Endoscopic transoral parathyroidectomy: Initial experience

BACKGROUND

We evaluate our initial experience of transoral vestibular approach parathyroidectomy (TOEPVA) for the treatment of primary hyperparathyroidism.

METHODS

We conducted a prospective study of patients with single parathyroid adenoma, using TOEPVA to perform the parathyroidectomy. The variables we analyzed were size, volume, and location of the adenoma, bleeding, identification, and preservation of the recurrent laryngeal nerve, injury to the mental nerve, and the effective cure rate, using measures of central tendency.

RESULTS

Our study included 21 women, with an average age of 43 years. The recurrent laryngeal nerve and mental nerve suffered no permanent damage, the average size of the adenoma was 26.6 mm, and a volume of 3.95 mL. We were able to identify the adenoma and cure the hyperparathyroidism in 20 of the patients (95.2%).

CONCLUSIONS

TOEPVA is viable and safe in who wish to avoid the cervical scar resulting for the patient with primary hyperparathyroidism.

Efficacy of Intraoperative Neuro-Monitoring to Localize the External Branch of the Superior Laryngeal Nerve

BACKGROUND

This study investigated whether visual localization of the external branch of the superior laryngeal nerve (EBSLN) coincides with its localization via intraoperative neuro-monitoring (IONM) during thyroidectomy and whether its use influences the frequency of injuries.

METHODS

A prospective, comparative, cross-sectional, observational study was performed in 240 superior thyroid poles. The metrics were visual identification of the EBSLN and its corroboration with IONM. The frequency of EBSLN injuries was also determined. Statistical analysis was achieved via kappa and chi-square tests, as well as odds ratios (OR).

RESULTS

Of the 240 superior thyroid poles, IONM identified 234 (97.5%) EBSLN, whereas 190 (79.1%) were identified visually: OR = 10.35 [CI 4.37-24.65] p < 0.0001. Of the 190 EBSLN identified visually, 150 were confirmed through IONM. Indeed, their structure corresponded to an EBSLN to yield a kappa with a linear weighting value of 0.362. The standard error was 0.0467 [CI 0.2686-0.4554], indicating a fair agreement between the visual and IONM classification.

CONCLUSION

IONM identified 97.5% of EBSLN cases. It was higher than the visual identification. There were no injuries to EBSLN identified through IONM.

Endovascular surgery by means of a Talent endoprosthesis implant in adult patients with thoracic aorta coarctation

AIM

The aim of this study was to show the initial experience of a therapeutic alternative in the surgical treatment of thoracic aorta coarctation in adult patients by means of a Talent endoprosthesis implant and angioplasty, maintaining the advantages of minimally invasive surgery, avoiding recurrence, offering safety and protection against dissections, tearing, or even aortic ruptures and, hence, minimizing risks and complications from a thoracic aorta surgery through thoracotomy.

METHODS

The authors present a series of 12 cases of thoracic aorta coarctation in adult patients, treated with endovascular surgery by means of a Talent endoprosthesis implant using a transfemoral or iliac access. Age, gender, gradient release, perioperative mortality and morbidity, presence of palpable pulses in the limbs, claudication, and follow-up time.

RESULTS

Eight men and four women, average age of 23.6 years (18 to 38). The average diameter of the normal aorta was 21.65 mm (13.5-24.5 mm) and the smallest diameter at the coarctation site was 3.4 mm (0 to 8 mm). No complications occurred and no patient required blood transfusion. The time spent in the intensive care unit for postoperative monitoring averaged 15 h (12 to 18 h) and hospital stay averaged 2.33 days (1 to 4 days). All patients presented palpable pulses of normal characteristics during the postoperative period. No residual pressure gradient was present requiring treatment. In this series, neither trans nor postoperative complications occurred, and the follow-up time averaged 52 months (6 to 93 months).

CONCLUSION

Endovascular treatment of thoracic aorta coarctation with protected dilatation is a safe and effective procedure.

[Clinical behavior of thyroid papillary cancer in pregnancy: optimal time for its treatment]

OBJECTIVE

To analyze the clinical characteristic and evolution of papillary thyroid cancer with pregnancy and know the optimal time to treatment.

MATERIAL AND METHODS

Cohort analytic study with two groups: One with 6 papillary cancer and pregnancy and group 2 with 24 papillary cancer and the same age, prognostic score AMES and MACIS, treatment, time of follow up and mortality. The variables analyzed was clinical presentation, local, regional, distant recurrence, and mortality. The statistical analyzed by Chi Square and t test.

RESULTS

There were no statistical differentiation between the two groups in age, prognostic score, rates of recurrence and mortality with a time of follow up for G1 83 (33 to 240) months and 88 (12 to 288) months for G2. There were differences only in clinical presentation with positive cervical nodes in 100% of patients in G1 vs. 12.5% in G2. This condition does not alter the final evolution.

CONCLUSION

A pregnant patient with papillary thyroid cancer can wait the end of the pregnancy and then receive the appropriated cancer treatment.

Selective use of drains in thyroid surgery

OBJECTIVE

To identify whether there are differences in the use of drains and, if used, which would be the best for thyroid surgery.

DESIGN

Prospective, longitudinal, comparative, randomized study.

SETTING

General Hospital Mexico City, Mexico.

PATIENTS AND METHODS

One hundred fifty patients were studied, divided into three groups: group A, without drain; group B, with a Penrose drain; and group C, with a semirigid suction drain. On the basis of the preoperative diagnosis, subtotal or total thyroidectomy or hemithyroidectomy was performed. Analyzed variables were thyroid volume (TV), transoperative bleeding (TOB), flow of postoperative drain (PD), length of hospital stay (HS), and complications, such as seromas, hematomas, and hemorrhages. Statistical Analysis. Multiple variant analysis, using Scheffe's procedure and chi2.

RESULTS

Group A had an average TOB of 107 mL, HS of 2 days, and TV of 153.24 mL with two complications (seromas). Group B had an average TOB of 149.8 mL, HS of 2.6 days, TV of 175.4 mL, PD of 29.6 mL, and three complications (2 seromas and 1 hematoma). Group C had an average TOB of 161.5 mL, HS of 3.11 days, TV of 173.5 mL, PD of 25.84 mL, and two seromas. No differences existed regardless of the type of drain used between groups B and C.

CONCLUSION

Statistical analysis showed that the size of the gland, diagnosis, type of surgery, transoperative bleeding, and complications are not valid arguments to leave an external drain in thyroid surgery. No advantages were found between the Penrose or the semirigid suction drains. Hospital stay was longer in patients with the suction drain. These results support the notion that the use of wound drainage cannot substitute for meticulous dissection and transoperative hemostasis.