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Zheng G, Ding W, Liu X, Liu Y, Sun H, Song X, Zheng H. Gasless Single-Incision Endoscopic Surgery via Subclavicular Approach for Lateral Neck Dissection in Patients with Papillary Thyroid Cancer. Ann Surg Oncol 2024; 31:1498-1508. [PMID: 38099992 DOI: 10.1245/s10434-023-14639-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/06/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND The technical difficulties and trauma of remote access methods in endoscopic surgery (ES) for lateral neck dissection (LND) can be daunting for most patients with papillary thyroid cancer (PTC) and surgeons. The purpose of study was to introduce gasless single-incision ES via a subclavicular approach (ESSA) and to explore its safety and efficacy for LND. METHODS Between January 2022 and February 2023, we retrospectively reviewed 17 patients with PTC who underwent ESSA for LND. In addition, 22 patients who received video-assisted ES (VAES) and 48 patients who underwent open surgery (OP) for LND during the same period were included. Clinicopathological characteristics, complications, and efficacy of the lymph node yield (LNY) were compared between the ESSA and the other two groups (VAES and OP). RESULTS The LNY from central and lateral neck dissection by ESSA was comparable to that by VAES (9.2 ± 8.1 vs. 9.5 ± 4.2, P = 0.986, and 33.5 ± 11.6 vs. 30.6 ± 9.2, P = 0.382, respectively) and OP (9.2 ± 8.1 vs. 11.0 ± 5.4, P = 0.420, and 33.5 ± 11.6 vs. 31.5 ± 7.9, P = 0.383, respectively). Swallowing impairment scores at 1 and 3 months were significantly lower after ESSA than those after VAES (1.8 ± 1.0 vs. 3.0 ± 1.2, P = 0.003, and 0.9 ± 0.8 vs. 1.7 ± 0.8, P = 0.006, respectively). The cosmetic satisfaction rate 1 month after surgery was significantly higher in the ESSA group than that in the VAES group (100 vs. 31.8%, P < 0.001). CONCLUSIONS ESSA is a safe and minimally invasive procedure that provides a scarless cervical appearance and has good efficacy for LND. Therefore, ESSA may be a feasible choice for selected patients with N1b PTC with cervical cosmetic needs.
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Affiliation(s)
- Guibin Zheng
- Department of Thyroid Surgery, The Affiliated Yantai Yuhuangding Hospital, Qingdao University, Yantai, People's Republic of China
| | - Weifang Ding
- Department of Health Care, The Affiliated Yantai Yuhuangding Hospital, Qingdao University, Yantai, People's Republic of China
| | - Xincheng Liu
- Department of Thyroid Surgery, The Affiliated Yantai Yuhuangding Hospital, Qingdao University, Yantai, People's Republic of China
| | - Yang Liu
- Department of Thyroid Surgery, The Affiliated Yantai Yuhuangding Hospital, Qingdao University, Yantai, People's Republic of China
| | - Haiqing Sun
- Department of Thyroid Surgery, The Affiliated Yantai Yuhuangding Hospital, Qingdao University, Yantai, People's Republic of China
| | - Xicheng Song
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, People's Republic of China.
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, Shandong, People's Republic of China.
| | - Haitao Zheng
- Department of Thyroid Surgery, The Affiliated Yantai Yuhuangding Hospital, Qingdao University, Yantai, People's Republic of China.
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Woods AL, Campbell MJ, Graves CE. A scoping review of endoscopic and robotic techniques for lateral neck dissection in thyroid cancer. Front Oncol 2024; 14:1297972. [PMID: 38390267 PMCID: PMC10883677 DOI: 10.3389/fonc.2024.1297972] [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: 09/20/2023] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
Introduction Lateral neck dissection (LND) in thyroid cancer has traditionally been performed by a transcervical technique with a large collar incision. With the rise of endoscopic, video-assisted, and robotic techniques for thyroidectomy, minimally invasive LND is now being performed more frequently, with better cosmetic outcomes. Methods The purpose of this paper is to review the different minimally invasive and remote access techniques for LND in thyroid cancer. A comprehensive literature review was performed using PubMed and Google Scholar search terms "thyroid cancer" and "lateral neck dissection" and "endoscopy OR robot OR endoscopic OR video-assisted". Results There are multiple surgical options now available within each subset of endoscopic, video-assisted, and robotic LND. The approach dictates the extent of the LND but almost all techniques access levels II-IV, with variability on levels I and V. This review provides an overview of the indications, contraindications, surgical and oncologic outcomes for each technique. Discussion Though data remains limited, endoscopic and robotic techniques for LND are safe, with improved cosmetic results and comparable oncologic and surgical outcomes. Similar to patient selection in minimally invasive thyroidectomy, it is important to consider the extent of the LND and select appropriate surgical candidates.
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Affiliation(s)
- Alexis L Woods
- Department of Surgery, University of California, Davis Medical Center, Sacramento, CA, United States
| | - Michael J Campbell
- Department of Surgery, University of California, Davis Medical Center, Sacramento, CA, United States
| | - Claire E Graves
- Department of Surgery, University of California, Davis Medical Center, Sacramento, CA, United States
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Chen ZX, Chen JB, Pang FS, Lin ZH, Zhang XB, Cai BY, Zheng WW, Cao Y, Qin Y. A novel hybrid approach for "Scarless" (at the neck) lateral neck dissection for papillary thyroid carcinoma: A case series and literature review. Front Oncol 2022; 12:985761. [PMID: 36568147 PMCID: PMC9780263 DOI: 10.3389/fonc.2022.985761] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022] Open
Abstract
Lateral neck dissection (LND) is a necessary treatment for thyroid cancer with lateral lymph node metastasis. However, the defect created during open surgery leaves a visible scar on the neck. With advancements in surgical technology, many robotic and endoscopic surgical techniques have been reported as alternatives to open surgery. In this study, we present a case series demonstrating the successful application of a novel hybrid approach for endoscopic LND and a review of different surgical approaches for "scarless" (at the neck) LND. We performed endoscopic LND via a combined chest and transoral approach in 24 patients between January 2021 and March 2022. The surgery was completed successfully in all patients with an average operation time of 298.1 ± 72.9 min. The numbers of positive/retrieved lymph nodes at levels II, III-IV, and VI were 0.7 ± 0.9/8.4 ± 4.1, 3.6 ± 2.7/19.5 ± 6.8, and 4.9 ± 3.9/10.3 ± 4.5, respectively. Complications included transient hypoparathyroidism in 10 patients, transient recurrent laryngeal nerve injury in 1 patient, internal jugular vein (IJN) injury in 1 patient, IJN sacrifice due to cancer invasion in 1 patient, and chyle leak in 1 patient, and no cases of tumor recurrence were observed during follow-up. The present case series indicates that the combined chest and transoral approach is feasible and effective for performing LND. Our review of different approaches for "scarless" (at the neck) LND identified advantages and disadvantages for all techniques. Our novel approach has unique advantages, and thus, it can provide an ideal surgical procedure for specific papillary thyroid carcinoma patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | - You Qin
- *Correspondence: You Qin, ; Zhen-Xin Chen,
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Kuang P, Wang Y, Wu G, Luo Y, Fu J, Yan W, Lin S, Hong X, Lin F, Lin E, Fu Y. Endoscopic lateral neck dissection via the breast and transoral approaches for papillary thyroid carcinoma: A preliminary report. Front Surg 2022; 9:997819. [PMID: 36386534 PMCID: PMC9663646 DOI: 10.3389/fsurg.2022.997819] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/26/2022] [Indexed: 06/22/2024] Open
Abstract
PURPOSE Complete lymph node dissection is essential for the management of papillary thyroid carcinoma (PTC) with lymph node metastasis (LNM). This work aimed to describe the feasibility of endoscopic lateral neck dissection via the breast and transoral approach (ELNDBTOA) in PTC patients and the necessity of the addition of the transoral approach. METHODS We included 13 patients with PTC and suspected lateral LNM who underwent ELNDBTOA at the Zhongshan Hospital, Xiamen University. Total thyroidectomy, ipsilateral central lymph node dissection, and selective neck dissection (levels IIA, IIB, III, and IV) were performed endoscopically via the breast approach. Residual lymph nodes were further dissected via the transoral approach. RESULTS The mean operation time was 362.1 ± 73.5 min. In the lateral neck compartments, the mean number of retrieved lymph nodes was 36.6 ± 23.8, and the mean number of positive lymph nodes was 6.8 ± 4.7. In further dissection via the transoral approach, lymph nodes in the lateral neck compartment were obtained in nine patients (9/13, 69.2%), and three patients (3/13, 23.1%) had confirmed lateral neck metastases. Transient hypocalcemia occurred in two patients (2/13, 15.4%), and three patients (3/13, 23.1%) developed transient skin numbness in the mandibular area. No other major complications were observed. There was no evidence of local recurrence or distant metastasis during the follow-up period (range, 24-87 months). All patients were satisfied with the good cosmetic outcome. CONCLUSION ELNDBTOA is an option with proven feasibility for select PTC patients with LNM, and the addition of the transoral approach is necessary to ensure complete dissection.
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Affiliation(s)
- Penghao Kuang
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Yuanyuan Wang
- Department of Thyroid Surgery, Zhengzhou University First Affiliated Hospital, Zhengzhou, China
| | - Guoyang Wu
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Yezhe Luo
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Jinbo Fu
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Wei Yan
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Suqiong Lin
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Xiaoquan Hong
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Fusheng Lin
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Ende Lin
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, China
| | - Yilong Fu
- Department of General Surgery, Zhongshan Hospital, Xiamen University, Xiamen, China
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Zhang Z, Sun B, Ouyang H, Cong R, Xia F, Li X. Endoscopic Lateral Neck Dissection: A New Frontier in Endoscopic Thyroid Surgery. Front Endocrinol (Lausanne) 2021; 12:796984. [PMID: 35002974 PMCID: PMC8728058 DOI: 10.3389/fendo.2021.796984] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/01/2021] [Indexed: 12/18/2022] Open
Abstract
Background Endoscopic thyroidectomy and robotic thyroidectomy are effective and safe surgical options for thyroid surgery, with excellent cosmetic outcomes. However, in regard to lateral neck dissection (LND), much effort is required to alleviate cervical disfigurement derived from a long incision. Technologic innovations have allowed for endoscopic LND, without the need for extended cervical incisions and providing access to remote sites, including axillary, chest-breast, face-lift, transoral, and hybrid approaches. Methods A comprehensive review of published literature was performed using the search terms "lateral neck dissection", "thyroid", and "endoscopy OR endoscopic OR endoscope OR robotic" in PubMed. Results This review provides an overview of the current knowledge regarding endoscopic LND, and it specifically addresses the following points: 1) the surgical procedure, 2) the indications and contraindications, 3) the complications and surgical outcomes, and 4) the technical advantages and limitations. Robotic LND, totally endoscopic LND, and endoscope-assisted LND are separately discussed. Conclusions Endoscopic LND is a feasible and safe technique in terms of complete resection of the selected neck levels, complications, and cosmetic outcomes. However, it is recommended to strictly select criteria when expanding the population of eligible patients. A formal indication for endoscopic LND has not yet been established. Thus, a well-designed, multicenter study with a large cohort is necessary to confirm the feasibility, long-term outcomes, oncological safety, and influence of endoscopic LND on patient quality of life (QoL).
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Affiliation(s)
| | | | | | | | - Fada Xia
- Department of Thyroid Surgery, Xiangya Hospital, Central South University, Changsha, China
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Chen Y, Xu S, Zeng X, Liang Y, Xu J. Comparison of the effectiveness and safety between endoscopic-assisted lateral neck dissection and conventional open lateral neck dissection:A meta-analysis. Asian J Surg 2021; 45:1809-1816. [PMID: 34649793 DOI: 10.1016/j.asjsur.2021.09.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 09/23/2021] [Accepted: 09/30/2021] [Indexed: 11/02/2022] Open
Abstract
The objective of this study was to systematically evaluate the effectiveness and safety of endoscopic-assisted lateral neck dissection (EALND) compared with conventional open lateral neck dissection (COLND) for the treatment of thyroid cancer with positive lymph node metastases. Medical literature databases including PubMed, Embase, the Cochrane Library, CNKI, Wan Fang and VIP were systematically searched for articles that compared EALND and COLND for the treatment of thyroid carcinoma with lymph node metastasis, up to June 2019. The quality of included studies was evaluated using the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using RevMan 5.3 software after two evaluators independently screened the literature, extracted information and evaluated the methodological quality of included studies according to inclusion and exclusion criteria, resulting in the selection of seven studies with a total of 372 patients from six non-RCTs and an RCT. The results of meta-analysis showed that EALND was associated with a longer operative time (MD = 24.86, 95∗CI:21.76 to 27.96, P<0.05), with a shorter postoperative stay (MD = -1.45, 95%CI:-2.70 to -0.21,P = 0.02), reduced length of scar (MD = -8.14,95%CI:-8.41 to -7.88, P<0.00001) and a lower incidence of neck discomfort (OR = 0.19, 95%CI:0.07 to 0.58, P = 0.003) compared with COLND. The incidences in both groups of transient hypocalcemia (OR = 0.66,95%CI:0.28 to 1.55,P = 0.343), transient hoarseness (OR = 0.58,95%CI:0.17 to 1.93,P = 0.38),chylous fistula (OR = 0.69,95%CI:0.26 to 1.83,P = 0.45), choking on water (OR = 0.24,95%CI:0.04 to 1.31,P = 0.10) and the number of lymph nodes retrieved from the lateral cervical region (MD = 0.14,95%CI:-0.36 to 0.65,P = 0.59) were not statistically significant. It was concluded that EALND was safe and feasible compared with COLND, despite the longer operation time. The incision was more aesthetically pleasing and the postoperative recovery was quicker, which makes EALND a clinical procedure worthy of use in such cases.
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Affiliation(s)
- Yongqiang Chen
- Department of Thyroid Breast Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, 362000, PR China
| | - Shuangta Xu
- Department of Thyroid Breast Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, 362000, PR China
| | - Xiaoshan Zeng
- Department of Thyroid Breast Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, 362000, PR China
| | - Yinghui Liang
- Department of Thyroid Breast Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, 362000, PR China
| | - Jianhua Xu
- Department of Thyroid Breast Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, 362000, PR China.
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Endoscopic Thyroidectomy With Level Vb Dissection Via a Chest-breast Approach: Technical Updates for Selective Lateral Neck Dissection. Surg Laparosc Endosc Percutan Tech 2021; 31:342-345. [PMID: 33900224 DOI: 10.1097/sle.0000000000000887] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/26/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the feasibility of endoscopic thyroidectomy with level Vb dissection using a chest-breast approach. METHODS Lateral neck level Vb dissection by endoscopic surgery using a chest-breast approach was performed as an update to the previously reported endoscopic selective lateral neck dissection. The demographic data, surgical outcomes, and adverse events were analyzed. RESULTS A total of 12 cases were performed successfully, and no patient was converted to the open procedure. The sex ratio was 16/2 (female/male). The average age and primary lesion diameter were 36.3±5.8 years old, and 1.97±0.58 cm, respectively. The average total and lateral lymph nodes dissection time of duration was 154.6±17.0 and 276.3±19.2 minutes, respectively. The lymph node ratio (mean number of metastasis/total number of dissected nodes) at levels II, III+IV, VI, and Vb were 1.6±1.4/6.8±2.0, 5.8±2.4/14.4±3.6, 3.2±1.1/6.5±1.9, and 0.8±0.9/5.8±1.6, respectively. One of 12 patients had lymphatic leakage and 2 of 12 patients had transient hypocalcemia. There was no incidence of uncontrolled bleeding, mental nerve injury, permanent hypoparathyroidism, permanent recurrent laryngeal nerve injury, skin bruise on neck, infection, asphyxia/dyspnea, large blood vessel injury or other complications like tracheal injury, esophageal injury, etc., nor was there any death or recurrence in either of the 2 groups during a short follow-up period. CONCLUSIONS It is feasible to perform endoscopic thyroidectomy with level Vb dissection using a chest-breast approach. Such strategy represents another option for selective papillary thyroid carcinoma patients with levels II, III, IV, and Vb lymph node metastasis.
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Yu X, Liu C, Yan M, Gong W, Wang Y. Hyperthermal liquid, spray, and smog may be potential risk factors for recurrent laryngeal nerve thermal injury during thyroid surgeries. Endocrine 2021; 72:198-207. [PMID: 32779090 DOI: 10.1007/s12020-020-02451-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 07/30/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE The hyperthermal liquid, spray and smog caused by energy-based surgical devices (EBDs) may be the potential risk factors for recurrent laryngeal nerve (RLN) thermal injury, but not been reported previously. We aim to demonstrated it both in thyroid surgeries and animal experiments. METHODS 321 thyroid patients and 32 rats were divided into two groups respectively. A type of endoscopic gauze was implemented in the protected group to prevent nerve from thermal risks. Electromyography and laryngoscope were recorded to determine nerve's conductive ability. Microstructural morphological damage to nerves and muscles were evaluated by light and electron microscopy in the animal experiments. RESULTS After thyroid surgeries, the incidence of transient vocal cord (VC) palsy was decreased in the protected group (1.4%) compared with the conventional group (4.7%) (P = 0.037). In animal experiments, the average nerve conductive velocity was significantly decreased in the conventional group (5.8 ± 2.1 vs. 25.5 ± 4.7 m/s, P < 0.01). Typical acute morphological thermal changes of edema, coagulation and homogenization in nerve tissues were recorded by light microscopy in the conventional group. Four weeks later, the average weight of gastrocnemius muscles in the injured limb was significantly decreased (1.3 ± 0.2 vs. 2.2 ± 0.2 g, P < 0.01), while no significant difference was noted in the protected group (2.0 ± 0.3 vs. 2.3 ± 0.4 g, P = 0.61). CONCLUSIONS Hyperthermal liquid, spray or smog may represent risk factors contributing to RLN thermal injury caused by EBDs. Damage to the nerve's conductive ability and morphological changes in nerves and muscles likely represent typical responses to thermal injury. Implementation of endoscopic gauze may be a promising method to protect the RLN from thermal damage especially in endoscopic thyroid surgeries.
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Affiliation(s)
- Xing Yu
- Department of Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Chang Liu
- College of Medicine, Zhejiang University, Hangzhou, 310058, China
| | - Maoxiao Yan
- Department of Otorhinolaryngology, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China
| | - Weihua Gong
- Department of Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China.
| | - Yong Wang
- Department of Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China.
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Endoscopic Lateral Neck Dissection (IIA, IIB, III, and IV) Using a Breast Approach: Outcomes From a Series of the First 24 Cases. Surg Laparosc Endosc Percutan Tech 2020; 31:66-70. [PMID: 32925819 DOI: 10.1097/sle.0000000000000849] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/10/2020] [Indexed: 01/13/2023]
Abstract
INTRODUCTION In order to avoid large neck scar caused by conventional lateral neck dissection. We have explored and introduced endoscopic lateral neck dissection (IIA, IIB, III, and IV) using a breast approach. Now, we summarized and shared the outcomes of the first 24 cases. MATERIALS AND METHODS All the patients were treated in our institute from January 2017 to May 2018, and followed-up for more than 1 year. The details of patients and this technique have been summarized and analyzed retrospectively. RESULTS A series of first 24 cases were successfully managed with this technique, and no cases were converted to an open approach. Among these 24 patients, levels III + IV dissection had been performed in 6 patients and levels II+III+IV dissection had been performed in 18 patients. The mean age, body mass index, and sex were 39.3±10.5 years old, 24.1±3.5, and 2 male/22 female, respectively. The average operative time of total operation and lateral neck dissection was 238.8±37.2 minutes and 128.8±21.1 minutes, respectively. The mean dissected lateral lymph nodes were 5.9±2.2 (level II) in 18 cases and 15.9±3.9 (levels III+IV) in 24 cases. In addition, with no severe complications to date, such as asphyxia, main nerves injury (cervical plexus, vagus nerve, etc.), and permanent hypoparathyroidism, nor permanent recurrent laryngeal nerve injury, and so on. However, unexpectedly, had some mild and common complications like transient hypocalcemia in 4 cases (16.67%), transient horse 1 case (4.2%), controllable lymphatic leakage in 2 cases (8.3%), and controllable jugular vein injury in 2 cases (8.3%). One year after the operation, 1 case found lung metastasis but no local recurrence. In other 23 patients, no recurrence/metastasis and the average of serum thyroglobulin is 3.2±3.8 ng/mL. CONCLUSIONS This technique can yield adequate oncological dissection for selected patients. Endoscopic thyroidectomy along with lateral neck dissection using a breast approach may provide an option for selected patients who favor avoiding a visible neck incision.
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Scarless endoscopic thyroidectomy (SET) lateral neck dissection for papillary thyroid carcinoma through breast approach: 10 years of experience. Surg Endosc 2020; 35:3540-3546. [PMID: 32691204 DOI: 10.1007/s00464-020-07814-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 07/10/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Breast approach endoscopic thyroidectomy with lateral neck lymph node metastases dissection has been described. However, in this article, we report on 10 years' experience with the breast approach to patients with endoscopic thyroidectomy with level II, III, and IV lateral neck dissection (LND). Patients with papillary thyroid carcinoma (PTC) who received scarless endoscopic thyroidectomy (SET) were included to evaluate its therapeutic effect. METHODS Between June 2009 and June 2019, we selected 155 patients with PTC with level II, III, or IV level lymph node metastasis suspected. Ipsilateral level II, III, and IV dissection was performed, accompanied by thyroidectomy and central compartment dissection. In addition, 102 patients received conventional open LND during the same period and were included. Clinicopathological characteristics, outcomes, and tumor prognosis were retrospectively compared in the two groups. RESULTS During the 10 years, the submitted patients' clinicopathological characteristics including tumor size, tumor stage, retrieved lymph nodes number, complication rates, postoperative PTH, and mean postoperative hospital stay were similar between the SET and open group. The mean operating time in the SET group (278.2 ± 38.6 min) was longer than in the open group (179.3 ± 25.4 min). The recurrent rate was not significantly different (2/155, 2/106) in the SET and conventional open group. CONCLUSION The safety and oncological completeness dissection of SET was similar to that of open procedures. SET is an effective treatment approach for patients with PTC having cosmetic results' demand of lateral neck lymph node metastases.
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Zhang D, Zhang J, Dionigi G, Li F, Wang T, Li H, Liang N, Sun H. Recurrent Laryngeal Nerve Morbidity: Lessons from Endoscopic via Bilateral Areola and Open Thyroidectomy Technique. World J Surg 2020; 43:2829-2841. [PMID: 31367782 DOI: 10.1007/s00268-019-05092-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIM Elucidating the mechanism of recurrent laryngeal nerve (RLN) injuries through intraoperative electromyographic (EMG) and laryngeal examination approaches may deepen our knowledge regarding its prevention strategies. To date, no studies have been reported on the mechanism of RLN injury caused by endoscopic thyroidectomy via bilateral areola approach (ETBAA). METHODS Both intraoperative EMG profiles and postoperative laryngeal examination were used to investigate the mechanisms of RLN injury and compare the safety aspects between ETBAA and open thyroidectomy approach (OTA). RESULTS This study examined 1420 nerves at risk. The mean follow-up period was 17 ± 4 (range 6-48) months. The incidence of vocal cord paralysis was 4.1% (59/1420). The number of cases with decreased EMG signals and vocal cord palsy was higher in ETBAA group than in OTA group (P < 0.05). The left RLNs in ETBAA group were at higher risk compared to the right nerves. CONCLUSIONS The results of the current study indicate that ETBAA exhibits higher risk of RLN injury. The topic includes a video.
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Affiliation(s)
- Daqi Zhang
- Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, China-Japan Union Hospital of Jilin University, 126 Xiantai Blvd, Changchun City, Jilin Province, People's Republic of China
| | - Jiao Zhang
- Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, China-Japan Union Hospital of Jilin University, 126 Xiantai Blvd, Changchun City, Jilin Province, People's Republic of China
| | - Gianlorenzo Dionigi
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood ''G. Barresi'', University Hospital G. Martino, University of Messina, Via C. Valeria 1, 98125, Messina, Italy
| | - Fang Li
- Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, China-Japan Union Hospital of Jilin University, 126 Xiantai Blvd, Changchun City, Jilin Province, People's Republic of China
| | - Tie Wang
- Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, China-Japan Union Hospital of Jilin University, 126 Xiantai Blvd, Changchun City, Jilin Province, People's Republic of China
| | - Hongbo Li
- Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, China-Japan Union Hospital of Jilin University, 126 Xiantai Blvd, Changchun City, Jilin Province, People's Republic of China
| | - Nan Liang
- Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, China-Japan Union Hospital of Jilin University, 126 Xiantai Blvd, Changchun City, Jilin Province, People's Republic of China.
| | - Hui Sun
- Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, China-Japan Union Hospital of Jilin University, 126 Xiantai Blvd, Changchun City, Jilin Province, People's Republic of China.
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12
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Xu Z, Song J, Li B, Sun S, Meng Y. Comparison of Conventional and Video-Assisted Lateral Neck Lymphadenectomy for Thyroid Cancer. Indian J Surg 2020. [DOI: 10.1007/s12262-019-01966-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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13
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Ma JJ, Zhang DB, Zhang WF, Wang X. Application of Nanocarbon in Breast Approach Endoscopic Thyroidectomy Thyroid Cancer Surgery. J Laparoendosc Adv Surg Tech A 2020; 30:547-552. [PMID: 32045316 DOI: 10.1089/lap.2019.0794] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objective: This study aimed to investigate the application of nanocarbon in surgical endoscopy in patients with thyroid cancer for the clinical tracing of level VI sentinel lymph nodes (SLNs) and for parathyroid gland protection. Materials and Methods: Ninety-three patients with papillary thyroid carcinoma (PTC) who underwent an endoscopic thyroid cancer operation were included. We randomly divided these patients into a control group (n = 42) and a nanocarbon group (n = 51). For the nanocarbon group, after thyroid exposure, nanocarbon was injected into the thyroid gland, and the SLNs were resected and subjected to frozen sectioning and routine pathological examination. In addition, the postoperative calcium and parathyroid hormone (PTH) levels of both groups were analyzed to compare the features of the nanocarbon application. Results: The number of central lymph (level VI) nodes dissected and the number of metastatic lymph nodes identified were analyzed in both groups. The number of dissected lymph nodes from both unilateral and bilateral thyroid surgeries was significantly larger in the nanocarbon group than in the control group. At the same time, the number of identified metastasis lymph nodes dissected were higher in the nanocarbon group than in the control group. We assessed the postoperative calcium and PTH level to evaluate the parathyroid function. Our results show that the nanocarbon group had a better protective effect on parathyroid function than the control group. Conclusions: As a lymph node trace agent, nanocarbon could better evaluate and permit a more clear lymph dissection for patients with PTC. Nanocarbon contributes to a decrease in the incidence rate of parathyroid damage, which has great clinical value.
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Affiliation(s)
- Jun-Jie Ma
- Department of Surgery, Linhai Hospital of Traditional Chinese Medicine, Taizhou, P.R. China
| | - Dong-Bao Zhang
- Department of Surgery, Linhai Hospital of Traditional Chinese Medicine, Taizhou, P.R. China
| | - Wei-Feng Zhang
- Department of Surgery, Linhai Hospital of Traditional Chinese Medicine, Taizhou, P.R. China
| | - Xiong Wang
- Department of Surgery, Linhai Hospital of Traditional Chinese Medicine, Taizhou, P.R. China
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14
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Tan Y, Guo B, Deng X, Ding Z, Wu B, Niu Y, Hou J, Zhang Y, Fan Y. Transoral endoscopic selective lateral neck dissection for papillary thyroid carcinoma: a pilot study. Surg Endosc 2019; 34:5274-5282. [PMID: 31834511 DOI: 10.1007/s00464-019-07314-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 12/03/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Transoral endoscopic thyroid surgery via the vestibular approach (TOETVA) has been gradually accepted worldwide due to its scar-free effect on the neck. Even central cervical lymphadenectomy has been performed in some cases of papillary thyroid carcinoma (PTC). However, there are few reports involving lateral neck dissection with TOETVA. In this study, we attempted to perform selective lateral neck dissection (SLND) for PTC via a transoral vestibular approach. METHODS This prospective study was conducted from January 2016 to December 2018 in twenty PTC patients with unilateral T1 tumors without capsular invasion and patients with abnormal level III and IV lymph nodes who underwent SLND via a transoral vestibular approach. RESULTS Endoscopic surgery was successfully accomplished in all 20 PTC patients. The mean age was 29.2 ± 5.5 (20-41) years. The mean operation time was 146.0 ± 18.7 (114-193) min. The average postoperative hospital stay was 6.8 ± 1.3 (5-10) days. The mean number of removed nodes was 7.4 ± 2.5 (4-12) in the central neck and 10.9 ± 2.8 (6-16) in the lateral neck, and the positive yield amounts were 2.0 ± 1.2 (0-4) and 2.7 ± 1.9 (0-6), respectively. No major complications occurred except for 1 case of transient unilateral recurrent laryngeal nerve palsy and two cases of effusion in the operative area. No evidence of persistent or recurrent disease was observed in these patients during a mean follow-up of 24.3 ± 9.1 (6-36) months. The cosmetic results and protection of personal privacy of this procedure were excellent. CONCLUSION Endoscopic SLND via the transoral vestibular approach is feasible, safe, and effective for selected PTCs. A multicenter large comparative study is necessary.
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Affiliation(s)
- YuYan Tan
- Department of Thyroid and Breast Surgery, The First College of Clinical Science of Three Gorges University, Yiling Road 183, Yichang, Hubei, 443003, China.,Department of Thyroid and Breast Surgery, Shanghai Jiao Tong University Affiliated with the Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China
| | - BoMin Guo
- Department of Thyroid and Breast Surgery, Shanghai Jiao Tong University Affiliated with the Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China
| | - XianZhao Deng
- Department of Thyroid and Breast Surgery, Shanghai Jiao Tong University Affiliated with the Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China
| | - Zheng Ding
- Department of Thyroid and Breast Surgery, Shanghai Jiao Tong University Affiliated with the Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China
| | - Bo Wu
- Department of Thyroid and Breast Surgery, Shanghai Jiao Tong University Affiliated with the Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China
| | - YiQi Niu
- Department of Thyroid and Breast Surgery, Shanghai Jiao Tong University Affiliated with the Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China
| | - JianZhong Hou
- Department of Thyroid and Breast Surgery, Shanghai Jiao Tong University Affiliated with the Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China
| | - YinChao Zhang
- Department of Thyroid and Breast Surgery, Shanghai Jiao Tong University Affiliated with the Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China
| | - YouBen Fan
- Department of Thyroid and Breast Surgery, Shanghai Jiao Tong University Affiliated with the Sixth People's Hospital, Yishan Road 600, Shanghai, 200233, China.
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15
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Xie QP, Xiang C, Wang Y, Yan HC, Zhao QZ, Yu X, Zhang ML, Wang P. The patterns and treatment of postoperative hemorrhage and hematoma in total endoscopic thyroidectomy via breast approach: experience of 1932 cases. Endocrine 2019; 63:422-429. [PMID: 30652236 DOI: 10.1007/s12020-018-01837-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 12/31/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Postoperative hemorrhage and hematoma formation is a potentially lethal complication in thyroid surgery, although the patterns and treatment of hemorrhage after total endoscopic thyroidectomy (TET) via breast approach has not been reported previously. We aim to share our experience about postoperative bleeding. METHODS A retrospective analysis of 1932 patients who underwent TET from April 2008 to May 2018 in our institution was carried out. The patterns of postoperative hemorrhage and hematoma formation that need surgical treatment were summarized and focused on the relation to the source of bleeding and the time interval between first surgery and hemorrhage. Related risk factors were analyzed by univariate or multivariate analysis processes. RESULTS The overall rate of hemorrhage and hematoma occurrence was only 0.724% (14 in 1932 patients). Of them, 12 occurred in the first 24 h after surgery, and the other two occurred after withdrawal of the drainage tube. The principle independent risk factors for postoperative hemorrhage and hematoma were age (older than 35 years old) and lateral compartment dissection (LCD) revealed by multivariate regression. During re-exploration, obvious bleeding points were detected in 13 patients. Among them, 12 bled from the vessels in the main trocar cavity and another 1 bled from a broken vein located between the two heads of the sternocleidomastoid (SCM) muscle with LCD. CONCLUSIONS Hemorrhage after TET usually occurs within 24 h, and the main video trocar cavity was the area most likely to bleed. Age and LCD may increase the bleeding risk. Appropriate dissection level is the main solution to prevent postoperative hemorrhage.
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Affiliation(s)
- Qiu-Ping Xie
- The Department of Surgery, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China
| | - Cheng Xiang
- The Department of Surgery, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China
| | - Yong Wang
- The Department of Surgery, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China
| | - Hai-Chao Yan
- The Department of Surgery, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China
| | - Qun-Zi Zhao
- The Department of Surgery, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China
| | - Xing Yu
- The Department of Surgery, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China
| | - Mao-Lin Zhang
- The Department of Surgery, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China
| | - Ping Wang
- The Department of Surgery, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China.
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16
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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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17
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Guo Y, Qu R, Huo J, Wang C, Hu X, Chen C, Liu D, Chen W, Xiong J. Technique for endoscopic thyroidectomy with selective lateral neck dissection via a chest-breast approach. Surg Endosc 2018; 33:1334-1341. [PMID: 30569419 DOI: 10.1007/s00464-018-06608-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 11/28/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Endoscopic thyroidectomy has been widely accepted because it can effectively avoid neck scarring. However, there are seldom reports concerning completely endoscopic lateral neck dissection approaches. In this study, we introduced a technique for performing endoscopic thyroidectomy with lateral neck dissection via a chest-breast approach. METHODS We retrospectively reviewed 18 patients who underwent endoscopic total thyroidectomy along with levels II, III, IV, and VI dissection. All major outcomes, such as cosmetic effect, operative time and complications, etc., were analyzed. In addition, another 20 patients who underwent traditional open surgery (open group) were enrolled in the study to conduct a contrasting analysis between patients treated with the endoscopic technique (endoscopic group) and open group patients, in terms of demographic data and main operative outcomes, to evaluate the feasibility of this technique. RESULTS All 18 endoscopic surgery cases were successfully performed, and no patient was converted to the open procedure intra-operatively. There were no significant differences between the two groups regarding age (P = 0.209), Body Mass Index (P = 0.479), sex (P = 0.218), drainage time (P = 0.153), operation time (P = 0.065), intra-operative blood loss (P = 0.139), post-operative pain (P = 0.114), and number of dissected lateral lymph nodes (II: P = 0.201; III + IV: P = 0.107). The mean total and lateral lymph nodes dissection (LLND) time in the endoscopic group were longer than those of the open group (P = 0.002; 235 ± 35 vs. 182 ± 20 min, P = 0.000; 125 ± 21 vs. 80 ± 14 min, P = 0.000). The primary lesion diameter of the endoscopic group was smaller than that of the open group (1.7 ± 0.8 vs. 2.9 ± 1.3 cm, P = 0.002). The scores for cosmetic satisfaction in the endoscopic group were higher than those in the open group (8.3 ± 0.7 vs. 4.4 ± 0.9, P = 0.000). Among the complications, there was no significant difference between the two approaches in transient vocal cord paresis (1/18 vs. 0/20, P = 0.474), transient hypoparathyroidism (4/18 vs. 4/20, P = 1.000), post-operative lymphatic leakage (1/18 vs. 3/20, P = 0.606), and intra-operative large blood vessel injury (2/18 vs. 0/20, P = 0.218). There was no incidence of uncontrolled bleeding, mental nerve injury, permanent hypoparathyroidism, permanent recurrent laryngeal nerve (RLN) injury, skin bruise on the neck, asphyxia/dyspnea or other complications like tracheal injury, esophageal injury, etc., nor was there any death or recurrence in either of the two groups during the short follow-up period. CONCLUSION It is feasible to perform LLND (levels II, III, IV, and VI) with endoscopic thyroidectomy via a chest-breast approach. In particular, this technique avoids a large scar on the patient's neck and has well operative outcomes compared with open surgery. Accordingly, this technique may offer one more option for selective patients.
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Affiliation(s)
- Youming Guo
- Department of Thyroid Surgery, First People's Hospital of Zunyi, Zunyi, 563000, China
| | - Rui Qu
- Department of Thyroid Surgery, First People's Hospital of Zunyi, Zunyi, 563000, China.
| | - Jinlong Huo
- Department of Thyroid Surgery, First People's Hospital of Zunyi, Zunyi, 563000, China
| | - Cunchuan Wang
- Department of General Surgery, First Affiliated Hospital of Jinan University, Guangzhou, 510630, China
| | - Xiaochi Hu
- Department of Thyroid Surgery, First People's Hospital of Zunyi, Zunyi, 563000, China
| | - Chen Chen
- Department of Thyroid Surgery, First People's Hospital of Zunyi, Zunyi, 563000, China
| | - Daosheng Liu
- Department of Thyroid Surgery, First People's Hospital of Zunyi, Zunyi, 563000, China
| | - Weiwei Chen
- Department of Endoscopy Center, First People's Hospital of Zunyi, Zunyi, 563000, China
| | - Jing Xiong
- Department of Thyroid Surgery, First People's Hospital of Zunyi, Zunyi, 563000, China
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18
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Wang Y, Zhang Z, Zhao Q, Xie Q, Yan H, Yu X, Xiang C, Zhang M, Wang P. Transoral endoscopic thyroid surgery via the tri-vestibular approach with a hybrid space-maintaining method: A preliminary report. Head Neck 2018; 40:1774-1779. [PMID: 29603475 DOI: 10.1002/hed.25157] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 12/10/2017] [Accepted: 02/08/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Transoral endoscopic thyroid surgery has been introduced in a few institutions. The purpose of this study was to present an innovative hybrid space-maintaining method for the tri-vestibular approach. METHODS Eighteen consecutive patients underwent transoral endoscopic thyroidectomy. Three incisions were made in the vestibule. The surgical space was maintained with CO2 insufflation along with a suspension device. Thyroidectomy and central neck dissection (CND) were performed safely and effectively. RESULTS The mean operation time was 124 minutes for a simple lobectomy, subtotal thyroidectomy, and isthmectomy in 8 patients, 172 minutes for hemithyroidectomy with ipsilateral CND in 8 patients, and 205 minutes for total thyroidectomy with ipsilateral CND in 7 patients. Transient superior laryngeal nerve (SLN) injury occurred in 3 patients and transient mental nerve injury was found in 1 patient. No evidence of recurrence or metastasis was found at follow-up. CONCLUSION This approach brings satisfactory cosmetic effect along with minimal invasion. Further study is needed to verify its validity.
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Affiliation(s)
- Yong Wang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Ziyi Zhang
- Zhejiang University, School of Medicine, Hangzhou, China
| | - Qunzi Zhao
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Qiuping Xie
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Haichao Yan
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Xing Yu
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Cheng Xiang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Maolin Zhang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Ping Wang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
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The Latest Advancements in Selective Neck Dissection for Early Stage Oral Squamous Cell Carcinoma. Curr Treat Options Oncol 2017; 18:31. [PMID: 28474264 DOI: 10.1007/s11864-017-0471-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OPINION STATEMENT The management of cervical lymph node metastasis remains a crucial component of the treatment of head and neck cancers. However, the proper management of clinical N 0 cases with early-stage oral squamous cell carcinoma (OSCC) remains undefined. In the advent of minimally invasive techniques in the 1980s, these techniques have gained popularity among numerous surgeons in all fields of surgery. Although there are no randomized controlled trial data comparing the outcomes of minimally invasive techniques (endoscopically assisted selective neck dissection (SND), robot-assisted SND) with conventional techniques, encouraging evidence from several studies suggests that both endoscopically assisted SND and robot-assisted SND are safe, minimally invasive techniques with achieved short-term oncologic outcomes and can reach a better cosmetic outcome than conventional SND. In this review, we also compare the indications, surgical approaches, and relative advantages and disadvantages of conventional SND, endoscopically assisted SND, and robot-assisted SND to provide surgeons with a means to better consider these techniques for the treatment of early-stage OSCC.
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20
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Singaporewalla RM, Tan BC, Rao AD. The lateral "backdoor" approach to open thyroid surgery: A comparative study. Asian J Surg 2017; 41:384-388. [PMID: 28693960 DOI: 10.1016/j.asjsur.2017.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 04/28/2017] [Accepted: 05/19/2017] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The traditionally taught technique for conventional open thyroidectomy is via a midline splitting of the strap muscles following a skin crease neck incision - midline approach (MA). The lateral "backdoor" approach (LA) uses the same central neck incision but approaches the thyroid gland between the anterior border of sternocleidomastoid (SCM) and strap muscles. This technique is usually reserved for re-do thyroid surgery. We compared the results of the two approaches in patients undergoing conventional thyroidectomy for the first time. METHODS A case-control study was performed on 90 patients undergoing conventional open thyroidectomy from 2012 to 2014. The first 45 patients underwent MA and subsequent 45 patients underwent LA. All patients were given 10 ml of 1% Marcaine infiltration into the neck incision before closure. Basic demographic data, operative time, incision length, weight of gland, need for transection of strap muscles and complications were recorded. Revision thyroid surgery and minimally invasive thyroid operations were excluded. RESULTS The demographics, operative timing, gland weight and incisional length showed no significant difference. Post-operative pain was significantly lower in the LA group. 5 patients (11%) in MA group needed horizontal transection of strap muscles to extract large goitres compared to 1 patient (2.2%) in the LA group. No major complications occurred in either group. CONCLUSION The LA method is as safe as the midline technique with comparable operative time and significantly lower pain scores. It avoids midline separation and suturing of strap muscles and reduces the need for strap muscle transection to removal large goitres.
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Affiliation(s)
- R M Singaporewalla
- Endocrine Surgical Service, Department of Surgery, Khoo Teck Puat Hospital, Singapore.
| | - B C Tan
- Endocrine Surgical Service, Department of Surgery, Khoo Teck Puat Hospital, Singapore
| | - A D Rao
- Endocrine Surgical Service, Department of Surgery, Khoo Teck Puat Hospital, Singapore
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21
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Pan JH, Zhou H, Zhao XX, Ding H, Wei L, Qin L, Pan YL. Robotic thyroidectomy versus conventional open thyroidectomy for thyroid cancer: a systematic review and meta-analysis. Surg Endosc 2017; 31:3985-4001. [PMID: 28337546 DOI: 10.1007/s00464-017-5433-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 01/20/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Despite the new technical alternative offered by the robotic surgery for minimally invasive thyroid surgery, the role of the robotic thyroidectomy (RT) in thyroid cancer has been highly disputed. This paper gives a systematic review and meta-analysis aiming to compare RT and open thyroidectomy (OT) based on the surgical outcomes and oncologic results. METHODS Relevant literature was searched from various databases up to July 2016, including PubMed, MEDLINE, EMBASE, Cochrane Library, Web of science and Clinical Trials. gov. Outcomes of interest included patient characteristics, surgical outcomes, adverse events and complications, recurrence rate, and surgical completeness. RESULTS The systematic review and meta-analysis were based on the 5200 cases selected from the twenty-three publications. RT was associated with an equivalent adverse event and complication rate including transient hypocalcemia, permanent hypocalcemia, transient hoarseness, permanent recurrent laryngeal nerve (RLN) palsy, transient hypoparathyroidism, permanent hypoparathyroidism, hematoma, postoperative bleeding, seroma, chyle leakage, the Voice Handicap Index-10 (VHI-10) score, as well as equivalent surgical completeness including postoperative radioactive iodine (RAI) ablation rate, number of RAI ablation sessions, mean total RAI ablation dose, mean stimulated Tg of postoperation RAI, and proportion of stimulated Tg < 1.0 ng/ml on first ablation. Moreover, RT had lesser blood loss (WMD - 1.47, p = 0.04), smaller number of retrieved lymph nodes (WMD - 1.21, p = 0.0002), a low level of swallowing impairment (WMD - 4.17, p < 0.00001), and better cosmetic satisfaction (OR 4.05, p < 0.00001). However, OT was associated with shorter operation time (WMD 69.80, p < 0.00001), less total drain amount (WMD 66.53, p < 0.0001), and lower postoperative serum Tg level (WMD 0.21, p < 0.00001). CONCLUSIONS RT is as safe as OT for the treatment of thyroid cancer. Based on the long-time follow-up and surgical completeness, the adverse events and complications, and recurrence rate of RT were comparable with OT. RT was associated with a significantly lesser blood loss, smaller number of retrieved lymph nodes, a lower level of swallowing impairment, and better cosmetic satisfaction. In contrast, OT was associated with shorter operation time, smaller total drain amount, and lower postoperative serum Tg level. Overall, randomized clinical trials and larger patient cohort with long-term follow-up are still essential to further demonstrate the value of the robotic approach.
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Affiliation(s)
- Jing-Hua Pan
- Department of General Surgery, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
| | - Hong Zhou
- Department of Gynecology, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
| | - Xiao-Xu Zhao
- Department of General Surgery, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
| | - Hui Ding
- Department of General Surgery, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
| | - Li Wei
- Department of General Surgery, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China
| | - Li Qin
- Department of Histology and Embryology, Medical School of Jinan University, Guangzhou, 510632, China
| | - Yun-Long Pan
- Department of General Surgery, the First Affiliated Hospital of Jinan University, Guangzhou, 510632, China.
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22
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Liu W, Zhou M. A Comparative Study on the Transareola Single-Site Versus Three-Port Endoscopic Thyroidectomy. J Laparoendosc Adv Surg Tech A 2016; 27:242-246. [PMID: 27705097 DOI: 10.1089/lap.2016.0333] [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] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To explore the feasibility, safety, and advantages of transareola single-site endoscopic thyroidectomy. METHODS From January 2014 to December 2015, 40 patients were randomly divided into an observation group who received single-site endoscopic thyroidectomy by the areola approach and a control group who underwent three-port endoscopic thyroidectomy by the areola approach with 20 patients in each group. The feasibility and safety of the operation and postoperative clinical outcomes were compared between these two groups. RESULTS There was no significant difference in operation time, intraoperative blood loss, and hospitalization time (P > .05) between the two groups. The subcutaneous dissection area in the observation group (130 [120-130] cm2) was significantly smaller than that in the control group (180 [170-190] cm2) (P < .01). In addition, there is much less postoperative drainage in the observation group (70 [50-80] mL) than in the control group (80 [60-100] mL) (P = .036). Furthermore, 24-hour postoperative pain score in the observation group (4.0 [3.0-5.5]) was significantly lower compared with that in the control group (5.0 [4.0-7.0]) (P = .047). Moreover, patients in the observation group present with significantly higher 7-day postoperative cosmetic satisfaction scores (9.0 [8.0-9.0]) than those in the control group (7.0 [7.0-8.0]) (P < .001). CONCLUSION Transareola single-site endoscopic thyroidectomy exhibits superior advantages in clinical outcomes such as causing less pain and achieving better cosmetic satisfaction, compared with three-port endoscopic thyroidectomy.
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Affiliation(s)
- Weiwei Liu
- Department of General Surgery, Shanghai Tongren Hospital , Shanghai, China
| | - Ming Zhou
- Department of General Surgery, Shanghai Tongren Hospital , Shanghai, China
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23
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Xiang D, Xie L, Li Z, Wang P, Ye M, Zhu M. Endoscopic thyroidectomy along with bilateral central neck dissection (ETBC) increases the risk of transient hypoparathyroidism for patients with thyroid carcinoma. Endocrine 2016; 53:747-53. [PMID: 26886901 DOI: 10.1007/s12020-016-0884-y] [Citation(s) in RCA: 13] [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] [Received: 12/16/2015] [Accepted: 02/01/2016] [Indexed: 01/01/2023]
Abstract
Increasing number of patients with thyroid carcinoma, especially young female patients, prefer to choose endoscopic thyroidectomy with bilateral central neck dissection (ETBC) for perfect cosmetic effects. However, the incidence of hypoparathyroidism after ETBC has not been well studied. Ninety six patients with papillary thyroid carcinoma were enrolled. All patients, including 49 ETBC and 47 open surgery patients, underwent total thyroidectomy with bilateral central neck dissection (CND). Some patients also underwent lateral neck dissection simultaneously. The incidence of hypoparathyroidism and parathyroid hormone (PTH) level were examined. Patients in the open surgery group had more advanced lesions, with larger tumor (p = 0.000), older age (p = 0.000), and more serious local involvement. The dissection extent of the open group was significantly larger than that of the ETBC group (p = 0.006). In contrast, the ETBC group with less dissection extent showed a significantly higher incidence of transient hypoparathyroidism than the open group (59.2 vs. 29.6 %, p = 0.004). The average PTH decline of the ETBC group was significantly higher than that of the open group on postoperative day 1 (POD1) (32.1 vs. 21.6 pg/ml, p = 0.010). Furthermore, the ETBC group had a significantly higher portion of patients with a PTH <10 pg/ml on POD1 (p = 0.001). One patient in the ETBC group developed permanent hypoparathyroidism. Autotransplantation and inadvertent removal rates of parathyroid did not differ between the two groups. Although generally considered a safe method for patients with thyroid carcinoma, ETBC may increase the risk of transient hypoparathyroidism compared with conventional open surgery.
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Affiliation(s)
- Dapeng Xiang
- Department of General Surgery, Second Affiliated Hospital School of Medicine, Zhejiang University, No. 88 Jiefang Avenue, Hangzhou, 310009, Zhejiang Province, China
| | - Liangqi Xie
- Department of Molecular and Cellular Biology, UC Berkeley, Berkeley, CA, USA
| | - Zhiyu Li
- Department of General Surgery, Second Affiliated Hospital School of Medicine, Zhejiang University, No. 88 Jiefang Avenue, Hangzhou, 310009, Zhejiang Province, China.
| | - Ping Wang
- Department of General Surgery, Second Affiliated Hospital School of Medicine, Zhejiang University, No. 88 Jiefang Avenue, Hangzhou, 310009, Zhejiang Province, China
| | - Mao Ye
- Department of General Surgery, Second Affiliated Hospital School of Medicine, Zhejiang University, No. 88 Jiefang Avenue, Hangzhou, 310009, Zhejiang Province, China
| | - Mingzhu Zhu
- Department of General Surgery, Second Affiliated Hospital School of Medicine, Zhejiang University, No. 88 Jiefang Avenue, Hangzhou, 310009, Zhejiang Province, China
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Wang Y, Yu X, Wang P, Miao C, Xie Q, Yan H, Zhao Q, Zhang M, Xiang C. Implementation of Intraoperative Neuromonitoring for Transoral Endoscopic Thyroid Surgery: A Preliminary Report. J Laparoendosc Adv Surg Tech A 2016; 26:965-971. [PMID: 27585396 DOI: 10.1089/lap.2016.0291] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Transoral endoscopic approach is the natural orifice surgery applied in thyroidectomy to achieve an excellent cosmetic result. Recurrent laryngeal nerve (RLN) injury is the most common complication and little advancement was achieved in the previous clinical studies of transoral thyroid surgery. Herein, we introduced the method of intraoperative neuromonitoring (IONM) for transoral endoscopic thyroid surgery. MATERIALS AND METHODS Patients with thyroid carcinoma received transoral endoscopic thyroid surgery through vestibular approach (TOETVA) for thyroidectomy and central node dissection (CND). IONM was implemented to identify whether the RLN benefited from oral tracheal intubation. The laryngeal electromyography (EMG) response, operation time, number of CND, drainage volume, hospital duration, surgical complications, and cosmetic results were evaluated. RESULTS From August to October 2015, 10 cases were performed with TOETVA and IONM. All EMG responses were recorded intraoperatively, and no case experienced transient or permanent RLN palsy. The operation time ranged from 130 to 215 minutes in ipsilateral lobectomy with CND, whereas bilateral lobectomy with ipsilateral CND lasted 345 minutes. The number of CNDs ranged from three to eight. The average time of drainage extubation and discharge was 4 days (3-5 days) postoperatively. All patients were satisfied with the cosmetic results, and no infection was observed at lip wound or in the anterior neck region. CONCLUSION IONM system implemented in transoral thyroid surgery was feasible and serviceable in preventing RLN injury. The method of TOETVA shows promise for thyroidectomy with CND due its ideal cosmetic results.
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Affiliation(s)
- Yong Wang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University College of Medicine , Hangzhou, China
| | - Xing Yu
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University College of Medicine , Hangzhou, China
| | - Ping Wang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University College of Medicine , Hangzhou, China
| | - Chundi Miao
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University College of Medicine , Hangzhou, China
| | - Qiuping Xie
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University College of Medicine , Hangzhou, China
| | - Haichao Yan
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University College of Medicine , Hangzhou, China
| | - Qunzi Zhao
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University College of Medicine , Hangzhou, China
| | - Maolin Zhang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University College of Medicine , Hangzhou, China
| | - Cheng Xiang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University College of Medicine , Hangzhou, China
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Reoperative thyroid surgery: can endoscopic areola approach be used? Surg Endosc 2016; 31:1296-1304. [PMID: 27422250 DOI: 10.1007/s00464-016-5110-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 07/11/2016] [Indexed: 10/21/2022]
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