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Li CY, He QQ, Li XL, Yuan J, Zhuang DY, Zhou P, Yue T, Liu YX, Shao CX, Xu J. [A retrospective comparative study between robotic thyroidectomy through transoral vestibular approach and bilateral breast-axillary approach]. Zhonghua Wai Ke Za Zhi 2023; 61:227-231. [PMID: 36650969 DOI: 10.3760/cma.j.cn112139-20220810-00348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Objective: To compare the surgical outcome of robotic thyroidectomy through transoral approach and the bilateral breast-axillary approach. Methods: Retrospective analysis was made on the clinical data of patients who performed transoral robotic thyroidectomy (TORT group) or bilateral breast-axillary approach (BABA group) in the Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army from July 2020 to May 2022. Both groups received lobectomy with lymph node dissection of the central region. A total of 100 cases were included in the study, including 48 cases in the TORT group and 52 cases in the BABA group. The propensity score matching method was used for 1∶1 matching of patients between the 2 groups, with a match tolerance of 0.03. There were 31 patients in each group successfully matched. In the TORT group, there were 5 males and 26 females, aged (33.2±7.9) years (range: 21 to 53 years). While there were 4 males and 27 females in the BABA group, aged (34.6±9.2) years (range: 19 to 58 years). The t test, Mann-Whitney U test, χ2 test or Fisher exact test were used to compare the clinical efficacy between the two groups. Results: All the patients successfully completed robotic thyroid surgery without conversion to open surgery. Compared with BABA group, the TORT group had longer operation time ((211.3±57.2) minutes vs. (126.2±37.8) minutes, t=6.915, P<0.01), shorter drainage tube retention time ((5.4±1.0) days vs. (6.4±1.2) days, t=-3.544, P=0.001), shorter total hospital stay ((6.6±1.2) days vs. (7.4±1.3) days, t=-2.353, P=0.022), and higher cosmetic score (9.46±0.25 vs. 9.27±0.26, t=2.925, P=0.005). There was no significant difference between the two groups in the number of lymph nodes dissection, metastasis in the central compartment, and the incidence of postoperative complications (all P>0.05). Conclusions: Compared with the bilateral breast-axillary approach, the transoral vestibular approach of robotic thyroidectomy is also safe and effective. It shows similar surgical results to the bilateral breast-axillary approach in strictly selected patients, but the postoperative recovery speed is much faster, and the hospital stay is shorter. Transoral robotic thyroidectomy is a more recommended surgical method for patients with high aesthetic demand.
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Affiliation(s)
- C Y Li
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan 250031, China
| | - Q Q He
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan 250031, China
| | - X L Li
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan 250031, China
| | - J Yuan
- Department of Information, the 960th Hospital of People's Liberation Army, Jinan 250031, China
| | - D Y Zhuang
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan 250031, China
| | - P Zhou
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan 250031, China
| | - T Yue
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan 250031, China
| | - Y X Liu
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan 250031, China
| | - C X Shao
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan 250031, China
| | - J Xu
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan 250031, China
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Li XL, He QQ, Li CY, Wang M, Zhuang DY, Zhou P, Yue T, Zhu J, Xu J, Shao CX. [Preliminary application of transoral robotic thyroidectomy: experience from an initial 30 cases]. Zhonghua Wai Ke Za Zhi 2021; 59:994-998. [PMID: 34839614 DOI: 10.3760/cma.j.cn112139-20210104-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To examine the surgical outcome of transoral robotic thyroidectomy. Methods: Clinic data of total 30 cases of transoral robotic thyroidectomy at the Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army from May 2020 to December 2020 were analyzed retrospectively. There were 3 males and 27 females, aged (31.5±11.0) years (range: 17 to 55 years), including 6 cases of benign tumor and 24 cases of malignant cancer (all papillary thyroid carcinoma). An inverted U-shaped incision 1.5 cm in length was made over the end of the frenulum of the lower lip. A wide subplatysmal space was created by bluntly passing with a vascular tunneller (8 mm diameter), and a 12 mm trocar was inserted through the lip incision for the camera port. Lateral oral mucosal incisions 8 mm in length were made near both lateral labial commissures, 8 mm robot trocars were inserted through the incisions. An 5 mm trocar was inserted through an incision made along the patient's right axillary fold into the subplatysmal working space and was connected with 5 mm ProGrasp for counter traction during the operation and for later drain insertion. Numerical scoring system (NSS) was used to assess cosmetic effect 1 month post-operation. Results: All the 30 transoral robotic thyroidectomies was successful, no case conversed to open operation. Postoperative hospital stay was (6.3±1.2) days (range: 4 to 10 days). The tumor size of thyroid cancers was (5.3±3.0) mm (range: 2 to 15 mm). Lymph node metastasis was observed in 12 cases. The retrieved central lymph node number was 10.5±4.4 (range: 4 to 20), while the central metastatic lymph node number was 2(2) (range: 1 to 11). Postoperative transient hypoparathyroidism occurred in 2 cases. Permanent hypoparathyroidism and vocal cord palsy didn't occur. Other surgical complications included hematoma, surgical site infection and perforation of chin flap, retrospectively in 1 case. Local regional lymph node recurrence wasn't developed during 1 to 7 months follow-up. All patients were satisfied with the postoperative cosmetic outcomes,NSS was 9.4±0.8 (range: 8.7 to 9.6). Conclusion: Transoral robotic thyroidectomy is safe and effective, suitable for early thyroid cancers without lateral lymph node metastasis, and has superior cosmetic results when the patients are selected carefully.
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Affiliation(s)
- X L Li
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan 250031, China
| | - Q Q He
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan 250031, China
| | - C Y Li
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan 250031, China
| | - M Wang
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan 250031, China
| | - D Y Zhuang
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan 250031, China
| | - P Zhou
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan 250031, China
| | - T Yue
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan 250031, China
| | - J Zhu
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan 250031, China
| | - J Xu
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan 250031, China
| | - C X Shao
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan 250031, China
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Li XL, He QQ, Zhuang DY, Wang M, Zhou P, Yue T, Zhu J, Liu Y, Lin F, Li CY, Shao CX, Wang D, Wang G. [Outcomes of 1 000 cases of robotic thyroidectomy by bilateral axillo-breast approach: a retrospective study in a single center]. Zhonghua Wai Ke Za Zhi 2021; 59:918-922. [PMID: 34743454 DOI: 10.3760/cma.j.cn112139-20201218-00866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To examine the surgical outcome, completeness and safety of robotic thyroidectomy by bilateral axillo-breast approach (BABA). Methods: From February 2014 to May 2019, 1 000 cases of robotic thyroidectomy via BABA at the Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army were performed. The clinicopathologic characteristics, operation times, perioperative complications, and oncologic outcomes of patients underwent robotic thyroidectomy were collected and reviewed retrospectively. There were 216 males and 784 females, aging (42.3±11.5) years (range: 7 to 75 years). There were 270 cases with benign tumors, and 730 cases with malignant cancers (the tumor diameter was (7.9±6.7) mm (range: 0.1 to 60.0 mm)). Results: There were 999 patients received robotic thyroidectomy using BABA approach successfully, while only 1 case conversed to open operation. The postoperative hospital stay was (7.5±2.5) days (range: 2 to 30 days). Among the 730 patients with thyroid cancers, 725 cases (99.3%) were papillary thyroid carcinoma, 579(79.3%) cases were with papillary thyroid microcarcinoma. Lymph node metastasis was observed in 371(50.8%) cases. The retrieved central lymph node number was 11.2±6.1 (range: 1 to 44),and the retrieved lateral lymph node number was 14.0±8.8 (range: 1 to 52). Postoperative transient hypoparathyroidism and vocal cord palsy occurred in 247(24.70%) and 56(5.60%) cases. Both of permanent hypoparathyroidism and vocal cord palsy occurred in 2 (0.20%) cases. Other surgical complications included chyle leakage (6.1%, 28/460), trachea injury (0.40%, 4/1 000), carotid artery injury (0.10%, 1/1 000). Local regional lymph node recurrence was developed in 4 patients. All patients were satisfied with the postoperative cosmetic outcomes. Conclusions: Robotic thyroidectomy by BABA is safe and effective, suitable for large benign tumors and early thyroid cancers with central or lateral lymph node metastasis. It could obtain superior cosmetic results.
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Affiliation(s)
- X L Li
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan 250031, China
| | - Q Q He
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan 250031, China
| | - D Y Zhuang
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan 250031, China
| | - M Wang
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan 250031, China
| | - P Zhou
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan 250031, China
| | - T Yue
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan 250031, China
| | - J Zhu
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan 250031, China
| | - Y Liu
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan 250031, China
| | - F Lin
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan 250031, China
| | - C Y Li
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan 250031, China
| | - C X Shao
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan 250031, China
| | - D Wang
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan 250031, China
| | - G Wang
- Department of Thyroid and Breast Surgery, the 960th Hospital of People's Liberation Army, Jinan 250031, China
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Liu C, Jiang ZC, Shao CX, Zhang HG, Yue HM, Chen ZH, Ma BY, Liu WY, Huang HH, Yang J, Wang Y, Liu HY, Xu D, Wang JT, Yang JY, Pan HQ, Zou SQ, Li FJ, Lei JQ, Li X, He Q, Gu Y, Qi XL. [Preliminary study of the relationship between novel coronavirus pneumonia and liver function damage: a multicenter study]. Zhonghua Gan Zang Bing Za Zhi 2020; 28:107-111. [PMID: 32077660 DOI: 10.3760/cma.j.issn.1007-3418.2020.02.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective: To analyze the clinical characteristics of cases of novel coronavirus pneumonia and a preliminary study to explore the relationship between different clinical classification and liver damage. Methods: Consecutively confirmed novel coronavirus infection cases admitted to seven designated hospitals during January 23, 2020 to February 8, 2020 were included. Clinical classification (mild, moderate, severe, and critical) was carried out according to the diagnosis and treatment program of novel coronavirus pneumonia (Trial Fifth Edition) issued by the National Health Commission. The research data were analyzed using SPSS19.0 statistical software. Quantitative data were expressed as median (interquartile range), and qualitative data were expressed as frequency and rate. Results: 32 confirmed cases that met the inclusion criteria were included. 28 cases were of mild or moderate type (87.50%), and four cases (12.50%) of severe or critical type. Four cases (12.5%) were combined with one underlying disease (bronchial asthma, coronary heart disease, malignant tumor, chronic kidney disease), and one case (3.13%) was simultaneously combined with high blood pressure and malignant tumor. The results of laboratory examination showed that the alanine aminotransferase (ALT), aspartate aminotransferase (AST), albumin (ALB), and total bilirubin (TBil) for entire cohort were 26.98 (16.88 ~ 46.09) U/L and 24.75 (18.71 ~ 31.79) U/L, 39.00 (36.20 ~ 44.20) g/L and 16.40 (11.34 ~ 21.15) μmol/L, respectively. ALT, AST, ALB and TBil of the mild or moderate subgroups were 22.75 (16.31 ~ 37.25) U/L, 23.63 (18.71 ~ 26.50) U/L, 39.70 (36.50 ~ 46.10) g/L, and 15.95 (11.34 ~ 20.83) μmol/L, respectively. ALT, AST, ALB and TBil of the severe or critical subgroups were 60.25 (40.88 ~ 68.90) U/L, 37.00 (20.88 ~ 64.45) U/L, 35.75 (28.68 ~ 42.00) g/L, and 20.50 (11.28 ~ 25.00) μmol/L, respectively. Conclusion: The results of this multicenter retrospective study suggests that novel coronavirus pneumonia combined with liver damage is more likely to be caused by adverse drug reactions and systemic inflammation in severe patients receiving medical treatment. Therefore, liver function monitoring and evaluation should be strengthened during the treatment of such patients.
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Affiliation(s)
- C Liu
- COVID-19 study group, The First Hospital of Lanzhou University, Lanzhou 730000, China
| | - Z C Jiang
- COVID-19 study group, Ankang Central Hospital, Ankang 725000, China
| | - C X Shao
- COVID-19 study group, Lishui Central Hospital, Lishui 323000, China
| | - H G Zhang
- COVID-19 study group, The Affiliated Third Hospital of Jiangsu University, Zhenjiang 212021, China
| | - H M Yue
- Department of Respiratory and Critical Care Medicine, The First Hospital of Lanzhou University, Lanzhou 730000, China
| | - Z H Chen
- COVID-19 study group, The People's Hospital of Baoding, Baoding 071000, China
| | - B Y Ma
- COVID-19 study group, The People's Hospital of LinXia Hui Prefecture, Linxia 731100, China
| | - W Y Liu
- COVID-19 study group, The First Hospital of Lanzhou University, Lanzhou 730000, China
| | - H H Huang
- COVID-19 study group, Ankang Central Hospital, Ankang 725000, China
| | - J Yang
- COVID-19 study group, Lishui Central Hospital, Lishui 323000, China
| | - Y Wang
- COVID-19 study group, The Sixth People's Hospital of Shenyang, Shenyang 110006, China
| | - H Y Liu
- COVID-19 study group, The Sixth People's Hospital of Shenyang, Shenyang 110006, China
| | - D Xu
- COVID-19 study group, The First Hospital of Lanzhou University, Lanzhou 730000, China
| | - J T Wang
- COVID-19 study group, The First Hospital of Lanzhou University, Lanzhou 730000, China
| | - J Y Yang
- COVID-19 study group, The Sixth People's Hospital of Shenyang, Shenyang 110006, China
| | - H Q Pan
- COVID-19 study group, The Affiliated Third Hospital of Jiangsu University, Zhenjiang 212021, China
| | - S Q Zou
- COVID-19 study group, The Affiliated Third Hospital of Jiangsu University, Zhenjiang 212021, China
| | - F J Li
- COVID-19 study group, The People's Hospital of Baoding, Baoding 071000, China
| | - J Q Lei
- COVID-19 study group, The First Hospital of Lanzhou University, Lanzhou 730000, China
| | - X Li
- COVID-19 study group, The First Hospital of Lanzhou University, Lanzhou 730000, China
| | - Q He
- COVID-19 study group, The Third People's Hospital of Shenzhen, Shenzhen 518100, China
| | - Y Gu
- COVID-19 study group, The Sixth People's Hospital of Shenyang, Shenyang 110006, China
| | - X L Qi
- COVID-19 study group, The First Hospital of Lanzhou University, Lanzhou 730000, China
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Wu SY, Zhang XX, Yang SS, Sun KG, Jia WL, Shao CX, Wu Q, Xuan XW, Liu YC, Liu SJ, Sun XY. [Physical activity level and its influence factors among residents in one suburb district of Beijing]. Beijing Da Xue Xue Bao Yi Xue Ban 2016; 48:483-490. [PMID: 27318912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To study the physical activity level and its influence factors among residents in one suburb of Beijing, so as to provide specific interventions for different people in different circumstances and to provide reference for health relevant policy-making in the future. METHODS In the study, 7 319 subjects aged 18 years or above were involved. The self-designed questionnaires based on Health Belief Model (HBM) had acceptable validity and reliability. The physical activity levels were calculated to classify sufficient or insufficient amount by a thousand-step equivalent greater than or equal to 6 or 10. Multiple variable Logistic regression was used to explore the influence factors of the physical activity among the residents. RESULTS The residents' median amount of physical activity in the suburb district of Beijing were 9.1 thousand-step equivalent with quartile of (3.8, 20.4). The percentages of the thousand-step equivalent greater than or equal to 6 or 10 were 63.7% and 47.7%, respectively. The median amounts of physical activity from work or household chores, transportation and recreation physical activities were 4.0, 1.0, 0.0 and the components of the total amount of physical activity from those were 61.7%, 18.3% and 20.1%, respectively. There were 8.6% residents whose life did notinvolve moderate or vigorous intensity activities. By using factor analysis, five factors were extracted from the scale based on the HBM; These factors together contributed to 63.7% of the sum of the squared loadings. The differences of physical activity levels on education level, age, gender, self-efficacy, cues, subjective and objective barriers were statistically significant (P<0.05).Those who were female, with older age, lower education level, higher self-efficacy, fewer cues, fewer subjective and objective barriers preferred to do more physical activities. CONCLUSION The physical activity levels among the residents in the suburb district of Beijing are moderate and high, and most amount of physical activities from work or household chores. Those who are male and whose ages are from 18 to 29 years and whose education levels are of university or above should be focused on intervention. Specific interventions should be developed for different people in different situations; More attention should be paid to improve the residents' self-efficacy and reduce the subjective and objective barriers of physical activity, and we also should actively advocate people to have more leisure exercise so as to improve the physical activity level among all residents.
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Affiliation(s)
- S Y Wu
- Department of Social Medicine and Health Education, Peking University School of Public Health, Beijing 100191, China
| | - X X Zhang
- Department of Social Medicine and Health Education, Peking University School of Public Health, Beijing 100191, China
| | - S S Yang
- Department of Social Medicine and Health Education, Peking University School of Public Health, Beijing 100191, China
| | - K G Sun
- Department of Social Medicine and Health Education, Peking University School of Public Health, Beijing 100191, China
| | - W L Jia
- Tongzhou Center for Disease Prevention and Control, Beijing 101100, China
| | - C X Shao
- Tongzhou Center for Disease Prevention and Control, Beijing 101100, China
| | - Q Wu
- Tongzhou Center for Disease Prevention and Control, Beijing 101100, China
| | - X W Xuan
- Tongzhou Center for Disease Prevention and Control, Beijing 101100, China
| | - Y C Liu
- Tongzhou Center for Disease Prevention and Control, Beijing 101100, China
| | - S J Liu
- Tongzhou Center for Disease Prevention and Control, Beijing 101100, China
| | - X Y Sun
- Department of Social Medicine and Health Education, Peking University School of Public Health, Beijing 100191, China
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Abstract
BACKGROUND In cases of right hepatectomy for huge tumour encroaching onto the diaphragm, the 'anterior approach' is the most common surgical procedure undertaken. The 'liver hanging manoeuvre' has been described previously as an adjunct to this procedure. It involves the dissection of a retrohepatic avascular plane anterior to the surface of the inferior vena cava. A tape is then passed through and the liver is resected under suspension. METHODS Cadaveric specimens were used to identify the structural relationship of the avascular plane and also to determine whether it is truly avascular. RESULTS Thirteen cases were analysed. The mean length of the avascular tunnel was 6.4 +/- 1.0 cm. The median number of accessory hepatic veins within the tunnel was two (zero to three). At the caudal half of the tunnel, the median number of veins was two (zero to three). As for the cranial half of the tunnel, there were two cases with one vein in each. CONCLUSIONS The key to the liver hanging manoeuvre is to develop the retrohepatic tunnel. However, our study showed that it is not absolutely avascular. During the blind dissection, there is a chance of damaging a retrohepatic vein. This may result in troublesome haemorrhage within the confines of the tunnel. Video-assisted dissection of this region may help in visualisation, and hence control, in order to avoid bleeding.
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Affiliation(s)
- William C S Meng
- Department of Surgery, Kwong Wah Hospital, Kowloon, Hong Kong, China.
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