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Yuan Y, Sun C, Yin T, Shao C, Pan B, Lu D, Hou S, Lowe S, Bentley R, Chen S, Huang C, Cheng C, Li Y, King B, Zhou Q, Yan C, Zhang F. Comparison of endoscopic thyroidectomy by complete areola approach and conventional open surgery in the treatment of differentiated thyroid carcinoma: A retrospective study and meta-analysis. Front Surg 2022; 9:1000011. [PMID: 36605164 PMCID: PMC9807756 DOI: 10.3389/fsurg.2022.1000011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Background The feasibility of endoscopic thyroidectomy by complete areola approach (ETCA) remains controversial. This study was conducted by combining our clinical data with the data obtained from a systematic review literature search to examine the effectiveness and safety of ETCA compared with conventional open thyroidectomy (COT) in differentiated thyroid carcinoma (DTC). Methods A total of 136 patients with a diagnosis of DTC who underwent unilateral thyroidectomy with central neck dissection from August 2020 to June 2021 were enrolled. The enrolled patients were divided into the ETCA group (n = 73) and the COT group (n = 63). The operative time, intraoperative bleeding volume, number of removed lymph nodes, number of metastatic lymph nodes, postoperative drainage volume, length of postoperative hospital stay, postoperative parathyroid hormone (PTH) levels, and complications were analyzed. Then, a systemic review and comprehensive literature search were conducted by using PubMed, Google Scholar, Embase, Web of Science, CNKI, Wanfang, and VIP database up to June 2022. Review Manager software version 5.3 was used for the meta-analysis. Results The results of clinical data showed that there were significant differences between the two groups in the operative time, intraoperative bleeding volume, removed lymph nodes, and postoperative drainage volume. There were no statistical differences in the length of postoperative hospital stay, number of metastatic lymph nodes, postoperative PTH level, and complications. In the systematic review and meta-analysis, 2,153 patients from fourteen studies (including our data) were ultimately included. The results of the meta-analysis found that ETCA had a longer operative time, larger postoperative drainage volume, and lower intraoperative bleeding volume. In terms of the length of postoperative hospital stay, the number of removed lymph nodes, and surgical complications, there was no significant difference between the two groups. Conclusion ETCA poses lower surgical bleeding and better cosmetic appearance compared with COT, while the length of operation and postoperative drainage in ETCA is less favorable compared with COT. In addition, ETCA is not inferior to COT in terms of the postoperative hospitalization stay, the number of removed lymph nodes, and surgical complications. Given its overall advantages and risks, ETCA is an effective and safe alternative for patients with cosmetic concerns.
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Affiliation(s)
- Yuquan Yuan
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China,Graduate School of Medicine, Chongqing Medical University, Chongqing, China
| | - Chenyu Sun
- Department of Medicine, AMITA Health Saint Joseph Hospital Chicago, Chicago, IL, United States
| | - Tingjie Yin
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Cong Shao
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Bin Pan
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China,Graduate School of Medicine, Chongqing Medical University, Chongqing, China
| | - Dengwei Lu
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China,Graduate School of Medicine, Chongqing Medical University, Chongqing, China
| | - Shaodong Hou
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China,Graduate School of Medicine, North Sichuan Medical College, Nanchong, China
| | - Scott Lowe
- College of Osteopathic Medicine, Kansas City University, Kansas, MO, United States
| | - Rachel Bentley
- College of Osteopathic Medicine, Kansas City University, Kansas, MO, United States
| | - Shuya Chen
- Foundation Program, Newham University Hospital, London, England, United Kingdom
| | - Christy Huang
- California Health Sciences University College of Osteopathic Medicine, Clovis, CA, United States
| | - Ce Cheng
- Hematology and Medical Oncology, St. Joseph Mercy Ann Arbor Hospital, Ypsilanti, MI, United States
| | - Yaru Li
- Internal Medicine, Swedish Hospital, Chicago, IL, United States
| | - Bethany King
- Internal Medicine, Mercy One Des Moines Medical Center, Des Moines, IA, United States
| | - Qin Zhou
- Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Cunye Yan
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China,Correspondence: Cunye Yan Fan Zhang
| | - Fan Zhang
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China,Graduate School of Medicine, Chongqing Medical University, Chongqing, China,Correspondence: Cunye Yan Fan Zhang
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2
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Sarda H, Arora V, Sachdeva T, Jain SK. Systematic Review of Comparison of use of Ultrasonic Scalpel Versus Conventional Haemostatic Techniques in Performing Thyroid Surgery. Indian J Otolaryngol Head Neck Surg 2022; 74:6285-6291. [PMID: 36742765 PMCID: PMC9895553 DOI: 10.1007/s12070-021-03026-5] [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: 07/20/2021] [Accepted: 10/02/2021] [Indexed: 02/07/2023] Open
Abstract
Haemostasis during any surgical procedure is fundamental for attaining a positive patient outcome. Safe thyroid surgery requires meticulous attention for careful control of bleeding and safe guarding important structures like recurrent laryngeal nerve. Many methods such as ligation and suturing, electro ligation sealing, coagulation, and ultrasonic coagulation have been put to use for achieving haemostasis. The objective of this systemic review was to compare and review the surgical outcomes between harmonic (ultrasonic) scalpel and conventional ligature techniques in performing thyroid surgery. The systematic review was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and checklist with a total of 11 studies selected for qualitative analysis. The statistical software Review Manager 5.4.1 provided by the Cochrane Collaboration was used for performing the analysis on the two groups. It was concluded that the use of harmonic scalpel for thyroid surgery is useful for reducing operative time, postoperative pain, drainage volume and transient hypocalcemia, hence can be a reliable and a safe tool compared to conventional techniques often used for surgery.
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Affiliation(s)
- Hitesh Sarda
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - Viresh Arora
- ENT Consultant Sandwell & West Birmingham NHS Hospital Trust, Birmigham, UK
| | - Tejasi Sachdeva
- Department of Radiotherapy, Maulana Azad Medical College, New Delhi, India
| | - Sudhir Kumar Jain
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
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3
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Chang JW, Na G, Shin SH, Kim YS, Koo BS, Ahn SH, Chang Choi E, Kim WS. Is an Ultrasonic and Bipolar Integrated Energy Device More Useful Than a Conventional Electric Device in Head and Neck Free Flap Reconstruction? A Prospective Comparison. J Oral Maxillofac Surg 2020; 78:1437.e1-1437.e9. [DOI: 10.1016/j.joms.2020.02.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Revised: 02/01/2020] [Accepted: 02/09/2020] [Indexed: 11/28/2022]
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4
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Siu JM, McCarty JC, Gadkaree S, Caterson EJ, Randolph G, Witterick IJ, Eskander A, Bergmark RW. Association of Vessel-Sealant Devices vs Conventional Hemostasis With Postoperative Neck Hematoma After Thyroid Operations. JAMA Surg 2019; 154:e193146. [PMID: 31532475 DOI: 10.1001/jamasurg.2019.3146] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Importance Vessel-sealant devices (VSDs) have been popularized for use in thyroid operations; however, the association of their use with postoperative neck hematoma, a rare but potentially fatal complication, has not been well studied. Objective To examine the association of VSDs vs conventional hemostasis (CH) in thyroid operations with the development of neck hematoma. Design, Setting, and Participants This retrospective cohort study evaluated 10 903 patients in the Thyroid Procedure-Targeted Database of the National Surgical Quality Improvement Program from January 1, 2016, to December 31, 2017. One-to-one nearest-neighbor propensity score matching was conducted to adjust for differences in baseline covariates, including demographics, comorbidities, indications for thyroid procedure (goiter, Graves disease, malignant and benign thyroid nodule), and several other thyroid-specific characteristics, between the VSD and CH groups. Main Outcomes and Measures The primary outcome was postoperative hematoma requiring intervention with open evacuation, return to the operating room, tracheostomy, additional observation, or extended length of stay. Secondary outcomes include recurrent laryngeal nerve injury, operative duration, and hospital length of stay. Results One-to-one propensity score matching yielded 6522 patients (mean [SD] age, 52 [15] years; 8544 [78.4%] female) with 3261 in each exposure group such that distribution of observed baseline covariates was not different between groups of the same propensity score. Within the matched cohort, CH was associated with higher odds of neck hematoma compared with VSD (odds ratio, 2.33; 95% CI, 1.55-3.49; P < .001), with 34 (1.0%) hematomas in the VSD group and 78 (2.4%) in the CH group. On the basis of this analysis, the number needed to treat with a VSD to prevent 1 postoperative hematoma was 74. Secondary outcomes included longer length of hospital stay (incidence rate ratio, 1.29; 95% CI, 1.23-1.36; P < .001]) in the CH group compared with the VSD group but no difference in the odds of recurrent laryngeal nerve injury (odds ratio, 0.90; 95% CI, 0.73-1.11; P = .32) or operative duration (incidence rate ratio, 0.99; 95% CI, 0.96-1.01; P = .24). Conclusions and Relevance Use of VSDs during thyroid operations was associated with reduced odds of neck hematoma compared with CH techniques without increasing odds of nerve injury. The results suggest that postoperative neck hematoma rates after thyroid surgery may differ based on the hemostasis technique and that these differences should be considered when developing strategies for quality improvement of postoperative outcomes.
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Affiliation(s)
- Jennifer M Siu
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Justin C McCarty
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.,Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Shekhar Gadkaree
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston.,Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Edward J Caterson
- Division of Plastic and Reconstructive Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Gregory Randolph
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston.,Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts
| | - Ian J Witterick
- Department of Otolaryngology-Head & Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Antoine Eskander
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology-Head & Neck Surgery, Surgical Oncology, University of Toronto, Sunnybrook Health Sciences Centre and Michael Garron Hospital, Toronto, Ontario, Canada
| | - Regan W Bergmark
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School, Boston, Massachusetts.,Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, Massachusetts
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5
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Suzuki K, Shimizu M, Sakagami T, Yagi M, Fujisawa T, Sawada S, Kanda A, Kobayashi Y, Iwai H. A comparison of short-term outcomes of neck dissection for head and neck cancers using Thunderbeat™, LigaSure™ or treatment without an energy-based device: A case controlled study. Int J Surg 2018; 58:60-64. [PMID: 30248411 DOI: 10.1016/j.ijsu.2018.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 08/30/2018] [Accepted: 09/18/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the efficacy of the new energy-based device Thunderbeat in neck dissection (ND) for head and neck cancer. MATERIALS AND METHODS We retrospectively examined 95 consecutive patients who underwent ND for head and neck squamous cell carcinoma between April 2013 and March 2018. The patients were divided into three groups: ND without the energy-based device (control group), ND using the LigaSure Small Jaw (LS group), and ND using the Thunderbeat Open Fine Jaw (TB group). The outcomes were compared among the three groups, as measured by the duration of ND (dissection time), blood loss during ND, and postoperative complications. We also analyzed the factors that may influence dissection time using multivariate analysis. RESULTS Compared to the control group, dissection time was found to be significantly shorter in both energy-based device groups (LS group and TB group) (96.4, 71.1, and 66.0 min, respectively, p = 0.0015) by univariate analysis. Blood loss during ND did not differ significantly among the three groups. Multivariate analysis showed that ND using the Thunderbeat as well as elderly patients (70 years and over), less extensive surgery (3 or fewer neck levels), and absence of extracapsular invasion were independently and significantly associated with shorter dissection time (p = 0.0069, 0.0337, <0.0001, and 0.0015, respectively). The incidence of postoperative complications in the LS group (20%) tended to be higher than those in the other groups (5.6% in the control group and 3.4% in the TB group), although the differences were not significant. CONCLUSION ND for head and neck cancers using the Thunderbeat is a safe and reliable method in terms of duration of dissection without increasing postoperative complications.
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Affiliation(s)
- Kensuke Suzuki
- Department of Otolaryngology, Head and Neck Surgery, Kansai Medical University Hospital, Japan.
| | - Minaki Shimizu
- Department of Otolaryngology, Head and Neck Surgery, Kansai Medical University Hospital, Japan
| | - Tomofumi Sakagami
- Department of Otolaryngology, Head and Neck Surgery, Kansai Medical University Hospital, Japan
| | - Masao Yagi
- Department of Otolaryngology, Head and Neck Surgery, Kansai Medical University Hospital, Japan
| | - Takuo Fujisawa
- Department of Otolaryngology, Head and Neck Surgery, Kansai Medical University Hospital, Japan
| | - Shunsuke Sawada
- Department of Dentistry and Oral Surgery, Kansai Medical University Hospital, Japan
| | - Akira Kanda
- Department of Otolaryngology, Head and Neck Surgery, Kansai Medical University Hospital, Japan
| | - Yoshiki Kobayashi
- Department of Otolaryngology, Head and Neck Surgery, Kansai Medical University Hospital, Japan
| | - Hiroshi Iwai
- Department of Otolaryngology, Head and Neck Surgery, Kansai Medical University Hospital, Japan
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Aires FT, Matos LLD, Dedivitis RA, Cernea CR. Effectiveness of harmonic scalpel in patients submitted to total thyroidectomy: systematic review with meta-analysis. Rev Assoc Med Bras (1992) 2018; 64:649-657. [DOI: 10.1590/1806-9282.64.07.649] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 12/06/2017] [Indexed: 11/22/2022] Open
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7
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Maniakas A, Christopoulos A, Bissada E, Guertin L, Olivier MJ, Malaise J, Ayad T. Perioperative practices in thyroid surgery: An international survey. Head Neck 2017; 39:1296-1305. [PMID: 28493562 DOI: 10.1002/hed.24722] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2016] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Perioperative practices in thyroid surgery vary from one specialty, institution, or country to the next. We evaluated the preoperative, intraoperative, and postoperative practices of thyroid surgeons focusing on preoperative ultrasound, vocal cord evaluation, wound drains, and hospitalization duration, among others. METHODS A survey was sent to 7 different otolaryngology and endocrine/general surgery associations. RESULTS There were 965 respondents from 52 countries. Surgeon-performed ultrasound is practiced by more than one third of respondents. Otolaryngologists perform preoperative and postoperative vocal cord evaluation more often than endocrine/general surgeons (p < .001). Sixty percent of respondents either never place drains or place drains <50% of the time in thyroid lobectomies (43% for total thyroidectomies). Outpatient thyroid surgery is most frequently performed by surgeons in the United States (63%). CONCLUSION This epidemiologic study is the first global thyroid survey of its kind and clearly demonstrates the variability and evolving trends in thyroid surgery. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1296-1305, 2017.
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Affiliation(s)
- Anastasios Maniakas
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.,Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada.,Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Apostolos Christopoulos
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.,Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Eric Bissada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.,Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada.,Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Louis Guertin
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.,Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Marie-Jo Olivier
- Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada.,Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Jacques Malaise
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.,Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
| | - Tareck Ayad
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada.,Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada.,Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
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8
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Zhang L, Li N, Yang X, Chen J. A meta-analysis comparing the outcomes of LigaSure Small Jaw versus clamp-and-tie technique or Harmonic Focus Scalpel in thyroidectomy. Medicine (Baltimore) 2017; 96:e6141. [PMID: 28296728 PMCID: PMC5369883 DOI: 10.1097/md.0000000000006141] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND LigaSure (LS) Small Jaw is a surgical hemostasis equipment that is newly introduced in thyroid surgery. The objective of this study is to assess the short-term efficacy and safety outcomes of LS Small Jaw compared with clamp-and-tie technique or Harmonic Focus Scalpel in thyroidectomy. METHODS A literature search was performed in the PubMed and Embase databases (until June 12, 2016) that reported the comparisons between LS Small Jaw and other techniques in thyroidectomy. Quality assessments were performed according to The Cochrane Collaboration's risk of bias tool and a modification of the Newcastle-Ottawa Scale in randomized controlled trials (RCTs) and non-RCTs, respectively. All statistical analyses were conducted using RevMan 5.3. RESULTS Finally, 7 studies with 813 patients were included into the meta-analysis, and all included studies were comparable with moderate-to-high quality. There was significant reduced operative time in LS Small Jaw, compared with clamp-and-tie (mean difference [MD] = -17.49, 95% confidence interval [CI]: -22.20 to 12.77, P < 0.00001) or Harmonic Focus Scalpel (MD = -2.29, 95% CI: -3.19 to 1.39, P < 0.00001). Besides, other perioperative outcomes including intraoperative blood loss and postoperative blood loss favored LS Small Jaw compared with clamp-and-tie. In terms of complications, less-temporary hypocalcemia rate was observed in LS Small Jaw compared with clamp-and-tie (odds ratio [OR] = 0.49, 95% CI: 0.27-0.90, P = 0.02), although no significant difference was detected compared with Harmonic Focus Scalpel (OR = 0.47, 95% CI: 0.14-1.56, P = 0.22). Other complications such as length of hospital stay, permanent hypocalcemia, temporary or permanent recurrent laryngeal nerve palsy, and hematomas were not significant. CONCLUSION In conclusion, LS Small Jaw is more favorable than clamp-and-tie technique or Harmonic Focus Scalpel in thyroidectomy.
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Affiliation(s)
- Lei Zhang
- Department of Endocrinology, Sichuan Academy of Medical Science & Sichuan Provincial Hospital
| | - Namei Li
- Department of Infection Disease, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Xuemei Yang
- Department of Infection Disease, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Jie Chen
- Department of Infection Disease, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
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9
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Dionigi G, Chiang FY, Kim HY, Randolph GW, Mangano A, Chang PY, Lu IC, Lin YC, Chen HC, Wu CW. Safety of LigaSure in recurrent laryngeal nerve dissection-porcine model using continuous monitoring. Laryngoscope 2016; 127:1724-1729. [PMID: 27578605 DOI: 10.1002/lary.26271] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 07/19/2016] [Accepted: 08/02/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study investigated recurrent laryngeal nerve (RLN) real-time electromyography (EMG) data to define optimal safety parameters of the LigaSure Small Jaw (LSJ) instrument during thyroidectomy. STUDY DESIGN Prospective animal model. METHODS Dynamic EMG tracings were recorded from 32 RLNs (16 piglets) during various applications of LSJ around using continuous electrophysiologic monitoring. At varying distances from the RLN, the LSJ was activated (activation study). The LSJ was also applied to the RLN at timed intervals after activation and after a cooling maneuver through placement on the sternocleidomastoid muscle (cooling study). RESULTS In the activation study, there was no adverse EMG event at 2 to 5 mm distance (16 RLNs, 96 tests). In the cooling study, there was no adverse EMG event after 2-second cooling time (16 RLNs, 96 tests) or after the LSJ cooling maneuver on the surrounding muscle before reaching the RLNs (8 RLNs, 24 tests). CONCLUSION Based on EMG functional assessment, the safe distance for LSJ activation was 2 mm. Further LSJ-RLN contact was safe if the LSJ was cooled for more than 2 seconds or cooled by touch muscle maneuver. The LSJ should be used with these distance and time parameters in mind to avoid RLN injury. LEVEL OF EVIDENCE N/A. Laryngoscope, 127:1724-1729, 2017.
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Affiliation(s)
- Gianlorenzo Dionigi
- 1st Division of Surgery, Research Center for Endocrine Surgery, Department of Surgical Sciences and Human Morphology, University of Insubria (Como-Varese), Varese, Italy
| | - Feng-Yu Chiang
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hoon Yub Kim
- Department of Surgery, KUMC Thyroid Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Laryngology and Otology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, U.S.A
| | - Alberto Mangano
- 1st Division of Surgery, Research Center for Endocrine Surgery, Department of Surgical Sciences and Human Morphology, University of Insubria (Como-Varese), Varese, Italy
| | - Pi-Ying Chang
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - I-Cheng Lu
- Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yi-Chu Lin
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hui-Chun Chen
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Che-Wei Wu
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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10
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Huang JK, Ma L, Song WH, Lu BY, Huang YB, Dong HM. Quality of life and cosmetic result of single-port access endoscopic thyroidectomy via axillary approach in patients with papillary thyroid carcinoma. Onco Targets Ther 2016; 9:4053-9. [PMID: 27445496 PMCID: PMC4938135 DOI: 10.2147/ott.s99980] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Endoscopic thyroidectomy for minimally invasive thyroid surgery has been widely applied in the past decade. The present study aimed to evaluate the effects of single-port access transaxillary totally endoscopic thyroidectomy on the postoperative outcomes and functional parameters, including quality of life and cosmetic result in patients with papillary thyroid carcinoma (PTC). PATIENTS AND METHODS Seventy-five patients with PTC who underwent endoscopic thyroidectomy via a single-port access transaxillary approach were included (experimental group). A total of 123 patients with PTC who were subjected to conventional open total thyroidectomy served as the control group. The health-related quality of life and cosmetic and satisfaction outcomes were assessed postoperatively. RESULTS The mean operation time was significantly increased in the experimental group. The physiological functions and social functions in the two groups were remarkably augmented after 6 months of surgery. However, there was no significant difference in the scores of speech and taste between the two groups at the indicated time of 1 month and 6 months. In addition, the scores for appearance, satisfaction with appearance, role-physical, bodily pain, and general health in the experimental group were better than those in the control group at 1 month and 6 months after surgery. CONCLUSION The single-port access transaxillary totally endoscopic thyroidectomy is safe and feasible for the treatment of patients with PTC. The subjects who underwent this technique have a good perception of their general state of health and are likely to participate in social activities. It is worthy of being clinically used for patients with PTC.
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Affiliation(s)
| | - Ling Ma
- Department of Gynecologic Tumor, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui
| | | | - Bang-Yu Lu
- Department of Minimally Invasive Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
| | - Yu-Bin Huang
- Department of Minimally Invasive Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China
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11
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Affiliation(s)
- Gaosong Wu
- Department of Thyroid and Breast Surgery, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, P.R. China
| | - Deguang Kong
- Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P.R. China
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12
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Cannizzaro MA, Borzì L, Lo Bianco S, Okatyeva V, Cavallaro A, Buffone A. Comparison between Focus Harmonic scalpel and other hemostatic techniques in open thyroidectomy: A systematic review and meta-analysis. Head Neck 2016; 38:1571-8. [PMID: 27224745 DOI: 10.1002/hed.24449] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 01/18/2016] [Accepted: 02/09/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The purpose of this review was to compare the efficacy and surgical outcomes of total thyroidectomy between the Focus Harmonic scalpel (Ethicon, Cincinnati, OH) and other hemostatic procedures. METHODS An extensive search was conducted using the PubMed and Cochrane databases from January 2008 to October 2014. Operating time, blood loss, pain, complications, and hospital stay were evaluated. RESULTS When compared with conventional techniques or LigaSure Precise Vessel Sealing System (Medtronic, Minneapolis, MN), the use of the Focus Harmonic scalpel reduced operative time by 22,428 minutes and blood loss by 13,914 mL. Length of hospital stay was significantly shorter in the Focus Harmonic scalpel group with a mean reduction of 0.410 days. CONCLUSION According to our meta-analysis, when comparing the Focus Harmonic scalpel versus conventional techniques, it seems evident that the use of this device in thyroid surgery is associated with a mean reduction in operating time, blood loss, and hospital stay, without any increase in pain and complications. There was no appreciable difference between the Focus Harmonic scalpel and the LigaSure Precise Vessel Sealing System. © 2016 Wiley Periodicals, Inc. Head Neck 38: First-1578, 2016.
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Affiliation(s)
- Matteo Angelo Cannizzaro
- Department of "Scienze Mediche, Chirurgiche e tecnologie Avanzate - G. F. Ingrassia", University of Catania, Endocrine Surgery Unit, "Policlinico-Vittorio Emanuele" Hospital, Catania, Italy.
| | - Laura Borzì
- Department of General Surgery and Senology Unit, "Policlinico-Vittorio Emanuele" Hospital, Catania, Italy
| | - Salvatore Lo Bianco
- Department of Endocrine Surgery, "Policlinico-Vittorio Emanuele" Hospital, Catania, Italy
| | - Valeriya Okatyeva
- Department of Endocrine Surgery, "Policlinico-Vittorio Emanuele" Hospital, Catania, Italy
| | - Andrea Cavallaro
- Department of General Surgery and Senology Unit, "Policlinico-Vittorio Emanuele" Hospital, Catania, Italy
| | - Antonino Buffone
- Department of Endocrine Surgery, "Policlinico-Vittorio Emanuele" Hospital, Catania, Italy
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Van Slycke S, Gillardin JP, Van Den Heede K, Minguet J, Vermeersch H, Brusselaers N. Comparison of the harmonic focus and the thunderbeat for open thyroidectomy. Langenbecks Arch Surg 2016; 401:851-9. [DOI: 10.1007/s00423-016-1448-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 05/11/2016] [Indexed: 02/04/2023]
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14
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Biron VL, Bang H, Farwell DG, Bewley AF. National Trends and Factors Associated with Hospital Costs Following Thyroid Surgery. Thyroid 2015; 25:823-9. [PMID: 25873398 PMCID: PMC4507087 DOI: 10.1089/thy.2014.0495] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Medical costs in the United States have been increasing disproportionally to gross domestic product, raising concerns about the sustainability of U.S. healthcare expenditures. Care of patients with thyroid disease has been identified as an area of medicine where cost increases have been pronounced. OBJECTIVES The goals of this study were to identify potential drivers of the cost of hospitalization following thyroid surgery, and to understand which of these factors may be contributing to observed increases in cost from 2003 to 2011. METHODS A retrospective cross-sectional analysis of discharge data from the Nationwide Inpatient Sample (NIS) database for all admissions following thyroid lobectomy or total thyroidectomy in the years 2003, 2007, and 2011 was performed. Multiple regression analysis via a weighted generalized linear model was used to identify factors that were independently associated with high cost of hospitalization. Trend as well as subgroup analyses were then performed to identify which of these factors could be contributing to increasing costs. RESULTS There were 47,854 hospital admissions following total thyroidectomy or thyroid lobectomy identified in the years 2003, 2007, and 2011. The aggregate national cost of hospitalization increased from $198 million in 2003 to $373 million in 2011 in inflation-adjusted 2011 dollars. The weighted mean cost of hospitalization following thyroid surgery increased from $6154 to $8982 from 2003 to 2011 in inflation-adjusted 2011 dollars. Higher comorbidity score, total thyroidectomy, lymphadenectomy, western region, rural region, and certain postoperative complications were the factors most highly associated with increased hospital costs. Of these, an increasing proportion of patients with higher severity of illness score and an increasing proportion of patients undergoing total thyroidectomy and lymphadenectomy were implicated as the most likely contributors to the cost increases. The rate of total thyroidectomy and lymphadenectomy was found to be increasing for patients with both benign and malignant thyroid disease. CONCLUSIONS According to the NIS data set, costs associated with hospitalization after thyroid surgery increased markedly from 2003 to 2011. This increase could be in part due to a growing proportion of sicker patients undergoing more extensive surgery, but a number of confounders in this study limit the conclusions. Further analysis of factors that could be associated with the rising costs of inpatient thyroid surgery should be undertaken.
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Affiliation(s)
- Vincent L. Biron
- Division of Otolaryngology—Head and Neck Surgery, Department of Surgery University of Alberta, Edmonton, Canada
| | - Heejung Bang
- Department of Public Health Sciences, Division of Biostatistics, University of California Davis, Davis, California
| | - D. Gregory Farwell
- Department of Otolaryngology—Head and Neck Surgery, University of California Davis, Sacramento, California
| | - Arnaud F. Bewley
- Department of Otolaryngology—Head and Neck Surgery, University of California Davis, Sacramento, California
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