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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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Video-assisted neck surgery (VANS) using a gasless lifting procedure for thyroid and parathyroid diseases: "The VANS method from A to Z". Surg Today 2019; 50:1126-1137. [PMID: 31728730 PMCID: PMC7501127 DOI: 10.1007/s00595-019-01908-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 09/04/2019] [Indexed: 12/20/2022]
Abstract
Purpose To describe and evaluate our video-assisted neck surgery (VANS) method for thyroid and parathyroid diseases. Methods We describe in detail the VANS method for enucleation, lobectomy, total (nearly total) thyroidectomy, and lymph node dissection for malignancy and Graves’ disease. In collaboration with the Japan Society of Endoscopic Surgery (JSES), we evaluated several aspects of this method. The JSES evaluated the method for working-space formation and surgical complications, whereas we examined the learning curve of the surgeons, and the cosmetic satisfaction of the patients and the degree of numbness and pain they experienced. We also asked patients who underwent conventional surgery whether they would have selected VANS had it been available. Results The working space for 81.5% of the procedures in Japan was created using the gasless lifting method. The learning curve, considering both blood loss and operating time, decreased after 30 cases. Both factors improved for tumors smaller than 5 cm in diameter. Over 60% of the patients who underwent conventional surgery stated that they would have selected VANS, had it been available. Postoperative pain was worse after conventional surgery than after VANS, but neck numbness after VANS was more frequent than expected. Conclusions The VANS method is a feasible, safe, and cost-effective procedure with clear cosmetic advantages over conventional surgery.
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Nayak SP, Sadhoo A, Gangadhara B, Reddy S, Khan A, Munisiddaiah D, Ramakrishnan A. Robotic-assisted breast-axillo insufflation thyroidectomy (RABIT): a retrospective case series of thyroid carcinoma. Int J Clin Oncol 2019; 25:439-445. [PMID: 31667663 DOI: 10.1007/s10147-019-01568-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 10/22/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the feasibility and safety of robotic-assisted breast-axillo insufflation thyroidectomy (RABIT) for differentiated thyroid cancer. METHODS In this retrospective case series, patients with differentiated thyroid carcinoma were enrolled in our hospital from January 2018 to December 2018. All patients underwent indirect laryngoscopy to assess the status of vocal cord preoperatively. RABIT was performed with five separate breast-axillo incisions. All the procedures were performed using da Vinci Xi Robotic Surgical System, a single docking method using CO2 insufflation. RESULTS Twelve patients completed RABIT, in which one case needed conversion to open thyroidectomy. The mean age was 30.25 ± 7 with male to female ratio being 1:1. Preoperative diagnosis showed papillary carcinoma (n = 9) and follicular neoplasm (n = 3). The mean operative time for RABIT was 140 ± 50.45 min and average blood loss during surgery was 22.92 ± 9 mL. Mean hospital stay was 4.42 ± 1.08 days. Final pathology confirmed classical papillary thyroid carcinoma (n = 10; 83.3%) and follicular variant of papillary carcinoma (n = 2; 16.7%). None of the cases reported injury or paralysis to the recurrent laryngeal nerves. CONCLUSION RABIT is a safe and feasible approach for thyroidectomy. It has several advantages in that it provides similar symmetrical view to conventional open surgery and enables to maintain specimen integrity and use of assistant port permits better handling of the gland. Additionally, the largest operating angles with this technique prevent collision between the robotic arms and provide excellent cosmetic satisfaction due to very small, five separate breast-axillo incisions.
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Affiliation(s)
- Sandeep P Nayak
- Department of Surgical Oncology, Fortis Hospitals, 154, 9, Bannerghatta Main Rd, Opposite IIM, Sahyadri Layout, Panduranga Nagar, Bangalore, Karnataka, 560076, India.
| | - Abhilasha Sadhoo
- Department of Surgical Oncology, Fortis Hospitals, 154, 9, Bannerghatta Main Rd, Opposite IIM, Sahyadri Layout, Panduranga Nagar, Bangalore, Karnataka, 560076, India
| | - Bharath Gangadhara
- Department of Surgical Oncology, Fortis Hospitals, 154, 9, Bannerghatta Main Rd, Opposite IIM, Sahyadri Layout, Panduranga Nagar, Bangalore, Karnataka, 560076, India
| | - Sreekanth Reddy
- Department of Surgical Oncology, Fortis Hospitals, 154, 9, Bannerghatta Main Rd, Opposite IIM, Sahyadri Layout, Panduranga Nagar, Bangalore, Karnataka, 560076, India
| | - Ameenuddin Khan
- Department of Surgical Oncology, Fortis Hospitals, 154, 9, Bannerghatta Main Rd, Opposite IIM, Sahyadri Layout, Panduranga Nagar, Bangalore, Karnataka, 560076, India
| | - Devaprasad Munisiddaiah
- Department of Surgical Oncology, Fortis Hospitals, 154, 9, Bannerghatta Main Rd, Opposite IIM, Sahyadri Layout, Panduranga Nagar, Bangalore, Karnataka, 560076, India
| | - Athira Ramakrishnan
- Department of ENT, Fortis Hospitals, Bannerghatta Main Rd, Bangalore, 560076, India
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Wang B, Weng Y, Wang S, Zhao W, Yan S, Zhang L, Wen J. Feasibility and safety of needle‐assisted endoscopic thyroidectomy with lateral neck dissection for papillary thyroid carcinoma: a preliminary experience. Head Neck 2019; 41:2367-2375. [PMID: 30775820 DOI: 10.1002/hed.25705] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 01/20/2019] [Accepted: 01/29/2019] [Indexed: 01/10/2023] Open
Affiliation(s)
- Bo Wang
- Department of Thyroid and Vascular SurgeryFujian Medical University Union Hospital Fuzhou Fujian China
| | - Yu‐jing Weng
- Department of Thyroid and Vascular SurgeryFujian Medical University Union Hospital Fuzhou Fujian China
| | - Si‐si Wang
- Department of Thyroid and Vascular SurgeryFujian Medical University Union Hospital Fuzhou Fujian China
| | - Wen‐xin Zhao
- Department of Thyroid and Vascular SurgeryFujian Medical University Union Hospital Fuzhou Fujian China
| | - Shou‐yi Yan
- Department of Thyroid and Vascular SurgeryFujian Medical University Union Hospital Fuzhou Fujian China
| | - Li‐yong Zhang
- Department of Thyroid and Vascular SurgeryFujian Medical University Union Hospital Fuzhou Fujian China
| | - Jia Wen
- Department of Thyroid and Vascular SurgeryFujian Medical University Union Hospital Fuzhou Fujian China
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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
Robot assisted thyroid surgery has been the latest advance in the evolution of thyroid surgery after endoscopy assisted procedures. The advantage of a superior field vision and technical advancements of robotic technology have permitted novel remote access (trans-axillary and retro-auricular) surgical approaches. Interestingly, several remote access surgical ports using robot surgical system and endoscopic technique have been customized to avoid the social stigma of a visible scar. Current literature has displayed their various advantages in terms of post-operative outcomes; however, the associated financial burden and also additional training and expertise necessary hinder its widespread adoption into endocrine surgery practices. These approaches offer excellent cosmesis, with a shorter learning curve and reduce discomfort to surgeons operating ergonomically through a robotic console. This review aims to provide details of various remote access techniques that are being offered for thyroid resection. Though these have been reported to be safe and feasible approaches for thyroid surgery, further evaluation for their efficacy still remains.
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Affiliation(s)
- Parisha Bhatia
- 1 Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA ; 2 Department of Otolaryngology Head & Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Hossam Eldin Mohamed
- 1 Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA ; 2 Department of Otolaryngology Head & Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Abida Kadi
- 1 Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA ; 2 Department of Otolaryngology Head & Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Emad Kandil
- 1 Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA ; 2 Department of Otolaryngology Head & Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Rohan R Walvekar
- 1 Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA ; 2 Department of Otolaryngology Head & Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
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Arora A, Kotecha J, Acharya A, Garas G, Darzi A, Davies DC, Tolley N. Determination of biometric measures to evaluate patient suitability for transoral robotic surgery. Head Neck 2014; 37:1254-60. [DOI: 10.1002/hed.23739] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2014] [Indexed: 11/07/2022] Open
Affiliation(s)
- Asit Arora
- Department of Otorhinolaryngology and Head and Neck Surgery; St. Mary's Hospital, Imperial College Healthcare NHS Trust; London United Kingdom
| | - Jalpa Kotecha
- Department of Otorhinolaryngology and Head and Neck Surgery; St. Mary's Hospital, Imperial College Healthcare NHS Trust; London United Kingdom
| | - Amish Acharya
- Department of Otorhinolaryngology and Head and Neck Surgery; St. Mary's Hospital, Imperial College Healthcare NHS Trust; London United Kingdom
| | - George Garas
- Department of Otorhinolaryngology and Head and Neck Surgery; St. Mary's Hospital, Imperial College Healthcare NHS Trust; London United Kingdom
| | - Ara Darzi
- Department of Surgery and Cancer; Imperial College London; St. Mary's Hospital Campus London United Kingdom
| | - D. Ceri Davies
- Human Anatomy Unit; Department of Surgery and Cancer; Imperial College London; Charing Cross Hospital Campus London United Kingdom
| | - Neil Tolley
- Department of Otorhinolaryngology and Head and Neck Surgery; St. Mary's Hospital, Imperial College Healthcare NHS Trust; London United Kingdom
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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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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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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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Galatà G, Mulla M. Primum non nocere, deinde philosophare. Surg Endosc 2011; 25:3474-5. [PMID: 21590500 DOI: 10.1007/s00464-011-1738-6] [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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