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Bonati E, Mullineris B, Del Rio P, Loderer T, De Gennaro F, Esposito G, Menduni N, Pedrazzi G, Piccoli M. Mini-invasive video-assisted thyroidectomy vs robot-assisted transaxillary thryoidectomy: analisys and comparison of safety and outcomes. Updates Surg 2024; 76:573-587. [PMID: 38198118 DOI: 10.1007/s13304-023-01732-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 12/12/2023] [Indexed: 01/11/2024]
Abstract
Thyroid surgery is characterized by large volumes and typically affects a young female population. Mini-invasive or remote access surgical techniques are born driven by the desire to improve aesthetic outcomes of the traditional technique, following technological advances that have upset the surgical world in the last 20 years. In our multicenter, retrospective observational study, we first compared an endoscopic technique with a robotic one: minimally invasive video-assisted thyroidectomy (MIVAT) and robot-assisted transaxillary thyroidectomy (RATT). We evaluated intraoperative features, complications, and cosmetic outcomes in a cohort of 609 patients. The efficacy and safety of these techniques are proven by a large literature and the comparison made in our study does not show inferiority of one technique compared to the other. Even the aesthetic results tend to be equal in the long term. It is desirable that further prospective and randomized studies are conducted to evaluate the outcomes of these procedures and the cost-benefit ratio.
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Affiliation(s)
- Elena Bonati
- General Surgical Clinic, University Hospital of Parma, Gramsci 14 Str., Parma, Italy.
| | - Barbara Mullineris
- Unit of General Surgery, Emergency and New Technologies of the Civil Hospital of Baggiovara, University Hospital of Modena, Modena, Italy
| | - Paolo Del Rio
- General Surgical Clinic, University Hospital of Parma, Gramsci 14 Str., Parma, Italy
| | - Tommaso Loderer
- General Surgical Clinic, University Hospital of Parma, Gramsci 14 Str., Parma, Italy
| | - Flavia De Gennaro
- General Surgical Clinic, University Hospital of Parma, Gramsci 14 Str., Parma, Italy
| | - Giuseppe Esposito
- Unit of General Surgery, Emergency and New Technologies of the Civil Hospital of Baggiovara, University Hospital of Modena, Modena, Italy
| | - Nunzia Menduni
- Unit of General Surgery, Emergency and New Technologies of the Civil Hospital of Baggiovara, University Hospital of Modena, Modena, Italy
| | - Giuseppe Pedrazzi
- Neuroscience Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Micaela Piccoli
- Unit of General Surgery, Emergency and New Technologies of the Civil Hospital of Baggiovara, University Hospital of Modena, Modena, Italy
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Zhu Y, Xu S, Teng X, Zhao R, Peng L, Fang Q, Xiao W, Jiang Z, Li Y, Luo X, Han Y, Daiko H, Leng X. Refining postoperative monitoring of recurrent laryngeal nerve injury in esophagectomy patients through transcutaneous laryngeal ultrasonography. Esophagus 2024; 21:141-149. [PMID: 38133841 DOI: 10.1007/s10388-023-01036-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Recurrent laryngeal nerve injury (RLNI) leading to vocal cord paralysis (VCP) is a significant complication following minimally invasive esophagectomy (MIE) with upper mediastinal lymphadenectomy. Transcutaneous laryngeal ultrasonography (TLUSG) has emerged as a non-invasive alternative to endoscopic examination for evaluating vocal cord function. Our study aimed to assess the diagnostic value of TLUSG in detecting RLNI by evaluating vocal cord movement after MIE. METHODS This retrospective study examined 96 patients with esophageal cancer who underwent MIE between January 2021 and December 2022, using both TLUSG and endoscopy. RESULTS VCP was observed in 36 out of 96 patients (37.5%). The incidence of RLNI was significantly higher on the left side than the right (29.2% vs. 5.2%, P < 0.001). Postoperative TLUSG showed a sensitivity and specificity of 88.5% (31/35) and 86.5% (45/52), respectively, with an AUC of 0.869 (P < 0.001, 95% CI 0.787-0.952). The percentage agreement between TLUSG and endoscopy in assessing VCP was 87.4% (κ = 0.743). CONCLUSIONS TLUSG is a highly effective screening tool for VCP, given its high sensitivity and specificity. This can potentially eliminate the need for unnecessary endoscopies in about 80% of patients who have undergone MIE.
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Affiliation(s)
- Yi Zhu
- Outpatient Department (Ultrasound), Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (UESTC), Chengdu, China
- Department of Diagnostic Radiology, National Cancer Center Hospital, Tokyo, Japan
| | - Shanling Xu
- Department of Critical Care Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Xiangnan Teng
- Department of Critical Care Medicine, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Rui Zhao
- Department of Endoscopy, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Lin Peng
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Qiang Fang
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Wenguang Xiao
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Zhuolin Jiang
- Outpatient Department (Ultrasound), Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Yanjie Li
- Outpatient Department (Ultrasound), Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Xinyi Luo
- Outpatient Department (Ultrasound), Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Yongtao Han
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (UESTC), Chengdu, China
| | - Hiroyuki Daiko
- Department of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Xuefeng Leng
- Department of Thoracic Surgery, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (UESTC), Chengdu, China.
- Department of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan.
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3
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Malka R, Isaac A, Gonzales G, Miar S, Walters B, Baker A, Guda T, Dion GR. Changes in vocal fold gene expression and histology after injection augmentation in a recurrent laryngeal nerve injury model. J Laryngol Otol 2024; 138:196-202. [PMID: 37846168 PMCID: PMC10838396 DOI: 10.1017/s0022215123001135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
OBJECTIVE To investigate changes in neuroregenerative pathways with vocal fold denervation in response to vocal fold augmentation. METHODS Eighteen Yorkshire crossbreed swine underwent left recurrent laryngeal nerve transection, followed by observation or augmentation with carboxymethylcellulose or calcium hydroxyapatite at two weeks. Polymerase chain reaction expression of genes regulating muscle growth (MyoD1, MyoG and FoxO1) and atrophy (FBXO32) were analysed at 4 and 12 weeks post-injection. Thyroarytenoid neuromuscular junction density was quantified using immunohistochemistry. RESULTS Denervated vocal folds demonstrated reduced expression of MyoD1, MyoG, FoxO1 and FBXO32, but overexpression after augmentation. Healthy vocal folds showed increased early and late MyoD1, MyoG, FoxO1 and FBXO32 expression in all animals. Neuromuscular junction density had a slower decline in augmented compared to untreated denervated vocal folds, and was significantly reduced in healthy vocal folds contralateral to augmentation. CONCLUSION Injection augmentation may slow neuromuscular degeneration pathways in denervated vocal folds and reduce compensatory remodelling in contralateral healthy vocal folds.
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Affiliation(s)
- Ronit Malka
- Department of Otolaryngology – Head and Neck Surgery, Brooke Army Medical Center, Joint Base San Antonio, Fort Sam Houston, TX, USA
| | - Alisa Isaac
- Department of Biomedical Engineering and Chemical Engineering, University of Texas at San Antonio, San Antonio, TX, USA
| | - Gabriela Gonzales
- Department of Biomedical Engineering and Chemical Engineering, University of Texas at San Antonio, San Antonio, TX, USA
| | - Solaleh Miar
- Department of Civil, Environmental, and Biomedical Engineering, University of Hartford, West Hartford, CT, USA
| | - Benjamin Walters
- Department of Otolaryngology – Head and Neck Surgery, Brooke Army Medical Center, Joint Base San Antonio, Fort Sam Houston, TX, USA
| | - Amelia Baker
- Department of Anesthesiology, Brooke Army Medical Center, Joint Base San Antonio, Fort Sam Houston, TX, USA
| | - Teja Guda
- Department of Biomedical Engineering and Chemical Engineering, University of Texas at San Antonio, San Antonio, TX, USA
| | - Gregory R Dion
- Department of Otolaryngology – Head and Neck Surgery, Brooke Army Medical Center, Joint Base San Antonio, Fort Sam Houston, TX, USA
- Department of Otolaryngology – Head and Neck Surgery, University of Cincinnati, Cincinnati, OH, USA
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Izadi S, Zendejas B, Meisner J, Kamran A, Mohammed S, Demehri F, Staffa S, Zurakowski D, Hseu A, Cunningham M, Choi S, Barnewolt C. Diagnostic Accuracy of Laryngeal Ultrasound for Evaluating Vocal Fold Movement Impairment in Children. J Pediatr Surg 2024; 59:109-116. [PMID: 37845124 DOI: 10.1016/j.jpedsurg.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/06/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE Vocal fold movement impairment (VFMI) secondary to recurrent laryngeal nerve (RLN) injury is a common source of morbidity after pediatric cervical, thoracic, and cardiac procedures. Flexible laryngoscopy (FL) is the gold standard to diagnose VFMI yet can be challenging to perform and/or risks possible clinical decompensation in some children and is an aerosolizing procedure. Laryngeal ultrasound (LUS) is a potential non-invasive alternative, but limited data exists in the pediatric surgical population regarding its efficacy. We aimed to investigate the diagnostic accuracy of LUS compared to FL in evaluating VFMI. METHODS A prospective, single-center, single-blinded (rater) cohort study was undertaken on perioperative pediatric patients at risk for RLN injury. Patients underwent FL and LUS. Cohen's kappa was used to determine chance-corrected agreement. RESULTS Between 2021 and 2023, 85 paired evaluations were performed with patients having a median (IQR) age of 10 (4, 42) months and weight of 7.5 (5.4, 13.4) kilograms. The prevalence of VFMI was 27.1%. Absolute agreement between evaluations was 98.8% (kappa 0.97, 95% CI: 0.91-1.00, P < 0.001). The sensitivity and specificity of LUS in detecting VFMI was 95.7% and 100%, yielding a positive predictive value (PPV) of 100% and negative predictive value (NPV) of 98.4% (95% CI: 90-100%). Diagnostic accuracy was 98.8% (95% CI: 93-100%). CONCLUSION LUS is a highly accurate modality in evaluating VFMI in children. While FL remains the gold standard for diagnosis, LUS offers a low-risk screening modality for children at risk for VFMI such that only those with an abnormal LUS or presence of clinical symptoms discordant with LUS findings should undergo FL. TYPE OF STUDY Prospective, single-center, single blinded (rater), cohort study. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Shawn Izadi
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | | | - Jay Meisner
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Ali Kamran
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Somala Mohammed
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Farokh Demehri
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Steven Staffa
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - David Zurakowski
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Anne Hseu
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Michael Cunningham
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Sukgi Choi
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA, USA
| | - Carol Barnewolt
- Department of Radiology, Boston Children's Hospital, Boston, MA, USA.
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Kanazawa H, Fujishima I, Ohno T, Kunieda K, Shigematsu T, Yamawaki M. Cricopharyngeal muscle origin transection for oropharyngeal dysphagia, a novel surgical technique. Eur Arch Otorhinolaryngol 2023; 280:483-486. [PMID: 35960351 DOI: 10.1007/s00405-022-07588-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/03/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Cricopharyngeal myotomy improves pharyngeal dysphagia by resecting the cricopharyngeal muscle. METHODS Our procedure, cricopharyngeal muscle origin transection (CPM-OT) is performed through a midline skin incision at the cricoid cartilage level under local anesthesia. CONCLUSIONS Sixteen patients demonstrated preservation of vocal fold movement without laryngeal nerve injury immediately after CPM-OT in the awake state during aspiration prevention surgery using the glottic closure technique. Postoperative videofluoroscopic examination of swallowing revealed the cricopharyngeal bar was absent and pharyngeal passage of the bolus and Food Intake LEVEL Scale was improved in all patients. CPM-OT is a feasible and less invasive treatment option.
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Affiliation(s)
- Hideaki Kanazawa
- Department of General Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
- Swallowish Clinic, Tokyo, Japan
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1 Wagokita, Naka-ku, Hamamatsu, Shizuoka, 433-8511, Japan.
| | - Tomohisa Ohno
- Department of Dentistry, Hamamatsu City Rehabilitation Hospital, Hamamatsu, Japan
| | - Kenjiro Kunieda
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1 Wagokita, Naka-ku, Hamamatsu, Shizuoka, 433-8511, Japan
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Takashi Shigematsu
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, 1-6-1 Wagokita, Naka-ku, Hamamatsu, Shizuoka, 433-8511, Japan
| | - Masanaga Yamawaki
- Department of Medical Education Research and Development, Tokyo Medical and Dental University, Tokyo, Japan
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Stopenski S, Grigorian A, Roditi R, Jutric Z, Yamamoto M, Lekawa M, Nahmias J. Discrepancies in Thyroidectomy Outcomes Between General Surgeons and Otolaryngologists. Indian J Otolaryngol Head Neck Surg 2022; 74:5384-5390. [PMID: 36742886 PMCID: PMC9895566 DOI: 10.1007/s12070-021-02650-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/17/2021] [Indexed: 02/07/2023] Open
Abstract
Thyroidectomy is a common operation, performed by general surgeons and otolaryngologists. Few studies compare complication rates between these two specialties. We hypothesized that there would be no difference in the incidence of postoperative complications including recurrent laryngeal nerve (RLN) injury, hypocalcemia, or hematoma based on the surgical specialty performing the thyroidectomy. The 2016-2017 National Surgical Quality Improvement Program Targeted Thyroidectomy database was queried for patients who underwent thyroidectomy for both benign and malignant thyroid diseases. Thyroidectomies performed by general surgeons were compared to those performed by otolaryngologists. Multivariate logistic regression was used to identify risk factors associated with RLN injury, hematoma, and hypocalcemia. From 11,595 patients, 6313 (54.4%) were performed by general surgeons and 5282 (45.6%) by otolaryngologists. Goiter (43.7%) and nodule/neoplasm (40.8%) were the most common indications for the general surgery and otolaryngology cohorts respectively. General surgeons used an energy vessel sealant device more frequently (77.7% vs. 51.5%, p < 0.001), whereas RLN monitoring (67.4% vs. 58.3%, p < 0.001) and drain placement (44.3% vs. 14.8%, p < 0.001) were utilized more often by otolaryngology. After controlling for covariates, thyroidectomy by general surgeons had an increased associated risk of RLN injury (OR = 1.26, CI = 1.07-1.48, p = 0.006) and post-operative hypocalcemia (OR = 1.17, CI = 1.00-1.37, p = 0.046). Thyroidectomy volume is relatively equally distributed among general surgeons and otolaryngologists. Operation by a general surgeon is associated with an increased risk for RLN injury and postoperative hypocalcemia. This discrepancy may be explained by case volume, training, and/or completion of an endocrine surgery fellowship; however, this discrepancy still merits ongoing attention.
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Affiliation(s)
- Stephen Stopenski
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, Irvine Medical Center, University of California, 333 The City Blvd West, Suite 1600, Orange, CA 92868 USA
| | - Areg Grigorian
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, Irvine Medical Center, University of California, 333 The City Blvd West, Suite 1600, Orange, CA 92868 USA
| | - Rachel Roditi
- Brigham and Women’s Hospital, Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, Boston, MA USA
| | - Zeljka Jutric
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, Irvine Medical Center, University of California, 333 The City Blvd West, Suite 1600, Orange, CA 92868 USA
| | - Maki Yamamoto
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, Irvine Medical Center, University of California, 333 The City Blvd West, Suite 1600, Orange, CA 92868 USA
| | - Michael Lekawa
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, Irvine Medical Center, University of California, 333 The City Blvd West, Suite 1600, Orange, CA 92868 USA
| | - Jeffry Nahmias
- Division of Trauma, Burns and Surgical Critical Care, Department of Surgery, Irvine Medical Center, University of California, 333 The City Blvd West, Suite 1600, Orange, CA 92868 USA
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Rosati D, Bononi M, Ruscito P, Radici M, Cavaliere C, Minni A. Bilateral and Ipsilateral Central Neck Dissection in Total Thyroidectomy: a Long Term Comparison of Complications. Indian J Otolaryngol Head Neck Surg 2022; 74:6206-6212. [PMID: 36742527 PMCID: PMC9895597 DOI: 10.1007/s12070-021-02904-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 10/02/2021] [Indexed: 02/07/2023] Open
Abstract
The role of prophylactic central compartment neck dissection (CCND) in total thyroidectomy (TT) is controversial in patients without clinically evident lymph nodes metastasis (cN0) because of association with transient and permanent hypoparathyroidism (HPT) as well as transient and permanent recurrent laryngeal nerve (RLN) injury. Instead of bilateral central neck dissection (bCCND), ipsilateral central compartment neck dissection (iCCND) has recently been proposed as a safer, alternative treatment for selected patients. The aim of this study is to characterize the morbidity that CCND (ipsilateral and bilateral) adds to TT. We enrolled 453 patients: Group A (316 patients) underwent TT alone, Group B (86 patients) underwent TT + iCCND, Group C (51 patients) underwent TT + bCCND. We compared the rates of RLN injury and HPT in three groups and data analysis showed that iCCND was associated with increased rate of transient HPT but not permanent HPT and bCCND was associated with increased rate of transient and permanent HPT, when compared with TT alone. Further studies are needed to evaluate the clear advantages of CCND (both ipsilateral and bilateral), but this should be considered in the context of an higher risk of surgical complications (especially transient and permanent hypoparathyroidism), in comparison with TT alone.
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Affiliation(s)
- Davide Rosati
- Department of Otorhinolaryngology and Cervico-facial Surgery, Ospedale San Camillo de Lellis, via John Fitzgerald Kennedy, 02100 Rieti, Italy
| | - Marco Bononi
- Department of Surgery “P. Valdoni”, Sapienza” University of Rome, Azienda Policlinico Umberto I, Rome, Italy
| | - Paolo Ruscito
- Department of Otorhinolaryngology and Cervico-facial Surgery, Ospedale San Camillo de Lellis, via John Fitzgerald Kennedy, 02100 Rieti, Italy
| | - Marco Radici
- Department of Otorhinolaryngology and Cervico-facial Surgery, Ospedale San Giovanni Calibita - Fatebenefratelli, Isola Tiberina, Rome, Italy
| | - Carlo Cavaliere
- Department of Sensory Organs, Sapienza” University of Rome, Azienda Policlinico Umberto I, Rome, Italy
| | - Antonio Minni
- Department of Sensory Organs, Sapienza” University of Rome, Azienda Policlinico Umberto I, Rome, Italy
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Xu S, Han Y. Hints for prevention of recurrent laryngeal nerve injury. Asian J Surg 2022:S1015-9584(22)00283-4. [PMID: 35367101 DOI: 10.1016/j.asjsur.2022.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 03/10/2022] [Indexed: 11/24/2022] Open
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9
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Duong W, Grigorian A, Farzaneh C, Elfenbein D, Yamamoto M, Rosenbaum K, Lekawa M, Nahmias J. Nerve monitoring decreases recurrent laryngeal nerve injury risk for neoplasm-related thyroidectomy. Am J Surg 2021; 223:918-922. [PMID: 34715986 DOI: 10.1016/j.amjsurg.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 09/06/2021] [Accepted: 10/11/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Conflicting reports exist regarding the benefit of intraoperative neuromonitoring (INM) for patients undergoing thyroidectomy. We hypothesized that in a national sample, the risk of mild and severe RLNi is decreased for patients undergoing neoplasm-related disease (NRD) thyroidectomy with INM compared to patients without INM. METHODS The database was queried for patients that underwent total thyroidectomy for NRD with and without INM. A multivariable logistic regression model was used to determine the associated odds of RLNi. RESULTS From 6942 patients, 4269 (61.5%) had INM during thyroidectomy. Patients with INM had a similar rate of overall RLNi compared to patients without INM (5.7% vs. 6.6%, p = 0.118). After adjusting for covariates, INM was associated with decreased odds of severe-RLNi (OR 0.23, p = 0.036) but not mild-RLNi (p = 0.16). CONCLUSION INM is associated with a nearly 80% decreased associated odds of severe RLNi during thyroidectomy for NRD. Future prospective confirmation is needed, and if confirmed, patients undergoing thyroidectomy for NRD should have INM to reduce the risk of RLNi and its associated morbidity.
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Affiliation(s)
- William Duong
- University of California, Irvine, Department of Surgery, Orange, CA, USA.
| | - Areg Grigorian
- University of Southern California, Department of Surgery, Los Angeles, CA, USA
| | - Cyrus Farzaneh
- University of California, Irvine, Department of Surgery, Orange, CA, USA
| | - Dawn Elfenbein
- University of Wisconsin, Madison, Department of Surgery, Madison, WI, USA
| | - Maki Yamamoto
- University of California, Irvine, Department of Surgery, Orange, CA, USA
| | - Kathryn Rosenbaum
- University of California, Irvine, Department of Surgery, Orange, CA, USA
| | - Michael Lekawa
- University of California, Irvine, Department of Surgery, Orange, CA, USA
| | - Jeffry Nahmias
- University of California, Irvine, Department of Surgery, Orange, CA, USA
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10
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Fackelmayer OJ, Wu JX, Yeh MW. Endocrine Surgery: Management of Postoperative Complications Following Endocrine Surgery of the Neck. Surg Clin North Am 2021; 101:767-784. [PMID: 34537142 DOI: 10.1016/j.suc.2021.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Cervical endocrine operations include parathyroidectomy, thyroid lobectomy, thyroidectomy, central neck dissection, and lateral neck dissection. The vital structures at risk include the recurrent laryngeal nerves to the intrinsic muscles of the larynx, additional cranial nerves, parathyroid glands essential for calcium homeostasis, aerodigestive structures, and great vessels. Here, the authors discuss complications of endocrine neck surgery, including cervical hematoma and other fluid collections, hypocalcemia from hypoparathyroidism, and nerve injuries, along with their prevention, mitigation, and management. Significant and permanent morbidity can result, but fortunately the overall rate of complications remains low, especially when surgery is performed by high-volume surgeons.
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Affiliation(s)
- Oliver J Fackelmayer
- Section of Endocrine Surgery, UCLA David Geffen School of Medicine, UCLA Endocrine Center, 100 Medical Plaza Driveway, Suite 310, Los Angeles, CA 90095, USA
| | - James X Wu
- Section of Endocrine Surgery, UCLA David Geffen School of Medicine, UCLA Endocrine Center, 100 Medical Plaza Driveway, Suite 310, Los Angeles, CA 90095, USA
| | - Michael W Yeh
- Section of Endocrine Surgery, UCLA David Geffen School of Medicine, UCLA Endocrine Center, 100 Medical Plaza Driveway, Suite 310, Los Angeles, CA 90095, USA.
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Abstract
BACKGROUND H type tracheoesophageal fistula (H-TEF) is a rare congenital anomaly. Management may be complicated by late diagnosis and variation(s) in the therapeutic strategy. A systematic review of published studies explores the utility of diagnostic studies, operations and postoperative complications. METHODS Medline and PubMed database(s) were searched for ALL studies reporting H-TEF during 1997-2020. Using PRISMA methodology, manuscripts were screened for eligibility and reporting. RESULTS Forty-seven eligible studies were analysed. Primary diagnosis varied widely with surgeons performing oesophagography and trachea-bronchoscopy. Preoperative localisation techniques included fluoroscopy, guidewire placement and catheterisation. A cervical approach (209 of 272 cases), as well as thoracotomy, thoracoscopy and endoscopic fistula ligation, were all described. Morbidity included fistula recurrence (1.7%), leak (2%), tracheomalacia (3.4%) and respiratory sequelae (1%). The major adverse complication in all studies was vocal cord palsy secondary to laryngeal nerve injury (18.5%) yet strikingly few centres routinely reported undertaking vocal cord screening pre or postoperatively. CONCLUSION This study shows that paediatric surgeons record low volume activity with H type tracheoesophageal fistula. Variation(s) in clinical practice are widely evident. Laryngeal nerve injury and its subsequent management warrant special consideration. Care pathways may offset attendant morbidity and define 'best practice.'
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Affiliation(s)
- Keerthika Sampat
- Department of Paediatric Surgery, Alder Hey Childrens’ Hospital, Liverpool, UK
| | - Paul D. Losty
- Department of Paediatric Surgery, Alder Hey Childrens’ Hospital, Liverpool, UK ,Institute of Child Health, School of Health And Life Science, University of Liverpool, Liverpool, UK
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Yu M, Ge M. Non-energy devices to dissect recurrent laryngeal nerve lymph nodes of non-small cell lung cancer under video-assisted thoracic surgery. BMC Surg 2021; 21:172. [PMID: 33785015 PMCID: PMC8008666 DOI: 10.1186/s12893-021-01179-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 03/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background Systematic nodal dissection plays a crucial role in improving survival and staging in resectable non-small cell lung cancer (NSCLC) patients but at the cost of increasing the occurrence of recurrent laryngeal nerve injury. Technology should be improved to protect the recurrent laryngeal nerve (RLN) during surgery. Methods NSCLC patients who underwent video-assisted thoracic surgery (VATS) surgical treatment by the same surgeon at our hospital from January 2016 to December 2017 were included as the research subjects and were divided into an energy-device group and a non-energy-device group. Their procedures included anatomic pulmonary resection, normative N1 dissection, and systemic N2 dissection. Results The rate of metastatically involved recurrent laryngeal nerve lymph nodes (RLNLNs) was 5.19% (39/752). Dissection device, side of primary, FEV1, operative time and BMI were independent predictors of recurrent laryngeal nerve injury (RLNI) (hazard ratio (HR) = 3.576, 95% confidence interval (CI): 1.490–8.583, P = 0.004; HR = 0.175, 95% CI: 0.072–0.424, P = < 0.001; HR = 3.008, 95% CI: 1.30–6.927, P = 0.010; HR = 0.328, 95% CI: 0.136–0.794, P = 0.013; HR = 0.344, 95%CI: 0.147–0.801, P = 0.013, respectively). Patients in the non-energy-device group had significantly less RLNI than the energy-device group (P = 0.016) and nearly half of the non-thermal RLNI recovered in 2 weeks (P = 0.025) whereas most thermal RLNI required 3 months for recovery. Conclusions Every station of RLNLN had some degree of cancer metastasis in NSCLC patients and when dissecting RLNLNs, dissection device was an independent and artificially controlled predictor of RLNI. Using a non-energy device is a feasible method to protect the RLN as well as an improved recovery time of RLNI.
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Affiliation(s)
- Minhao Yu
- Department of Thoracic Surgery, Chengdu BOE Hospital, Chengdu, 610200, China
| | - Mingjian Ge
- Department of Thoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016, China.
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Yuan Q, Liao Y, Liao X, Hou J, Zheng L, Liu J, Wang K, Wu G. Warning criterion to predict recurrent laryngeal nerve injury with percentage reduction of the amplitude of V2/R2d in neuromonitoring thyroidectomy. Auris Nasus Larynx 2021; 48:942-948. [PMID: 33451885 DOI: 10.1016/j.anl.2021.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/31/2020] [Accepted: 01/07/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the contribution of amplitude reduction compared vagal stimulation at the end of thyroid dissection (V2) to the most distal RLN stimulation during thyroidectomy in predicting postoperative vocal cords paralysis (VCP). METHODS Patients with intact preoperative RLN function who underwent monitored thyroidectomy between August 2017 and April 2018 were included. We routinely tested the exposed RLN at the lowest proximal end (R2p signal) and the most distal end near the laryngeal entry point (R2d signal), and then routinely detected the vagal nerve at the horizontal plane of the inferior pole of thyroid with 2mA stimulation current. The cut-off value was calculated with Receiver Operating Characteristic curve. Rates of specificity, sensitivity, negative predictive value, positive predictive value (PPV) for V2/R2d and R2p/R2d were compared. RESULTS Percentage reduction of the amplitude of V2/R2d ranged from 34.8% to 76.7%. Twenty-two (1.5%) nerves developed temporary VCP, in which one nerve with VCP showed no significant amplitude reduction at the end of the surgery. There was no permanent or bilateral VCP. Sensitivity, specificity, PPV, NPV, and accuracy for the amplitude reduction of V2/R2d> 60% were 95.5%, 99.8%, 99.9%, 98.2%, respectively, for R2p/R2d were 99.5%, 99.2%, 63.6%, 99.9%, 97.7%, respectively. CONCLUSION Percentage reduction of the amplitude of V2/R2d is a reliable and practical warning criterion for RLN injury. When the amplitude reduction> 60% surgeons should consider the possibility of postoperative VCP and correct some surgical maneuvers.
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Affiliation(s)
- Qianqian Yuan
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, People's Republic of China
| | - Yiqin Liao
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, People's Republic of China
| | - Xing Liao
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071 Hubei Province, People's Republic of China
| | - Jinxuan Hou
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, People's Republic of China
| | - Lewei Zheng
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, People's Republic of China
| | - Jiuyang Liu
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, People's Republic of China
| | - Kun Wang
- Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Gaosong Wu
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, People's Republic of China.
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Wang H, Wang H, Li X, Xu W. Characteristics of Early Internal Laryngeal Muscle Atrophy After Recurrent Laryngeal Nerve Injuries in Rats. Laryngoscope 2020; 131:E1256-E1264. [PMID: 33098577 DOI: 10.1002/lary.29210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/09/2020] [Accepted: 10/15/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS The present study investigated the characteristics of early internal laryngeal muscle atrophy in recurrent laryngeal nerve injury (RLNI) rats. STUDY DESIGN To observe the characteristics of early internal laryngeal muscle atrophy post RLNI. METHODS Rats were divided into three groups: sham-operated control group (n = 20), recurrent laryngeal nerve transverse injury group (RLNTI, n = 50), and recurrent laryngeal nerve blunt contusion group (RLNBC, n = 50). Five weeks after RLNI, certain rats were sacrificed weekly, and their laryngeal tissues were harvested. The atrophic features of internal laryngeal muscles were detected using hematoxylin and eosin. NF-κB and MuRF-1 levels were tested using IHC. RESULTS The atrophic degree and fibrosis of thyroarytenoid, posterior cricoarytenoid, and lateral cricoarytenoid muscles were related to the type of RLNI. The average myofiber cross-sectional areas increased before an obvious decrease in the RLNTI and RLNBC groups. Muscle recovery occurred in the RLNBC group starting 4 weeks after RLNI, but only a weak trend was observed in the RLNTI group in the 5th week. During the muscle atrophy process, MuRF-1 and NF-κB were upregulated early and were maintained at a high level, which showed a trend similar to muscle atrophy. However, NF-κB expression was opposite to MuRF-1 expression and muscle atrophy when the muscles recovered. CONCLUSION The atrophy degree of internal laryngeal muscles was associated with the type of RLNI. The NF-κB/MuRF-1 signaling pathway was involved in internal laryngeal muscle atrophy after RLNI, which is different from skeletal muscle after denervation. LEVEL OF EVIDENCE NA Laryngoscope, 131:E1256-E1264, 2021.
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Affiliation(s)
- Hong Wang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, China
| | - Haizhou Wang
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, China
| | - Xueyan Li
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, China
| | - Wen Xu
- Department of Otolaryngology-Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Key Laboratory of Otolaryngology Head and Neck Surgery, Ministry of Education, Capital Medical University, Beijing, China
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Hosoda K, Niihara M, Ushiku H, Harada H, Sakuraya M, Washio M, Yamashita K, Hiki N. Prevention of intra-thoracic recurrent laryngeal nerve injury with robot-assisted esophagectomy. Langenbecks Arch Surg 2020; 405:533-40. [PMID: 32494883 DOI: 10.1007/s00423-020-01904-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/25/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Transthoracic esophagectomy for esophageal cancer is one of the most invasive procedures in surgery for gastrointestinal cancer. Serious complications sometimes occur after esophageal cancer surgery, including recurrent laryngeal nerve injury and pneumonia. The purpose of this study was to access the possibility of robot-assisted thoracoscopic esophagectomy for esophageal cancer in terms of preventing recurrent laryngeal nerve injury. METHODS Operations in thoracic part were performed in prone position with bilateral ventilation. During dissection of the recurrent laryngeal nerve lymph nodes, thin blood vessels were coagulated with Maryland bipolar forceps in the left hand and then dissected with monopolar scissors in the right hand. Especially when dissecting left recurrent laryngeal nerve lymph nodes, the nerve was left unisolated from the vascular sheath that involves the aortic arch. Short-term outcomes including operative time, estimated blood loss, and postoperative complications including recurrent laryngeal nerve injury were accessed. RESULTS From November 2018 to January 2020, 20 patients underwent robot-assisted thoracoscopic esophagectomy for esophageal cancer. Thoracic operative time was 242 min, estimated blood loss in the thoracic part was minimal, the number of dissected mediastinal lymph nodes was 19 (all median), and the incidence rates of recurrent laryngeal nerve injury and pneumonia were 10% (2 case) and 10% (2 cases), respectively. CONCLUSION Robot-assisted thoracoscopic esophagectomy for esophageal cancer has the possibility of reducing recurrent laryngeal nerve injury even in the introductory period. Randomized controlled trials are required to confirm this advantage of the robotic surgery.
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Karimian F. A commentary on the article: Comparison of outcomes after differentiated thyroid cancer surgery performed with and without energy devices: A population-based cohort study using a nationwide database in Japan, Int. J. Surg. 2020 Apr 9, doi: 10.1016/j.ijsu.2020.03.072, pii: S1743-9191(20)30286-7. Int J Surg 2020; 78:164-165. [PMID: 32387206 DOI: 10.1016/j.ijsu.2020.04.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/29/2020] [Indexed: 12/01/2022]
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Al-Hakami HA, Al Garni MA, Malas M, Abughanim S, Alsuraihi A, Al Raddadi T. Surgical Complications After Thyroid Surgery: A 10-Year Experience at Jeddah, Saudi Arabia. Indian J Otolaryngol Head Neck Surg 2019; 71:1012-1017. [PMID: 31742111 DOI: 10.1007/s12070-019-01695-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/24/2019] [Indexed: 11/29/2022] Open
Abstract
To evaluate the incidence and predictive risk factors of complications in patients who underwent thyroid surgery at our hospital with a residency training program. This retrospective cohort study analyzed the complications in all patients who underwent thyroid surgery between January 2008 and December 2017. Demographic data, preoperative diagnosis based on fine needle aspiration cytology, surgical approach, permanent pathology, postoperative complications, and factors associated with complications were recorded. At our hospital, 456 patients underwent thyroidectomy. The most common surgical complications were asymptomatic biochemical hypocalcemia and symptomatic hypocalcemia in 109 (23.9%) and 50 (11%) patients, respectively. Other surgical complications included permanent hypocalcemia, transient vocal cord palsy, permanent vocal cord palsy, hematoma, seroma, chyle fistula, and Horner's syndrome. Mean age > 45 years and more extensive surgery were significantly associated with overall complications (P = 0.003; < 0.001). Mean age > 50 years and vitamin D level < 25 nmol/L (< 10 ng/mL) were significantly associated with hypocalcemia (P = 0.008; < 0.001). Moreover, the extent of surgery and advanced thyroid carcinoma were significantly associated with vocal cord palsy (P < 0.001; 0.05). Hypocalcemia and vocal cord palsy are the most significant complications. Thyroid surgery can be performed safely by senior residents in the residency training program under the direct supervision of an experienced surgeon.
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Affiliation(s)
- Hadi A Al-Hakami
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, National Guard Health Affairs, P.O. Box 9515, Jeddah, 21423 Saudi Arabia
| | - Mohammed A Al Garni
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, National Guard Health Affairs, P.O. Box 9515, Jeddah, 21423 Saudi Arabia
| | - Moayyad Malas
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, National Guard Health Affairs, P.O. Box 9515, Jeddah, 21423 Saudi Arabia
| | - Sultan Abughanim
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, National Guard Health Affairs, P.O. Box 9515, Jeddah, 21423 Saudi Arabia
| | - Anas Alsuraihi
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, National Guard Health Affairs, P.O. Box 9515, Jeddah, 21423 Saudi Arabia
| | - Thamer Al Raddadi
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, National Guard Health Affairs, P.O. Box 9515, Jeddah, 21423 Saudi Arabia
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18
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Baumgarten HD, Bauer AJ, Isaza A, Mostoufi-Moab S, Kazahaya K, Adzick NS. Surgical management of pediatric thyroid disease: Complication rates after thyroidectomy at the Children's Hospital of Philadelphia high-volume Pediatric Thyroid Center. J Pediatr Surg 2019; 54:1969-1975. [PMID: 30902456 DOI: 10.1016/j.jpedsurg.2019.02.009] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/29/2018] [Accepted: 02/03/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Recent studies suggest improved outcomes for children undergoing thyroidectomy at high-volume pediatric surgery centers. We present outcomes after thyroid surgery at a single center and advocate for referral to high-volume centers for multidisciplinary management of these children. METHODS Medical records were reviewed for all pediatric patients undergoing thyroid surgery at a single institution from 2009 through 2017. Routine recurrent laryngeal nerve and parathyroid hormone monitoring was used. Lymph node dissections were performed in appropriately selected cancer patients. Data collection focused on pathologic diagnosis, surgical technique, and surgical complications, including postoperative hematoma, neurapraxia, permanent nerve damage, hypocalcemia, and transient and permanent hypoparathyroidism. RESULTS From 2009 through 2017, 464 patients underwent thyroid surgery. Median age of the cohort was 15 years (range 2-24). Thirty-three percent were diagnosed with benign nodules (n=151), 36% with papillary or follicular thyroid cancer (n=168), 27% with Graves' disease (n=124), 3% with medullary thyroid cancer (n=14), and 1.5% underwent prophylactic thyroidectomy for MEN2a (n=7). Six patients required return to the OR for hematoma evacuation including 5 patients after surgery for Graves' disease (RR 8.7, 95% CI 1.06-71.85). In sixteen cases, concern about neurapraxia resulted in laryngoscopy, revealing eleven patients with vocal cord paresis. Two of these patients demonstrated a persistent deficit at 6 months postoperatively (0.4%). Thirty-seven percent of patients had transient hypoparathyroidism (n=137), and two patients had persistent hypoparathyroidism 6 months after total thyroidectomy (0.6%). There was no significant difference in either hypocalcemia or hypoparathyroidism after total thyroidectomy based on age or diagnosis. CONCLUSIONS Characterizing outcomes for pediatric patients based on diagnosis will assist in preoperative counseling for patients and their families. This high-volume center reports low complication rates after pediatric thyroid surgery, highlighting that referral to high-volume centers should be considered for children and adolescents with thyroid disease requiring surgery. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Heron D Baumgarten
- Department of Surgery, Children's Hospital of Philadelphia, and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Andrew J Bauer
- Department of Pediatrics, and the Pediatric Thyroid Center, Children's Hospital of Philadelphia, and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Amber Isaza
- Department of Pediatrics, and the Pediatric Thyroid Center, Children's Hospital of Philadelphia, and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Sogol Mostoufi-Moab
- Department of Pediatrics, and the Pediatric Thyroid Center, Children's Hospital of Philadelphia, and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Ken Kazahaya
- Department of Surgery, Children's Hospital of Philadelphia, and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Division of Pediatric Otolaryngology, Children's Hospital of Philadelphia, and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - N Scott Adzick
- Department of Surgery, Children's Hospital of Philadelphia, and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
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Henry BM, Hsieh WC, Sanna B, Vikse J, Taterra D, Tomaszewski KA. Incidence, Risk Factors, and Comorbidities of Vocal Cord Paralysis After Surgical Closure of a Patent Ductus Arteriosus: A Meta-analysis. Pediatr Cardiol 2019; 40:116-25. [PMID: 30167748 DOI: 10.1007/s00246-018-1967-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 08/16/2018] [Indexed: 12/15/2022]
Abstract
Surgical closure of a patent ductus arteriosus (PDA) is considered standard treatment for symptomatic neonates refractory to medical therapy. Sometimes, iatrogenic injury to the left recurrent laryngeal nerve during the procedure can result in vocal cord paralysis (VCP). This study aimed to estimate the incidence of VCP in patients after surgical PDA closure and to identify any associated risk factors and morbidities associated with VCP in the preterm infant population. A thorough search of the major electronic databases was conducted to identify studies eligible for inclusion into this meta-analysis. Studies reporting data on the incidence of VCP (primary outcomes) or risk factors and morbidities associated with VCP in premature infant population (secondary outcomes) were included. A total of 33 studies (n = 4887 patients) were included into the analysis. Overall pooled incidence estimate of VCP was 7.9% (95%CI 5.3-10.9). The incidence of VCP after PDA closure was significantly much higher in premature infants (11.2% [95%CI 7.0-16.3]) than in non-premature patients (3.0% [95%CI 1.5-4.9]). The data showed that VCP was most common after surgical ligation and in studies conducting universal laryngoscopy scoping. The risk factors for postoperative VCP in preterm infants included birth weight and gestational age. In addition, VCP was significantly associated with the occurrence of bronchopulmonary dysplasia, gastrostomy tube insertion, and increased duration of mechanical ventilation. Vocal cord paralysis remains a frequent complication of surgical closure of a PDA, especially in premature neonates, and is associated with significant post-procedural complications.
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Haney MM, Hamad A, Leary E, Bunyak F, Lever TE. Automated Quantification of Vocal Fold Motion in a Recurrent Laryngeal Nerve Injury Mouse Model. Laryngoscope 2018; 129:E247-E254. [PMID: 30478924 DOI: 10.1002/lary.27609] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 08/16/2018] [Accepted: 09/17/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS The goal of this study was to objectively examine vocal fold (VF) motion dynamics after iatrogenic recurrent laryngeal nerve (RLN) injury in a mouse surgical model. Furthermore, we sought to identify a method of inducing injury with a consistent recovery pattern from which we can begin to evaluate spontaneous recovery and test therapeutic interventions. STUDY DESIGN Animal model. METHODS The right RLN in C57BL/6J mice was crushed for 30 seconds using an aneurysm clip with 1.3-N closing force. Transoral laryngoscopy enabled visualization of VF movement prior to surgery, immediately post-crush, and at two endpoints: 3 days (n = 5) and 2 weeks (n = 5). VF motion was quantified with our custom motion-analysis software. At each endpoint, RLN samples were collected for transmission electron microscopy for correlation with VF motion dynamics. RESULTS Our VF tracking software permitted automated quantification of several measures of VF dynamics, such as range and frequency of motion. By 2 weeks post-injury, the frequency of VF movement on the right (injured) side equaled the left, yet range of motion only partially recovered. These objective outcome measures enabled detection of VF dysfunction that persisted at 2 weeks post-crush. Transmission electron microscopy images revealed RLN degeneration 3 days post-crush and partial regeneration at 2 weeks, consistent with functional results obtained with automated VF tracking. CONCLUSIONS Our motion-analysis software provides novel objective, quantitative, and repeatable metrics to detect and describe subtle VF dysfunction in mice that corresponds with underlying RLN degeneration and recovery. Adaptation of our tracking software for use with human patients is underway. LEVEL OF EVIDENCE NA Laryngoscope, 129:E247-E254, 2019.
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Affiliation(s)
- Megan M Haney
- Department of Veterinary Pathobiology , University of Missouri, Columbia, Missouri, U.S.A
| | - Ali Hamad
- Department of Electrical Engineering and Computer Science , University of Missouri, Columbia, Missouri, U.S.A
| | - Emily Leary
- Department of Orthopaedic Biostatistics , University of Missouri, Columbia, Missouri, U.S.A
| | - Filiz Bunyak
- Department of Electrical Engineering and Computer Science , University of Missouri, Columbia, Missouri, U.S.A
| | - Teresa E Lever
- Department of Otolaryngology-Head and Neck Surgery , University of Missouri, Columbia, Missouri, U.S.A
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Gambardella C, Polistena A, Sanguinetti A, Patrone R, Napolitano S, Esposito D, Testa D, Marotta V, Faggiano A, Calò PG, Avenia N, Conzo G. Unintentional recurrent laryngeal nerve injuries following thyroidectomy: Is it the surgeon who pays the bill? Int J Surg 2018; 41 Suppl 1:S55-S59. [PMID: 28506414 DOI: 10.1016/j.ijsu.2017.01.112] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/27/2017] [Accepted: 01/30/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Thyroidectomy is one of the most common intervention in general surgery and, after the turn of the century, its rate has sharply increased, along with a worldwide increased incidence of differentiated thyroid cancers. Therefore, injuries of the recurrent laryngeal nerve have become one of the most frequent cause of surgical malpractice claims, mostly following surgery for benign pathology. MAIN BODY Even if the incidence of definitive paralysis is generally lower than 3%, during the last 20 years in Italy, the number of claims for damages has sharply raised. As a consequence, a lot of defensive medicine has been caused by this issue, and a witch-hunt has been accordingly triggered, so determining mostly a painful and lasting frustration for the surgeons, who sometimes are compelled to pay a lot of money for increasing insurance premiums and lawyers fees. Recurrent laryngeal nerve injury should be considered as a potentially catastrophic predictable but not preventable event, rather than the result of a surgical mistake. CONCLUSION Purposes of the Authors are analyzing incidence, conditions of risk, and mechanisms of recurrent laryngeal nerve injuries, underlining notes of surgical technique and defining medical practice recommendations useful to reduce the risk of malpractice lawsuits and judgments against surgeons.
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Affiliation(s)
- C Gambardella
- Division of General and Oncologic Surgery, Via Pansini 5, 80131, Napoli, Department of Cardiothoracic Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - A Polistena
- Endocrine Surgery Unit, University of Perugia, Perugia, Italy
| | - A Sanguinetti
- Endocrine Surgery Unit, University of Perugia, Perugia, Italy
| | - R Patrone
- Division of General and Oncologic Surgery, Via Pansini 5, 80131, Napoli, Department of Cardiothoracic Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - S Napolitano
- Medical Officer, Italian Air Force Medical Corps, Ministry of Defence, Rome, Italy
| | - D Esposito
- Division of General and Oncologic Surgery, Via Pansini 5, 80131, Napoli, Department of Cardiothoracic Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - D Testa
- Otolaryngology - Head and Neck Surgery Unit, Department of Cardiothoracic Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - V Marotta
- Department of Molecular and Clinical Endocrinology and Oncology, Federico II University, Naples, Italy
| | - A Faggiano
- Department of Molecular and Clinical Endocrinology and Oncology, Federico II University, Naples, Italy
| | - P G Calò
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042 Monserrato, CA, Italy
| | - N Avenia
- Endocrine Surgery Unit, University of Perugia, Perugia, Italy
| | - G Conzo
- Division of General and Oncologic Surgery, Via Pansini 5, 80131, Napoli, Department of Cardiothoracic Sciences, University of Campania "Luigi Vanvitelli", Italy.
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Fallon SC, Langer JC, St Peter SD, Tsao K, Kellagher CM, Lal DR, Whitehouse JS, Diesen DL, Rollins MD, Pontarelli E, Malek MM, Iqbal CW, Upperman JS, Leys CM, Wulkan ML, Hill SJ, Blakely ML, Kane TD, Wesson DE. Congenital H-type tracheoesophageal fistula: A multicenter review of outcomes in a rare disease. J Pediatr Surg 2017; 52:1711-4. [PMID: 28528013 DOI: 10.1016/j.jpedsurg.2017.05.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 04/03/2017] [Accepted: 05/07/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To perform a multicenter review of outcomes in patients with H-type tracheoesophageal fistula (TEF) in order to better understand the incidence and causes of post-operative complications. BACKGROUND H-type TEF without esophageal atresia (EA) is a rare anomaly with a fundamentally different management algorithm than the more common types of EA/TEF. Outcomes after surgical treatment of H-type TEF are largely unknown, but many authoritative textbooks describe a high incidence of respiratory complications. METHODS A multicenter retrospective review of all H-type TEF patients treated at 14 tertiary children's hospital from 2002-2012 was performed. Data were systematically collected concerning associated anomalies, operative techniques, hospital course, and short and long-term outcomes. Descriptive analyses were performed. RESULTS We identified 102 patients (median 9.5 per center, range 1-16) with H-type TEF. The overall survival was 97%. Most patients were repaired via the cervical approach (96%). The in-hospital complication rate, excluding vocal cord issues, was 16%; this included an 8% post-operative leak rate. Twenty-two percent failed initial extubation after repair. A total of 22% of the entire group had vocal cord abnormalities (paralysis or paresis) on laryngoscopy that were likely because of recurrent laryngeal nerve injury. Nine percent required a tracheostomy. Only 3% had a recurrent fistula, all of which were treated with reoperation. CONCLUSIONS There is a high rate of recurrent laryngeal nerve injury after H-type TEF repair. This underscores the need for meticulous surgical technique at the initial repair and suggests that early vocal cord evaluation should be performed for any post-operative respiratory difficulty. Routine evaluation of vocal cord function after H-type TEF repair should be considered. THE LEVEL OF EVIDENCE RATING Level IV.
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Kadakia S, Mourad M, Hu S, Brown R, Lee T, Ducic Y. Utility of intraoperative nerve monitoring in thyroid surgery: 20-year experience with 1418 cases. Oral Maxillofac Surg 2017; 21:335-339. [PMID: 28577127 DOI: 10.1007/s10006-017-0637-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 05/29/2017] [Indexed: 06/07/2023]
Abstract
PURPOSE The efficacy of intraoperative nerve monitoring is controversial in the literature. This study of a single surgeon's experience seeks to determine if the use of intraoperative nerve monitoring influences recurrent laryngeal nerve injury during thyroid surgery. METHODS Six hundred fifty-seven patients with normal pre-operative vocal fold function underwent thyroid surgery without the use of intraoperative nerve monitoring from September 1997 to January 2007, while 761 patients underwent thyroid surgery from February 2007 to February 2016 with routine use of nerve monitoring. Patients were followed for a minimum of 6 months after surgery, and postoperative nerve function was determined by fiberoptic laryngoscopy. A Fisher test was used to determine if nerve injury was statistically different between both groups. RESULTS In patients operated on without nerve monitoring, 21 patients were found to have postoperative vocal fold paralysis with nine regaining functioning. In patients operated on with nerve monitoring, 27 were found to have vocal fold dysfunction with 17 regaining function. Fisher test analysis, both with and without patients regaining function, showed no difference in nerve injury between groups (p > 0.05, p > 0.05). CONCLUSION Intraoperative monitoring during thyroidectomy may not prevent injury to the recurrent laryngeal nerve.
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Affiliation(s)
- Sameep Kadakia
- New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA.
| | - Moustafa Mourad
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, TX, USA
| | - Shirley Hu
- New York Eye and Ear Infirmary of Mount Sinai, New York, NY, USA
| | | | - Thomas Lee
- Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, TX, USA
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Naraynsingh V, Cawich S, Hassranah D, Maharaj R, Islam S, Singh Y. Retrograde Thyroidectomy for preservation of the External Branch of the Superior Laryngeal Nerve: A case series. Int J Surg Case Rep 2017; 53:517-521. [PMID: 28624166 PMCID: PMC6290875 DOI: 10.1016/j.ijscr.2017.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/27/2017] [Accepted: 04/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The external branch of the Superior Laryngeal nerve (EBSLN) is at high risk of injury in surgery for large multinodular goitre (MNG) since the upper pole is high in the neck, well cephalad to the EBSLN. We present a technique of drawing the lobe caudally by retrograde thyroidectomy in order to minimize nerve injury. DESIGN & METHOD All patients having surgery for benign MNG were included. Cases with previous thyroid surgery, malignant and toxic disease were excluded. The thyroid lobe was mobilized from its inferior aspect and capsular dissection performed cephalad with bipolar or ligasure cautery, lifting the gland off the trachea while separating it from the parathyroids and branches of the inferior thyroid vessels. The ligament of Berry is divided and the entire lobe freed, attached only by the superior pedicle which is drawn caudally well below the EBSLN prior to ligation. Patients were followed for voice change at 24 hours, 7 days and 3 months. RESULTS Ninety-one consecutive lobectomies were done in 60 patients, 31 bilateral. Forty-four (73%) patients had voice change at 24h, 10 (11%) at 7days and 1 at 3 months. The patient with persistent voice change complained of change in tone but not volume; vocal cords were normal on indirect laryngoscopy. CONCLUSION Retrograde thyroidectomy is recommended for large MNG where the EBSLN lies well below the upper pole; it minimizes risk to the nerve.
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Affiliation(s)
- Vijay Naraynsingh
- Department of Clinical Surgical Sciences, The University of West Indies, St Augustine, Trinidad and Tobago
| | - Shamir Cawich
- Department of Clinical Surgical Sciences, The University of West Indies, St Augustine, Trinidad and Tobago
| | - Dale Hassranah
- Department of Clinical Surgical Sciences, The University of West Indies, St Augustine, Trinidad and Tobago
| | - Ravi Maharaj
- Department of Clinical Surgical Sciences, The University of West Indies, St Augustine, Trinidad and Tobago
| | - Shariful Islam
- Department of Clinical Surgical Sciences, The University of West Indies, St Augustine, Trinidad and Tobago.
| | - Yardesh Singh
- Department of Clinical Surgical Sciences, The University of West Indies, St Augustine, Trinidad and Tobago
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Pan Y, Jiao G, Yang J, Guo R, Li J, Wang C. Insights into the Therapeutic Potential of Heparinized Collagen Scaffolds Loading Human Umbilical Cord Mesenchymal Stem Cells and Nerve Growth Factor for the Repair of Recurrent Laryngeal Nerve Injury. Tissue Eng Regen Med 2017; 14:317-326. [PMID: 30603488 DOI: 10.1007/s13770-017-0032-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 07/05/2016] [Accepted: 08/22/2016] [Indexed: 12/16/2022] Open
Abstract
Recurrent laryngeal nerve (RLN) injury can result in unilateral or bilateral vocal cords paralysis, thereby causing a series of complications, such as hoarseness and dyspnea. However, the repair of RLN remains a great challenge in current medicine. This study aimed to develop human umbilical mesenchymal stem cells (HuMSCs) and nerve growth factor (NGF)-loaded heparinized collagen scaffolds (HuMSCs/NGF HC-scaffolds) and evaluate their potential in the repair of RLN injury. HuMSCs/NGF HC-scaffolds were prepared through incorporating HuMSCs and NGF into heparinized collagen scaffolds that were prefabricated by freeze-drying in a template. The resulting scaffolds were characterized by FTIR, SEM, porosity, degradation in vitro, NGF release in vitro and bioactivity. A rabbit RLN injury model was constructed to appraise the performance of HuMSCs/NGF HC-scaffolds for nerve injury repair. Electrophysiology, histomorphology and diagnostic proteins expression for treated nerves were checked after application of various scaffolds. The results showed that the composite scaffolds with HuMSCs and NGF were rather helpful for the repair of broken RLN. The RLN treated with HuMSCs/NGF HC-scaffolds for 8 weeks produced a relatively normal electromyogram, and the levels of calcium-binding protein S100, neurofilament and AchE pertinent to nerve were found to be close to the normal ones but higher than those resulted from other scaffolds. Taken together, HuMSCs/NGF HC-scaffolds exhibited a high score on the nerve injury repair and may be valuable for the remedy of RLN injury.
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Affiliation(s)
- Yongqin Pan
- 1Department of General Surgery, First Affiliated Hospital of Jinan University, No. 613 West Huangpu Avenue, Guangzhou, 510630 People's Republic of China
| | - Genlong Jiao
- 2Department of Orthopedics, First Affiliated Hospital of Jinan University, Guangzhou, 510630 People's Republic of China
| | - Jingge Yang
- 1Department of General Surgery, First Affiliated Hospital of Jinan University, No. 613 West Huangpu Avenue, Guangzhou, 510630 People's Republic of China
| | - Rui Guo
- 3College of Life Science and Technology, Jinan University, Guangzhou, 510630 People's Republic of China
| | - Jinyi Li
- 1Department of General Surgery, First Affiliated Hospital of Jinan University, No. 613 West Huangpu Avenue, Guangzhou, 510630 People's Republic of China
| | - Cunchuan Wang
- 1Department of General Surgery, First Affiliated Hospital of Jinan University, No. 613 West Huangpu Avenue, Guangzhou, 510630 People's Republic of China
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Lin YS, Wu HY, Lee CW, Hsu CC, Chao TC, Yu MC. Surgical management of substernal goitres at a tertiary referral centre: A retrospective cohort study of 2,104 patients. Int J Surg 2016; 27:46-52. [PMID: 26796368 DOI: 10.1016/j.ijsu.2016.01.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 01/09/2016] [Accepted: 01/17/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND When to use a thoracic approach to treat substernal goitres has often been discussed in the literature. But there are few published reports describing surgical outcomes and associated complications for patients with right-sided vs. left-sided substernal goitres. OBJECTIVE This study evaluated the characteristics and clinical outcomes of patients who underwent surgical management of substernal goitres, presenting factors indicating the use of a thoracic approach and differences between right- and left-sided goitre extensions. DESIGN Retrospective cohort study. SETTING Tertiary referral centre. METHODS Between January 2007 and December 2012, 2104 patients underwent thyroidectomy at Chang Gung Memorial Hospital and 140 (6.7%) were diagnosed with substernal goitres. Patient medical records were retrospectively reviewed, and data were analysed to assess surgical outcomes. RESULTS Seven (5.0%) patients required a thoracic approach for goitre removal. Goitre malignancy was verified in 17 (12.1%) patients. The most common postoperative complication was transient hypoparathyroidism (15.0%). Permanent RLN injury occurred in 4.3% of patients and was significantly more frequent using the thoracic approach. Unilateral extension of a substernal goitre was more common than bilateral extension. Right- and left-sided extensions occurred with equal frequency. The rate of postoperative complications was similar between groups and there were no patient deaths. CONCLUSION Chest radiography and thyroid sonography may provide initial radiologic evidence of goitre extension into the superior mediastinum. Computed tomography evaluation of the depth of goitre extension to the tracheal bifurcation was the strongest predictor of the need to use a thoracic approach. There were no significant differences in the clinical features and outcomes of patients with right- and left-sided substernal goitres. The right recurrent laryngeal nerve shows increased susceptibility to damage during thyroid surgery for substernal goitres. The incidence of malignant substernal goitres is similar to that of malignant cervical goitres.
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Affiliation(s)
- Yann-Sheng Lin
- Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; Chang Gung University, Kwei-Shan Tao-Yuan, Taiwan
| | - Hsin-Yi Wu
- Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; Chang Gung University, Kwei-Shan Tao-Yuan, Taiwan
| | - Chao-Wei Lee
- Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; Chang Gung University, Kwei-Shan Tao-Yuan, Taiwan
| | - Chih-Chieh Hsu
- Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; Chang Gung University, Kwei-Shan Tao-Yuan, Taiwan
| | - Tzu-Chieh Chao
- Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; Chang Gung University, Kwei-Shan Tao-Yuan, Taiwan
| | - Ming-Chin Yu
- Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan; Chang Gung University, Kwei-Shan Tao-Yuan, Taiwan.
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Alfares FA, Hynes CF, Ansari G, Chounoune R, Ramadan M, Shaughnessy C, Reilly BK, Zurakowski D, Jonas RA, Nath DS. Outcomes of recurrent laryngeal nerve injury following congenital heart surgery: A contemporary experience. J Saudi Heart Assoc 2015; 28:1-6. [PMID: 26778899 PMCID: PMC4685232 DOI: 10.1016/j.jsha.2015.05.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/29/2015] [Accepted: 05/05/2015] [Indexed: 12/04/2022] Open
Abstract
Objective Injury to the recurrent laryngeal nerve can lead to significant morbidity during congenital cardiac surgery. The objective is to expand on the limited understanding of the severity and recovery of this iatrogenic condition. Design A six-year retrospective review of all congenital heart operations at a single institution from January 1, 2008 to December 31, 2013 was performed. All patients with documented vocal cord paralysis on laryngoscopic examination comprised the study cohort. Evaluation of time to vocal cord recovery and need for further surgical intervention was the primary focus. Results The incidence of post-operative vocal cord paralysis was 1.1% (32 out of 3036 patients; 95% confidence interval: 0.7–1.5%). The majority were left-sided injuries (71%). Overall rate of recovery was 61% with a median time of 10 months in those who recovered, and a total follow up of 46 months. Due to feeding complications, 45% of patients required gastrostomy tube after the injury, and these patients were found to have longer duration of post-operative days of intubation (median 10 vs. 5 days, p = 0.03), ICU length of stay (50 vs. 8 days, p = 0.002), and hospital length of stay (92 vs. 41 days, p = 0.01). No pre-operative variables were identified as predictive of recovery or need for gastrostomy placement. Conclusion Recurrent laryngeal nerve injury is a serious complication of congenital heart surgery that impacts post-operative morbidity, in some cases leading to a need for further intervention, in particular, gastrostomy tube placement. A prospective, multi-center study is needed to fully evaluate factors that influence severity and time to recovery.
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Affiliation(s)
- Fahad A Alfares
- Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, United States
| | - Conor F Hynes
- Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, United States
| | - Ghedak Ansari
- Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, United States
| | - Reginald Chounoune
- Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, United States
| | - Manelle Ramadan
- Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, United States
| | - Conner Shaughnessy
- Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, United States
| | - Brian K Reilly
- Department of Otolaryngology, Children's National Health System, Washington, DC, United States
| | - David Zurakowski
- Departments of Anesthesia and Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
| | - Richard A Jonas
- Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, United States
| | - Dilip S Nath
- Division of Cardiovascular Surgery, Children's National Health System, Washington, DC, United States
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Kitajima T, Momose K, Lee S, Haruta S, Ueno M, Shinohara H, Fujimori S, Fujii T, Takei R, Kohno T, Udagawa H. Bronchial bleeding caused by recurrent pneumonia after radical esophagectomy for esophageal cancer. World J Gastroenterol 2015; 21:3394-3401. [PMID: 25805950 PMCID: PMC4363773 DOI: 10.3748/wjg.v21.i11.3394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 09/08/2014] [Accepted: 10/15/2014] [Indexed: 02/06/2023] Open
Abstract
We herein report a case of bronchial bleeding after radical esophagectomy that was treated with lobectomy. A 65-year-old male who underwent subtotal esophagectomy with three-field lymph node dissection for esophageal carcinoma was referred to our hospital because of sudden hemoptysis. After the esophagectomy, bilateral vocal cord paralysis was observed, and the patient suffered from repeated episodes of aspiration pneumonia. Bronchoscopy revealed hemosputum in the right middle lobe bronchus, and contrast-enhanced computed tomography showed tortuous arteries arising from the right inferior phrenic artery and left subclavian artery toward the right middle lobe bronchus. Although bronchial arterial embolization was performed twice to control the recurrent hemoptysis, the procedures were unsuccessful. Right middle lobectomy was therefore performed via video-assisted thoracic surgery. Engorged bronchial arterys with medial hypertrophy and overgrowth of the small branches were noted near the bronchus in the resected specimen. The patient recovered uneventfully and was discharged on postoperative day 14.
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Huang CF, Jeng Y, Chen KD, Yu JK, Shih CM, Huang SM, Lee CH, Chou FF, Shih ML, Jeng KC, Chang TM. The preoperative evaluation prevent the postoperative complications of thyroidectomy. Ann Med Surg (Lond) 2015; 4:5-10. [PMID: 25685337 DOI: 10.1016/j.amsu.2014.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 11/14/2014] [Accepted: 11/15/2014] [Indexed: 11/21/2022] Open
Abstract
Objective Thyroid surgery is generally a safe surgery but its complications are still common. We wish to identify preoperative factors that predict postoperative complications. Methods A nationwide survey was conducted by senior surgeons from 16 medical centers and 5 regional hospitals in Taiwan to thyroid operations performed over 3 years. 3846 cases were retrospectively examined to identify factors influencing complications: indication for surgery, preoperative evaluation, such as ultrasonography, chest X-ray, computed tomography and magnetic resonance imaging, isotope scanning, fine-needle aspiration cytology (FNAC) and thyroid function test, and patient characteristics. Results Eighty-four percent of patients were female. Seven percent of the patients had immediate postoperative hypocalcemia (mild and severe) and 2.3%, hoarseness (recurrent laryngeal nerve (RLN) injury, temporary/permanent). Logistic regression analysis identified an association between hypocalcemia and RLN injury with age, hospital category, surgical procedure types (total thyroidectomy, unilateral, bilateral subtotal or total resection). A lower incidence of hypocalcemia was related to preoperative neck ultrasound and FNAC analysis (the odds ratio (OR) = 0.5 and 0.65, [95% confidence interval (CI) 0.331–0.768 and 0.459–0.911], P = 0.0014 and 0.0127, respectively), while RLN injury was not associated with any preoperative evaluation. The ORs of hypocalcemia and RLN injury for patients older than 50 years were 0.55 and 2.15, [0.393–0.763 and 1.356–3.4], P < 0.001 and 0.0012, respectively. Conclusions The success of thyroid surgery depends on careful preoperative planning, including a preoperative neck ultrasound to determine the proximity of the nodule to the recurrent laryngeal nerve course, and the consideration of the type of anesthesia, adjuvant devices for intra-op monitoring of the RLN, and surgical modalities. Our results suggest that preoperative evaluation implementations are positively associated with strategy of surgery and postoperative hypocalcemia prevention. Thyroid surgery depends on careful preoperative planning. Evaluation for lesions, adjuvant devices, and surgical modalities are important. Preoperative evaluation affects the hypocalcemia. Intraoperative monitor may reduce RLN injury.
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Ambe PC, Brömling S, Knoefel WT, Rehders A. Prolonged duration of surgery is not a risk factor for postoperative complications in patients undergoing total thyroidectomy: a single center experience in 305 patients. Patient Saf Surg 2014; 8:45. [PMID: 25610494 PMCID: PMC4301896 DOI: 10.1186/s13037-014-0045-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 11/20/2014] [Indexed: 11/17/2022] Open
Abstract
Background Hypocalcemia and nerve injury are the most severe complications after thyroid surgery. The duration of surgery has not been previously considered as a risk factor for postoperative complications in patients undergoing total thyroidectomy. We sort to investigate the influence of prolonged surgery on postoperative complications in patients undergoing total thyroidectomy. Methods We hypothesized that a threshold of > 120 minutes of surgical time could represent a surrogate marker for postoperative complications in patients undergoing total thyroidectomy for benign thyroid disorders. The study population was divided into two groups based on the median duration of surgery (120 min): group I ≤ 120 minutes (control group), group II > 120 minutes (study group). The charts of eligible patients undergoing total thyroidectomy within a six-year period from January 1st 2006 to December 31st 2012 were reviewed. The primary outcomes included the rates postoperative hypocalcemia and recurrent laryngeal nerve palsy. The secondary outcomes included the rates of postoperative hemorrhage, wound dehiscence and length of hospital stay. Results 305 cases of thyroidectomy were included for analysis; 130 (42.6%) control group and 175 (57.4%) study group. Transient (15.4% vs 19.4%) and permanent (3.8% vs. 2.9%) hypocalcemia were recorded in control and study group respectively. The incidence of nerve palsy was 1.5% in the control group and 1.4% in the study group. The mean length of postoperative hospital stay was 3d in both groups. There was no significant difference amongst both groups with regard to postoperative bleeding (p = 0.57) and wound dehiscence (p = 0.31). Prolonged surgery (> 120 min) was not identified as a risk factor for increased postoperative complication. Conclusion Prolonged duration of surgery > 120 minutes is not a surrogate marker for postoperative complications in patients undergoing total thyroidectomy.
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Affiliation(s)
- Peter C Ambe
- Department of General and Visceral Surgery (A), University Hospital Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany ; Helios Klinikum Wuppertal, Department of Surgery II, Witten - Herdecke University, Heusner Str. 40, 42283 Wuppertal, Germany
| | - Silvia Brömling
- Department of General and Visceral Surgery (A), University Hospital Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Wolfram T Knoefel
- Department of General and Visceral Surgery (A), University Hospital Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Alexander Rehders
- Department of General and Visceral Surgery (A), University Hospital Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
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Kim WH, Ryu SA. Acute pulmonary edema secondary to upper airway obstruction by bilateral vocal cord paralysis after total thyroidectomy -A case report-. Korean J Anesthesiol 2012; 62:387-90. [PMID: 22558509 PMCID: PMC3337389 DOI: 10.4097/kjae.2012.62.4.387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Revised: 05/04/2011] [Accepted: 05/06/2011] [Indexed: 11/24/2022] Open
Abstract
This paper reports the case of a 65-year-old woman with a history of mild arterial hypertension who presented with acute pulmonary edema immediately after a total thyroidectomy. The edema was found to have been caused by an acute upper airway obstruction secondary to bilateral vocal cord paralysis. Her pulmonary edema resolved with treatment including reintubation, mechanical ventilation with positive end-expiratory pressure, diuretics, morphine, and fluid restriction. This report discusses the possible pathogenesis of this rare clinical situation. This case highlights the possibility of an acute upper airway obstruction caused by bilateral vocal cord paralysis after a total thyroidectomy and the need for prompt treatment to prevent the development of pulmonary edema.
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Affiliation(s)
- Won Ho Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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