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Laios K, Tsoucalas G, Zografos CG, Androutsos G, Karamanou M. Highlighting the contribution of the Greek physician Theodoros Aretaios to the history of thyroidectomy. Hormones (Athens) 2024:10.1007/s42000-024-00575-6. [PMID: 38913226 DOI: 10.1007/s42000-024-00575-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 06/11/2024] [Indexed: 06/25/2024]
Abstract
Theodoros Aretaios (1829-1893), having pursued advanced studies at home and abroad and possessing a wide range of competences and interests, was among the first Greek physicians to produce educational treatises for both students and doctors of medicine. Among these is his medical treatise Surgery which deals with thyroid operations and goiter symptoms as well as post-operative lesions which included a record of his extensive experience, learned recommendations, deep insights, and advanced techniques. In this medical archive, which is preserved in the National Library of Greece, there is, for example, the physician's vivid description of a thyroidectomy that he performed which illustrates his expertise as a surgeon as well as the surgical knowledge of his times. Aretaios was not the first to perform this operation in Greece: he was, however, the first to document it, which he did for the benefit of his fellow Greeks and of surgeons worldwide.
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Affiliation(s)
- Konstantinos Laios
- Department of History of Medicine and Medical Ethics, Medical School National and Kapodistrian University of Athens, Athinodorou 1, Kato Petralona, 118 53, Athens, Greece.
| | - Gregory Tsoucalas
- Department of History of Medicine and Medical Deontology, Medical School University of Crete, Heraklion, Greece
| | - Constantinos G Zografos
- Department of History of Medicine and Medical Ethics, Medical School National and Kapodistrian University of Athens, Athinodorou 1, Kato Petralona, 118 53, Athens, Greece
| | | | - Marianna Karamanou
- Department of History of Medicine and Medical Ethics, Medical School National and Kapodistrian University of Athens, Athinodorou 1, Kato Petralona, 118 53, Athens, Greece
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Zhang L, Wu Y, Liu X, Han J, Zhao J. Effect of drainage versus no drainage after thyroid surgery on wound complications, a meta-analysis. Int Wound J 2023; 20:4023-4030. [PMID: 37400984 PMCID: PMC10681530 DOI: 10.1111/iwj.14291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/17/2023] [Indexed: 07/05/2023] Open
Abstract
A meta-analysis study was used to assess whether not placing a drain after thyroidectomy reduces postoperative wound complications. A critical review of the comprehensive literature up to May 2023 was conducted using four databases: PubMed, Embase, the Cochrane Library, and the web of science. Fourteen interrelated studies were reviewed after passing the inclusion and exclusion criteria established by the study and assessing the quality of the literature.95% confidence intervals (Cl) and odds ratios (OR) were calculated using fixed effects models. The data were meta-analysed using RevMan 5.3 software. The results showed that the use of drains during thyroid surgery did not have a favourable impact on patients. Intraoperative placement of drains did not reduce postoperative wound haematoma formation in patients, (OR, 0.86; 95% CI, 0.54, 1.36 p = 0.52). However, the incidence of postoperative wound infection was significantly higher in patients with drains used in intraoperative thyroid surgery, (OR, 0.22; 95% CI, 0.10, 0.45 p < 0.0001). As the sample size of the randomised controlled study used for this meta-analysis was limited, it is important to approach the findings with caution when interpreting the results.Conducting additional high-quality research with larger sample sizes is crucial in order to further confirm these results and reduce the likelihood of duplication.
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Affiliation(s)
- Lei Zhang
- Department of General SurgeryShanxi Bethune HospitalTaiyuanChina
| | - Yi Wu
- Shanxi Academy of Medical Sciences,Shanxi Bethune HospitalThird Hospital of Shanxi Medical UniversityTaiyuanChina
| | - Xiaoqi Liu
- Department of EndocrinologyShanxi Bethune HospitalTaiyuanChina
| | - Jianli Han
- Department of General SurgeryShanxi Bethune HospitalTaiyuanChina
| | - Jun Zhao
- Department of General SurgeryShanxi Bethune HospitalTaiyuanChina
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Kudpaje A, Subash A, Subramaniam N, Palme CE, US VR, Arakeri G. Remote Access Thyroid Surgery: A Review of Literature. Indian J Surg Oncol 2022; 13:191-198. [PMID: 35462662 PMCID: PMC8986942 DOI: 10.1007/s13193-021-01364-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 06/01/2021] [Indexed: 11/26/2022] Open
Abstract
Since the first description of endoscopic thyroid lobectomy in 1997, a variety of techniques have been developed to avoid the visible cervical scar conventionally been associated with thyroidectomy. These "remote access" approaches, which typically use either endoscopic or robotic instrumentation, have successfully avoided the anterior neck scar, which has a measurable impact on the patient's quality of life (Graves and Suh Surgery 168(5):845-850, 2020; Sakorafas World J Surg 34(8):1793-1804, 2010). The main advantage of these techniques is better cosmesis compared to conventional transcervical approaches (Graves and Suh Surgery 168(5):845-850, 2020) However, these techniques have failed to gain widespread acceptance in the surgical community because of the technical challenges, scepticism about oncological safety and cost factors. This review presents an overview of the various methods of remote access thyroid surgery (RATS) and also evaluates the selection criteria, oncological efficacy, training requirements and key advantages of this technique.
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Affiliation(s)
- Akshay Kudpaje
- Department of Head and Neck Surgical Oncology, HCG Cancer Centre, Bengaluru, Karnataka India
| | - Anand Subash
- Department of Head and Neck Surgical Oncology, HCG Cancer Centre, Bengaluru, Karnataka India
| | - Narayana Subramaniam
- Department of Head and Neck Surgical Oncology, Mazumdar Shaw Cancer Centre, Narayana Health, Bengaluru, Karnataka India
| | - Carsten E. Palme
- Department of Head and Neck Surgery, The Sydney Head and Neck Cancer Institute, Chris O’Brien Lifehouse, Sydney, Australia
| | - Vishal Rao US
- Department of Head and Neck Surgical Oncology, HCG Cancer Centre, Bengaluru, Karnataka India
| | - Gururaj Arakeri
- Department of Head and Neck Surgical Oncology, HCG Cancer Centre, Bengaluru, Karnataka India
- Department of Oral and Maxillofacial Surgery, Novodaya Dental College and Hospital, Raichur, India
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Partial Versus Total Thyroidectomy: What Influences Most Surgeons' Decision? Analysis of a Nationwide Cohort of 375,810 Patients Over 10 Years. Ann Surg 2021; 274:829-835. [PMID: 34353991 DOI: 10.1097/sla.0000000000005134] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
National and international guidelines about thyroid surgery seem to be moving more and more towards less radical surgical procedures but everyday practice does not seem to always align with them. We describe for the first time the role of non-surgical parameters in the surgeon's choice for thyroid surgery. OBJECTIVE To describe thyroid surgery and to identify the factors leading to either a total or a partial thyroidectomy regardless of the severity of the thyroid disease. SUMMARY BACKGROUND DATA National and international guidelines about thyroid surgery seem to be moving more and more towards less radical surgical procedures but everyday practice does not seem to always align with them. METHODS We based this nationwide retrospective cohort study on a national database that compiles discharge abstracts for every admission for thyroidectomy to French acute healthcare facilities (PMSI database 2010 to 2019). RESULTS In this study, 375,810 patients (male: 23%; age = 53 ± 15 y) had a thyroidectomy (partial: 28%) for cancer (17%), hyperthyroidism (16%), non-functioning goiter (64%) or other (3%). We noticed a global trend toward more partial thyroidectomy (p < 0.001) with a significant increase in the proportion of lobectomy in the post-ATA recommendations' period (p < 0.001) as well as in the "French Levothyrox crisis" period, in which we saw an unexpected rise of adverse events notifications associated with the marketing of a new formula of Levothyrox (p < 0.001) amid widespread media coverage. In a multivariate analysis, we also identified that complete resection was more frequently performed in centers with a caseload > 40/y (p < 0.001, OR = 1.48), for obese patients (BMI> 30 kg/m2; p < 0.001, OR = 1.42), and according to the indication of surgery (OR benign = 1, OR cancer = 2.25, OR hyperthyroidism = 4.13). CONCLUSION We describe for the first time the role of non-surgical parameters in the surgeon's choice for thyroid surgery.
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Moreno Llorente P, A Gonzales Laguado E, Alberich Prats M, Francos Martínez JM, García Barrasa A. Surgical approaches to thyroid. Cir Esp 2020; 99:267-275. [PMID: 33069356 DOI: 10.1016/j.ciresp.2020.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 01/03/2023]
Abstract
Thyroidectomy is the most frequent procedure in endocrine surgery. The conventional approach through a collar incision, as described by Kocher in XIXth century, has become the "gold standard". It is continuously evolving in spite of, many years ago, it showed to be safe and efficient with quality standards difficult to beat. Endoscopic and robotic surgery have developed "new approaches" to thyroid in order to improve the cosmetic results, looking even for invisible scars. We have done a thoughtful review of most of them trying to understand their benefits and drawbacks. Currently none of these "new approaches" have been shown to be better than conventional open thyroidectomy beyond offering a better cosmetic result. Besides, only a small percentage of patients can benefit of them. However, most of these approaches will remain if they treat the diseased thyroid and also improve the quality of life of our patients.
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Affiliation(s)
- Pablo Moreno Llorente
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, España.
| | - Erick A Gonzales Laguado
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, España
| | - Marta Alberich Prats
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, España
| | - José Manuel Francos Martínez
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, España
| | - Arantxa García Barrasa
- Unidad de Cirugía Endocrina, Hospital Universitari de Bellvitge, Universidad de Barcelona (UB), L'Hospitalet de Llobregat, Barcelona, España
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Rodríguez-Torres J, López-López L, Cabrera-Martos I, Torres-Sánchez I, Ortíz-Rubio A, Valenza MC. Musculoskeletal neck disorders in thyroid cancer patients after thyroidectomy. Eur J Cancer Care (Engl) 2019; 28:e13053. [PMID: 31016824 DOI: 10.1111/ecc.13053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 02/14/2019] [Accepted: 03/25/2019] [Indexed: 11/29/2022]
Abstract
Thyroid cancer (TC) is the most common type of cancer in the endocrine system, and thyroidectomy is the preferred treatment. Complications associated are still common and 80% of patients complain of posterior neck pain. The aim of this study was to analyse the long-term musculoskeletal disorders in TC patients who had undergone thyroidectomy. An observational case-control study was carried out. Twenty-eight patients who had undergone thyroidectomy and 28 healthy control patients were included. Outcomes were collected 6 months after surgery and included: musculoskeletal neck disorders (neck range of movement, trigger points) and functional variables (pain intensity and disability). Significant differences were found between groups in flexion (p = 0.002) and extension (p = 0.005), with lower values in the thyroidectomy group. The number of trigger points was higher in the thyroidectomy group in both scalenes (p < 0.001), both sternocleidomastoids (p < 0.001), both upper trapezius (p = 0.005 and p = 0.008), right levator scapulae (p = 0.002) and both suboccipitalis (p = 0.002). Pain intensity (p < 0.001) and the Neck Outcome Scale subscales (p < 0.05) also presented significant differences. Thyroidectomy patients, 6 months after surgery, show a significant decrease in neck range of movement and an increase in the number of trigger points. They also show greater pain intensity and more disability.
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Affiliation(s)
- Janet Rodríguez-Torres
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Laura López-López
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Irene Cabrera-Martos
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Irene Torres-Sánchez
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Araceli Ortíz-Rubio
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Marie C Valenza
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
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Could post-thyroidectomy bleeding be the clue to modify the concept of postoperative drainage? A prospective randomized controlled study. Asian J Surg 2018; 41:511-516. [DOI: 10.1016/j.asjsur.2017.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 08/02/2017] [Accepted: 08/28/2017] [Indexed: 11/23/2022] Open
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Das AT, Prakash SB, Priyadarshini V. Outcomes of Capsular Dissection Technique with Use of Bipolar Electrocautery in Total Thyroidectomy: A Rural Tertiary Center Experience. J Clin Diagn Res 2017; 10:MC01-MC03. [PMID: 28208891 DOI: 10.7860/jcdr/2016/24201.8975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 10/24/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Total thyroidectomy is one of the most routinely performed head and neck surgical procedures with extremely low mortality. This procedure has been associated with two major complications such as recurrent laryngeal nerve injury and hypocalcaemia due to parathyroid insufficiency. The use of bipolar electrocautery has not been widely accepted in view of thermal damage to adjacent structures. AIM To study the outcomes and complications of capsular dissection technique along with use of bipolar electrocautery in total thyroidectomy. MATERIALS AND METHODS The study was conducted from May 2013 to May 2016. The study was performed at Department of ENT Otorhinolayngology, DM WIMS Hospital, Wayanad, Kerala, India. This retrospective descriptive study analysed the outcome of 130 patients who underwent total thyroidectomy by capsular dissection technique along with use of bipolar electrocautery for cauterization of vascular pedicles, at our institution over a 3 year period. RESULTS The incidence of permanent unilateral vocal cord palsy was 1.5% and permanent hypocalcaemia was 2.3%. There was no case of haemorrhage or haematoma in this study. CONCLUSION Total thyroidectomy by capsular dissection technique along with the use of bipolar electrocautery has very low incidence of recurrent laryngeal nerve and parathyroid injury, as per our data. Hence, we recommend this technique along with routine use of bipolar electrocautery for total thyroidectomy.
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Affiliation(s)
- Amal T Das
- Assistant Professor, Department of ENT and HNS, DM Wayanad Institute of Medical Sciences , Wayanad, Kerala, India
| | - S B Prakash
- Associate Professor, Department of ENT and HNS, DM Wayanad Institute of Medical Sciences , Wayanad, Kerala, India
| | - V Priyadarshini
- Assistant Professor, Department of ENT and HNS, DM Wayanad Institute of Medical Sciences , Wayanad, Kerala, India
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Gulec S. The Art and Science of Thyroid Surgery in the Age of Genomics: 100 years after Theodor Kocher. Mol Imaging Radionucl Ther 2017; 26:1-9. [PMID: 28117284 PMCID: PMC5283713 DOI: 10.4274/2017.26.suppl.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Cancer is a disorder of the genome. The thyroid cancer genome is being decoded. Recent studies have identified a mutation or a genetic alteration in 95% of thyroid cancers. The National Cancer Institute initiated the Cancer Genome Atlas project in 2006 to catalogue genetic mutations associated with cancer, using genome sequencing and bioinformatics. The project has expanded to carry out genomic characterization and sequence analysis of thyroid cancer. The concept of risk stratification based on traditional parameters will soon vacate their role for clear molecular markers of non-invasive/focal, invasive/metastatic and systemic stages/phases of neoplastic disorder. A refined classification scheme based on genomics and its phenotypic expressions will accurately reflect the biologic differences between the different morphologic definitions we use today. Tumor differentiation/de-differentiation, and clinical behavior of an individual cancer will be defined by molecular markers, in addition to standard morpho-pathology. Empiricism in science of medicine and surgery has acquired a new method for testing the appropriate treatment for individual patients; that is molecular pathology, governed by genomics. The technology is present and rapidly evolving. The surgeons will determine the extent of interventions with molecular evidence and guidance.
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Affiliation(s)
- Seza Gulec
- Florida International University Herbert Wertheim College of Medicine, Departments of Surgery and Nuclear Medicine, Miami, USA, Phone: (786) 693 08 21, E-mail:
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Al-Qurayshi Z, Randolph GW, Srivastav S, Aslam R, Friedlander P, Kandil E. Outcomes in thyroid surgery are affected by racial, economic, and healthcare system demographics. Laryngoscope 2016; 126:2194-9. [DOI: 10.1002/lary.25871] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 12/16/2015] [Accepted: 12/18/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Zaid Al-Qurayshi
- Department of Surgery; Tulane University School of Medicine; New Orleans Louisiana
| | - Gregory W. Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery; Massachusetts Eye and Ear Infirmary; Boston Massachusetts
| | - Sudesh Srivastav
- Department of Biostatistics and Bioinformatics; Tulane University School of Public Health and Tropical Medicine; New Orleans Louisiana
| | - Rizwan Aslam
- Department of Otolaryngology; Tulane University School of Medicine; New Orleans Louisiana
| | - Paul Friedlander
- Department of Otolaryngology; Tulane University School of Medicine; New Orleans Louisiana
| | - Emad Kandil
- Department of Surgery; Tulane University School of Medicine; New Orleans Louisiana
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Tharakan SJ, Hiller D, Shapiro RM, Bose SK, Blinman TA. Vessel sealing comparison: old school is still hip. Surg Endosc 2016; 30:4653-8. [PMID: 26895898 DOI: 10.1007/s00464-016-4778-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 01/21/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Ligation with either absorbable or non-absorbable sutures has been the traditional state of the art, but a proliferation of technology now offers a host of methods to close and divide vessels. Only limited data are available that objectively compare different vessel sealing methods. The objective of this study was to compare a broad variety of methods of surgical vessel closure in a reproducible, independent, standardized test-to-failure ex vivo pressure challenge. METHODS Ten of the most common surgical sealing devices were represented in this study, including both mechanical and energy devices. Unfixed porcine carotid arteries were selected for testing. They were connected to a pump, and automated controlled infusion was initiated. Upon identification of a leak at the source of sealing, the maximum pressure in mmHg was logged. RESULTS There were a total of 184 trials conducted using the 10 vessel sealing methods. The average burst pressure across all trials was 1100 mmHg with a range of 51.3-5171 mmHg. Suture-based methods displayed the highest average pressure until failure. Stapling methods showed the lowest burst pressures. All methods showed mean burst pressures above the "physiologically relevant" level of 250 mmHg. CONCLUSIONS This study presents an independent, reproducible, ex vivo comparison of multiple methods of surgical arterial closure. In these laboratory conditions, tests to failure demonstrated widely varying sealing strength, highly dependent on method. All hemostatic modalities tested are capable of securing vessels safely and well above physiologic blood pressures, while suture-based methods were significantly stronger than other mechanical methods or modern energy devices.
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Affiliation(s)
- Sasha J Tharakan
- Division of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA.
| | - Dennis Hiller
- Division of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Rachel M Shapiro
- Division of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Sourav K Bose
- Division of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Thane A Blinman
- Division of General, Thoracic, and Fetal Surgery, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
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Modifications of transaxillary approach in endoscopic da Vinci-assisted thyroid and parathyroid gland surgery. J Robot Surg 2015; 9:37-44. [PMID: 26530969 DOI: 10.1007/s11701-014-0486-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 08/11/2014] [Indexed: 10/24/2022]
Abstract
Endoscopic surgery for treatment of thyroid and parathyroid pathologies is increasingly gaining attention. The da Vinci system has already been widely used in different fields of medicine and quite recently in thyroid and parathyroid surgery. Herein, we report about modifications of the transaxillary approach in endoscopic surgery of thyroid and parathyroid gland pathologies using the da Vinci system. 16 patients suffering from struma nodosa in 14 cases and parathyroid adenomas in two cases were treated using the da Vinci system at the ENT Department of Homburg/Saar University and in cooperation with the Department of General Surgery in New Sant'Agostino Hospital, Modena/Italy. Two different retractors, endoscopic preparation of the access and three different incision modalities were used. The endoscopic preparation of the access allowed us to have a better view during preparation and reduced surgical time compared to the use of a headlamp. To introduce the da Vinci instruments at the end of the access preparation, the skin incisions were over the axilla with one incision in eight patients, two incisions in four patients and three incisions in a further four patients. The two and three skin incisions modality allowed introduction of the da Vinci instruments without arm conflicts. The use of a new retractor (Modena retractor) compared to a self-developed retractor made it easier during the endoscopic preparation of the access and the reposition of the retractor. The scar was hidden in the axilla and independent of the incisions selected, the cosmetic findings were judged by the patients to be excellent. The neurovascular structures such as inferior laryngeal nerve, superior laryngeal nerve and vessels, as well as the different pathologies, were clearly 3D visualized in all 16 cases. No paralysis of the vocal cord was observed. All patients had a benign pathology in their histological examination. The endoscopic surgery of the thyroid and parathyroid gland can be performed using the da Vinci system and offers an excellent, intra-operative, 3D visualization of the neurovascular structures. The new incision modalities, use of a new retractor, and endoscopic preparation of the access made the surgery easier and safer using the transaxillary access to the thyroid and parathyroid glands. The modified skin incisions allowed an improved movement of the da Vinci arms during operation.
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13
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Ayala MA, Yencha MW. Outpatient Thyroid Surgery in a Low-Surgical Volume Hospital. World J Surg 2015; 39:2253-8. [DOI: 10.1007/s00268-015-3097-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Minimally invasive video-assisted versus minimally invasive nonendoscopic thyroidectomy. BIOMED RESEARCH INTERNATIONAL 2014; 2014:450170. [PMID: 24800227 PMCID: PMC3996987 DOI: 10.1155/2014/450170] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 03/18/2014] [Indexed: 02/08/2023]
Abstract
Minimally invasive video-assisted thyroidectomy (MIVAT) and minimally invasive nonendoscopic thyroidectomy (MINET) represent well accepted and reproducible techniques developed with the main goal to improve cosmetic outcome, accelerate healing, and increase patient's comfort following thyroid surgery. Between 2007 and 2011, a prospective nonrandomized study of patients undergoing minimally invasive thyroid surgery was performed to compare advantages and disadvantages of the two different techniques. There were no significant differences in the length of incision to perform surgical procedures. Mean duration of hemithyroidectomy was comparable in both groups, but it was more time consuming to perform total thyroidectomy by MIVAT. There were more patients undergoing MIVAT procedures without active drainage in the postoperative course and we also could see a trend for less pain in the same group. This was paralleled by statistically significant decreased administration of both opiates and nonopiate analgesics. We encountered two cases of recurrent laryngeal nerve palsies in the MIVAT group only. MIVAT and MINET represent safe and feasible alternative to conventional thyroid surgery in selected cases and this prospective study has shown minimal differences between these two techniques.
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Butskiy O, Wiseman SM. Electrothermal bipolar vessel sealing system (LigaSure™) for hemostasis during thyroid surgery: a comprehensive review. Expert Rev Med Devices 2014; 10:389-410. [DOI: 10.1586/erd.13.6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
PURPOSE The false thyroid capsule is an important anatomical structure involved in thyroidectomy, yet it is rarely studied. This study aimed to define the anatomy of the false thyroid capsule, and its clinical significance. METHODS A prospective study was performed involving 151 patients with goitre who underwent thyroid lobectomy. The anatomy of the false thyroid capsule was carefully documented intra-operatively. RESULTS The false thyroid capsule enclosed the inferior and middle thyroid veins and the superior thyroid vessels, forming a mesentery-like structure by attaching to the gland. Once the unilateral lobe had been removed, the thyroid mesentery could be seen to have a C-shaped edge. The recurrent laryngeal nerve, inferior thyroid artery and parathyroid glands were located beneath the C-shaped edge of the thyroid mesentery. CONCLUSION The thyroid mesentery is a distinctive structure that can be used as a guide for surgical dissection.
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Mitchem JB, Gillanders WE. Endoscopic and Robotic Thyroidectomy for Cancer. Surg Oncol Clin N Am 2013; 22:1-13, v. [DOI: 10.1016/j.soc.2012.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Affiliation(s)
- June Young Choi
- Department of Surgery, Seoul National University College of Medicine and Division of Surgery, Thyroid Center, Seoul National University Hospital, Seoul, Korea
| | - Yeo-Kyu Youn
- Department of Surgery, Seoul National University College of Medicine and Division of Surgery, Thyroid Center, Seoul National University Hospital, Seoul, Korea
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Abstract
Current multimodal imaging techniques offer practicing providers the adequate framework to plan and accomplish care for patients with thyroid and parathyroid disorders. Available imaging modalities include ultrasonography (US), nuclear scintigraphy, computed tomography (CT), and magnetic resonance imaging (MRI). US remains the most cost-effective and the safest approach for the initial evaluation of the thyroid gland. Parathyroid subtraction scintigraphy provides localization of pathologic parathyroid glands with the greatest sensitivity. Localizing imaging studies allow for surgical planning with minimal risk and morbidity to the patient. CT scan and MRI play an adjunctive role in the further characterization of neck pathology.
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Affiliation(s)
- Bianca J Vazquez
- Division Gastroenterologic and General Surgery, Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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