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Riva FMG, Kerawala C. Perforator Flaps and Robotic Surgery for Head and Neck Reconstruction. Oral Maxillofac Surg Clin North Am 2024; 36:557-566. [PMID: 39142950 DOI: 10.1016/j.coms.2024.07.006] [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] [Indexed: 08/16/2024]
Abstract
Head and neck cancer (HNC) is the sixth most common cancer across the world. Despite a general reduction in tobacco consumption and therefore reduction in risk exposure there has been an increasing incidence of oropharyngeal squamous cell carcinoma. Progress made in the past decades in free tissue transfer reconstruction and robotic surgery have merged into transoral robotic reconstruction with free perforator flaps for head and neck. We reviewed and discussed indications and contraindications for this type of procedure, as well as potential limits refinements.
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Affiliation(s)
- Francesco M G Riva
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK.
| | - Cyrus Kerawala
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK
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Mirghani H, Alhowiti A. Knowledge and perception of medical students regarding remote-access thyroidectomy in Tabuk: the effects of extensive counseling-an interventional study. Front Surg 2024; 11:1428046. [PMID: 39360196 PMCID: PMC11445224 DOI: 10.3389/fsurg.2024.1428046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Accepted: 08/29/2024] [Indexed: 10/04/2024] Open
Abstract
Introduction Remote-access scarless thyroidectomies are relatively new surgical procedures, and their uptake for cosmetic concerns is rapidly evolving. However, demographic factors, previous thyroid surgery, and culture substantially influence the patient's choice. This is the first study to assess the extensive counseling effect on the patient's preference for remote-access thyroidectomies compared to conventional transcervical approaches. We aimed to assess the same among medical students at the University of Tabuk, Saudi Arabia. Methods This interventional study was conducted from December 2023 to March 2024. A structured questionnaire was used to gather information about demographic factors, knowledge, and perception of the medical students regarding remote-access thyroidectomies before and after a slide presentation. Results Of 394 medical students (age 22.65 ± 1.62 years), 53.8% were women. Initially, the majority of the students preferred remote-access thyroidectomy over the conventional approach (85.3% vs. 14.7%, respectively); however, a substantial change toward the cervical approach was evident after extensive counseling [odds ratio, 2.59; 95% confidence interval (CI), 1.58-4.27; and P-value <0.00]. Knowledge regarding remote-access thyroidectomy was poor (26.9%). The students were anxious regarding postoperative complications (3.22 ± 1.59/5), thyroid scar appearance (3.28 ± 1.36/5), and postoperative pain (3.17 ± 1.38/5). Concerns regarding body satisfaction and cost were lower. Conclusion Medical students at the University of Tabuk, Saudi Arabia, demonstrated low knowledge. The strong preference for remote-access thyroidectomy over transcervical thyroidectomy shifted substantially toward the conventional approach after counseling. The main factors were thyroid scar appearance, pain, and complications. Further larger-scale studies involving the general public and assessing the effect of extensive counseling on surgical choice are needed.
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Affiliation(s)
- Hyder Mirghani
- Department of Internal Medicine, Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia
| | - Amirah Alhowiti
- Department of Family and Community Medicine, Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia
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Thiagarajan S, Menon A, Panmand H, Bamane P, Pawar A. A prospective study to assess cervical scar satisfaction following conventional open thyroidectomy for thyroid cancer. Eur Arch Otorhinolaryngol 2024; 281:4363-4372. [PMID: 38676715 DOI: 10.1007/s00405-024-08668-z] [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: 02/02/2024] [Accepted: 04/08/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Conventional open thyroidectomy (COT) remains a common method of thyroidectomy in many parts of the world for various reasons. METHODS In this prospective (cross-sectional) study, we evaluated the scar satisfaction among patients and surgeons following COT using the Patient and Observer Scar Assessment Scale (POSAS) and the Patient Scar Assessment Questionnaire (PSAQ). RESULTS A total of 116 patients were included. The median age of the patients was 44 years and the majority were women. The median scar length overall was 12.2 cm. On POSAS, the median score for surgeon 1 was 1 (range 1-5), for surgeon 2, it was 2 (range 1-6), and for the patient, it was 1 (range 1-6) suggesting good scar satisfaction. The patient's response in the PSAQ was also echoing similar outcomes with scar satisfaction. CONCLUSIONS Overall, both the patients and the surgeons seem to be satisfied with the overall scar appearance following COT despite the scar length.
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Affiliation(s)
- Shivakumar Thiagarajan
- Division of Head & Neck, Department of Surgical Oncology, Homi Bhabha National Institute (HBNI), Tata Memorial Centre, Mumbai, India.
| | - Abhishek Menon
- Division of Head & Neck, Department of Surgical Oncology, Homi Bhabha National Institute (HBNI), Tata Memorial Centre, Mumbai, India
| | - Hrutika Panmand
- Department of Clinical Research, Homi Bhabha National Institute (HBNI), Tata Memorial Centre, Mumbai, India
| | - Pooja Bamane
- Department of Clinical Research, Homi Bhabha National Institute (HBNI), Tata Memorial Centre, Mumbai, India
| | - Akash Pawar
- Clinical Research Secretariate, Homi Bhabha National Institute (HBNI), Tata Memorial Centre, Mumbai, India
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Agne GR, Kohler HF, Lira RB, Belli M, Bento GN, Viana A, Kowalski LP. Aesthetic Perceptions Regarding a Thyroidectomy Scar and Transvestibular Approach in Brazil. Laryngoscope 2024; 134:3862-3867. [PMID: 38411345 DOI: 10.1002/lary.31372] [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: 11/06/2023] [Revised: 02/05/2024] [Accepted: 02/15/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE We investigated motivation levels across the general Brazilian population and subgroups and their willingness to spend for surgery without a cervical scar. METHODS This random-sample survey was performed by a specialized third-party research institute. In this study, we created a hypothetical thyroidectomy scenario, and the transcervical and transoral endoscopic thyroidectomy vestibular approach (TOETVA) were used. The survey included sociocultural data and questions regarding participants' surgical preferences. RESULTS Data were obtained from 1250 participants; 42.4% were of the opinion that a cervical scar affects social or professional life. Young and childless women were most likely to be affected (p <0.001). All respondents accepted the transoral approach to avoid cervical scarring. However, 30.7% and 31.9% of respondents maintained their preference for TOETVA despite understanding the risks of a hypothetical increase in complications and unfavorable oncological outcomes and 98.6% were of the opinion that this approach was likely associated with greater postoperative pain. Only 16.2% were unwilling to spend for TOETVA. The variable that most affected patients' willingness to spend was a salary greater than 10 Brazilian minimum wages (odds ratio 9.797, 95% confidence interval, p <0.005). Upper class respondents were 10 times more likely to spend for TOETVA than lower class patients. CONCLUSION This study highlights patients' interest in TOETVA. Cervical scar perception is affected by concerned about appearance, particularly in certain societal subgroups. Our study population showed significant motivation to undergo TOETVA, which was emphasized by their acceptance of the complication rate, poor postoperative outcomes, greater postoperative pain, and willingness to spend on surgery with an invisible scar. LEVEL OF EVIDENCE 4 Laryngoscope, 134:3862-3867, 2024.
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Affiliation(s)
| | - Hugo Fontan Kohler
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Renan Bezerra Lira
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Marcelo Belli
- Department of Head and Neck Surgery, PESCOP Group, Balneário Camboriú, Brazil
| | - Gustavo Nunes Bento
- Department of Head and Neck Surgery, PESCOP Group, Balneário Camboriú, Brazil
| | - Acklei Viana
- Department of Head and Neck Surgery, NICAP Group, Florianópolis, Brazil
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo, Brazil
- Department of Head and Neck Surgery, Universidade de São Paulo, São Paulo, Brazil
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Nagururu NV, Seo S, Ding AS, Grogan R, Wolfe SA, Harbison RA, Tufano RP, Russell JO. Long-term Quality of Life After Thyroidectomy: Transoral Endoscopic Thyroidectomy Vestibular Approach Versus Transcervical Approach. Otolaryngol Head Neck Surg 2024; 171:45-53. [PMID: 38488229 DOI: 10.1002/ohn.712] [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: 10/12/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE To compare long-term health-related quality of life (HRQOL) after Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) and transcervical approach (TCA) thyroidectomy. STUDY DESIGN Prospective cohort study. SETTING Tertiary referral center. METHODS A web-based survey was distributed to patients at our institution who met the criteria for TOETVA and underwent thyroidectomy by TOETVA or TCA between August 2017 and October 2021. All survey participants were at least 6 months postsurgery. Minors, non-English speakers, and patients who received concomitant neck dissection or reoperative thyroidectomy were excluded from the study. The survey assessed quality of life through 4 standardized instruments: the Dermatology Life Quality Index (DLQI), the Eating Assessment Tool (EAT-10), the Voice Handicap Index (VHI-10), and the Short Form Health Survey (SF-36). RESULTS A total of 108 TOETVA and 129 TCA patients were included in the study. The median age of respondents was 44 (36, 54; 25th, 75th percentile) years and median time from surgery to survey was 35 (22, 45; 25th, 75th percentile) months. TOETVA group DLQI (0.63 vs 0.99; P = .17), VHI-10 (1.94 vs 1.67; P = .35), EAT-10 (2.14 vs 2.32; P = .29), SF-36 physical component (52.25 vs 51.00; P = .25), and SF-36 mental component (47.74 vs 47.29; P = .87) scores were all similar to those of the TCA group. Scrutinizing specific DLQI questions, individuals in the TOETVA group were less self-conscious of their skin as compared to the TCA group (Q2; 0.08 vs 0.26, P = .03). CONCLUSION Long-term HRQOL after TOETVA is similar to TCA, with significantly lower skin-related self-consciousness.
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Affiliation(s)
- Nimesh V Nagururu
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Stefanie Seo
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andy S Ding
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Raymon Grogan
- Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Samantha A Wolfe
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Richard Alex Harbison
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ralph P Tufano
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Head and Neck Endocrine Surgery, Sarasota Memorial Health Care System, Sarasota, Florida, USA
| | - Jonathon O Russell
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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La Via L, Zanghì A, Cavallaro A, Di Vita M, Maniaci A, Cocuzza S, Cappellani A, Di Majo S. Vestibular approach for thyroid surgery: a comprehensive review. Front Surg 2024; 11:1423222. [PMID: 38948483 PMCID: PMC11211391 DOI: 10.3389/fsurg.2024.1423222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 05/29/2024] [Indexed: 07/02/2024] Open
Abstract
The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is an innovative technique in thyroid surgery. This review compiles current research on TOETVA, covering its development, anatomical challenges, techniques, selection of suitable patients, results, complications, and future advancements. We performed a comprehensive literature review on PubMed, EMBASE, and Cochrane databases for articles published up to 15th March 2024. The search strategy included a combination of terms focused on "vestibular approach" and "thyroidectomy". The review underscores the necessity for preoperative planning and careful patient selection to reduce risks and enhance outcomes. It discusses the unique anatomical challenges of TOETVA, such as avoiding mental nerve damage and the complexities involved in creating a subplatysmal space. Outcomes of TOETVA, including surgical duration, complication rates, and recovery times, are compared favorably to traditional methods. The approach is particularly noted for high patient satisfaction and superior cosmetic results. Complications specific to TOETVA, like infection, bleeding, and potential harm to the recurrent laryngeal nerve, are recognized. Future research directions are discussed as well. In summary, TOETVA is a promising alternative for thyroidectomy with excellent cosmetic outcomes and patient satisfaction. Success relies on selective patient criteria, surgical expertise, and continuous research to refine the approach.
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Affiliation(s)
- Luigi La Via
- Department of Anesthesia and Intensive Care, University Hospital Policlinico “G.Rodolico-San Marco”, Catania, Italy
| | - Antonio Zanghì
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
- Centro di Ricerca in Chirurgia Delle Sindromi Malformative Complesse Della Transizione e dell’Età Adulta, University of Catania, Catania, Italy
| | - Andrea Cavallaro
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Maria Di Vita
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Antonino Maniaci
- Faculty of Medicine and Surgery, University of Enna “Kore”, Enna, Italy
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Catania, Italy
| | - Alessandro Cappellani
- Department of General Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Simone Di Majo
- Residency Program in General Surgery, University of Catania, Catania, Italy
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Sayan A, Ganesarajah T, Baheerathan N, Ilankovan V. Do we still need Crile or Hayes Martin approach for cervical lymphadenectomy? A retrospective study of 56 patients with minimal access neck dissection. Br J Oral Maxillofac Surg 2024; 62:471-476. [PMID: 38685146 DOI: 10.1016/j.bjoms.2024.01.016] [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: 12/21/2023] [Revised: 01/22/2024] [Accepted: 01/30/2024] [Indexed: 05/02/2024]
Abstract
The concept of neck dissection was introduced by Crile more than a century ago. Since then, multiple modifications have been adopted to ensure the preservation of vital structures. With the new era of minimal access surgery, the incorporation of laparoscopic, endoscopic, and robotic surgery is becoming the new normal. Over the years we have carried out neck dissections using minimal access incisions. Although there is no definitive answer about the average nodal yield required in selective or modified neck dissections, it has been reported that the average nodal yield of more than 18 is associated with better survival rate. In this publication we share the results of our three-year retrospective study of 56 patients who underwent minimal access neck dissection. We look at the nodal yield, assess operating duration, complications, outcome with a three-year follow up from a single unit. Our results demonstrate that minimal access neck dissection should be considered in head and neck lymphadenectomies.
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Affiliation(s)
- Anna Sayan
- Poole Hospital, University Hospital Dorset NHS Foundation Trust, United Kingdom.
| | | | - Nall Baheerathan
- Poole Hospital, University Hospital Dorset NHS Foundation Trust, United Kingdom
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Zhao X, Bie F, Luo C, Zhang JE. Distress, illness perception and coping style among thyroid cancer patients after thyroidectomy: A cross-sectional study. Eur J Oncol Nurs 2024; 69:102517. [PMID: 38340645 DOI: 10.1016/j.ejon.2024.102517] [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: 04/08/2023] [Revised: 12/30/2023] [Accepted: 01/24/2024] [Indexed: 02/12/2024]
Abstract
PURPOSE Thyroid cancer generally has a good prognosis, and thyroidectomy is the main treatment given to thyroid cancer patients. Almost every cancer patient experiences varying degrees of distress, which can reduce their quality of life. This study aims to explore the level of distress and its relationship with illness perception and coping style among Chinese thyroid cancer patients after thyroidectomy and to identify the influencing factors on distress. METHODS A cross-sectional study with convenience sampling method was conducted. Totally 184 thyroid cancer patients after thyroidectomy were recruited in a tertiary hospital in Southern China with the response rate being 94.4% . The participants were investigated by a self-designed demographic and disease-related questionnaire, the Distress Management, the Brief Illness Perception Questionnaire, and the Medical Coping Modes Questionnaire. Descriptive statistics, univariate analysis, and multivariate linear regression were applied for data analysis. RESULTS In total, 99 (53.8%) thyroid cancer patients after thyroidectomy scored 4 or higher on the DT. Illness perception, emotional problem, body image loss by surgical scars, and acceptance-resignation were the influencing factors of distress and could explain 67.6% of the variance of distress among thyroid cancer patients after thyroidectomy. CONCLUSIONS Healthcare professionals should not ignore the distress among thyroid cancer patients after thyroidectomy and should take effective measures to alleviate the distress of thyroid cancer patients after thyroidectomy by enhancing their accurate and positive illness perceptions, decreasing their emotional problems, alleviating their body image loss by surgical scars, and avoiding acceptance-resignation coping style.
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Affiliation(s)
- Xinyue Zhao
- Department of Operating Room, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 2nd Zhongshan Road, Guangzhou, 510080, China.
| | - Fenggui Bie
- Department of Operating Room, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 2nd Zhongshan Road, Guangzhou, 510080, China
| | - Caixia Luo
- Department of Operating Room, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, No. 106 2nd Zhongshan Road, Guangzhou, 510080, China
| | - Jun-E Zhang
- School of Nursing, Sun Yat-sen University, No. 74 2nd Zhongshan Road, Guangzhou, 510080, China.
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9
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Roh JL. Scarless Excision of Second Branchial Cleft Cyst via Retroauricular Hairline Incision. Aesthetic Plast Surg 2024; 48:1264-1270. [PMID: 38097689 DOI: 10.1007/s00266-023-03770-9] [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: 09/13/2023] [Accepted: 11/17/2023] [Indexed: 04/24/2024]
Abstract
BACKGROUND Second branchial cleft cyst (2nd BCC) is treated by complete excision. Conventional transcervical skin incision on the lesion may leave a prominent scar in the cosmetically sensitive area. The retroauricular hairline incision (RAHI) approach may maintain neurological, mobility, and cosmetic functions of the neck and face after excision. This study evaluated the clinical outcomes and disease control of scarless surgery via RAHI in 57 consecutive patients with 2nd BCC. METHODS The patients received the prospective evaluation of postoperative neurological, subjective pain, swallowing, neck motion, and cosmetic functions. Postoperative complications, subjective satisfaction, and recurrence were also assessed in each patient. RESULTS Excision was performed in all cases without injury to the facial nerve or other neurological complications and conversion to other incisions or approaches with a median operation time of 44 min. Complications were minimal, without dysphagia, neurological deficits, or limited neck motion. Postoperative incision scars in the postauricular and hairline region were commonly invisible. Subjective satisfaction with the scar and facial deformity was high after surgery. No patients had a recurrence for a median follow-up of 66 months. CONCLUSION The RAHI approach for 2nd BCC has excellent cosmetic, functional, and disease control outcomes. This can be safely applied to the treatment of 2nd BCC. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Jong-Lyel Roh
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Gyeonggi-do, 13496, Republic of Korea.
- Department of Biomedical Science, General Graduate School, CHA University, Seongnam, Republic of Korea.
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10
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Kang YJ, Stybayeva G, Hwang SH. Surgical safety and effectiveness of bilateral axillo-breast approach robotic thyroidectomy: a systematic review and meta-analysis. Braz J Otorhinolaryngol 2024; 90:101376. [PMID: 38228051 PMCID: PMC10823096 DOI: 10.1016/j.bjorl.2023.101376] [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: 09/23/2023] [Revised: 11/09/2023] [Accepted: 12/04/2023] [Indexed: 01/18/2024] Open
Abstract
OBJECTIVES To assess the safety and effectiveness of bilateral axillo-breast approach robotic thyroidectomy in thyroid tumor. METHODS Bilateral axillo-breast approach robotic thyroidectomy and other approaches (open thyroidectomy, transoral robotic thyroidectomy, and bilateral axillo-breast approach endoscopic thyroidectomy) were compared in studies from 6 databases. RESULTS Twenty-two studies (8830 individuals) were included. Bilateral axillo-breast approach robotic thyroidectomy had longer operation time, greater cosmetic satisfaction, and reduced transient hypoparathyroidism than conventional open thyroidectomy. Compared to bilateral axillo-breast approach endoscopic thyroidectomy, bilateral axillo-breast approach robotic thyroidectomy had greater amount of drainage, lower chances of transient vocal cord palsy and permanent hypothyroidism, and better surgical completeness (postopertive thyroblobulin level and lymph node removal). Bilateral axillo-breast approach robotic thyroidectomy induced greater postoperative drainage and greater patient dissatisfaction than transoral robotic thyroidectomy. CONCLUSION Bilateral axillo-breast approach robotic thyroidectomy is inferior to transoral robotic thyroidectomy in drainage and cosmetic satisfaction but superior to bilateral axillo-breast approach endoscopic thyroidectomy in surgical performance. Its operation time is longer, but its cosmetic satisfaction is higher than open thyroidectomy.
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Affiliation(s)
- Yun Jin Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Gulnaz Stybayeva
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, United States
| | - Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, The Catholic University of Korea, College of Medicine, Bucheon St. Mary's Hospital, Seoul, Republic of Korea.
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11
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Au VH, Miller LE, Mitchell MB, Larson AR, Lin DT, Feng AL, Richmon JD. Neck scar perception after neck dissection in HPV-associated oropharyngeal squamous cell carcinoma. Am J Otolaryngol 2024; 45:104074. [PMID: 37865986 DOI: 10.1016/j.amjoto.2023.104074] [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: 08/13/2023] [Accepted: 09/29/2023] [Indexed: 10/24/2023]
Abstract
IMPORTANCE While there has been an increased understanding of the impact of visible neck scars in some patients with certain diseases, this has not yet been explored in the HPV+ OPSCC population. OBJECTIVE To understand patients' perception of their scar and the impact on their quality of life (QOL) at least 6 months after neck dissection (ND) for HPV+ oropharyngeal squamous cell carcinoma (OPSCC). DESIGN, SETTING, AND PARTICIPANTS In this retrospective case-control study, patients who underwent primary transoral robotic surgery (TORS) and ND for HPV+ OPSCC between 2016 and 2021 at a single tertiary care center were identified. Data analysis was performed in January 2022. MAIN OUTCOMES AND MEASURES Dermatology Life Quality Index was modified (mDLQI) to assess patients' perceptions of their scars. The primary outcome was the mean mDLQI survey score with higher scores corresponding to worse perceptions. Three questions adapted from the Self-Consciousness Scale (SCS) were also included to assess awareness of appearance. All questions were scaled on a 0-3 Likert Scale. Tweedie generalized linear model was used to understand the relationship between mDLQI score and patient- and procedure-specific factors (including the three SCS survey questions). An additional exploratory logistic regression was performed to understand the risk factors for clinically significant mDLQI score change. RESULTS A total of 67 patients (response rate 57 %) completed the survey with a mean mDLQI survey score of 0.84 (max 30). Although there was a statistically significant negative association between private insurance and mDLQI survey score (95 % Confidence Interval [CI]: -2.72 - -0.38), and a positive association between the SCS score and mDLQI survey score (95 % CI: 0.23-0.81) (p < 0.05), these variables were not found to be risk factors for a clinically significant difference in mDLQI on multivariable analysis. CONCLUSION The majority of patients felt their neck scars did not interfere with their daily lives. Patient perceptions of neck scars were consistent despite differing patient characteristics and treatment regimens.
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Affiliation(s)
- Vivienne H Au
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States of America; Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, United States of America
| | - Lauren E Miller
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States of America; Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, United States of America
| | - Margaret B Mitchell
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States of America; Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, United States of America
| | - Andrew R Larson
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States of America; Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, United States of America
| | - Derrick T Lin
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States of America; Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, United States of America
| | - Allen L Feng
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States of America; Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, United States of America
| | - Jeremy D Richmon
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States of America; Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, United States of America.
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12
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Xie G, Cheng X, Wan Y. Retrospective comparison of endoscopic transoral and bilateral areolar approaches for thyroglossal cyst resection: a single-centre experience. Eur Arch Otorhinolaryngol 2024; 281:335-341. [PMID: 37589752 DOI: 10.1007/s00405-023-08164-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/26/2023] [Indexed: 08/18/2023]
Abstract
PURPOSE Our study aimed to compare the efficacy, safety, and clinical effect of the transoral approach and the bilateral areolar approach (BAA) for endoscopic thyroglossal duct cyst (TGDC) resection. METHODS In total, 42 patients who received an endoscopic TGDC resection between January 2019 and May 2022 via a transoral (n = 22) or bilateral areolar (n = 20) approach by a single surgeon were retrospectively enrolled. We collected and compared the following data: patients' demographic data, complication events, operative time, bleeding volume, drainage volume, 6-h postoperative pain scores, length of hospitalisation, resected TGDC size, and cosmetic satisfaction. RESULTS There were no cases of conversion to a transcervical approach in the two groups. No significant differences were found between the two groups in terms of age, sex, body mass index, complication, bleeding volume, 6-h postoperative pain scores, and TGDC size (all p > 0.05). However, the operative time and patients' cosmetic satisfaction were higher in the transoral group than in the BAA group (all p < 0.05). In addition, the drainage volume and length of hospitalisation in the transoral group were less than those in the BAA group (all p < 0.05). CONCLUSIONS Both the transoral approach and BAA are safe and reliable; however, the transoral approach is more complex than the BAA and offers better cosmetic satisfaction. Doctors should choose the appropriate surgical procedure based on the patient's condition and preferences.
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Affiliation(s)
- Gang Xie
- Department of Otolaryngology, Head and Neck Surgery, Chaohu Hospital Affiliated to Anhui Medical University, Hefei, 230022, China
| | - Xiaowen Cheng
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, China
| | - Yufeng Wan
- Department of Otolaryngology, Head and Neck Surgery, Chaohu Hospital Affiliated to Anhui Medical University, Hefei, 230022, China.
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Zhu P, Zhang H, Gu X, Ding Y, Qian M, Wang W, Shi G, Lee A. Quality of Life in Chinese Youth Following Open Thyroid Surgery: A Qualitative Study. Cancer Nurs 2023:00002820-990000000-00202. [PMID: 38100753 DOI: 10.1097/ncc.0000000000001314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
BACKGROUND Because of the increased incidence of thyroid cancer and good survival rates and with research into scarless techniques, it is increasingly important to understand the quality of life of thyroid cancer patients and identify areas for improvement. Therefore, it is necessary to explore the importance of neck appearance after thyroidectomy for thyroid cancer survivors in China. OBJECTIVE The purpose of this study was to investigate the effect of scarring after open thyroid surgery on the quality of life of young patients. METHODS A descriptive qualitative design was used. Data were collected using face-to-face semistructured interviews and analyzed using directed content analysis. RESULTS Five men and 19 women participated in the study. The following 3 broad themes and 9 subthemes emerged, which were (1) emotional functioning, including low self-esteem due to high visibility of scars, concerns and helplessness about scarring lesions, and feelings of isolation due to lack of support; (2) social functioning, including restricted choice of employment, avoidance of socializing with others, and reduced participation in social activities; and (3) information seeking, acceptance, and living with the scar, including bargaining, seeking professional help, and use of social media. CONCLUSIONS After open surgery for thyroid cancer, patients experience a variety of scarring features that affect their quality of life. Therefore, preoperative communication and long-term postoperative care should be emphasized in clinical practice and research. IMPLICATIONS FOR PRACTICE Understanding the experience of carrying scars after thyroid cancer surgery helps provide adequate information, expectation management, and informed decision-making.
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Affiliation(s)
- Pingting Zhu
- Author Affiliations: Department of Nursing, Yangzhou University, Yangzhou, Jiangsu, People's Republic of China (Mss Zhang, Gu, Ding, Qian, Wang, and Shi; Dr Zhu) and Manchester Metropolitan University, Manchester, England (Dr Lee)
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14
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Ho MP, Hughes H, Fleming P. The Attitudes of Patients Toward Orthopaedic Post-surgical Scars. Cureus 2023; 15:e47975. [PMID: 38034173 PMCID: PMC10686239 DOI: 10.7759/cureus.47975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Background Post-surgical scars (PSS) are an expected consequence of surgery. Several factors have previously been associated with PSS satisfaction including patient age and time elapsed post-operative. Little data are available regarding patient attitudes toward orthopaedic PSS. Knowledge of patient attitudes and the various associated factors may allow physicians to administer peri-operative care to mitigate the potential negative effects of PSS. Our study aims to investigate the attitudes of patients toward their PSS using quantitative scar assessment scales and to identify factors associated with PSS satisfaction. Methods We conducted a retrospective study with a follow-up. We included all patients with orthopaedic PSS on their upper or lower limbs between two and 18 weeks postoperative attending Cork University Hospital, Ireland, between February and August 2022. Patients completed an initial baseline questionnaire and then a follow-up questionnaire six months post-operative. The Patient and Observer Scar Assessment Scale (POSAS) evaluated PSS satisfaction. The European Quality of Life 5 Domain (EQ-5D), alongside several Likert scales, evaluated the patient's quality of life (QoL). Results In total, 91 patients were included. The mean POSAS score was 28.41 (95% CI, 25.85-30.97). Younger patient age (p=0.045) and decreased time passed post-operatively (p=0.002) were associated with poorer PSS satisfaction. Patients reporting their PSS appearing worse than expected were more likely to agree that their QoL had been adversely affected by it (p=0.001). Conclusion Most patients were satisfied with their orthopaedic PSS. This study identified several factors associated with poor PSS satisfaction. Our finding, which associated patient scar expectations and QoL, is novel and has not been previously examined. Accordingly, peri-operative interventions, including scar expectation management, may be implemented to mitigate scar-related QoL impact.
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Affiliation(s)
- Martin P Ho
- Department of Trauma and Orthopaedic Surgery, Cork University Hospital, Cork, IRL
| | - Hannah Hughes
- Department of Trauma and Orthopaedic Surgery, Cork University Hospital, Cork, IRL
| | - Patrick Fleming
- Department of Trauma and Orthopaedic Surgery, Cork University Hospital, Cork, IRL
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15
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Ishii D, Kumata Y, Ishii S, Motoki K, Miyagi H. Quantitative evaluation of pediatric umbilical loop stomas: 2 decades of experience from a single institution. Pediatr Surg Int 2023; 39:269. [PMID: 37679509 PMCID: PMC10485087 DOI: 10.1007/s00383-023-05546-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 09/09/2023]
Abstract
PURPOSE Since pediatric stomas are often temporary, their creation, management, and closure should be simple, with minimal complications and excellent cosmetic results. We began employing umbilical stomas in 2000. This study aimed to characterize the ingenuity and utility of umbilical stomas and provide a quantitative evaluation of their cosmetic outcomes. METHODS We examined cases of stoma construction and closure surgery performed in our department from January 2000 to December 2022. The umbilical and non-umbilical stoma groups included 54 and 42 cases, respectively, and the findings for both groups were compared and analyzed. RESULTS The two groups showed no significant differences in the incidence of complications. The Manchester Scar Scale score for the umbilical stoma group (8.42 ± 1.85) was significantly better than that for the non-umbilical stoma group (16.31 ± 2.96; P < 0.01). Likewise, in Patient and Observer Scar Assessment Scale assessments, the umbilical stoma group showed significantly better scores in both the observer scale (9.48 ± 2.50 vs. 21.78 ± 7.26; P < 0.01) and the patient scale (10.5 ± 1.39 vs. 22.40 ± 7.35; P < 0.01). CONCLUSIONS Umbilical stomas are easy to manage and yield an inconspicuous closure incision with excellent cosmetic outcomes. Although patient selection is important, pediatric umbilical stomas are a valuable option that can be actively employed.
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Affiliation(s)
- Daisuke Ishii
- Division of Pediatric Surgery, Department of Surgery, Asahikawa Medical University, 2-1-1, Midorigaoka-Higashi, Asahikawa, 078-8510, Japan.
| | - Yuka Kumata
- Division of Pediatric Surgery, Department of Surgery, Asahikawa Medical University, 2-1-1, Midorigaoka-Higashi, Asahikawa, 078-8510, Japan
| | - Seiya Ishii
- Division of Pediatric Surgery, Department of Surgery, Asahikawa Medical University, 2-1-1, Midorigaoka-Higashi, Asahikawa, 078-8510, Japan
| | - Keita Motoki
- Division of Pediatric Surgery, Department of Surgery, Asahikawa Medical University, 2-1-1, Midorigaoka-Higashi, Asahikawa, 078-8510, Japan
| | - Hisayuki Miyagi
- Division of Pediatric Surgery, Department of Surgery, Asahikawa Medical University, 2-1-1, Midorigaoka-Higashi, Asahikawa, 078-8510, Japan
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16
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Alci E, Kim SY, Yun HJ, Gozener S, Ozdemir M, Turk Y, Hassoy H, Lee YS, Kim SM, Icoz G, Chang HS, Makay O. Evaluation of public's perception of scar cosmesis after thyroidectomy: results of a survey of Turkish versus South Korean individuals. Ann Surg Treat Res 2023; 105:119-125. [PMID: 37693291 PMCID: PMC10485354 DOI: 10.4174/astr.2023.105.3.119] [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: 06/27/2023] [Revised: 08/07/2023] [Accepted: 08/14/2023] [Indexed: 09/12/2023] Open
Abstract
Purpose Visible scars on the neck caused by thyroid surgery give rise to significant aesthetic, functional, and psychosocial problems. The objective of this study is to comparatively investigate the public perception of neck scar cosmesis in Turkish and South Korean populations. Methods This survey was prepared to collect participants' demographic and socioeconomic data and determine their perception of scar cosmesis on the neck and consisted of 15 questions. One thousand thirty-nine individuals who did not undergo thyroid surgery completed the survey. The P-values of <0.05 were deemed to indicate statistical significance. Results There were 1,039 respondents, of whom 525 (50.5%) were Turkish and 514 (49.5%) were South Korean. South Korean respondents stated that they would be significantly more uncomfortable with the thought of having a scar due to thyroid surgery, compared to the Turkish respondents (P < 0.001). The South Korean respondents stated that they would be significantly more concerned about the scar's length, thickness, and darkening color, compared to the Turkish respondents (P < 0.001 for all cases). Conclusion Patients' expectations, which are affected by various sociodemographic factors and cultural characteristics, are as important as the medical condition when deciding on the type of thyroid surgery. The study findings clearly indicated that the South Korean population would be significantly more uncomfortable with having a scar on the neck, compared to the Turkish population. Therefore, in selected cases, a scarless thyroidectomy approach, such as transoral endoscopic thyroidectomy, vestibular approach may be preferable for societies like South Korea.
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Affiliation(s)
- Erman Alci
- Department of General Surgery, School of Medicine, Balikesir University, Balikesir, Türkiye
| | - Soo Young Kim
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital and Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeok Jun Yun
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital and Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, Korea
| | - Seda Gozener
- Department of Anatomy, İstanbul Medipol University, School of Medicine, Izmir, Türkiye
| | - Murat Ozdemir
- Division Endocrine Surgery, Department of General Surgery, Ege University Hospital, Izmir, Türkiye
| | - Yigit Turk
- Division Endocrine Surgery, Department of General Surgery, Ege University Hospital, Izmir, Türkiye
| | - Hur Hassoy
- Department of Public Health, School of Medicine, Ege University, Izmir, Türkiye
| | - Yong Sang Lee
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital and Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, Korea
| | - Seok-Mo Kim
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital and Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, Korea
| | - Gokhan Icoz
- Division Endocrine Surgery, Department of General Surgery, Ege University Hospital, Izmir, Türkiye
| | - Hang-Seok Chang
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital and Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, Korea
| | - Ozer Makay
- Division Endocrine Surgery, Department of General Surgery, Ege University Hospital, Izmir, Türkiye
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17
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Li Y, Liu Z, Wang Y, Yu X, Wang T, Xiang C, Wang P. Is transoral endoscopic thyroidectomy safe for total thyroidectomy compared to open thyroidectomy? A propensity-score matched cohort study with papillary thyroid carcinoma. J Surg Oncol 2023; 128:502-509. [PMID: 37303249 DOI: 10.1002/jso.27360] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/09/2023] [Accepted: 04/26/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Transoral endoscopic thyroidectomy via vestibular approach (TOETVA) has become increasingly popular in the treatment of papillary thyroid cancer (PTC). This study aimed to describe the safety and feasibility of total thyroidectomy between the TOETVA and open thyroidectomy (OT) approaches for the treatment of patients with PTC. METHODS We retrospectively reviewed 780 consecutive patients suffering from PTC that had undergone total thyroidectomy using TOETVA (n = 107) and OT (n = 673) between April 2016 and December 2021 at our institute. Afterward, a total of 101 matched patients' surgical outcomes were compared using propensity score matching (PSM) analysis. RESULTS Before PSM, the patients in the TOETVA group were younger (p < 0.001), had a lower body mass index (p < 0.001) and a greater female population (p < 0.001). After PSM, the TOETVA group was associated with significantly longer operative time (p < 0.001), greater blood loss (p < 0.001), total drainage amount (p < 0.001), higher C-reaction protein level (p < 0.001), better cosmetic satisfaction (p < 0.001) and quality of life (p < 0.001) and lower scar self-consciousness (p < 0.001). There was no statistical difference between the groups in the rate of parathyroid autotransplantation and bilateral lymph node dissection, the positivity of lymph node metastasis, number of dissected lymph nodes and positive lymph nodes, multifocality, postoperative level of blood calcium and parathyroid hormone (PTH), rate of PTH < 15 ng/mL, visual analog scale score, duration of hospital stay, complications, mean thyroid stimulating hormone (TSH)-stimulated Tg level before radioactive iodine, mean Tg level without TSH stimulation, and the proportion of serum Tg level of <1. CONCLUSION TOETVA is a safe and feasible technique for better cosmetic effects and similar surgical outcomes compared to conventional open surgery for the studied patients that required total thyroidectomy.
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Affiliation(s)
- Yujun Li
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, Zhejiang, China
| | - Zhaodi Liu
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, Zhejiang, China
| | - Yong Wang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, Zhejiang, China
| | - Xing Yu
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, Zhejiang, China
| | - Tiantian Wang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, Zhejiang, China
| | - Cheng Xiang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, Zhejiang, China
| | - Ping Wang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, Zhejiang, China
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Choi YS, Choi JH, Jeon MS, Yu MJ, Lee HM, Shin AY, Yi JW. First Experience of Single-Port Robotic Areolar Approach Thyroidectomy. Clin Exp Otorhinolaryngol 2023; 16:275-281. [PMID: 37475141 PMCID: PMC10471905 DOI: 10.21053/ceo.2023.00682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/14/2023] [Accepted: 07/04/2023] [Indexed: 07/22/2023] Open
Abstract
OBJECTIVES Numerous minimally invasive thyroidectomy techniques have been developed and are actively utilized in hospitals around the globe. Herein, we describe a recently developed minimally invasive thyroidectomy technique that employs the da Vinci SP, and we present the preliminary clinical outcomes of single-port robotic areolar thyroidectomy (SPRA). METHODS A 3-cm semi-circular incision on the right areola and a small 8-mm incision on the left areola were created. Using hydro-dissection and an advanced bipolar device, a subcutaneous skin flap was created, extending from the areola to the thyroid cartilage. The da Vinci SP was then inserted through the incision in the right areola. Between December 2022 and March 2023, 21 SPRA procedures were conducted. Patients' medical records and surgical videos were subsequently reviewed. RESULTS Lobectomy was performed in 17 patients, isthmectomy in 2 patients, and total thyroidectomy in 2 patients. The mean flap time was 14.9±4.2 minutes and the console time was 62.4±17.1 minutes. The mean tumor size was 0.89± 0.65 cm and the number of retrieved lymph nodes was 3.94±3.98 (range, 0-12). There were no observed instances of vocal cord palsy or hypoparathyroidism. CONCLUSION We successfully developed and performed the novel SPRA for the first time worldwide. Unlike other robotic surgery. METHODS SPRA is less invasive and leaves no visible scars. This technique employs a sophisticated single-port robotic device. However, to assess the efficacy of this method, we need to analyze more cases and conduct comparative studies in the near future.
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Affiliation(s)
- Yun Suk Choi
- Department of Surgery, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
- Robot Surgery Center, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Ji Hyun Choi
- Robot Surgery Center, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Mi Sook Jeon
- Robot Surgery Center, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Min Jung Yu
- Robot Surgery Center, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Hye Mi Lee
- Robot Surgery Center, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Ae Young Shin
- Robot Surgery Center, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| | - Jin Wook Yi
- Department of Surgery, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
- Robot Surgery Center, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
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Ludwig B, Ludwig M, Dziekiewicz A, Mikuła A, Cisek J, Biernat S, Kaliszewski K. Modern Surgical Techniques of Thyroidectomy and Advances in the Prevention and Treatment of Perioperative Complications. Cancers (Basel) 2023; 15:cancers15112931. [PMID: 37296896 DOI: 10.3390/cancers15112931] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/16/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Thyroid cancer is the most common cancer of the endocrine system, and, in recent years, there has been a phenomenon of overdiagnosis followed by subsequent overtreatment. This results in an increasing number of thyroidectomy complications being faced in clinical practice. In this paper, we present the current state of knowledge and the latest findings in the fields of modern surgical techniques, thermal ablation, the identification and assessment of parathyroid function, recurrent laryngeal nerve monitoring and treatment and perioperative bleeding. We reviewed 485 papers, from which we selected 125 papers that are the most relevant. The main merit of this article is its comprehensive view of the subject under discussion-both general, concerning the selection of the appropriate method of surgery, and particular, concerning the selection of the appropriate method of prevention or treatment of selected perioperative complications.
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Affiliation(s)
- Bartłomiej Ludwig
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Maksymilian Ludwig
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Anna Dziekiewicz
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Agnieszka Mikuła
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Jakub Cisek
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Szymon Biernat
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
| | - Krzysztof Kaliszewski
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland
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Altedlawi Albalawi IA, Mirghani HO. The quality of life after trans oral video-assisted thyroidectomy and cervical thyroidectomy: a systematic review and meta-analysis. Front Surg 2023; 10:1116473. [PMID: 37266003 PMCID: PMC10229877 DOI: 10.3389/fsurg.2023.1116473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 05/03/2023] [Indexed: 06/03/2023] Open
Abstract
Trans oral video-assisted thyroidectomy (TOVAT) is increasingly performed for cosmetic reasons. The quality of life after thyroidectomy is important for decision-making. This is the first meta-analysis to compare the quality of life among conventional transcervical thyroidectomies. This meta-analysis aimed to assess the same in the current literature. The authors systematically searched PubMed, Google Scholar, and EBSCO for relevant articles from the first published to December 4, 2022. The keywords endoscopic transoral via vestibular thyroidectomy, transcervical thyroidectomy, conventional thyroidectomy, scarless thyroidectomy, and quality of life were used. Out of the 482 studies retrieved, 27 full texts were reviewed, and only six fulfilled the inclusion and exclusion criteria. Patients with transoral thyroidectomy showed better quality of life that their counterparts who underwent transcervical thyroidectomy at 4-6 weeks following surgery, odd ratio, 2.26, 95% CI, 2.02-2.5, P-value <0.001. Substantial heterogeneity was observed, I2 for heterogeneity, 100%. The quality of life was better among patients who underwent the trans oral video-assisted thyroidectomy (TOVAT) compared to their counterparts with the conventional cervical approach (surgical questionnaire). All the components of the SF-36 quality of life questionnaire were better among TOVAT compared to the conventional approach except for social and general health components, which were equal between the two arms. Further multi-center studies with larger samples and controlling for pain and the surgical curve are needed.
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Affiliation(s)
| | - Hyder Osman Mirghani
- Department of Internal Medicine, Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia
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21
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Tomic J, Metzler P, Schanbacher M, Berkessy K, Hassanzadeh H, Zemann W, Zrnc TA. Facial scars resulting from a transbuccal approach during osteosynthesis of a sagittal split osteotomy: A retrospective study. J Craniomaxillofac Surg 2023:S1010-5182(23)00056-2. [PMID: 37059652 DOI: 10.1016/j.jcms.2023.04.002] [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: 11/16/2022] [Revised: 02/01/2023] [Accepted: 04/02/2023] [Indexed: 04/16/2023] Open
Abstract
The purpose of the current study was to assess the quality of facial linear scars. The Stony Brook Scar Evaluation Scale (SBSES) was developed and validated as a tool to assess postoperative scars. Postoperative facial scars were rated using high-quality macrophotographs and SBSES by three independent raters at baseline and three months thereafter. Percentage agreement (PA) and intraclass correlation coefficient (ICC) were used to measure interrater and intrarater reliability. Scar outcomes ranging from 0 (worst) to 5 (best) were evaluated against age and gender. One-hundred-sixty-six patients with a mean age of 30.6 years (range of 17-59) were included in this study. Forty-four were male (26.5%), and 122 were female (73.5%). Mean total SBSES scores were 4.63 (range of 4.56-4.76) at baseline and 4.60 (range of 4.54-4.72) at three months. As patient's age increased, mean total SBSES scores also decreased significantly (r = -0.216, p = 0.005). Gender did not significantly affect raters' perception of scar cosmesis (p = 0.847). Interrater reliability showed an ICC of 0.675 (95% CI, 0.609-0.731) and a PA of 65.4% at baseline, and an ICC of 0.655 (95% CI, 0.585-0.715) and a PA of 64.2% at three months. Intrarater reliability found ICCs ranging from 0.988 to 0.990 and a PA of 96.8% with 3 separate raters. Within the limitations of the study it seems that the transbuccal approach during osteosynthesis of a sagittal split osteotomy seems still to be acceptable when the patient gives his or her informed consent and advanced instruments like an angled screwdriver are not available.
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Affiliation(s)
- Josip Tomic
- Department of Oral and Maxillofacial Surgery, University Hospital, Medical University of Graz Auenbruggerplatz 5, 8036, Graz, Styria, Austria.
| | - Philipp Metzler
- Department of Oral and Maxillofacial Surgery, University Hospital, Medical University of Graz Auenbruggerplatz 5, 8036, Graz, Styria, Austria
| | - Monika Schanbacher
- Department of Oral and Maxillofacial Surgery, University Hospital, Medical University of Graz Auenbruggerplatz 5, 8036, Graz, Styria, Austria
| | - Katja Berkessy
- Department of Oral and Maxillofacial Surgery, University Hospital, Medical University of Graz Auenbruggerplatz 5, 8036, Graz, Styria, Austria
| | - Hamid Hassanzadeh
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA
| | - Wolfgang Zemann
- Department of Oral and Maxillofacial Surgery, University Hospital, Medical University of Graz Auenbruggerplatz 5, 8036, Graz, Styria, Austria
| | - Tomislav A Zrnc
- Department of Oral and Maxillofacial Surgery, University Hospital, Medical University of Graz Auenbruggerplatz 5, 8036, Graz, Styria, Austria
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Wu V, Samargandy S, Philteos J, Pasternak JD, de Almeida JR, Monteiro E. Evaluation of Preference and Utility Measures for Transoral Thyroidectomy. Ann Otol Rhinol Laryngol 2023; 132:381-386. [PMID: 35503808 PMCID: PMC9989232 DOI: 10.1177/00034894221094950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Traditional, trans-cervical thyroidectomy results in the presence of a neck scar, which has been shown to correlate with lower quality of life and lower patient satisfaction. Transoral thyroid surgery (TOTS) has been utilized as an alternative approach to avoid a cutaneous incision and scar by accessing the neck and thyroid through the oral cavity. This study was designed to evaluate patient preference through health-state utility scores for TOTS as compared to conventional trans-cervical thyroidectomy. METHODS In this cross-sectional study, patient preferences were elicited for TOTS and trans-cervical thyroidectomy with the use of an online survey. Respondents were asked to consider 4 hypothetical health scenarios involving thyroid surgery with varying approaches. Health-state utility scores were elicited using visual analog scale and standard gamble exercises. RESULTS Overall, 516 respondents completed the survey, of whom 261 (50.6%) were included for analysis, with a mean age of 41.5 years (SD 14.9 years), including 171 (65.5%) females. Health utility scores were similar for TOTS and conventional transcervical techniques. Statistically significant differences in the standard gamble utility score were noted for gender and ethnicity across all scenarios. Comparisons of visual analog score utilities were not statistically significant based on respondent demographics. CONCLUSION Preferences for TOTS and trans-cervical thyroidectomy did not significantly differ in the current study. Females and white ethnicity indicated stronger preference for a TOTs approach compared to males and other ethnicities, respectively. Some literature suggests certain types of patients who might prefer minimally invasive thyroidectomy more so than other patients-in keeping with the current findings of this study.
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Affiliation(s)
- Vincent Wu
- Department of Otolaryngology-Head & Neck Surgery, Sinai Health, University of Toronto, Toronto, ON, Canada
| | - Shireen Samargandy
- Department of Otolaryngology-Head & Neck Surgery, Sinai Health, University of Toronto, Toronto, ON, Canada
| | - Justine Philteos
- Department of Otolaryngology-Head & Neck Surgery, Sinai Health, University of Toronto, Toronto, ON, Canada
| | - Jesse D Pasternak
- Department of Surgery, University Health Network, University of Toronto, Toronto, ON, Canada
| | - John R de Almeida
- Department of Otolaryngology-Head & Neck Surgery, Sinai Health, University of Toronto, Toronto, ON, Canada.,Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Eric Monteiro
- Department of Otolaryngology-Head & Neck Surgery, Sinai Health, University of Toronto, Toronto, ON, Canada
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23
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Saavedra-Pérez D, Manyalich M, Domínguez P, Farguell J, Rull R, López-Boado MÁ, Vilaça J, Vidal Ó. Unilateral axilo-breast approach (UABA) with gas insufflation versus open conventional hemithyroidectomy: A prospective comparative study. Cir Esp 2023; 101:107-115. [PMID: 36100055 DOI: 10.1016/j.cireng.2022.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/17/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The objective of this study was to compare with the conventional open approach, the surgical and aesthetic results of endoscopic thyroidectomy via unilateral axillo-breast approach (UABA) with gas insufflation in patients with a unilateral thyroid nodule. METHODS Between August 2017 and August 2020, a prospective comparative cohort study was carried out in patients proposed for hemithyroidectomy. The patients were assigned to one type of approach (Open or Endoscopic) in a successive manner. Surgical results and aesthetic satisfaction at hospital discharge and during the 12-month follow-up were evaluated and compared between both groups. RESULTS A total of 200 patients were included in the study: 100 for the Open approach and 100 for the Endoscopic. The baseline patient characteristics were similar between both groups. Total operative time was longer in the Endoscopic approach, due to the time required for subcutaneous dissection (the hemithyroidectomy time was similar in both groups). There was no significant difference in the frequency of major complications. The length of hospital stay was longer (for 1 day) in the Endoscopic group. The aesthetic satisfaction of the patients was significantly higher in the Endoscopic than in the Open group (p < 0.001), at hospital discharge and at 12-month follow-up. CONCLUSION UABA with gas insufflation for hemithyroidectomy represents a safe and effective therapeutic option for the treatment of unilateral benign thyroid pathologies.
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Affiliation(s)
- David Saavedra-Pérez
- Unidad de Endocrinología Médico-Quirúrgica, Cirugía Endocrina, Servicio de Cirugía General y del Aparato Digestivo, Instituto Clínic de Enfermedades Digestivas y Metabólicas (ICMDiM), Hospital Clínic de Barcelona, Universidad de Barcelona, IDIBAPS, Barcelona, Spain.
| | - Marti Manyalich
- Unidad de Endocrinología Médico-Quirúrgica, Cirugía Endocrina, Servicio de Cirugía General y del Aparato Digestivo, Instituto Clínic de Enfermedades Digestivas y Metabólicas (ICMDiM), Hospital Clínic de Barcelona, Universidad de Barcelona, IDIBAPS, Barcelona, Spain
| | - Paula Domínguez
- Unidad de Endocrinología Médico-Quirúrgica, Cirugía Endocrina, Servicio de Cirugía General y del Aparato Digestivo, Instituto Clínic de Enfermedades Digestivas y Metabólicas (ICMDiM), Hospital Clínic de Barcelona, Universidad de Barcelona, IDIBAPS, Barcelona, Spain
| | - Jordi Farguell
- Unidad de Endocrinología Médico-Quirúrgica, Cirugía Endocrina, Servicio de Cirugía General y del Aparato Digestivo, Instituto Clínic de Enfermedades Digestivas y Metabólicas (ICMDiM), Hospital Clínic de Barcelona, Universidad de Barcelona, IDIBAPS, Barcelona, Spain
| | - Ramón Rull
- Unidad de Endocrinología Médico-Quirúrgica, Cirugía Endocrina, Servicio de Cirugía General y del Aparato Digestivo, Instituto Clínic de Enfermedades Digestivas y Metabólicas (ICMDiM), Hospital Clínic de Barcelona, Universidad de Barcelona, IDIBAPS, Barcelona, Spain
| | - Miguel Ángel López-Boado
- Unidad de Endocrinología Médico-Quirúrgica, Cirugía Endocrina, Servicio de Cirugía General y del Aparato Digestivo, Instituto Clínic de Enfermedades Digestivas y Metabólicas (ICMDiM), Hospital Clínic de Barcelona, Universidad de Barcelona, IDIBAPS, Barcelona, Spain
| | - Jaime Vilaça
- Departamento de Cirugía General y del Aparato Digestivo, Hospital da Luz Arrábida, Escola de Medicina, Universidade do Minho, Braga, Porto, Portugal
| | - Óscar Vidal
- Unidad de Endocrinología Médico-Quirúrgica, Cirugía Endocrina, Servicio de Cirugía General y del Aparato Digestivo, Instituto Clínic de Enfermedades Digestivas y Metabólicas (ICMDiM), Hospital Clínic de Barcelona, Universidad de Barcelona, IDIBAPS, Barcelona, Spain
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24
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Tzelnick S, Tsur N, Amir I, Mizrachi A, Watt T, Rabinovics N, Mamun Y, Yaniv D, Bachar G, Najjar E. Quality of Life Following Robotic Transaxillary Versus Conventional Hemithyroidectomy: A Comparative Analysis. J Laparoendosc Adv Surg Tech A 2023; 33:8-14. [PMID: 36322881 DOI: 10.1089/lap.2022.0183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background: Robotic technology has proven safe and effective for thyroidectomy procedures. Few studies have addressed the quality-of-life outcomes of robotic thyroidectomy compared with conventional thyroidectomy. Materials and Methods: The database of a tertiary medical center was retrospectively reviewed for all patients with thyroid disease who had undergone robotic hemithyroidectomy in 2012-2020. All patients treated by transaxillary robotic surgery and a similar number of randomly selected patients treated by conventional cervical surgery completed a standardized self-administered thyroid disease-specific quality-of-life (QOL) questionnaire (ThyPRO). Clinical data were derived from the medical files. The results were compared using mean comparison tests and multivariate logistic regression models. Results: The cohort consisted of 131 patients: 63 after robotic thyroidectomy and 68 after conventional thyroidectomy. The mean age was 38.87 ± 14.11 and 58.85 ± 14.1 years, respectively (P < .0001). The robotic hemithyroidectomy group reported better QOL outcomes in physical and mental health parameters, including decreased anxiety, depression, lower sex life impairment, and cognitive impairment scores (P < .0001). Furthermore, after adjusting for age, gender, malignancy status, and surgical approach, we found that patients undergoing robotic hemithyroidectomy had a lower probability of experiencing depressive symptoms than the conventional hemithyroidectomy group (odds ratio = 0.31; 95% confidence interval, 0.11-0.88). Of interest, no significant difference in cosmetic outcomes was found. Conclusions: Patients who underwent robotic thyroidectomy report better postoperative QOL after surgery than patients operated by the conventional approach in terms of anxiety, depression, cognitive and sex-life scores.
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Affiliation(s)
- Sharon Tzelnick
- Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nir Tsur
- Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Amir
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviram Mizrachi
- Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Torquil Watt
- Department of Endocrinology, National University Hospital, Copenhagen, Denmark
| | - Naomi Rabinovics
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Otorhinolaryngology-Head and Neck Surgery, Samson Assuta Ashdod Hospital, Ashdod, Israel
| | - Yaakov Mamun
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Radiology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Dan Yaniv
- Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gideon Bachar
- Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Esmat Najjar
- Department of Otorhinolaryngology-Head and Neck Surgery, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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25
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Li Y, Liu Z, Song Z, Wang Y, Yu X, Wang P. Comparison of the endoscopic thyroidectomy via areola approach and open thyroidectomy: A propensity score matched cohort study of 302 patients in the treatment of papillary thyroid non-microcarcinoma. Front Oncol 2023; 13:1081835. [PMID: 36925920 PMCID: PMC10012860 DOI: 10.3389/fonc.2023.1081835] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/13/2023] [Indexed: 03/04/2023] Open
Abstract
Background The endoscopic thyroidectomy via areola approach (ETAA) is widely used in patients with benign thyroid tumors and papillary thyroid microcarcinoma (PTMC). Its safety and complication rates are reported to be similar to open thyroidectomy (OT). This study aimed to evaluate the safety and feasibility of ETAA, compared with OT, in patients with papillary thyroid non-microcarcinoma (PTNMC). Methods We retrospectively reviewed all patients with PTNMC who underwent ETAA or OT in our hospital from January 2017 to December 2021. A total of 302 patients were matched at a ratio of 1:1 by the propensity score matching (PSM) analysis and surgical outcomes. Safety and feasibility were analyzed between two groups. Results Before PSM, patients in the ETAA group were younger (p < 0.001) and had a larger proportion of female patients (p < 0.001) with a lower BMI (p < 0.001) compared with the OT group. The ETAA group also had a higher proportion of unilateral thyroidectomy (p = 0.002). PSM was used to create a highly comparable control group. After PSM, the ETAA group had a longer operative time (p < 0.001), larger blood loss (p = 0.046) and total drainage amount (p = 0.035), with higher C-reactive protein (p = 0.023) and better cosmetic outcomes (p < 0.001). There were no significant differences in the following clinicopathologic characteristics: number of dissected positive lymph nodes, rate of recurrent laryngeal nerve signal weakened, parathyroid autotransplantation, postoperative pain, hospital stay, complications, and oncologic completeness. There was no patient converted to OT in the ETAA group and two patients suffered from persistence/recurrence in the follow-up. Conclusion ETAA is a safe and feasible surgical approach for patients with PTNMC.
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Affiliation(s)
- Yujun Li
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Zhaodi Liu
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Zhuolin Song
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Yong Wang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Xing Yu
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
| | - Ping Wang
- Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, Zhejiang, China
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26
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Karakas E, Klein G, Schopf S. Transoral thyroid surgery vestibular approach. Innov Surg Sci 2022; 7:107-113. [PMID: 36561507 PMCID: PMC9742272 DOI: 10.1515/iss-2021-0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/01/2021] [Indexed: 12/25/2022] Open
Abstract
Objectives Transoral thyroid surgery vestibular approach (TOETVA) is a novel and feasible surgical technique that allows for cervical surgery without visible incisions. TOETVA represents a new frontier in endocrine surgery since aesthetic results play a more and more decisive role in elective surgery. However, acceptance is different around the world with widespread prevalence in Asian countries and some high-volume centres in the US. While inclusion criteria for TOETVA are limited regarding size and volume a combination with other extracervical techniques like the retroauricular endoscopic cephalic access thyroid surgery (EndoCATS) approach or transaxillary access is an option. Methods TOETVA is carried out through a three-port technique placed at the oral vestibule. Originally one 10-mm port for a 30° endoscope and two additional 5-mm ports for dissecting and coagulating instruments are used. Alternatively, one 5-mm and one or two 3 mm ports can be used. CO2 insufflation pressure is set at 6 mmHg. An additional device to optimize gas outflow for optimum view might be helpful. An anterior cervical subplatysmal space is created by hydrodissection from the oral vestibule to the sternal notch, laterally to the sternocleidomastoid muscle. Conventional endoscopic instruments are used. Combination of TOETVA with a modified retroauricular access includes insertion of a 10-12 mm trocar placed subcutaneously via a skin incision on the scalp, behind the ear by blunt dissection. Results Since Anuwong published the first case series of 60 patients who underwent scarless thyroidectomy via the lower vestibule of the mouth with excellent results in 2016 almost 1,000 cases are reported in literature to date with comparable results especially regarding traditional complications. In contrast to other extracervical approaches, areolar or axillary for example, the transoral access route is short and the dissection planes are rather like transcervical surgery. Surgical indications and contraindications have been modified since its first description and are partly institution specific to date. To amend indications combination with other extracervical techniques is an option. In addition, patients must carefully be selected for and surgeons` candidacy is of utmost importance in transoral surgery. Conclusions Transoral surgery will likely continue to gain attraction as surgeons become more experienced with the technique. With increased operative use and surgeon experience the gap in conventional outcomes between transoral surgery and the transcervical approach will narrow, with both operative time and the incidence of specific complications diminishing. Experience in thyroid and endoscopic surgery is required to achieve excellent results with low complication rates. However, the new transoral technique is related to novel complications that must be evaluated.
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Affiliation(s)
- Elias Karakas
- Dept. of General-, Abdominal- and Endocrine Surgery, Hospital Maria Hilf, Alexianer GmbH, Krefeld, Germany
| | - Günther Klein
- Dept. of General Surgery, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | - Stefan Schopf
- Dept. of General-, Abdominal- and Endocrine Surgery, RoMed Hospital, Bad Aibling, Germany
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27
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Pitt SC, Zanocco K, Sturgeon C. The Patient Experience of Thyroid Cancer. Endocrinol Metab Clin North Am 2022; 51:761-780. [PMID: 36244692 DOI: 10.1016/j.ecl.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The 3 phases of thyroid cancer care are discussed: diagnosis, management, and survivorship. Drivers of quality of life (QOL) in each phase are described, and suggestions are made for mitigating the risk of poor QOL. Active surveillance is another emerging management strategy that has the potential to improve QOL by eliminating upfront surgical morbidity but will need to be studied prospectively.
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Affiliation(s)
- Susan C Pitt
- Department of Surgery, University of Michigan Taubman 2920F, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Kyle Zanocco
- Department of Surgery, University of California Los Angeles, CHS 72-222, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Cord Sturgeon
- Department of Surgery, Northwestern University, 676 North Saint Claire Street, Suite 650, Chicago, IL 60611, USA.
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28
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Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA)—a Case Series Analysis. Indian J Surg 2022. [DOI: 10.1007/s12262-022-03558-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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29
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Saavedra-Perez D, Manyalich M, Dominguez P, Vilaça J, Jordan J, Lopez-Boado MA, Rull R, Vidal O. Thyroidectomy via unilateral axillo-breast approach (UABA) with gas insufflation: prospective multicentre European study. BJS Open 2022; 6:6633734. [PMID: 35799351 PMCID: PMC9263156 DOI: 10.1093/bjsopen/zrac087] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 05/05/2022] [Accepted: 05/20/2022] [Indexed: 11/23/2022] Open
Abstract
Background Extracervical approaches for thyroidectomy are seldom explored in the western population. The objective of this study was to evaluate the outcomes of hemithyroidectomy via endoscopic unilateral axillo-breast approach (UABA) with gas insufflation. Method Consecutive patients undergoing UABA hemithyroidectomy for symptomatic benign or cytologically indeterminate nodules (Bethesda III lesions) of less than 5 cm from July 2015 to December 2020 at three European institutions were included. Patients were excluded if presenting with a BMI more than 25 kg/m2, had previous neck surgery and/or radiation, had bilateral thyroid lesions, retrosternal goitre, Hashimoto thyroiditis or Graves’ disease. Follow-up was carried out at 2 weeks, 3 months and 1 year. Outcomes of interest were surgical (including operating time, mean duration of hospital stay and complications) and self-assessed cosmetic outcomes. Results Out of 984 patients treated with hemithyroidectomy during the study interval, 253 were selected, including 214 women and 39 men. Patients’ mean age was of 46.6 years with a mean BMI of 22.57. Mean operating time was 72.9 minutes. A transient recurrent laryngeal nerve injury was reported in 3.6 per cent of the patients, but none was persistent. Transient pectoral/cervical hypoesthesia was noted in 24.1 per cent of patients, with no permanent hypoesthesia. Skin burns and subcutaneous hematoma developed in 2.4 per cent and 2 per cent of patients but resolved within the third month after surgery. There was no tracheal/oesophageal perforation, conversion to open surgery or reoperation. The final pathology revealed 241 benign nodules, nine underlying papillary thyroid carcinomas, and three cases of follicular carcinoma. Hospital discharge was achieved on the first in 68.8 per cent of the patients and on the second postoperative day in 31.2 per cent of the cases. All patients were satisfied with the cosmetic aspect. Conclusion In selected patients, UABA with gas insufflation for hemithyroidectomy could be performed for the treatment of unilateral thyroid pathologies.
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Affiliation(s)
- David Saavedra-Perez
- Unit of Medical and Surgical Endocrinology, Endocrine Surgery, Department of General and Digestive Surgery, Hospital Clinic of Barcelona, University of Barcelona , Barcelona , Spain
| | - Marti Manyalich
- Unit of Medical and Surgical Endocrinology, Endocrine Surgery, Department of General and Digestive Surgery, Hospital Clinic of Barcelona, University of Barcelona , Barcelona , Spain
| | - Paula Dominguez
- Unit of Medical and Surgical Endocrinology, Endocrine Surgery, Department of General and Digestive Surgery, Hospital Clinic of Barcelona, University of Barcelona , Barcelona , Spain
| | - Jaime Vilaça
- Endocrine Surgery, Department of General and Digestive Surgery, Hospital da Luz Arrábida, Universidade do Minho , Porto , Portugal
| | - Julio Jordan
- Endocrine Surgery, Department of General and Digestive Surgery, University Hospital Nuestra Señora de la Candelaria, La Laguna University , Tenerife , Spain
| | - Miguel A Lopez-Boado
- Unit of Medical and Surgical Endocrinology, Endocrine Surgery, Department of General and Digestive Surgery, Hospital Clinic of Barcelona, University of Barcelona , Barcelona , Spain
| | - Ramon Rull
- Unit of Medical and Surgical Endocrinology, Endocrine Surgery, Department of General and Digestive Surgery, Hospital Clinic of Barcelona, University of Barcelona , Barcelona , Spain
| | - Oscar Vidal
- Unit of Medical and Surgical Endocrinology, Endocrine Surgery, Department of General and Digestive Surgery, Hospital Clinic of Barcelona, University of Barcelona , Barcelona , Spain
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30
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Kim BR, Kwon SH, Kim JW, Jeong WJ, Cha W, Jung YH, Na JI, Huh CH, Shin JW. Early Postoperative Polydeoxyribonucleotide Injections Prevent Hypertrophic Scarring after Thyroidectomy: A Randomized Controlled Trial. Adv Wound Care (New Rochelle) 2022; 12:361-370. [PMID: 35713247 DOI: 10.1089/wound.2022.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Polydeoxyribonucleotide (PDRN) is known to enhance wound healing, but there has been no clinical trial investigating the effect of PDRN on scar prevention in surgical wounds. This study aimed to evaluate the efficacy of PDRN administration in preventing postoperative scars. APPROACH In this randomized controlled trial (NCT05149118), 44 patients who underwent open thyroidectomy were randomly assigned to the PDRN treatment or untreated control group. Only patients in the treatment group received two consecutive injections of PDRN one and two days after surgery. The modified Vancouver Scar Scale (mVSS), patients' subjective symptoms, erythema index (EI), melanin index (MI), and scar height were assessed three months after surgery. RESULTS Patients in the treatment group had lower mVSS scores (1.619 ± 1.244 vs. 2.500 ± 1.540, respectively; P = 0.059) and a significantly lower vascularity subscore (0.476 ± 0.512 vs. 0.900 ± 0.447, respectively; P = 0.010) than those in the control group at the 3-month follow-up. Compared with the control group, the level of subjective symptoms, EI, and scar height were all significantly lowered in the PDRN injection group. No specific side effects related to PDRN injection were observed. INNOVATION This is the first clinical study which demonstrated that PDRN injections rapidly decreased postsurgical wound erythema and as a result, significantly reduced both excessive scar formation and accompanying symptoms. CONCLUSION Early postoperative injection of PDRN is an effective and safe treatment to prevent hypertrophic scars and improve scar outcomes.
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Affiliation(s)
- Bo Ri Kim
- Seoul National University Bundang Hospital, 65462, Department of Dermatology, 82 Gumi-Ro 173 Beon-Gil, Seongnam, Korea (the Republic of), 13620;
| | - Soon Hyo Kwon
- Seoul National University Bundang Hospital, 65462, Department of Dermatology, Seongnam, Korea (the Republic of);
| | - Jee Woo Kim
- Seoul National University Bundang Hospital, 65462, Seongnam, Korea (the Republic of);
| | - Woo-Jin Jeong
- Seoul National University Bundang Hospital, 65462, Seongnam, Korea (the Republic of);
| | - Wonjae Cha
- Seoul National University Bundang Hospital, 65462, Seongnam, Korea (the Republic of);
| | - Young Ho Jung
- Seoul National University Bundang Hospital, 65462, Seongnam, Korea (the Republic of);
| | - Jung Im Na
- Seoul National University Bundang Hospital, 65462, Seongnam, Korea (the Republic of);
| | - Chang Hun Huh
- Seoul National University Bundang Hospital, 65462, Seongnam, Korea (the Republic of);
| | - Jung Won Shin
- Seoul National University Bundang Hospital, 65462, Seongnam, Korea (the Republic of);
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31
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Comparison of wound closure techniques after thyroid and parathyroid surgery: an updated systematic review and network meta-analysis. Updates Surg 2022; 74:1225-1237. [DOI: 10.1007/s13304-022-01296-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/01/2022] [Indexed: 10/18/2022]
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32
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The Effectiveness and Quality of Life Outcomes by Transoral Endoscopic Vestibular Thyroidectomy Using Intraoperative Indocyanin Green Fluorescence Imaging and Neuromonitoring—A Cohort Study. Healthcare (Basel) 2022; 10:healthcare10050953. [PMID: 35628090 PMCID: PMC9140775 DOI: 10.3390/healthcare10050953] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/18/2022] [Accepted: 05/19/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Transoral endoscopic vestibular thyroidectomy (TOEVT), a variant of natural orifice transluminal endoscopic surgery, offers a scar-less thyroid to young females. However, few studies have compared the effectiveness and quality of life (QoL) outcomes of the TOEVT with open thyroidectomy (OT). This is the first study in the Middle East and North Africa region that compares the effectiveness, safety profile and QoL outcomes between TOEVT with OT. Methods: We reviewed the medical records of consecutive patients with TOETV and OT at Zulekha Hospital Sharjah and Dubai United Arab Emirates, between 1 January 2019 and 1 April 2021. The data for demographics, type of surgery, operative time, blood loss, post-operative nodule size, hospital stay and post-operative complications were analyzed. We used an SF-36 questionnaire pre- and postoperatively for the assessment of QoL in both groups. Findings: Out of a total of 41 OT and 32 TOEVT procedures, 59 patients (31 TOEVT and 28 OT) fulfilled the inclusion criteria. There were 45 women and 14 men with an average age of 41 years. The mean operating time was 126 min in TOEVT and 96 min in OT (p = 0.000). The mean thyroid size was 5.55 cm in TOEVT and 8.76 cm in OT (p = 0.000). Lastly, the mean intraoperative blood loss was 39 cc and 95.7 cc in TOEVT and OT, respectively (p = 0.001). There was one temporary hypocalcemia and seroma in TOEVT, four cases of temporary hypocalcemia and one with minor bleeding in OT. The post-operative QoL significantly improved in all patients. However, the QoL improved more significantly in the TOEVT group for bodily pain, vitality, role emotions and cosmetic concerns (p = 0.000). Conclusion: The safety profile and effectiveness of the TOEVT is comparable to the OT procedure. However, TOEVT has an additional advantage of being scarless and offers a better QoL.
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Saavedra-Pérez D, Manyalich M, Domínguez P, Farguell J, Rull R, López-Boado MÁ, Vilaça J, Vidal Ó. Hemitiroidectomía vía abordaje axilo-mamario unilateral (UABA) con insuflación de gas vs. convencional abierta: estudio prospectivo comparativo. Cir Esp 2022. [DOI: 10.1016/j.ciresp.2022.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bach K, Prince S, Pitt SC, Robbins S, Connor NP, Macdonald C, Sippel RS, Long KL. Time Heals Most Wounds - Perceptions of Thyroidectomy Scars in Patients With Thyroid Cancer. J Surg Res 2022; 270:437-443. [PMID: 34798426 PMCID: PMC8712385 DOI: 10.1016/j.jss.2021.09.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/23/2021] [Accepted: 09/23/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Patients understandably have concerns about thyroidectomy scars. This study aimed to characterize patients' perceptions of their thyroidectomy scar before and up to 1-y after surgery. METHODS Patients with papillary thyroid cancer (n = 83) completed semi-structured interviews before and at 2-wks, 6-Wk, 6-mo, and 1-y post-thyroidectomy. Interviews probed about scar concerns and appearance. Content analysis was used to identify themes. RESULTS The majority of participants did not express concerns about scar appearance. When expressed, preoperative concerns often stemmed from previous surgery experiences or unease with neck incisions. Postoperatively, concerns about scar appearance decreased over time throughout the healing period with most patients being satisfied with their scar appearance by 6-mo after surgery. CONCLUSIONS Patients with papillary thyroid cancer express few concerns about scar thyroidectomy appearance. Surgeons can reassure patients who have preoperative concerns that most patients are satisfied with their scar appearance by 6-mo after surgery.
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Affiliation(s)
- Kathy Bach
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison Wisconsin USA, 53792
| | - Samantha Prince
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison Wisconsin USA, 53792
| | - Susan C. Pitt
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison Wisconsin USA, 53792
| | - Sarah Robbins
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison Wisconsin USA, 53792
| | - Nadine P. Connor
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison Wisconsin USA, 53792
| | - Cameron Macdonald
- Qualitative Health Research Consultants,111 King St #23, Madison Wisconsin USA 53703
| | - Rebecca S. Sippel
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison Wisconsin USA, 53792
| | - Kristin L. Long
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison Wisconsin USA, 53792
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Guo T, Wu Z, He J, Liu D, Wan H, Li Y, Peng S, Xu A. Gasless endoscopic thyroidectomy via modified areola approach with a simple flap-lifting technique. Front Endocrinol (Lausanne) 2022; 13:1028805. [PMID: 36619584 PMCID: PMC9816138 DOI: 10.3389/fendo.2022.1028805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Studies have shown that carbon dioxide (CO2) insufflation during endoscopic thyroidectomy is associated with many risks. Recently, we have designed a simple lifting tool using Kirschner wire. We aimed to use this tool for flap-lifting in modified areola approach endoscopic thyroidectomy and compare it with conventional CO2 insufflation. METHODS In a prospective study, patients who underwent endoscopic thyroidectomy via modified areola approach were randomly assigned into gasless (n = 20) or CO2 groups (n = 22). Pre-operative variables included age, gender, tumor diameter, and clinical diagnosis. Intra-operative hemodynamic monitoring included mean arterial pressure, heart rate, pulse oximetry, end-tidal carbon dioxide (ET-CO2) and arterial pH. Other intra-operative details included total operative time, operative blood loss, conversion from endoscopic surgery to open surgery, intra-operative events, and endoscope video score. Postoperatively, the hospital stay, drainage volume, and complications were recoded. RESULTS Patient characteristics were not different between the two groups. During the operation, ET-CO2 levels were significantly higher in the CO2 group (P < 0.05), whereas arterial pH levels were significantly lower (P < 0.05). The CO2 group had longer operation time and higher endoscope clarity VAS score than gasless group. Hospital stay, drainage volume, and postoperative complications did not differ significantly between the two groups (P > 0.05). CONCLUSIONS The gasless endoscopic thyroidectomy we performed via our Kirschner wire hook was safe, feasible, and yielded good results.
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Affiliation(s)
- Tao Guo
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Anhui Public Health Clinical Center, Hefei, Anhui, China
| | - Zehui Wu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Juntong He
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Anhui Public Health Clinical Center, Hefei, Anhui, China
| | - Defeng Liu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Anhui Public Health Clinical Center, Hefei, Anhui, China
| | - Hong Wan
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Anhui Public Health Clinical Center, Hefei, Anhui, China
| | - Yangyang Li
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Anhui Public Health Clinical Center, Hefei, Anhui, China
| | - Shihao Peng
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Anhui Public Health Clinical Center, Hefei, Anhui, China
| | - Aman Xu
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- *Correspondence: Aman Xu,
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Wu Y, Zhu F, Shen Y, Fang Y, Zhu L, He Q, Pan J, Chen L, Tian W. The steps and key points of thyroid surgery with lateral cervical incision. Zhejiang Da Xue Xue Bao Yi Xue Ban 2021; 50:701-706. [PMID: 35347918 PMCID: PMC8931620 DOI: 10.3724/zdxbyxb-2021-0341] [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: 10/07/2021] [Accepted: 12/10/2021] [Indexed: 06/14/2023]
Abstract
The thyroid surgery with lateral cervical incision uses the sternocleidomastoid intermuscular approach through the gap between band muscles and carotid sheath to reach the surgical field. The recurrent laryngeal nerve and upper and lower parathyroid glands are first identified, the upper pole vessels are severed; then the Berry ligament is separated; the isthmus is severed, and the thyroid gland is finally removed. This approach can avoid the trauma of the skin and muscle tissue in the anterior neck region, to relieve the pressure on the neck and swallowing stretch feeling for patients after surgery. The surgical modality is effective and less time-consuming. This article gives a detailed introduction to the standardized procedures and some key points of thyroid surgery with lateral cervical incision.
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Affiliation(s)
- Yijun Wu
- 1. Department of Thyroid Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Feng Zhu
- 1. Department of Thyroid Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Yibin Shen
- 1. Department of Thyroid Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Yun Fang
- 1. Department of Thyroid Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Lixian Zhu
- 1. Department of Thyroid Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Qiwen He
- 1. Department of Thyroid Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Jun Pan
- 1. Department of Thyroid Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Linghui Chen
- 1. Department of Thyroid Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Wen Tian
- of Thyroid and Hernia Surgery, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
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Banuchi VE, Long SM, Sachs BY, Kostas JC, Ali KM, Russell JO. Transoral endoscopic vestibular approach Sistrunk procedure: First reported case series. Head Neck 2021; 44:E1-E5. [PMID: 34693592 DOI: 10.1002/hed.26889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/28/2021] [Accepted: 09/30/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Standard of care for management of thyroglossal duct cysts (TGDCs) is a Sistrunk procedure performed through a transcervical incision. We describe the first series of Sistrunk procedures performed through a transoral endoscopic vestibular approach, eliminating a visible external scar. METHODS The transoral endoscopic vestibular approach to the Sistrunk (TEVAS) was performed in patients with TGDCs meeting inclusion criteria who desired a scarless approach. RESULTS Six patients (five females and one male) underwent TEVAS, with a mean age of 38 years (range 16-56 years) and a mean TGDC size of 1.8 cm (range 1.1-2.4 cm). Mean operative time was approximately 5 h (range 2-8 h). There were no surgical complications or recurrences. CONCLUSIONS For appropriately selected patients, the TEVAS is an alternative to open neck surgery that provides improved cosmesis while maintaining successful resection outcomes. More data on outcomes including complications and recurrences are needed as additional case information is collected.
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Affiliation(s)
- Victoria E Banuchi
- Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Sallie M Long
- Department of Otolaryngology-Head and Neck Surgery, NewYork-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | | | | | - Khalid M Ali
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jonathon O Russell
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
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Abstract
OBJECTIVE To identify the risk factors of hypertrophic scarring (HS) after thyroidectomy and construct a risk prediction model. METHODS From November 2018 to March 2019, the clinical data of patients undergoing thyroidectomy were collected for retrospective analysis. According to the occurrence of HS, the patients were divided into an HS group and a non-HS group. Univariate analysis and binary logistic regression analysis were conducted to explore the independent risk factors for HS. Receiver operating characteristic analysis was also carried out. RESULTS In this sample, 121 of 385 patients developed HS, an incidence of 31.4%. Univariate analysis showed significant differences in sex, age, postoperative infection, history of abnormal wound healing, history of pathologic scar, family history of pathologic scar, and scar prevention measures between the two groups (P < .05). Binary logistic regression analysis indicated that age 45 years or younger (odds ratio [OR], 1.815), history of abnormal wound healing (OR, 4.247), history of pathologic scarring (OR, 9.840), family history of pathologic scarring (OR, 5.708), and absence of preventive scar measures (OR, 5.566) were independent factors for HS after thyroidectomy. The area under the receiver operating characteristic curve was 0.837. When the optimal diagnostic cutoff value was 0.206, the sensitivity was 0.661, and the specificity was 0.932. CONCLUSIONS The development of HS after thyroidectomy is related to many factors, and the proposed risk prediction model based on the combined risk factors shows a good predictive value for postoperative HS. When researchers consider the prevention and treatment of scarring in patients at risk, the incidence of HS in different populations can provide theoretical support for clinical decision-making.
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Sanabria A, Pinillos P, Lira RB, Shah JP, Tufano RP, Zafereo ME, Nixon IJ, Randolph GW, Simo R, Vander Poorten V, Rinaldo A, Medina JE, Khafif A, Angelos P, Mäkitie AA, Shaha AR, Rodrigo JP, Hartl DM, Kowalski LP, Ferlito A. Current therapeutic options for low-risk papillary thyroid carcinoma: A scoping evidence review. Head Neck 2021; 44:226-237. [PMID: 34590380 DOI: 10.1002/hed.26883] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/10/2021] [Indexed: 01/04/2023] Open
Abstract
Most cases of thyroid carcinoma are classified as low risk. These lesions have been treated with open surgery, remote access thyroidectomy, active surveillance, and percutaneous ablation. However, there is lack of consensus and clear indications for a specific treatment selection. The objective of this study is to review the literature regarding the indications for management selection for low-risk carcinomas. Systematic review exploring inclusion and exclusion criteria used to select patients with low-risk carcinomas for treatment approaches. The search found 69 studies. The inclusion criteria most reported were nodule diameter and histopathological confirmation of the tumor type. The most common exclusions were lymph node metastasis and extra-thyroidal extension. There was significant heterogeneity among inclusion and exclusion criteria according to the analyzed therapeutic approach. Alternative therapeutic approaches in low-risk carcinomas can be cautiously considered. Open thyroidectomy remains the standard treatment against which all other approaches must be compared.
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Affiliation(s)
- Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia/IPS Universitaria/Hospital Universitario San Vicente Fundación, Medellín, Colombia.,CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello/Clínica Las Vegas-grupo Quirónsalud, Medellín, Colombia
| | - Pilar Pinillos
- Department of Surgery, School of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia-Hospital Universitario Nacional de Colombia, Bogotá, Colombia
| | - Renan B Lira
- Head and Neck Surgery and Otorhinolaryngology Department, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Jatin P Shah
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA.,Department of Oncology, Radiotherapy and Plastic Surgery, Sechenov University, Moscow, Russia
| | - Ralph P Tufano
- Director of the FPG Thyroid and Parathyroid Center, Division of Head and Neck Endocrine Surgery, The Sarasota Memorial Health Care System, Sarasota, Florida, USA
| | - Mark E Zafereo
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Iain J Nixon
- Department of Otorhinolaryngology Head and Neck Surgery, Edinburgh Royal Infirmary, Edinburgh, UK
| | - Gregory W Randolph
- Thyroid/Parathyroid Endocrine Surgical Division, Thyroid Surgical Oncology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Ricard Simo
- Department of Otorhinolaryngology-Head and Neck Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, King's College London, London, UK
| | - Vincent Vander Poorten
- Otorhinolaryngology Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | | | - Jesus E Medina
- Department of Otolaryngology and Head and Neck Surgery, The University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA
| | - Avi Khafif
- Head and Neck Surgery and Oncology Unit, A.R.M. Center for Advanced Otolaryngology Head and Neck Surgery, Assuta Medical Center, Tel Aviv, Israel
| | - Peter Angelos
- Department of Surgery and MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, Illinois, USA
| | - Antti A Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ashok R Shaha
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias-ISPA, Oviedo, Spain.,University of Oviedo-IUOPA, Oviedo, Spain.,Head and Neck Cancer Unit, CIBERONC, Madrid, Spain
| | - Dana M Hartl
- Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, Villejuif Cedex, France.,Laboratoire de Phonétique et de Phonologie, Paris, France
| | - Luiz P Kowalski
- Head and Neck Surgery and Otorhinolaryngology Department, A.C. Camargo Cancer Center, São Paulo, Brazil.,Department of Head and Neck Surgery, University of São Paulo Medical School, São Paulo, Brazil
| | - Alfio Ferlito
- Coordinator of International Head and Neck Scientific Group, Padua, Italy
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Feasibility, Safety, Nodal yields and Learning curves in Retroauricular Robot/Endoscope Assisted Neck Dissection in the Management of Head and Neck Cancer. Indian J Surg Oncol 2021; 12:808-815. [DOI: 10.1007/s13193-021-01444-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 09/01/2021] [Indexed: 11/26/2022] Open
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How we do it: 'tonsil swabs please' - an alternative use in open neck surgery. The Journal of Laryngology & Otology 2021; 135:844-845. [PMID: 34376269 DOI: 10.1017/s0022215121001705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Thyroid and parathyroid surgery often involves the use of heated instruments for dissection. Whilst these are beneficial, accidental thermal damage to the exposed skin edges can occur, resulting in an unsatisfactory cosmetic outcome. Tonsil swabs can be used in head and neck surgery intra-operatively to control bleeding. This paper describes an alternative use for them in protecting wound edges during the procedure. METHOD Damp tonsil swabs are sutured onto the wound edges after the initial skin incision. They remain present for the duration of the surgery and are removed at the time of skin closure. RESULTS The tonsil swabs provide protection and help avoid accidental injury to the skin. No complications with this technique have been experienced. CONCLUSION This paper describes a simple, effective and practical technique for protecting the skin during neck procedures using resources readily available in a standard ENT operating theatre.
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Hussain I, Zulfiqar F, Li X, Ahmad S, Aljammal J. Safety and Efficacy of Radiofrequency Ablation of Thyroid Nodules-Expanding Treatment Options in the United States. J Endocr Soc 2021; 5:bvab110. [PMID: 34258495 PMCID: PMC8271212 DOI: 10.1210/jendso/bvab110] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Indexed: 12/15/2022] Open
Abstract
CONTEXT Radiofrequency ablation (RFA) has only recently gained popularity in the United States for treatment of thyroid nodules (TNs), with a limited number of patients having undergone the procedure in this country. OBJECTIVE To evaluate the safety and efficacy of RFA of TNs performed in an outpatient setting in the United States. METHODS This is a retrospective, single-center study of 53 patients who underwent RFA of 58 TNs between November 2018 and January 2021. The reduction in volume of nodule, cosmetic and symptomatic improvement, effect on thyroid function, and complications following RFA were assessed. RESULTS Eleven out of 53 patients were excluded from the analysis. A total of 47 benign TNs (23 nonfunctioning thyroid nodules [NFTNs] and 24 autonomously functioning thyroid nodules [AFTNs]), were assessed after RFA. The median reduction in volume was 70.8% after a median follow-up period of 109 days, with symptomatic and cosmetic improvement (P < 0.0001). Compared with larger nodules, smaller nodules had greater volume reduction (P = 0.0266). RFA improved thyrotropin (TSH) in AFTNs (P value = 0.0015) and did not affect TSH in NFTNs (P value = 0.23). There were no major complications; however, 1 patient had self-limited local bleeding and another had transient voice change that recovered in 6 months. CONCLUSION RFA is a safe and efficacious treatment for symptomatic NFTNs and AFTNs in our population and is especially effective for smaller nodules. RFA should be considered an alternative for TNs in patients who cannot or do not want to undergo surgery.
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Affiliation(s)
- Iram Hussain
- Division of Endocrinology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390-8537, USA
| | | | - Xilong Li
- Division of Biostatistics, Department of Population and Data Science, University of Texas Southwestern Medical Center, Dallas, TX 75390-8537, USA
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Abstract
Technological developments have disrupted the practice of medicine throughout history. Endoscopic and robotic techniques in head and neck surgery have emerged over the past half-century and have been incrementally adapted to expanding indications within otolaryngology. Robotic and endoscopic surgery have an established role in treatment of oropharyngeal and laryngeal cancers, reducing surgical morbidity and improving survival relative to traditional open approaches. Surgical treatment of human papillomavirus-mediated oropharyngeal cancer via transoral robotic surgery offers equivalent oncologic and functional outcomes relative to radiotherapy. Newer iterations of single-port robotic systems continue to expand the scope of robotics in head and neck surgery.
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Bertelli AAT, Rangel LG, Lira RB, Tesseroli MAS, Santos IC, Silva GD, Gomes MA, Tenório LR, Kowalski LP, Gonçalves AJ, Russel JO, Tufano RP. Trans Oral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) in Brazil: Safety and complications during learning curve. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:259-264. [PMID: 34191415 PMCID: PMC10065341 DOI: 10.20945/2359-3997000000380] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective The aim of this study was to address the first cases of TOETVA done in Brazil, by TOETVA-Bra study group, regarding safety and complications. Methods Series of the first 93 TOETVAs cases in Brazil. All authors except LPK, AJG JOR and RPT received TOETVA training including cadaveric hands-on in Thailand or United States (Johns Hopkins Medicine) during 2017. After they came back to Brazil and started doing their first TOETVA cases in the cities of Rio de Janeiro, Sao Paulo and Chapecó they agreed to collaborate and gather data using an online spreadsheet. All patients were submitted to the technique described by Anuwong. Results A total of 93 patients underwent TOETVA. Most patients (58.1%) were submitted to total thyroidectomy and 59.1% had benign disease. Two patients (2.2%) needed conversion to open surgery. Five patients (9.3%) developed transient hypoparathyroidism and there were 3 (2.0%) temporary recurrent laryngeal nerve palsy. There was one (0.7%) permanent unilateral palsy. Twenty patients had some sort of complication, 16.1% were minor and 5.4% were major. A total of 73 patients (78.5%) had an uneventful recovery. Conclusion The technique is reproducible with a low complication rate. While further studies are needed to confirm equivalency, early efforts suggest that TOETVA is not inferior to traditional open thyroidectomy in appropriately selected patients.
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Affiliation(s)
- Antonio Augusto Tupinambá Bertelli
- Disciplina de Cirurgia de Cabeça e Pescoço, Departamento de Cirurgia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil
| | | | | | | | | | - Guilherme Duque Silva
- Serviço de Cirurgia de Cabeça e Pescoço, Hospital Central da Polícia Militar do Rio de Janeiro, Universidade do Estado do Rio de Janeiro, RJ, Brasil
| | | | - Lucas Ribeiro Tenório
- Disciplina de Cirurgia de Cabeça e Pescoço, Departamento de Cirurgia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil,
| | | | - Antonio José Gonçalves
- Disciplina de Cirurgia de Cabeça e Pescoço, Departamento de Cirurgia, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brasil
| | - Jonathon Owen Russel
- Head and Neck Endocrine Surgery, Otolaryngology-Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, USA
| | - Ralph Patrick Tufano
- Head and Neck Endocrine Surgery, Otolaryngology-Head and Neck Surgery, Johns Hopkins Medicine, Baltimore, USA
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Broekhuis JM, Chen HW, Maeda AH, Duncan S, Grogan RH, James BC. Public perceptions of transoral endocrine surgery and their influence on choice of operative approach. J Surg Res 2021; 267:56-62. [PMID: 34130239 DOI: 10.1016/j.jss.2021.04.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/23/2021] [Accepted: 04/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Transoral Endocrine Surgery (TES) represents an alternative to the open approach with no visible scar. Studies have shown TES has a safety profile similar to the open approach, but adoption has been limited. Public perception and preference for TES are factors associated with adoption that have not been explored. Here we aim to understand the perception of TES by the public and factors which influence decision making. MATERIALS AND METHODS A 38-question survey was designed to assess factors which influence willingness to pursue TES. The survey was distributed utilizing Amazon Mechanical Turk (MTurk), a crowdsourcing marketplace in which individuals perform tasks virtually based on interest. Descriptive analyses, Pearson chi-squared tests, Student's t-tests, and multivariate logistic regression were performed to evaluate theoretical decision to pursue TES. RESULTS Respondents (n = 795) were 47% female, 78% white, 70% held a college degree or higher, and had a mean age of 37. The majority (69%) preferred a mouth incision over a neck incision. Respondents were willing to pursue TES for a theoretical cancer despite increased cost (52%) and longer operative time (70%). Respondents top two most important surgical factors were safety and experience. CONCLUSIONS Our data suggest the general public is willing to pursue TES and factors thought to be barriers to choosing TES may not deter the public. An informed discussion with appropriately-selected patients should be had between the patient and surgeon regarding specific surgical and postoperative differences including risks, safety, and experience.
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Affiliation(s)
- Jordan M Broekhuis
- Harvard Medical School, Boston, MA; Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA.
| | - Hao Wei Chen
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Anthony H Maeda
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Sarah Duncan
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Raymon H Grogan
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Benjamin C James
- Harvard Medical School, Boston, MA; Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA.
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Abstract
The parotid gland is located in a cosmetically sensitive area. Given cultural emphasis on cosmesis, using minimally invasive or hidden incisions, when appropriate, can significantly improve patient satisfaction and quality of life following surgery. Facelift-style incisions have been used since the late 1960s to approach parotid pathology. Several alternative incisions, including technology-assisted approaches, also have been described in the literature. To that end, this article explore the existing data regarding several historical and emerging cosmetic approaches to the parotid gland comparing relative advantages and disadvantages of each.
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47
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Deroide G, Honigman I, Berthe A, Branger F, Cussac-Pillegand C, Richa H, Anuwong A. Trans oral endoscopic thyroidectomy (TOETVA): First French experience in 90 patients. J Visc Surg 2021; 158:103-110. [PMID: 33676861 DOI: 10.1016/j.jviscsurg.2021.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Thyroidectomy techniques using extracervical approaches have grown in popularity for about 20 years and their feasibility has now been demonstrated. We wanted to evaluate one of these new approaches: the anterior vestibular endoscopic approach (TOETVA). The aim of this study was to evaluate the results of an initial series patients who underwent an anterior trans-vestibular endoscopic oral thyroidectomy. METHODS From February 2018 to September 2020, this technique was offered to patients aged 18 to 70, ASA I or II, who presented with an indication for thyroid surgery and who wished to avoid cervical scars. The approach was through the anterior vestibule of the mouth and the specimen was extracted either transorally or via the axilla depending on its size. Apart from the first ten cases, all patients underwent recurrent nerve neuromonitoring. The patients were operated on by two surgeons experienced in thyroid surgery. All the patients had follow-up visits on D15, D30 and at 2 months. The pre- and intra-operative data, length of stay and complications were evaluated. RESULTS A total of 90 consecutive patients (87 women) aged 46±12.4 years (18 to 69) with a mean BMI of 24.4±4 were included. The indications for surgery included 11 papillary cancers, 5 oncocytic nodules, 15 toxic nodules, 13 cases of Graves disease and 46 symptomatic goiters and/or nodules. The mean pre-operative diameter of the nodules was 3.61±1.99 (0.44 to 7.3) cm. The interventions performed were 44 lobo-isthmectomies, 41 total thyroidectomies and 5 isthmectomies. The mean operating time was 134±45min (40 to 255). On D1, the post-operative ionized calcium was 1.09±0.11mmol/L (4.3685±0.44mg/dL) (normal 0.8-1.15mmol/L) (3.206-4.609mg/dL)) and the total serum calcium was 2.07±0.11mmol/L 8.296±0.44mg/dL (normal 2.2-2.5mmol/L) (8.817-10.019mg/dL). Five patients underwent conversion from endoscopic to open cervical approach (5.5%). The complications were seven cases of transient recurrent nerve palsy (7.8%), eight cases of hypoparathyroidism (19%) including six transient and two permanent, one skin burn and 26 cases of transient chin numbness related to the electrocautery (29%). Ten patients (11%) presented with transient post-operative skin ecchymosis that resolved within 7-10 days. A spontaneous pneumo-mediastinum was observed on chest CT in three patients and evolved favorably. No hematoma, or surgical site infection, or complications related to axillary extraction were observed. All the patients declared themselves satisfied post-operatively and at the end of the follow-up. CONCLUSION The TOETVA route of entry is a safe and reliable technique in well-selected patients wishing to avoid a cervical scar.
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Affiliation(s)
- G Deroide
- Franco-British Hospital Institute, 4, Rue Kleber Hôpital Franco-Britannique, 92300 Levallois, France; Clinique Lambert Ramsay, La garenne Colombes, France.
| | - I Honigman
- Polyclinique de Saint-Jean-de-Luz, Saint-Jean-de-Luz, France
| | - A Berthe
- Clinique Lambert Ramsay, La garenne Colombes, France
| | - F Branger
- Franco-British Hospital Institute, 4, Rue Kleber Hôpital Franco-Britannique, 92300 Levallois, France; Clinique Lambert Ramsay, La garenne Colombes, France
| | - C Cussac-Pillegand
- Franco-British Hospital Institute, 4, Rue Kleber Hôpital Franco-Britannique, 92300 Levallois, France
| | - H Richa
- Franco-British Hospital Institute, 4, Rue Kleber Hôpital Franco-Britannique, 92300 Levallois, France
| | - A Anuwong
- Police General Hospital, Bangkok, Thailand
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Kandil E, Hadedeya D, Shalaby M, Toraih E, Aparício D, Garstka M, Munshi R, Elnahla A, Russell JO, Aidan P. Robotic-assisted parathyroidectomy via transaxillary approach: feasibility and learning curves. Gland Surg 2021; 10:953-960. [PMID: 33842239 DOI: 10.21037/gs-20-761] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background There have been few reports of robotic-assisted transaxillary parathyroidectomy in the literature. We aim to report our experience with robotic-assisted transaxillary parathyroidectomy for primary hyperparathyroidism (PHPT) in the Western population. Methods A retrospective study was performed from July 2010 through July 2019 at two institutions, one in the United States and one in France. Demographic characteristics and perioperative data were collected for all patients undergoing robotic-assisted transaxillary parathyroidectomy by a single surgeon at each institution. A linear regression model was developed to describe the learning curve for this procedure at each institution. Results One-hundred and two patients with PHPT were included with a median age of 55.6±12.4 years and median body mass index (BMI) of 25.5±6.1 kg/m2. The majority of patients were female (80.4%). Median total operative time was 116±53 minutes. Minor complications were reported in 2 patients (1.96%), and one case was converted to a trans-cervical approach (TCA) for four-gland exploration. Median patient follow-up time was 6.5±12.2 months, and disease recurrence was reported in one patient. Calculated learning curves showed that one surgeon achieved proficiency by the eighth case, and the other achieved proficiency by the fourteenth case. Conclusions This is the largest reported experience of robotic-assisted transaxillary parathyroidectomy for PHPT in the Asian and Western population. Analysis of the procedural learning curve demonstrates that proficiency in this technique was achieved after performance of less than 15 surgeries. This procedure is safe and feasible in the hands of experienced surgeons for select patients with localized disease.
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Affiliation(s)
- Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Deena Hadedeya
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Mahmoud Shalaby
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Eman Toraih
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.,Genetic Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - David Aparício
- Department of Otorhinolaryngology and Head and Neck Surgery, American Hospital of Paris, Paris, France
| | - Meghan Garstka
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Ruhul Munshi
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Ahmed Elnahla
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Jonathon O Russell
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Patrick Aidan
- Department of Otorhinolaryngology and Head and Neck Surgery, American Hospital of Paris, Paris, France
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Chen LW, Assadi N, Hefetz-Kirshenbaum L, Hong H, Razavi CR, Grogan RH, Tufano RP, Khafif A, Russell JO. Preferences for thyroidectomy technique: Comparing traditional and transoral approaches. Head Neck 2021; 43:1747-1758. [PMID: 33555089 DOI: 10.1002/hed.26627] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 12/14/2020] [Accepted: 01/21/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND We investigated preferences between the transcervical and transoral thyroidectomy approach in the United States and Israel. METHODS An online survey assessing scar attitudes and surgical preferences, in English and Hebrew, was distributed on ThyCa.com and other platforms. RESULTS 928 and 339 responses from the United States and Israel cohorts, respectively, were analyzed. In both countries, individuals without prior thyroidectomy preferred a scarless approach when hypothetical risks equaled those of traditional thyroidectomy (77% United States, 76% Israel, p = 0.61). U.S. respondents without thyroidectomy had greater preference to avoid a scar and would pay more to do so than those with thyroidectomy (both p < 0.001). Many respondents with prior thyroidectomy still expressed interest in scarless alternatives (57% United States). CONCLUSIONS Populations in Israel and the United States prefer scarless thyroidectomy when risks equal the traditional approach. While individuals without prior thyroidectomy are more likely to favor a scarless option, former thyroidectomy patients may have preferred avoiding a scar.
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Affiliation(s)
- Lena W Chen
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Niddal Assadi
- A.R.M. Otolaryngology - Head and Neck, Maxillofacial Clinics, Assuta Medical Center, Tel Aviv, Israel
| | - Lior Hefetz-Kirshenbaum
- A.R.M. Otolaryngology - Head and Neck, Maxillofacial Clinics, Assuta Medical Center, Tel Aviv, Israel
| | - Hanna Hong
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christopher R Razavi
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Raymon H Grogan
- Endocrine Surgery Program, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Ralph P Tufano
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Avi Khafif
- A.R.M. Otolaryngology - Head and Neck, Maxillofacial Clinics, Assuta Medical Center, Tel Aviv, Israel
| | - Jonathon O Russell
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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50
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Razavi CR, Tanavde VA, Kim AS, Shaear M, Tufano RP, Russell JO. The variable direct cost and cost drivers of transoral endoscopic thyroidectomy vestibular approach. Gland Surg 2021; 10:521-528. [PMID: 33708535 DOI: 10.21037/gs-20-653] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background As transoral endoscopic thyroidectomy vestibular approach grows in popularity, there is a need for data on cost in order to better characterize its value to patients. To this end, we compared the variable direct cost of transoral endoscopic thyroidectomy vestibular approach and transcervical approach thyroidectomy and determined which factors drive the increased cost for the transoral approach. Methods Patients undergoing thyroid lobectomy and total thyroidectomy that met inclusion criteria for transoral endoscopic thyroidectomy vestibular approach, including those patients that opted for management via the transcervical approach, between 8/2016 and 4/2019 were reviewed. The variable direct cost for the surgical encounter was collected and means were compared between the transoral and transcervical cohorts for lobectomy and total thyroidectomy respectively. The operative time independent variable direct cost was similarly compared between cohorts. Results Out of 238 patients, 118 (50%) were managed via transoral endoscopic thyroidectomy vestibular approach and 120 (50%) were managed via transcervical approach thyroidectomy. Mean variable direct cost, our primary outcome, was $4,455 (SD 1,129, 95% CI: 4,204-4,706) for transoral lobectomy and $3,179 (SD 687, 95% CI: 2,990-3,369) for transcervical lobectomy [t(132.05)=8.09, P<0.001] representing a difference in cost of $1,276 (SD 158, 95% CI: 964-1,587). Mean variable direct cost was $4,681 (SD 829, 95% CI: 4,405-4,957) for transoral total thyroidectomy and $3,645 (SD 876, 95% CI: 3,431-3,858) for transcervical total thyroidectomy [t(79.92)=5.98, P<0.001], representing a difference in cost of $1,036 (SD 173, 95% CI: 691-1,381). Differences in energy devices alone account for $487.53 and $447.96 of the cost differences, respectively. Conclusions The differences in mean variable direct cost between transoral endoscopic vestibular approach and transcervical approach for lobectomy and total thyroidectomy were $1276 and $1036 respectively, amounts far less than some believe them to be. This data will be invaluable as we ultimately aim to define the value of transoral endoscopic thyroidectomy vestibular approach.
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Affiliation(s)
- Christopher R Razavi
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ved A Tanavde
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alexander S Kim
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mohammad Shaear
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ralph P Tufano
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonathon O Russell
- Department of Otolaryngology - Head & Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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