Hospital of Guangzhou Medical University − Ultrasound
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