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Yuan Y, Pan B, Tang E, Mo H, Zhu J, Yi Z, Lu D, Yin T, Sun Y, Yin S, Yang Z, Zhang F. Surgical methods of total thyroidectomy for differentiated thyroid cancer: a systematic review and Bayesian network meta-analysis. Int J Surg 2024; 110:529-540. [PMID: 37916941 PMCID: PMC10793844 DOI: 10.1097/js9.0000000000000819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/25/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Emerging remote-access surgical methods are utilized to treat differentiated thyroid cancer. The study aimed to compare the surgical integrity, safety, efficacy, and postoperative experience of patients among common surgical methods. METHODS The PubMed, Medline, Cochrane Library, Web of Science, and EMBASE databases were searched from their inception until March 2023. Pairwise meta-analysis and Bayesian network meta-analysis were performed. The surface under the cumulative ranking curve (SUCRA) was used to illuminate the probability that each method would be the best for each outcome. RESULTS Thirty-two studies comprising 7042 patients were included. Robotic bilateral axillo-breast approach (RBABA) and robotic gasless transaxillary approach (RGAA) retrieved fewer lymph nodes (LNs) than open thyroidectomy (OT). RBABA showed a significantly lower permanent recurrent laryngeal nerve (RLN) palsy rate than OT. According to SUCRA values, endoscopic transoral approach (EOA) ranked the highest in retrieved LNs (0.84), the proportion of stimulated serum thyroglobulin less than 1.0 ng/ml (0.77), and the pain score (0.77). Endoscopic bilateral areola approach (EBAA) ranked the highest in the transient RLN palsy rate (0.72). The endoscopic gasless transaxillary approach (EGAA) ranked the highest in the transient hypoparathyroidism rate (0.78). RBABA ranked the highest in the rate of permanent RLN palsy (0.94) and hypoparathyroidism (0.77). OT ranked the highest in operative time (0.92). CONCLUSIONS Each surgical method of total thyroidectomy has benefits and limitations. EOA performed the best in maintaining surgical integrality and reducing the pain score, while taking a long operative time. Generally, RBABA showed the best advantage in protecting parathyroid glands and RLN but with the longest operative time. OT had the best advantage in operative time. Therefore, OT and EOA are ideal methods for patients with a higher risk of central LN metastasis. RBABA and EOA may not be suitable for elderly patients or those with high anesthesia risk.
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Affiliation(s)
- Yuquan Yuan
- Graduate School of Medicine, Chongqing Medical University
- Chongqing Institute Green and Intelligent Technology, Chinese Academy of Sciences
- Chongqing School, University of Chinese Academy of Sciences
- Department of Breast and Thyroid Surgery, Chongqing General Hospital
| | - Bin Pan
- Graduate School of Medicine, Chongqing Medical University
- Chongqing Institute Green and Intelligent Technology, Chinese Academy of Sciences
- Chongqing School, University of Chinese Academy of Sciences
- Department of Breast and Thyroid Surgery, Chongqing General Hospital
| | - Enjie Tang
- Epidemiology Department, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, People’s Republic of China
| | - Hongbiao Mo
- Department of Breast and Thyroid Surgery, Chongqing General Hospital
| | - Junping Zhu
- Department of Breast and Thyroid Surgery, Chongqing General Hospital
| | - Ziying Yi
- Department of Breast and Thyroid Surgery, Chongqing General Hospital
| | - Dengwei Lu
- Graduate School of Medicine, Chongqing Medical University
- Chongqing Institute Green and Intelligent Technology, Chinese Academy of Sciences
- Chongqing School, University of Chinese Academy of Sciences
- Department of Breast and Thyroid Surgery, Chongqing General Hospital
| | - Tingjie Yin
- Graduate School of Medicine, Chongqing Medical University
- Chongqing Institute Green and Intelligent Technology, Chinese Academy of Sciences
- Chongqing School, University of Chinese Academy of Sciences
- Department of Breast and Thyroid Surgery, Chongqing General Hospital
| | - Yiceng Sun
- Department of Breast and Thyroid Surgery, Chongqing General Hospital
| | - Supeng Yin
- Department of Breast and Thyroid Surgery, Chongqing General Hospital
| | - Zeyu Yang
- Graduate School of Medicine, Chongqing Medical University
- Chongqing Institute Green and Intelligent Technology, Chinese Academy of Sciences
- Chongqing School, University of Chinese Academy of Sciences
- Department of Breast and Thyroid Surgery, Chongqing General Hospital
| | - Fan Zhang
- Graduate School of Medicine, Chongqing Medical University
- Chongqing Institute Green and Intelligent Technology, Chinese Academy of Sciences
- Chongqing School, University of Chinese Academy of Sciences
- Department of Breast and Thyroid Surgery, Chongqing General Hospital
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Schardey J, Huber T, Kappenberger AS, Horné F, Beger N, Weniger M, Werner J, Kühn F, Wirth U. [Expected effects of the new continuing education regulations in general and visceral surgery : Survey among Bavarian surgeons and residents]. CHIRURGIE (HEIDELBERG, GERMANY) 2023; 94:155-163. [PMID: 36260140 PMCID: PMC9898356 DOI: 10.1007/s00104-022-01738-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The new competency-based continuing education regulations for surgical training (WBO) came into effect in Bavaria in August 2022. METHODS From May to July 2022, we conducted an anonymized online survey among Bavarian general and visceral surgeons and surgical residents (ÄiW). The aim was to survey expectations of the effects of the new WBO. RESULTS The response rate was 35%. In total data could be collected from 80 persons, 36 ÄiW (45%), 30 specialists and senior physicians (37.5%) and 14 chief physicians (17.5%). The majority of respondents worked at a university hospital (38.8%) or a regular provider (35%). A strengthening of the competence to act through implementation of the new WBO is seen by 41.3% and 55.7% see independent operating under partial supervision by the instructor as a goal. Of the respondents 50% see the required case numbers as not achievable and 55.1% deny reaching them in the expected period of 6 years. About 60% do not expect to be able to train the same number of ÄiWs in the same amount of time. Almost 75% of the respondents state that from their point of view, a good continuing education with the achievement of a solid competence to act would not work without overtime hours. About 44% of the respondents expect that a full surgical training would continue to be possible at their institution. CONCLUSION Both among the instructors and among the trainees there is a tendency to fear that realistic training, in particular the achievement of the guideline figures, will no longer be possible in the usual further training time. This necessitates the consistent implementation of structured continuing education with a high degree of transparency in training.
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Affiliation(s)
- Josefine Schardey
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurige, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377 Munich, Deutschland ,Chirurgische Arbeitsgemeinschaft Junge Chirurgen (CAJC), Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Berlin, Deutschland
| | - Tobias Huber
- Chirurgische Arbeitsgemeinschaft Junge Chirurgen (CAJC), Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Berlin, Deutschland ,Abteilung für Allgemein‑, Viszeral- und Transplantationschirurige, Universitätsmedizin der Johannes Gutenberg-Universität, Mainz, Deutschland
| | - Alina Sophie Kappenberger
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurige, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377 Munich, Deutschland
| | - Fabian Horné
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurige, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377 Munich, Deutschland ,Chirurgische Arbeitsgemeinschaft Junge Chirurgen (CAJC), Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Berlin, Deutschland
| | - Nicola Beger
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurige, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377 Munich, Deutschland ,Chirurgische Arbeitsgemeinschaft Junge Chirurgen (CAJC), Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Berlin, Deutschland
| | - Maximilian Weniger
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurige, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377 Munich, Deutschland ,Chirurgische Arbeitsgemeinschaft Junge Chirurgen (CAJC), Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Berlin, Deutschland
| | - Jens Werner
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurige, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377 Munich, Deutschland
| | - Florian Kühn
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurige, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377 Munich, Deutschland ,Chirurgische Arbeitsgemeinschaft Junge Chirurgen (CAJC), Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV), Berlin, Deutschland
| | - Ulrich Wirth
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurige, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377 Munich, Deutschland
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Quality of life and surgical outcome of ABBA versus EndoCATS endoscopic thyroid surgery: a single center experience. Surg Endosc 2021; 36:968-979. [PMID: 33683436 PMCID: PMC8758646 DOI: 10.1007/s00464-021-08361-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 02/09/2021] [Indexed: 12/02/2022]
Abstract
Background Thyroid surgery is often performed, especially in young female patients. As patient satisfaction become more and more important, different extra-cervical “remote” approaches have evolved to avoid visible scars in the neck for better cosmetic outcome. The most common remote approaches are the transaxillary and retroauricular. Aim of this work is to compare Endoscopic Cephalic Access Thyroid Surgery (EndoCATS) and axillo-bilateral-breast approach (ABBA) to standard open procedures regarding perioperative outcome and in addition to control cohorts regarding quality of life (QoL) and patient satisfaction. Methods In a single center, 59 EndoCATS und 52 ABBA procedures were included out of a 2 years period and compared to 225 open procedures using propensity-score matching. For the endoscopic procedures, cosmetic outcome, patient satisfaction and QoL (SF-12 questionnaire) were examined in prospective follow-up. For QoL a German standard cohort and non-surgically patients with thyroid disease were used as controls. Result The overall perioperative outcome was similar for all endoscopic compared to open thyroid surgeries. Surgical time was longer for endoscopic procedures. There were no cases of permanent hypoparathyroidism and no significant differences regarding temporary or permanent recurrent laryngeal nerve (RLN) palsies between open and ABBA or EndoCATS procedures (χ2; p = 0.893 and 0.840). For ABBA and EndoCATS, 89.6% and 94.2% of patients were satisfied with the surgical procedure. Regarding QoL, there was an overall significant difference in distribution for physical, but not for mental health between groups (p < 0.001 and 0.658). Both endoscopic groups performed slightly worse regarding physical health, but without significant difference between the individual groups in post hoc multiple comparison. Conclusion Endoscopic thyroid surgery is safe with comparable perioperative outcome in experienced high-volume centers. Patient satisfaction and cosmetic results are excellent; QoL is impaired in surgical patients, as they perform slightly worse compared to German standard cohort and non-surgical patients.
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von Ahnen T, Wirth U, von Ahnen M, Kroenke J, Busch P, Schardey HM, Schopf S. Endoscopic cephalic access thyroid surgery (EndoCATS) using the retroauricular approach - a single centre retrospective data analysis. Surg Endosc 2021; 36:117-125. [PMID: 33427912 DOI: 10.1007/s00464-020-08244-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Due to improvements in endoscopic as well as robotic technology, and a request for better cosmetic results, there was a significant increase in thyroid surgery using these methods during the past decade. METHODS The aim of our study is to evaluate the perioperative short- and long-term outcome as well as the learning curve of EndoCATS and the Quality of Life (QoL). RESULTS A total of 150 patients with 152 hemithyroidectomies who underwent endoscopic thyroid surgery by EndoCATS between 2010 and 2016 were enrolled in this study. The mean specimen volume was 15.04 g ± 7.89 g. The mean operation time was 132.79 ± 50.52 min. There is a significant reduction of the operation time after the 53th case. (p < 0.05) There was no acute rebleeding or permanent hypoparathyroidism. Permanent RLN palsy occurred in 3 nerves at risk (NAR) 1.97%. There were no cases of pneumothorax, postoperative infections or skin flap ischemia. 94.11% of the patients describe their state of general health as good as or better than before the surgery. CONCLUSIONS EndoCATS is a safe and effective, but a demanding single port access procedure; therefore, extensive training is required. An advantage is the near ideal visualization of the RLN and the parathyroid glands as well as the ability to recover even large specimens without difficulties.
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Affiliation(s)
- Thomas von Ahnen
- Department of General, Visceral, Vascular and Endocrine Surgery, Agatharied Hospital, Norbert Kerkel Platz, 83734, Hausham, Germany.
| | - Ulrich Wirth
- Department of General, Visceral, Vascular and Endocrine Surgery, Agatharied Hospital, Norbert Kerkel Platz, 83734, Hausham, Germany.,Department of General, Visceral, and Transplant Surgery, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Martin von Ahnen
- Department of General, Visceral, Vascular and Endocrine Surgery, Agatharied Hospital, Norbert Kerkel Platz, 83734, Hausham, Germany
| | - Julia Kroenke
- Department of Radiology, Agatharied Hospital, Hausham, Germany
| | - Peter Busch
- Department of General, Visceral, Vascular and Endocrine Surgery, Agatharied Hospital, Norbert Kerkel Platz, 83734, Hausham, Germany
| | - Hans-Martin Schardey
- Department of General, Visceral, Vascular and Endocrine Surgery, Agatharied Hospital, Norbert Kerkel Platz, 83734, Hausham, Germany
| | - Stefan Schopf
- Department of General, Visceral, Vascular and Endocrine Surgery, Agatharied Hospital, Norbert Kerkel Platz, 83734, Hausham, Germany.,Department of General Surgery, RoMed Klinik Bad, Aibling, Germany
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New developments and possibilities in the field of post-mortem medicine mortui vivos docent. Rechtsmedizin (Berl) 2020. [DOI: 10.1007/s00194-020-00402-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Karakas E, Klein G, Schopf S. Transoral thyroid surgery vestibular approach: does size matter anymore? J Endocrinol Invest 2020; 43:615-622. [PMID: 31989449 DOI: 10.1007/s40618-019-01149-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/19/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Various approaches for endoscopic and minimally invasive thyroid operations have been reported, with some becoming popular to date. The aim of these procedures is to reduce and prevent visible scars in the neck. This led to the transoral endoscopic thyroidectomy vestibular approach (TOETVA) technique applicable in small thyroid specimen. To amend TOETVA and to broaden the indication for transoral thyroid surgery, our aim was to combine the TOETVA with the retroauricular endoscopic cephalic access thyroid surgery (EndoCATS) facelift approach. METHODS After successful implementation of the TOETVA technique in 2017, we evaluated the transoral technique regarding feasibility and safety in well-selected patients in Germany and Austria. With the combination of TOETVA and EndoCATS, we were able to optimize the extraction process of the specimen by avoiding damage to the thyroid capsule and to broaden the indication of transoral surgery by operating on thyroid glands with higher volume. Patients' characteristics, surgical outcome and complications were determined. RESULTS Seventy-one transoral procedures were performed in 70 patients. The TOETVA procedure was performed in 60 patients, and 10 female patients underwent TOVARA with transoral thyroid lobe mobilization and removal of the specimen via the retroauricular access. Overall, median operation time was 205 min (range 96-370 min) and permanent RLNP rate was 1% accordant to 99 nerves at risk (39 hemithyroidectomies, 29 total thyroidectomies, 2 parathyroid resections, and 1 thyroglossal cyst resection). No conversion to conventional open surgery was necessary. Long-term mental nerve injury occurred in two patients. No infection was identified. CONCLUSIONS Transoral thyroid and parathyroid surgery via the vestibular approach is both feasible and safe in Western Europe. The combination of the TOETVA with the retroauricular endoscopic cephalic access thyroid surgery (EndoCATS) facelift approach, called TOVARA, is a promising opportunity to allow for thyroid surgery without a visible scar in specimen with volume of more than 40 ml also.
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Affiliation(s)
- E Karakas
- Department of General, Abdominal and Endocrine Surgery, Hospital Maria Hilf, Alexianer GmbH, 47805, Krefeld, Germany.
- University of Marburg, Marburg, Germany.
| | - G Klein
- Department of Surgery, Hospital Wiener Neustadt, Wiener Neustadt, Austria
| | - S Schopf
- Department of General, Abdominal and Vascular Surgery, Hospital Agatharied GmbH, Hausham, Germany
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Feasibility and Safety of Endoscopic Thyroidectomy Via a Unilateral Axillobreast Approach for Unilateral Benign Thyroid Tumor in Vietnam. Surg Laparosc Endosc Percutan Tech 2019; 29:447-450. [DOI: 10.1097/sle.0000000000000621] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Retro-Auricular Thyroidectomy: An Open Approach. Indian J Otolaryngol Head Neck Surg 2018; 70:218-222. [PMID: 29977844 DOI: 10.1007/s12070-017-1069-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 01/09/2017] [Indexed: 10/20/2022] Open
Abstract
Distant access robot-assisted thyroidectomy has gained popularity in recent years. Adoption of distant access procedures has been limited by cost, need for specialized training and expertise. We report our preliminary clinical experience with our modification of the retro-auricular thyroidectomy approach that allows adequate exposure for thyroid lobectomy without robotic or endoscopic assistance. This is a retrospective chart review of ten patients who have undergone retro-auricular thyroidectomies in the absence of robotic or endoscopic assistance. Ten patients were identified to have undergone this procedure over an 18-month period. All patients were female with average age 36 years (range 27-52). Six were right sided and 4 were left sided procedures. The average gland size was 4.2 cm (range 3.7-6 cm). The average nodule size was 2.1 cm (range 1.1-3.5 cm). The average operative time was 91 min (range 76-114 min). All patients had benign pathology on final histopathology. There were no conversions to open cervical thyroidectomy. Two patients had vocal cord paresis that resolved spontaneously. The average postoperative follow up was 3 months (range 1-7 months). Our technique for retro-auricular thyroidectomy is a safe, reproducible, and cost effective option for remote access thyroidectomy.
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Abstract
In thyroid surgery multiple different cervical minimally invasive (partly endoscopically assisted) and extracervical endoscopic (partly robot-assisted) approaches have been developed in the last 20 years. The aim of all these alternative approaches to the thyroid gland is optimization of the cosmetic result. The indications for the use of alternative and conventional approaches are principally the same. Important requirements for the use of alternative methods are nevertheless a broad experience in conventional thyroid operations of the thyroid and adequate patient selection under consideration of the size of the thyroid and the underlying pathology. Contraindications for the use of alternative approaches are a large size of the thyroid gland including local symptoms, advanced carcinomas, reoperations and previous radiations of the anterior neck. The current article gives an overview of the clinically implemented alternative approaches for thyroid surgery. Of those the majority must still be considered as experimental. The alternative approaches to the thyroid gland can be divided in cervical minimally invasive, extracervical endosopic (robot-assisted) and transoral operations (natural orifice transluminal endoscopic surgery, NOTES). Since conventional thyroid operations are standardized procedures with low complication rates, alternative approaches to the thyroid gland are considered critically in Germany. The request for a perfect cosmetic result should not overweigh patients' safety. Only a few alternative approaches (e. g. MIVAT, RAT) can yet be considered as a safe addition in experienced hands in highly selected patients.
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Affiliation(s)
- E Maurer
- Klinik für Visceral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Gießen/Marburg GmbH, Baldingerstraße, 35043, Marburg, Deutschland.
| | - S Wächter
- Klinik für Visceral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Gießen/Marburg GmbH, Baldingerstraße, 35043, Marburg, Deutschland
| | - D K Bartsch
- Klinik für Visceral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Gießen/Marburg GmbH, Baldingerstraße, 35043, Marburg, Deutschland
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New endoscopic thyroidectomy with the transareola single-site approach: a comparison with the bilateral areolar approach. Surg Laparosc Endosc Percutan Tech 2014; 25:178-84. [PMID: 25503747 DOI: 10.1097/sle.0000000000000119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We developed the transareola single-site approach (TASSA) for less invasive endoscopic thyroidectomy to avoid scars on exposed areas. Here, we report our experience with the TASSA technique in treatment of benign thyroid tumors and evaluate its feasibility through comparison with the bilateral areolar approach (BAA). METHODS From September 2009 to December 2011, 129 patients with benign thyroid tumors were enrolled in the study. Of these patients, 51 patients underwent endoscopic thyroidectomy by TASSA and 78 patients by BAA. The TASSA technique was performed using one 10 mm trocar and one 5 mm trocar through circumareolar incisions using conventional endoscopic instruments. The BAA procedure was performed using one 10 mm trocar and two 5 mm trocars through bilateral circumareolar incisions. RESULTS Comparing TASSA with BAA, there were significant differences in the mean operative time (141.96 ± 19.85 vs. 98.14 ± 14.15 min) for lobectomy (P<0.05) and in the subcutaneous dissection area (101.00 ± 6.33 vs. 132.51 ± 5.25 cm, P<0.05). However, there were no significant differences in the duration of hospitalization, amount of drainage, occurrence of postoperative complications, and postoperative pain. All the patients were satisfied with the cosmetic result in the 2 groups. CONCLUSIONS Endoscopic thyroidectomy using the TASSA procedure is feasible and safe, and affords the advantages of minimal invasiveness and excellent cosmesis results compared with other approaches including BAA. The 2 procedures are technically more challenging procedures, which may become alternative procedures for treatment of patients with benign thyroid tumors, especially those with strong desire for cervical cosmesis.
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Dralle H, Machens A, Thanh PN. Minimally invasive compared with conventional thyroidectomy for nodular goitre. Best Pract Res Clin Endocrinol Metab 2014; 28:589-99. [PMID: 25047208 DOI: 10.1016/j.beem.2013.12.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Since minimally invasive thyroidectomy was introduced in 1997, different surgical approaches to the thyroid have been described: the minimal neck incision and the anterior chest, areolar breast or axillary access. Whereas conventional open thyroidectomy is suitable for any thyroid disease, minimal neck incision thyroidectomy or extracervical scarless neck thyroidectomy are limited to small-volume disease. In 11 prospective randomized studies and six systematic reviews, minimally invasive video-assisted thyroidectomy via a central or lateral neck approach afforded better cosmesis in the first 3 months than conventional open thyroidectomy, with less postoperative pain for the first 48 h. Surgical morbidity did not differ in these limited studies. No head-to-head comparison is available for extracervical scarless neck thyroidectomy and conventional open thyroidectomy. Extracervical scarless neck thyroidectomy caused more postoperative pain and gave rise to complications not seen with minimal neck incision thyroidectomy or conventional open thyroidectomy. In the absence of evidence to the contrary, conventional open thyroidectomy continues to remain the gold standard for any nodular goitre.
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Affiliation(s)
- Henning Dralle
- Department of General, Visceral and Vascular Surgery, University Hospital, Medical Faculty, University of Halle-Wittenberg, Ernst-Grube-Str. 40, D-06097 Halle/Saale, Germany.
| | - Andreas Machens
- Department of General, Visceral and Vascular Surgery, University Hospital, Medical Faculty, University of Halle-Wittenberg, Ernst-Grube-Str. 40, D-06097 Halle/Saale, Germany
| | - Phuong Nguyen Thanh
- Department of General, Visceral and Vascular Surgery, University Hospital, Medical Faculty, University of Halle-Wittenberg, Ernst-Grube-Str. 40, D-06097 Halle/Saale, Germany
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Zhang W, Dang C, Shan C, Liu S, Jiang Z, Wang B, Qiu M. Use of a mini-instrument in endoscopic thyroidectomy via a breast approach to improve cosmetic outcomes. Biosci Trends 2014; 8:280-5. [DOI: 10.5582/bst.2014.01053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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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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Billmann F, Bokor-Billmann T, Voigt J, Kiffner E. Effects of a cost-effective surgical workflow on cosmesis and patient's satisfaction in open thyroid surgery. Int J Surg 2012; 11:31-6. [PMID: 23164990 DOI: 10.1016/j.ijsu.2012.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Revised: 11/11/2012] [Accepted: 11/11/2012] [Indexed: 12/13/2022]
Abstract
PURPOSE In thyroid surgery, minimally invasive procedures are thought to improve cosmesis and patient's satisfaction. However, studies using standardized tools are scarce, and results are controversial. Moreover, minimally invasive techniques raise the question of material costs in a context of health spending cuts. The aim of the present study is to test a cost-effective surgical workflow to improve cosmesis in conventional open thyroid surgery. METHODS Our study ran between January 2009 and November 2010, and was based on a prospectively maintained thyroid surgery register. Patients operated for benign thyroid diseases were included. Since January 2010, a standardized surgical workflow was used in addition to the reference open procedure to improve the outcome. Two groups were created: (1) G1 group (patients operated with the reference technique), (2) G2 group (patients operated with our workflow in addition to reference technique). Patients were investigated for postoperative outcomes, self-evaluated body image, cosmetic and self-confidence scores. RESULTS 820 patients were included in the present study. The overall body image and cosmetic scores were significantly better in the G2 group (P < 0.05). No significant difference was noted in terms of surgical outcomes, scar length, and self-confidence. CONCLUSIONS Our surgical workflow in conjunction with the reference technique is safe and shows significant better results in terms of body image and cosmesis than do the reference technique alone. Thus, we recommend its implementation in order to improve outcomes in a cost-effective way. The limitations of the present study should be kept in mind in the elaboration of future studies.
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Affiliation(s)
- Franck Billmann
- Department of Abdominal, Endocrine and Vascular Surgery, St. Vincentius Kliniken, Südendstrasse 32, D-76137 Karlsruhe, Germany.
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Robotic surgery in otolaryngology and head and neck surgery: a review. Minim Invasive Surg 2012; 2012:286563. [PMID: 22567225 PMCID: PMC3337488 DOI: 10.1155/2012/286563] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 01/04/2012] [Indexed: 01/12/2023] Open
Abstract
Recent advancements in robotics technology have allowed more complex surgical procedures to be performed using minimally invasive approaches. In this article, we reviewed the role of robotic assistance in Otolaryngology and Head and Neck Surgery. We highlight the advantages of robot-assisted surgery and its clinical application in this field.
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Bokor T, Kiffner E, Kotrikova B, Billmann F. Cosmesis and Body Image after Minimally Invasive or Open Thyroid Surgery. World J Surg 2012; 36:1279-85. [DOI: 10.1007/s00268-012-1563-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Schardey HM, Schopf S. Invisible-scar endoscopic thyroidectomy by the dorsal approach. Surg Endosc 2012; 25:3472-3. [PMID: 21487855 DOI: 10.1007/s00464-011-1694-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Trans-areola single-site endoscopic thyroidectomy: pilot study of 35 cases. Surg Endosc 2011; 26:939-47. [PMID: 22179439 DOI: 10.1007/s00464-011-1972-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 09/13/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND Endoscopic thyroidectomy via thoracic/breast approach is an acceptable and successful technique in Asia. This technique has the advantage of better cosmesis compared with open or even video-assisted thyroidectomy. Unfortunately, because of the need for three separate ports, conventional endoscopic thyroidectomy usually involves significantly more tissue dissection, and thus more injury to patients, limiting the popularity of this technique. We herein present 35 cases of trans-areola single-site endoscopic thyroidectomy (TASSET), which was first performed in 2009. METHODS Thirty-five patients who underwent TASSET for thyroid nodules from September 2009 to March 2011 were evaluated. The surgical outcomes of the surgery were retrospectively analyzed, including conversion, operative time, estimated blood loss, complications, length of stay, and patient satisfaction. RESULTS Thirty-one of the 35 patients (88.5%) underwent successful TASSET, with subtotal lobectomy being the most common procedure. Median operative time for the surgery was 153.65 min (range 100-190 min). Estimated blood loss ranged from 20 to 40 mL. Length of postoperative stay ranged from 2 to 4 days (average 2.5 days). Visual analog scale scores were 0 to 4 without administration of analgesics. The complication rate was low (8.6%) and included one case of transient recurrent laryngeal nerve (RLN) palsy, one case of subcutaneous seroma, and one case of tracheal injury. All patients were satisfied with the cosmetic outcome after mean follow-up of 8 months. CONCLUSIONS TASSET is feasible and safe, with great cosmetic benefits and less injury than other procedures. It may become an alternative procedure for treatment of patients with benign thyroid tumors, especially those with strong desire for cervical cosmesis.
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Hur SM, Kim SH, Lee SK, Kim WW, Choe JH, Lee JE, Kim JH, Nam SJ, Yang JH, Kim JS. New Endoscopic Thyroidectomy With the Bilateral Areolar Approach. Surg Laparosc Endosc Percutan Tech 2011; 21:e219-24. [DOI: 10.1097/sle.0b013e3182239989] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Invisible Scar Endoscopic Dorsal Approach Thyroidectomy: A Clinical Feasibility Study: Reply. World J Surg 2011. [DOI: 10.1007/s00268-011-1183-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Wirth U, Kammal M, Doberauer J, Graw M, Schardey HM, Schopf S. Invisible scar endoscopic thyroid surgery by the dorsal approach: importance of the spinal accessory nerve. Surg Radiol Anat 2011; 33:703-11. [PMID: 21720816 DOI: 10.1007/s00276-011-0845-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 06/17/2011] [Indexed: 12/16/2022]
Abstract
PURPOSE With about 100,000 surgeries per year in Germany, thyroid operations count among the most common procedures performed in general and endocrine visceral surgery. Twentieth century technological development gives the opportunity to perform thyroid surgery without leaving visible scar like conventional approaches do. This study is part of the work on the videoendoscopic retro-auricular access to the thyroid gland using the EndoCATS method by Schardey and Schopf. To avoid possible complications with the spinal accessory nerve (SAN), like irritation or injury of the nerve as happened during a feasibility study, a systematic study of the surgical anatomy at the nerve's entry to the posterior cervical triangle is performed especially in relation to the EndoCATS operation method. METHODS Sixty-one neck regions in fifty-three specimens were examined at the anatomical institute of Munich to investigate the course of the SAN relative to the anatomic landmarks tip of mastoid bone, sternal notch, and posterior border of the sternocleidomastoid muscle together with the SAN's course variants at its entry to the posterior cervical triangle. The results were then statistically analyzed. RESULTS From this analysis, we derived a simple method to predict the course of the SAN preoperatively and offer a new approach to protect the SAN during EndoCATS surgery. Additionally, we found a significant difference of the SAN's course between male and female specimens. CONCLUSION The EndoCATS method can be a safe alternative to conventional thyroid surgery, but the SAN is at risk during the surgery procedure. Here we give feasible solutions to eliminate the SAN-problem performing EndoCATS thyroid surgery.
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Affiliation(s)
- Ulrich Wirth
- Institut für Chirurgische Forschung Oberbayern e.V., Norbert-Kerkel-Platz, 83734, Hausham, Bavaria, Germany
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Hong HJ, Kim WS, Koh YW, Lee SY, Shin YS, Koo YC, Park YA, Choi EC. Endoscopic thyroidectomy via an axillo-breast approach without gas insufflation for benign thyroid nodules and micropapillary carcinomas: preliminary results. Yonsei Med J 2011; 52:643-54. [PMID: 21623608 PMCID: PMC3104441 DOI: 10.3349/ymj.2011.52.4.643] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To examine the feasibility of endoscopic thyroidectomy (ET) via an axillo- breast approach without gas insufflation for large thyroid tumors and micropapillary carcinomas. MATERIALS AND METHODS The patients in the benign group were separated into groups 1 (n=95, <4 cm in tumor diameter) and 2 (n=37, ≥4 cm in tumor diameter). Also, 57 patients in the micropapillary carcinoma group underwent an endoscopic hemithyroidectomy (HT) (group 3) and were compared with 60 patients who received conventional open HT (group 4). Postoperative functional outcome, local complications, surgical outcomes, and pathological outcomes were compared between the groups. RESULTS In the benign group, there was no significant difference in mean operating time, hospital stay, or overall perioperative complications between the two groups. In the micropapillary carcinoma group, mean operating time and hospital stay in group 3 were significantly longer than in group 4 (p=0.015 and p≤0.001). The overall perioperative complications did not differ significantly between the groups. The postoperative cosmetic result was better in groups 1-3 (endo group) than in group 4 (open group). CONCLUSION ET via a gasless axillo-breast approach seems to be a safe procedure even for benign thyroid lesions ≥4 cm and micropapillary carcinomas. Although it has the advantage of better cosmetic results over open thyroidectomy, there is room for improvement in terms of lessening its invasiveness and shortening the operative time.
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Affiliation(s)
- Hyun Jun Hong
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Won Shik Kim
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Woo Koh
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - So Yoon Lee
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Yoo Seob Shin
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Cheol Koo
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon A Park
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Chang Choi
- Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul, Korea
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Terris DJ, Singer MC, Seybt MW. Robotic facelift thyroidectomy: II. Clinical feasibility and safety. Laryngoscope 2011; 121:1636-41. [DOI: 10.1002/lary.21832] [Citation(s) in RCA: 144] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 03/22/2011] [Indexed: 11/11/2022]
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Invisible Scar Endoscopic Dorsal Approach Thyroidectomy: A Clinical Feasibility Study. World J Surg 2010; 34:2997-3006. [DOI: 10.1007/s00268-010-0769-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Benhidjeb T, Witzel K, Burghardt J, Bärlehner E, Stark M, Mann O. Endoscopic minimally invasive thyroidectomy: ethical and patients safety considerations on the first clinical experience of an innovative approach. Surg Endosc 2010. [PMID: 20734079 DOI: 10.1007/s00464-010-1290-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Tahar Benhidjeb
- Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany,
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Retro-auricular video-assisted “gasless” thyroidectomy: feasibility study in human cadavers. Surg Endosc 2010; 24:2895-9. [DOI: 10.1007/s00464-010-1068-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Accepted: 03/21/2010] [Indexed: 10/19/2022]
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