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Chand G, Johri G, Mishra A, Mishra SK. Endoscopic Thyroid Surgery: Initial Experience of More than 100 Cases from a Tertiary Care Centre in India. Indian J Surg 2019. [DOI: 10.1007/s12262-018-1851-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Bellantone R, Raffaelli M, De Crea C, Sessa L, Traini E, Princi P, Lombardi CP. Video-Assisted Thyroidectomy for Papillary Thyroid Carcinoma: Oncologic Outcome in Patients with Follow-Up ≥ 10 Years. World J Surg 2018; 42:402-408. [PMID: 29238849 DOI: 10.1007/s00268-017-4392-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Video-assisted thyroidectomy (VAT) arisen as a valid treatment for selected patients with papillary thyroid carcinoma (PTC), but no data concerning long-term oncologic outcome are available. The primary aim of the study was to evaluate the oncologic outcome of patients who underwent VAT for PTC with a follow-up ≥ 10 years. METHODS The medical charts of all the patients who successfully underwent VAT for PTC were reviewed. The patients with a minimum follow-up period of 120-months were included. Patients with unifocal PTC ≤ 1 cm, in the absence of lymph node metastases, without gross extracapsular invasion and age < 45 years were considered "low-risk" patients and followed with ultrasound and serum thyroglobulin (sTg) on levothyroxine (LT4); the remaining patients underwent nuclear medicine evaluation. RESULTS Two hundred and fifty-seven patients, operated on between May 2000 and October 2006, were included. Postoperative complications included four transient recurrent palsies, 76 transient and 1 permanent hypocalcemia. One hundred and four low-risk patients were followed with ultrasound and sTg on LT4. At a mean follow-up of 136.6 months, mean sTg on LT4 was 0.1 ± 0.1 ng/ml. None of them showed recurrence. The remaining 153 patients underwent nuclear medicine evaluation. Among these 153, 62 did not undergo radioiodine ablation (RAI). At a mean follow-up of 150.8 months, mean sTg on LT4 was 0.1 ± 0.1 ng/ml. None of them showed recurrence. The remaining 91 patients underwent RAI. Mean pre-RAI sTg off-LT4 was 8.3 ± 5.8 ng/ml, mean radioiodine uptake was 2.8 ± 4.4%. Among these 91, three pN1a patients developed a lateral neck node recurrence. No other recurrence was registered. At the latest follow-up mean sTg on LT4 in this subgroup of patients was 0.1 ± 0.2 ng/ml. CONCLUSIONS The long-term (≥ 10 years) oncologic outcome further demonstrates that VAT is a valid option for selected PTC patients.
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Affiliation(s)
- Rocco Bellantone
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Marco Raffaelli
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy.
| | - Carmela De Crea
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Luca Sessa
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Emanuela Traini
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Pietro Princi
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
| | - Celestino Pio Lombardi
- U.O.C. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168, Rome, Italy
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Sessa L, Lombardi CP, De Crea C, Raffaelli M, Bellantone R. Video-assisted endocrine neck surgery: state of the art. Updates Surg 2017. [DOI: 10.1007/s13304-017-0467-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Surgical approach to level VI in papillary thyroid carcinoma: an overview. Updates Surg 2017; 69:205-209. [DOI: 10.1007/s13304-017-0468-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 05/16/2017] [Indexed: 10/19/2022]
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Li B, Zhao W, Xu L, Sun J, Chen B, Yu G, Ye L, Gong M, Cong W, Qi Y. Minimally invasive video-assisted lateral neck lymphadenectomy for the papillary thyroid carcinoma with cervical lymph nodes metastasis. Jpn J Clin Oncol 2016; 46:635-41. [PMID: 27162317 DOI: 10.1093/jjco/hyw055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 03/31/2016] [Indexed: 12/30/2022] Open
Affiliation(s)
- Bo Li
- Department of Thyroid Surgery, The Second Hospital of Shandong University, Shandong, People's Republic of China
| | - Wenxing Zhao
- Department of Operating Theatre, Jinan Central Hospital, Shandong
| | - Lina Xu
- Department of Thyroid Surgery, The Second Hospital of Shandong University, Shandong, People's Republic of China
| | - Jingfu Sun
- Department of Thyroid Surgery, The Second Hospital of Shandong University, Shandong, People's Republic of China
| | - Bo Chen
- Department of Thyroid Surgery, Qilu Hospital of Shandong University, Shandong
| | - Guanying Yu
- Department of Gastrointestinal Surgery, Jinan Central Hospital, Shandong
| | - Lan Ye
- Department of Cancer Center, The Second Hospital of Shandong University, Shandong
| | - Maosong Gong
- Department of Thyroid Surgery, The Second Hospital of Shandong University, Shandong, People's Republic of China
| | - Wei Cong
- Department of Thyroid Surgery, The Second Hospital of Shandong University, Shandong, People's Republic of China
| | - Yuzhong Qi
- Department of Thyroid Surgery, The Second Hospital of Shandong University, Shandong, People's Republic of China
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Hensler MS, Falciglia M, Yaqub A, Yang H, Steward DL. Elective central node dissection: Comparison of open to minimally invasive video-assisted approach. Laryngoscope 2016; 126:1715-8. [DOI: 10.1002/lary.25844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 11/08/2015] [Accepted: 12/01/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Matthew S. Hensler
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati; Cincinnati Ohio
| | | | - Abid Yaqub
- Division of Endocrinology; University of Cincinnati; Cincinnati Ohio
| | - Huaitao Yang
- Department of Pathology; University of Cincinnati; Cincinnati Ohio U.S.A
| | - David L. Steward
- Department of Otolaryngology-Head and Neck Surgery; University of Cincinnati; Cincinnati Ohio
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Minimally Invasive Video-Assisted Total Thyroidectomy (mi V.A.T.T.) - Case Series of 48 Patients. CURRENT HEALTH SCIENCES JOURNAL 2016; 42:40-46. [PMID: 30568811 PMCID: PMC6256148 DOI: 10.12865/chsj.42.01.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 03/10/2016] [Indexed: 11/18/2022]
Abstract
PURPOSE The first report of miVATT was published in 1998 by Miccoli, leading to a revolution in the field of thyroid surgery. This prospective study aims to evaluate the technique with regard to our department's experience over a four-year period. MATERIAL-METHODS Between September 2009 and October 2013, 48 adult patients (37 females, 11 males) with a mean age of 41.3 (± 11.6) years underwent scheduled miVATT for benign thyroid lesions. Selection criteria included thyroid volume <15 ml and nodules not exceeding 3.5 cm of diameter. Thyroiditis, previous neck surgery and previous irradiation, mediastinal goiter and involvement in another clinical study constituted the exclusion criteria. The procedure we performed was miVATT as described by Miccoli with the only additions being the use of the Harmonic Scalpel and the fixation of the endoscope on a holding device. Also, no drains were applied. RESULTS No conversions to open surgery were needed. Operation time for total thyroidectomy was 71.23 min (± 23.81) with a mean hospitalization of 1.14 days (± 0.4). Five patients (10.4%) exhibited transient hypocalcemia, whereas there were no recurrent laryngeal nerve palsies. Post-operative pain was mild and the final aesthetic result was considered excellent by the patients. CONCLUSION miVATT is a safe and feasible alternative to the conventional thyroidectomy when performed in carefully selected patients by experienced surgeons.
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Abstract
Robot assisted thyroid surgery has been the latest advance in the evolution of thyroid surgery after endoscopy assisted procedures. The advantage of a superior field vision and technical advancements of robotic technology have permitted novel remote access (trans-axillary and retro-auricular) surgical approaches. Interestingly, several remote access surgical ports using robot surgical system and endoscopic technique have been customized to avoid the social stigma of a visible scar. Current literature has displayed their various advantages in terms of post-operative outcomes; however, the associated financial burden and also additional training and expertise necessary hinder its widespread adoption into endocrine surgery practices. These approaches offer excellent cosmesis, with a shorter learning curve and reduce discomfort to surgeons operating ergonomically through a robotic console. This review aims to provide details of various remote access techniques that are being offered for thyroid resection. Though these have been reported to be safe and feasible approaches for thyroid surgery, further evaluation for their efficacy still remains.
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Affiliation(s)
- Parisha Bhatia
- 1 Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA ; 2 Department of Otolaryngology Head & Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Hossam Eldin Mohamed
- 1 Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA ; 2 Department of Otolaryngology Head & Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Abida Kadi
- 1 Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA ; 2 Department of Otolaryngology Head & Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Emad Kandil
- 1 Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA ; 2 Department of Otolaryngology Head & Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Rohan R Walvekar
- 1 Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA ; 2 Department of Otolaryngology Head & Neck Surgery, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
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Byeon HK, Koh YW. The new era of robotic neck surgery: The universal application of the retroauricular approach. J Surg Oncol 2015; 112:707-16. [DOI: 10.1002/jso.24019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 08/08/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Hyung Kwon Byeon
- Department of Otorhinolaryngology; Yonsei University College of Medicine; Seoul Republic of Korea
| | - Yoon Woo Koh
- Department of Otorhinolaryngology; Yonsei University College of Medicine; Seoul Republic of Korea
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Minimally invasive video-assisted thyroidectomy: experience of 200 cases in a single center. Wideochir Inne Tech Maloinwazyjne 2014; 9:337-43. [PMID: 25337155 PMCID: PMC4198635 DOI: 10.5114/wiitm.2014.43077] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 01/27/2014] [Accepted: 02/17/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction Minimally invasive techniques in thyroid surgery including video-assisted technique originally described by Miccoli have been accepted in several continents for more than 10 years. Aim To analyze our preliminary results from minimally invasive video-assisted thyroidectomy (MIVAT) and to evaluate the feasibility and effects of this method in a general department over a 4-year period. Material and methods Initial experience was presented based on a series of 200 patients selected for MIVAT at the General Surgery Department of Yantai Yuhuangding Hospital affiliated with Qingdao University during the period from May 2008 to June 2012. The enrolling criteria were rigorously observed. An above sternal incision with average length of 2.5 cm (1.5–3.0 cm) was made. Clinicopathologic characteristics, postoperative pain, length of hospital stay, cosmetic results and complications were retrospectively analyzed. Results All patients received general anesthesia. Thyroid unilateral lobectomy was successfully accomplished in 108 cases, total thyroidectomy in 84, and partial lobectomy in 8. Conversion to standard conventional thyroidectomy was required in 6 patients (3%) because of thyroiditis and bleeding. The mean lymph node yield of the cancer specimens was 3.6 per patient. Permanent unilateral recurrent laryngeal nerve (RLN) palsy occurred in 1 case (0.5%), transient unilateral RLN palsy in 6 patients (3.0%, complete recovery after 1–6 months), and transient hypocalcemia in 7 patients (3.5%). No definitive hypocalcemia was observed. No postoperative hematomas occurred. Postoperative pain was endurable. The cosmetic result was excellent in most cases. Conclusions The MIVAT is feasible and safe in selected patients, with better results comparable to conventional thyroidectomy. The MIVAT can also be performed in a general surgery department.
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Ouyang DQ, Su YX, Zheng GS, Liang YJ, Zhang SE, Liao GQ. Long-term outcomes of endoscopic neck dissection in the treatment of early-stage oral cancer: a pilot study. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:546-52. [PMID: 25442490 DOI: 10.1016/j.oooo.2014.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 06/14/2014] [Accepted: 07/01/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study aimed to investigate the feasibility and safety of endoscopic neck dissection in the treatment of early-stage oral cancer and to evaluate the long-term clinical outcomes. STUDY DESIGN Six patients with early-stage oral cancer were enrolled in this pilot study from December 2006 to May 2007. All the patients underwent endoscopic selective neck dissection (levels I-IV) of the ipsilateral neck and partial glossectomy or hemiglossectomy as the primary treatment. RESULTS All endoscopic procedures were successfully performed, with important neck structures identified and preserved. All the patients survived with no persistent or recurrent disease during the 76- to 83-month follow-up. CONCLUSIONS Our preliminary results indicated that endoscopic neck dissection is a technically feasible and safe technique for treating early-stage oral cancer. The oncologic indications and validation should be further confirmed in patients with clinically positive neck lymph nodes in a future study.
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Affiliation(s)
- Dai-Qiao Ouyang
- Oral and Maxillofacial Surgeon, Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yu-Xiong Su
- Associate Professor, Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Guang-Sen Zheng
- Attending Physician, Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yu-Jie Liang
- Attending Physician, Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Si-En Zhang
- Oral and Maxillofacial Surgeon, Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Gui-Qing Liao
- Professor and Chairman, Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, Guangdong, China.
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Video-assisted selective lateral neck dissection for papillary thyroid carcinoma. Langenbecks Arch Surg 2013; 398:395-401. [DOI: 10.1007/s00423-012-1045-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 12/29/2012] [Indexed: 10/27/2022]
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Yang Y, Gu X, Wang X, Xiang J, Chen Z. Endoscopic thyroidectomy for differentiated thyroid cancer. ScientificWorldJournal 2012; 2012:456807. [PMID: 23304086 PMCID: PMC3530176 DOI: 10.1100/2012/456807] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Accepted: 12/03/2012] [Indexed: 11/17/2022] Open
Abstract
Endoscopic thyroidectomy is a relatively new approach in treating differentiated thyroid cancer. Since last decades, more and more endoscopic thyroidectomies have been performed. We review the indications and contraindications, methods, and postoperational complications of this surgical procedure. Lots of surgical approaches have been developed in endoscopic thyroidectomy for differentiated thyroid cancer. Compared to conventional thyroidectomy, scarless endoscopic thyroidectomy has a superior cosmetic result. And it also reduces the incidence of hypesthesia, paresthesia, or feelings of self-consciousness. However, the outcome depends, to a large extent, on the skill of the operator and the learning curve being relatively long. With the development of surgical equipments and skills, operation time and complications will be reduced. Indications of endoscopic thyroidectomy will be widened and it will be more and more performed.
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Affiliation(s)
- Yi Yang
- Department of General surgery, Huashan Hospital, Fudan University, Shanghai 200040, China
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Yu JJ, Bao SL, Yu SL, Zhang DQ, Loo WTY, Chow LWC, Su L, Cui Z, Chen K, Ma LQ, Zhang N, Yu H, Yang YZ, Dong Y, Yip AYS, Ng ELY. Minimally invasive video-assisted thyroidectomy for the early-stage differential thyroid carcinoma. J Transl Med 2012; 10 Suppl 1:S13. [PMID: 23046557 PMCID: PMC3445859 DOI: 10.1186/1479-5876-10-s1-s13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Minimally invasive video-assisted thyroidectomy (MIVAT), the modified Miccoli’s thyroid surgery, is the most widespread minimally invasive technique and has been widely used for treatment of thyroid disease. This study aimed to verify the potential benefits of the modified Miccoli’s thyroid surgery, determine the feasibility of the MIVAT for early-stage differential thyroid carcinoma and evaluate the likelihood of the surgical method as a standard operation for early malignant thyroid carcinoma. Methods A total of 135 patients were retrospectively compared which included two groups of patients: the first group underwent the conventional thyroidectomy; the other group underwent MIVAT. Patients with thyroid nodule smaller than 20 mm and without previous neck surgery were included while those with wide-ranging and distant metastases of cervical tissues, or any suspected thyroid nodal metastases were excluded for analysis. MIVAT and the central compartment (level VI) lymph nodes dissection (LND) were considered as a new treatment method for this retrospective study. In addition to the comparison of surgical outcomes between the new treatment and the conventional thyroid surgery, other surgical parameters including operative time, operative volume of hemorrhage, incisional length, postoperative volume of drainage, length of hospitalization, accidence of hoarse voice, accidence of bucking, accidence of hypocalcemia and peak angle of cervical axial rotation were also compared. Results Out of 135 patients, 111 patients underwent conventional thyroid surgery and 24 patients underwent MIVAT plus level VI LND for treatment of early-stage differential malignant carcinoma. Patients who received the new surgical treatment had significantly shorter incisional length (3.1 cm vs. 6.9 cm, p < 0.0001), shorter operative time (109 min vs. 139 min, p = 0.014) and fewer operative hemorrhage (29.5 ml vs. 69.7 ml, p < 0.0001) when compared to the conventional treatment. Postoperative peak angle of cervical axial rotation of patients treated with MIVAT was less than those treated with conventional surgery (L: 31.5° vs. 39.0°, p < 0.0001; R: 31.5° vs. 38.0°, p < 0.0001). Incisional wound infection, postoperative hoarse voice, bucking and hypocalcemia were not observed in all patients. Postoperative analgetica was not required as well. Conclusions Compared with conventional thyroid surgery for early-stage differential thyroid carcinoma, the new surgical treatment could be considered as an alternative surgical method for treatment of early-stage thyroid carcinoma since it was feasible, safe and clinically effective with better surgical and cosmetic outcomes.
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Affiliation(s)
- Jian-jun Yu
- Department of Surgical-oncology, Affiliated Tumor Hospital, Ningxia Medical University, Ningxia, PR China.
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Lombardi CP, Raffaelli M, De Crea C, Sessa L, Rampulla V, Bellantone R. Video-assisted versus conventional total thyroidectomy and central compartment neck dissection for papillary thyroid carcinoma. World J Surg 2012; 36:1225-30. [PMID: 22302283 DOI: 10.1007/s00268-012-1439-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although video-assisted (VA) thyroidectomy emerged as effective treatment for selected patients with papillary thyroid carcinoma (PTC), some concerns remain about obtaining adequate central neck node clearance. We compared patients who underwent VA and conventional total thyroidectomy (TT) and central compartment dissection (CCD) for PTC. METHODS A total of 52 consecutive patients successfully underwent VA-TT and VA-CCD for PTC (VA group) were compared to 52 controls who underwent conventional TT and CCD (C group) for PTC. RESULTS The two groups were matched for age (p = 0.75), sex (p = 0.07), and tumor size (p = 1.0). Operating time (p = 0.23), overall postoperative complications (p = 0.41), pT (p = 0.44), and pN (p = 0.84) were similar in the two groups. The mean number of removed nodes was similar (10.6 ± 4.6 in VA group vs. 12.2 ± 5.6 in C group) (p = 0.11).Mean postoperative serum thyroglobulin (sTg) off levothyroxine (LT4) suppressive treatment was 3.2 ± 5.0 ng/ ml in the VA group and 2.6 ± 7.4 ng/ml in the C-group (P = 0.67). Mean postoperative radioiodine uptake (RAIU) was similar in the two groups (1.5 ± 1.3 vs. 1.7 ± 1.3%) (p = 0.49). When pN1a patients alone were considered, no difference was found between the VA group (21 patients) and the controls (24 patients) concerning the mean number of removed nodes (10.3 ± 4.1 vs. 12.4 ± 5.6) (p = 0.16), the mean sTg off LT4 (4.4 ± 6.0 vs. 1.9 ± 2.7 ng/ml) (p = 0.07) and the mean RAIU (1.9 ± 1.5 vs. 1.7% ± 1.3%) (p = 0.63). CONCLUSIONS The results of VA-TT and CCD in selected cases of PTC appear to be comparable to those of conventional surgery. A longer follow-up and larger series are necessary to draw definitive conclusions concerning longterm outcomes.
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Affiliation(s)
- Celestino P Lombardi
- Division of General and Endocrine Surgery, Department of Surgery, Università Cattolica del Sacro Cuore, Policlinico A. Gemelli, L.go A. Gemelli 8, 00168 Rome, Italy
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Neidich MJ, Steward DL. Safety and feasibility of elective minimally invasive video-assisted central neck dissection for thyroid carcinoma. Head Neck 2011; 34:354-8. [PMID: 21374758 DOI: 10.1002/hed.21733] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 12/22/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Minimally invasive video-assisted thyroidectomy (MIVAT) is accepted as treatment for select patients with thyroid carcinoma. We report both benefits and limitations of elective central neck dissection performed with the MIVAT technique. METHODS Patients undergoing elective central neck dissection with MIVAT during November 2006 to October 2009 were studied retrospectively. Outcomes included complications and recurrence rates. RESULTS In all, 28 patients were studied. There were no recurrences, with median follow-up of 14 months. Eleven patients (39%) had positive central lymph nodes for metastases. No permanent hypocalcemia resulted, although 3 patients (10.7%) experienced transient hypocalcemia on postoperative day 1 (Ca <8 mg/dL). No permanent hypoparathyroidism resulted, although 7 patients (25%) had transient hypoparathyroidism (postanesthesia care unit parathyroid hormone [PTH] <8 mg/dL) treated with short-term supplementation. Transient recurrent laryngeal nerve paresis occurred in 1 patient (3.6%). At the most recent check, 91% of patients had low/undetectable (<1 ng/mL) thyroglobulin. CONCLUSIONS Elective central neck dissection performed with MIVAT is a safe and feasible procedure in our institutional experience.
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Affiliation(s)
- Marci J Neidich
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, Cincinnati, Ohio, USA.
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The endoscopic approach to the neck: a review of the literature, and overview of the various techniques. Surg Endosc 2010; 25:1358-63. [PMID: 21136119 DOI: 10.1007/s00464-010-1452-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Accepted: 09/14/2010] [Indexed: 12/27/2022]
Abstract
BACKGROUND The endoscopic surgical approach to the neck has reached the head and neck surgeons' view with a certain delay, compared to other fields of endoscopic procedures. This may be attributed to the tight work space and plenty of vital structures in the operating field. Since study groups described first attempts with endoscopic or video assisted removals of thyroid glands in the late nineties, selective neck dissections on animal models or cadaveric dissections were performed in 2003. METHOD The review consists of a Medline Search regarding the terms of endoscopic, video- assisted neck dissections, excision of neck lesions, thyroidectomy and submandibular resection and minimal access surgery. The three main procedures (selective neck dissection, submandibular resection and thyroidectomy) are described and reviewed in the following test. RESULTS Various techniques have been performed successfully and led to good clinical results. The studies described in literature other than for thyroidectomy often do not exceed the level of small series or case-reports. CONCLUSION With a good proof of indication gasless lifting techniques, video assisted endoscopical techniques and subcutaneous approaches with gas filling procedures are feasible in neck surgery. All methods depending on the surgeons' experience describe no significantly extended operation times, a better and faster wound-healing and an optimized cosmetic outcome, compared to open approaches. Surgeons should always be aware of the limitations of the minimal invasive techniques regarding the complications or modifications during neck dissection/thyroidectomy.
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Video-assisted thyroidectomy for papillary thyroid carcinoma. JOURNAL OF ONCOLOGY 2010; 2010. [PMID: 20953412 PMCID: PMC2952809 DOI: 10.1155/2010/148542] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 03/17/2010] [Accepted: 05/04/2010] [Indexed: 12/21/2022]
Abstract
Background. The results of video-assisted thyroidectomy (VAT) were evaluated in a large series of patients with papillary thyroid carcinoma (PTC), especially in terms of completeness of the surgical resection and short-to-medium term recurrence. Methods. The medical records of all patients who underwent video-assisted thyroidectomy for PTC between June 1998 and May 2009 were reviewed. Results. Three hundred fifty-nine patients were included. One hundred twenty-six patients underwent concomitant central neck node removal. Final histology showed 285 pT1, 26 pT2, and 48 pT3 PTC. Lymph node metastases were found in 27 cases. Follow-up was completed in 315 patients. Mean postoperative serum thyroglobulin level off levothyroxine was 5.4 ng/mL. Post operative ultrasonography showed no residual thyroid tissue in all the patients. Mean post-operative 131I uptake was 1.7%. One patient developed lateral neck recurrence. No other recurrence was observed.
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Technological innovations in surgical approach for thyroid cancer. JOURNAL OF ONCOLOGY 2010; 2010. [PMID: 20798772 PMCID: PMC2926682 DOI: 10.1155/2010/490719] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Revised: 04/15/2010] [Accepted: 06/27/2010] [Indexed: 12/18/2022]
Abstract
Over the last decade, surgeons have witnessed dramatic changes in surgical practice as a result of the introduction of new technological advancement. Some of these changes include refinement of techniques in thyroid cancer surgery. The development of various endoscopic thyroidectomy techniques, the addition of the da Vinci robot, and the use of operative adjuncts in thyroid surgery, such as intraoperative neuromonitoring and quick intraoperative parathyroid hormone, have made thyroid cancer surgery not only safer and better accepted by patients with thyroid cancer but also offer them more surgical treatment options.
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Lewis CM, Chung WY, Holsinger FC. Feasibility and surgical approach of transaxillary robotic thyroidectomy without CO(2) insufflation. Head Neck 2010; 32:121-6. [PMID: 19998442 DOI: 10.1002/hed.21318] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Our objective was to evaluate the anatomic basis for robotic-assisted transaxillary thyroidectomy and to determine its feasibility in a prospective clinical trial. METHODS AND RESULTS Using the da Vinci Surgical Robotic System, we performed 5 cadaveric dissections, via transaxillary approach without gas insufflation. Once the safety and feasibility of this approach had been demonstrated in cadavers, it was utilized to perform a thyroid lobectomy in a patient. The da Vinci system provided excellent visualization of the recurrent and superior laryngeal nerves, parathyroid glands, and paratracheal lymphatics. After the 5 cadaver dissections, the procedure time diminished from >90 minutes to <30 minutes. CONCLUSION Robotic-assisted transaxillary thyroidectomy is feasible with proper instrumentation and an understanding of the surgical anatomy. Based on this preclinical laboratory study and our experience in 1 patient, further evaluation of this approach in the setting of a prospective clinical trial is warranted to determine standardized criteria identifying patients who would benefit from this approach.
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Affiliation(s)
- Carol M Lewis
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
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Seybt MW, Terris DJ. Minimally Invasive Thyroid and Parathyroid Surgery: Where Are We Now and Where Are We Going? Otolaryngol Clin North Am 2010; 43:375-80, ix. [DOI: 10.1016/j.otc.2010.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Choh MS, Madura JA. The role of minimally invasive treatments in surgical oncology. Surg Clin North Am 2009; 89:53-77, viii. [PMID: 19186231 DOI: 10.1016/j.suc.2008.09.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This article reviews the use of minimally invasive surgical and endoscopic techniques in the field of surgical oncology. It reviews the indications and techniques of the use of minimally invasive surgery for several oncologic indications in general surgery. In particular, it reviews the currently published literature discussing the oncologic outcomes of these techniques.
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Affiliation(s)
- Mark S Choh
- Department of General Surgery, Rush University Medical Center, and Department of Surgery, John H Stroger Hospital of Cook County, 1725 West Harrison Avenue, Chicago, IL 60612, USA
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Kania R, Parodi M, Coste A, Herman P, Tran Ba Huy P, Papon JF. La chirurgie thyroïdienne endoscopique par techniques vidéo-assistées et totalement endoscopiques. ACTA ACUST UNITED AC 2009; 126:82-93. [DOI: 10.1016/j.aorl.2009.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Accepted: 01/29/2009] [Indexed: 01/10/2023]
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Spinelli C, Donatini G, Berti P, Materazzi G, Costanzo S, Miccoli P. Minimally invasive video-assisted thyroidectomy in pediatric patients. J Pediatr Surg 2008; 43:1259-61. [PMID: 18639679 DOI: 10.1016/j.jpedsurg.2008.02.073] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Minimally invasive video-assisted thyroidectomy (MIVAT) proved to be safe and effective in the treatment of both benign diseases and malignancies. We report our experience in thyroid surgery in pediatric patients. METHODS From October 1998 to December 2005, 35 patients (27 females and 8 males) underwent MIVAT for thyroid disease. The mean age was 14.0 years (range, 8-18 years); mean ecographically estimated thyroid volume was 11.13 mL (range, 8-25 mL). RESULTS A total thyroidectomy was performed in 22 patients, whereas lobectomy was performed in 13. Two patients of the latter group had a second lobectomy for a false-negative result at frozen section during the first operation. One patient underwent also a prophylactic central neck dissection for positive RET oncogene. The histologic examination found a papillary carcinoma in 11 patients, a microfollicular nodule in 7 patients, and multinodular goiter in 17 patients. The mean operative time was 54.1 minutes for thyroidectomy (range, 25-110 minutes) and 38.5 minutes for lobectomy (range, 20-65 minutes). All patients but one was discharged on the first postoperative day. One transient hypoparathyroidism was observed in the patient who underwent total thyroidectomy plus central neck lymphadenectomy. CONCLUSIONS The MIVAT technique proved to be as safe and effective as conventional thyroidectomy with Kocher approach to treat patients with both benign and malignant diseases of the thyroid gland. The advantages of MIVAT are represented by a better and faster postoperative course and an improved aesthetic result, which is particularly important in this group of patients.
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Miccoli P, Materazzi G, Ambrosini CE, Fosso A, Berti P. Minimally invasive video-assisted central compartment lymph node dissection. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.otot.2008.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lombardi CP, Raffaelli M, de Crea C, Princi P, Castaldi P, Spaventa A, Salvatori M, Bellantone R. Report on 8 years of experience with video-assisted thyroidectomy for papillary thyroid carcinoma. Surgery 2007; 142:944-51; discussion 944-51. [DOI: 10.1016/j.surg.2007.09.022] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2007] [Revised: 09/06/2007] [Accepted: 09/11/2007] [Indexed: 11/26/2022]
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Lombardi CP, Raffaelli M, Princi P, De Crea C, Bellantone R. Minimally invasive video-assisted functional lateral neck dissection for metastatic papillary thyroid carcinoma. Am J Surg 2007; 193:114-8. [PMID: 17188101 DOI: 10.1016/j.amjsurg.2006.02.024] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2005] [Revised: 02/14/2006] [Accepted: 02/14/2006] [Indexed: 10/23/2022]
Abstract
Functional lateral neck dissection requires a large incision providing adequate exposure of the surgical field. We evaluated the feasibility of minimally invasive video-assisted functional lateral neck dissection (VALNED) in patients with papillary thyroid carcinoma (PTC). Low-risk PTC patients with lateral neck metastases <2 cm, in absence of any evidence of great vessels involvement, were considered eligible. After accomplishing total thyroidectomy and central neck clearance, dissection was performed under endoscopic vision by using a technique very similar to conventional surgery through the single 4-cm skin incision used for thyroidectomy. Two patients were selected: 1 underwent bilateral and 1 unilateral VALNED. The mean number of the removed nodes was 25 per side. Both patients experienced transient postoperative hypocalcemia. No other complication occurred. No evidence of residual or recurrent disease was found at follow-up. VALNED is feasible, and the results are encouraging. For definitive conclusions, larger series and comparative studies are necessary.
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Affiliation(s)
- Celestino Pio Lombardi
- Department of Surgery, Division of Endocrine Surgery, Università Cattolica del S. Cuore, L. go A. Gemelli 8, 00168 Rome, Italy
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Lombardi CP, Raffaelli M, Princi P, De Crea C, Bellantone R. Video-assisted thyroidectomy: report on the experience of a single center in more than four hundred cases. World J Surg 2006; 30:794-800; discussion 801. [PMID: 16680593 DOI: 10.1007/s00268-005-0390-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND We report on our series of patients selected for video-assisted thyroidectomy (VAT) over a 7-year period and discuss the results obtained. METHODS Video-assisted thyroidectomy is a gasless procedure performed under endoscopic vision through a single 1.5-2.0-cm skin incision, using a technique very similar to conventional surgery. Eligibility criteria were these: thyroid nodules < 35 mm; thyroid volume < 30 ml; no previous conventional neck surgery. Small, low-risk, papillary thyroid carcinomas (PTC) were considered eligible. RESULTS A total of 473 VATs were attempted on 459 patients. Locoregional anesthesia was used in 15 patients. Conversion was necessary in 6 (difficult dissection in 1 case, large nodule size in 3, gross lymph node metastases in 2). Thyroid lobectomy was successfully performed in 110 cases, total thyroidectomy in 343, and completion thyroidectomy in 14. In 66 patients with carcinoma, central neck nodes were removed through the same access. Concomitant parathyroidectomy was performed in 14 patients. Pathology showed benign disease in 277 cases, PTC in 175, and medullary microcarcinoma in 1. Postoperative complications included 8 transient recurrent nerve palsies, 64 transient hypocalcemias, 3 definitive hypocalcemias, 1 postoperative hematoma, and 2 wound infections. Postoperative pain was minimal and the cosmetic result excellent. In patients with PTC no evidence of recurrent or residual disease was shown. CONCLUSIONS Indications for VAT are still limited (20% of patients who require thyroidectomy). Nonetheless, in selected patients, it seems a valid option for thyroidectomy and it could be considered even preferable to conventional surgery because of its significant advantages, especially in terms of cosmetic result.
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Affiliation(s)
- Celestino Pio Lombardi
- Division of Endocrine Surgery, Department of Surgery, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
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Miccoli P, Elisei R, Donatini G, Materazzi G, Berti P. Video-assisted central compartment lymphadenectomy in a patient with a positive RET oncogene: initial experience. Surg Endosc 2006; 21:120-3. [PMID: 16960675 DOI: 10.1007/s00464-005-0642-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2005] [Accepted: 02/15/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Prophylactic surgery for patients carrying a positive RET proto-oncogene proved to be highly effective in curing those likely to experience the development of a medullary carcinoma. Video-assisted procedures have been proved feasible for central compartment dissection. METHODS A total of 15 patients (7 men and 8 women) with a positive RET proto-oncogene underwent total thyroidectomy and central compartment lymphadenectomy via a video-assisted approach. The mean age of the patients was 32.5 years. The echographically estimated mean volume was 10.3 ml, and the mean diameter of the main nodule was 8.8 mm. Preoperative ultrasound showed an absence of lateral neck lymph node involvement in all cases. No drain was used. Direct laryngoscopy was performed in all cases 1 month after surgery. RESULTS The mean operative time was 67.3 min. A transient hypoparathyroidism occurred in one patient, and a permanent hypoparathyroidism occurred in another patient. No laryngeal nerve palsy was present. All the patients were discharged on postoperative day 1. Histology showed a medullary carcinoma in 10 patients and diffuse C-cell hyperplasia in 5 patients. The mean number of lymph nodes removed was 5.1. None of these nodes proved to be metastatic. Calcitonin levels were undetectable in all six patients who had a follow-up period longer than 1 year. CONCLUSION Video-assisted central compartment lymphadenectomy was proved to be effective and safe. The procedure demonstrated a complication rate comparable with that for the conventional procedure, a better cosmetic outcome, and less postoperative pain. Although the video-assisted access proved to be a valid option for the treatment of patients carrying a positive RET proto-oncogene, a greater number of cases with a longer follow-up period is necessary to estimate the impact of the video-assisted approach on central neck lymphadenectomy.
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Affiliation(s)
- P Miccoli
- S. Chiara Hospital, University of Pisa, via Roma 67, 56100, Pisa, Italy
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Lombardi CP, Raffaelli M, Princi P, De Crea C, Bellantone R. Video-assisted thyroidectomy: report of a 7-year experience in Rome. Langenbecks Arch Surg 2006; 391:174-7. [PMID: 16528568 DOI: 10.1007/s00423-006-0023-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2005] [Accepted: 12/21/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND AIMS We report on our series of patients selected for video-assisted thyroidectomy (VAT) over a 7-year period. MATERIALS AND METHODS VAT is a gasless procedure performed under endoscopic vision through a single 1.5-2.0 cm skin incision. The eligibility criteria are thyroid nodules < or =35 mm, thyroid volume <30 ml, and no previous conventional neck surgery. Small, low-risk papillary thyroid carcinomas (PTC) were considered eligible. RESULTS There were 521 VATs attempted. Conversion was necessary six times (difficult dissection in one case, large nodule size in three, and gross lymph node metastases in two). Thyroid lobectomy was successfully accomplished in 113 cases, total thyroidectomy in 398, and completion thyroidectomy in 14. In 66 patients, the central neck nodes were removed through the same access. Pathology showed benign diseases in 313 cases, PTC in 187, and medullary microcarcinoma in 1. Postoperative complications included 9 transient recurrent nerve palsies, 73 transient hypocalcemias, 3 definitive hypoparathyroidisms, 1 postoperative haematoma, and 2 wound infections. The cosmetic result was excellent. In patients with PTC, no evidence of recurrent disease was shown. CONCLUSIONS The indications for VAT are still limited. Nonetheless, in selected patients, it seems a valid option for thyroidectomy and even preferable to conventional surgery because of its significant advantages, especially in terms of cosmetic result.
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Affiliation(s)
- Celestino Pio Lombardi
- Division of Endocrine Surgery, Department of Surgery, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy
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Maeda S, Uga T, Hayashida N, Ishigaki K, Furui J, Kanematsu T. Video-assisted subtotal or near-total thyroidectomy for Graves' disease. Br J Surg 2006; 93:61-6. [PMID: 16323164 DOI: 10.1002/bjs.5173] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Surgery remains the treatment of choice for patients with Graves' disease. The purpose of the present study was to assess the usefulness and efficacy of video-assisted subtotal or near-total thyroidectomy in patients with Graves' disease. METHODS Between March 2000 and December 2004, 63 patients with Graves' disease underwent video-assisted subtotal, near-total or total thyroidectomy. Fifty-three patients (84 per cent) were considered for surgery after failure of antithyroid drug and radioiodine therapy, whereas the other ten patients were initially selected for surgical treatment based on their own preference. Treatment outcome was evaluated, including surgical complications, thyroid function, quality of life and patient satisfaction with the surgical result. RESULTS All patients were operated on using a video-assisted technique, with some modifications depending on time and experience. There were no conversions to open surgery. Three patients (5 per cent) had temporary recurrent laryngeal nerve palsy that recovered spontaneously. Most patients were satisfied with the surgical results, particularly regarding the placement of the surgical scars. CONCLUSION Video-assisted subtotal or near-total thyroidectomy is a safe and effective procedure for treatment of Graves' disease.
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Affiliation(s)
- S Maeda
- Division of Endocrine Surgery, Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
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Mathonnet M. [Lymph node dissection in non-medullary differentiated thyroid carcinoma]. ACTA ACUST UNITED AC 2005; 131:361-8. [PMID: 16329987 DOI: 10.1016/j.anchir.2005.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2005] [Accepted: 10/23/2005] [Indexed: 11/17/2022]
Abstract
Papillary and follicular thyroid carcinomas are the most common form of endocrine carcinomas. Lymph node involvement seems to be a low risk factor for death, but it increases the risk for loco-regional recurrences and distant metastasis. The limits and the key points of the cervical lymph node dissection are described. The sentinel lymph node is used to rarely, so it could limit the lymph dissection. Node-picking has to be avoided. Central lymph node resection is recommended for high-risk patients, as male, patients more than 45 or less than 21 years old, papillary carcinomas greater than 1 cm or follicular carcinoma more than 2 cm in diameter. Lateral lymph node resection is performed when the lymph nodes of the central compartment are involved, more than 3 cm in diameter, and bulked. Prophylactic lymphadenectomy is useless. When thyroid carcinoma is known postoperatively, re-operation depends of the cervical mass and of the results of the radioactive iodine treatment.
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Affiliation(s)
- M Mathonnet
- Service de Chirurgie Digestive, Générale et Endocrinienne, CHU de Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges, France.
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Asao T, Kuwano H, Yamaguchi S, Uchida N, Yanagita Y. Videoscopic Thyroidectomy With Fine Needle-Type Apparatuses. Surg Laparosc Endosc Percutan Tech 2005; 15:339-44. [PMID: 16340565 DOI: 10.1097/01.sle.0000191628.81752.18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A total videoscopic operation with constant CO(2) gas insufflation is ideal for performing a scarless thyroidectomy because the skin incisions at the surgical ports are made far from the neck in the axillar area. However, there are many difficulties associated with the performance of a videoscopic thyroidectomy when approaching pneumo-subcutaneously from distant ports, because the instruments are inserted tangentially toward the thyroid gland from a distant port and their range of manipulation is limited. The devices and surgical techniques used for a videoscopic thyroidectomy that does not leave a scar on the anterior chest or neck were developed. Fine needle-type cautery and forceps that could access directly to the thyroid gland from the neck were used to support the forceps. A CO(2) reservoir bag connected to the CO(2) insufflation tube contributed to the safer manipulation by the creation of a stable operation space during emitting smoke from coagulation device. A silicon ring stopper was useful to prevent dislodging of the ports. In conclusion, videoscopic neck surgery would be easier using these new devices and techniques and would produce better cosmetic results than video-assisted and conventional neck surgeries.
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Affiliation(s)
- Takayuki Asao
- Department of General Surgical Science, Gunma University, Graduate School of Medicine, Maebashi, Japan.
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Schabram J, Vorländer C, Wahl RA. Differentiated Operative Strategy in Minimally invasive, Video-assisted Thyroid Surgery Results in 196 Patients. World J Surg 2004; 28:1282-6. [PMID: 15597231 DOI: 10.1007/s00268-004-7681-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
To date, experience in minimally invasive thyroid surgery has been limited to unilateral lobectomy and total thyroidectomy. There are no reports regarding selective operative strategy, guided by morphology and function, which is widely accepted in endemic goiter regions. To analyze the efficiency and outcome of tissue-preserving thyroid surgery using a minimally invasive video-assisted technique (MIVA-T), a total of 196 patients were operated on for thyroid nodules between February 1999 and October 2003. Concurrent primary hyperthyroidism was treated in 22 (11%) cases. Indications for operation were solitary, multiple unilateral, or bilateral nodules with a maximum diameter of 30 mm and a maximum lobe volume of 15 ml. Contraindications for minimally invasive operation were thyroid malignancy diagnosed by fine-needle aspiration (FNA), recurrent goiter, and Hashimoto's thyroiditis. Nodule excision was performed in 6% of these cases; subtotal lobectomy, in 6%; selective resection, in 48%; and total lobectomy, in 39%. Histological examination revealed follicular adenoma in 82%, colloid and cystic lesions in 11%, thyroiditis in 1%, and differentiated thyroid carcinoma in 6%. Conversion to open surgery was necessary in 7.7% of the patients (secondary to malignancy demonstrated on frozen section in 3% and to technical difficulties in 4.7%). Transient and permanent laryngeal nerve palsy occurred in 2.0% and 0.5% of patients, respectively. Temporary hypoparathyroidism occurred in 5.6% of patients exclusively after conversion to open total thyroidectomy or in those patients ( n = 22) with additional primary hyperparathyroidism. Given a correct indication, MIVA-T technique can be performed with low conversion and complication rates. Selective operative strategy, guided by morphology and thyroid function, with a variety of operative procedures fitting the individual situation may be performed by this minimally invasive technique.
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Affiliation(s)
- Jochen Schabram
- Department of Surgery, Bürgerhospital, Nibelungenallee 37-41, D-60318 Frankfurt, Germany
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Chao TC, Lin JD, Chen MF. Gasless Video-assisted Total Thyroidectomy in the Treatment of Low Risk Intrathyroid Papillary Carcinoma. World J Surg 2004; 28:876-9. [PMID: 15593460 DOI: 10.1007/s00268-004-7446-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Video-assisted thyroidectomy, although an increasingly used method to treat benign thyroid nodules, is rarely used to treat thyroid cancer. We performed gasless video-assisted total thyroidectomy for the treatment of papillary carcinoma of the thyroid. The patients were two men and five women with ages ranging from 29 to 52 years (median 35 years). Tumor size ranged from 0.7 to 3.8 cm (median 1.8 cm). The remnants of functional thyroid tissues were ablated with 1110 MBq of 131I following total thyroidectomy. One year after radioiodine ablation uptake of 74 MBq 131I shown by scintigraphy ranged from 0.29% to 0.70% (median 0.57%), and the serum thyroglobulin level was less than 1 microg/L. No perioperative complications occurred. The follow-up period ranged from 1 year 5 months to 3 years 7 months (median 2 years 10 months). In conclusion, gasless video-assisted total thyroidectomy is a feasible means for treating relatively small, non-invasive, clinically solitary, differentiated thyroid carcinomas.
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Affiliation(s)
- Tzu-Chieh Chao
- Division of General Surgery, Department of Surgery Chang Gung University College of Medicine, Chang Gung Memorial Hospital, 5 Fuhsing Street, Kweishan, Taoyuan, Taiwan.
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Lombardi CP, Raffaelli M, Princi P, Lulli P, Rossi ED, Fadda G, Bellantone R. Safety of video-assisted thyroidectomy versus conventional surgery. Head Neck 2004; 27:58-64. [PMID: 15459914 DOI: 10.1002/hed.20118] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Thyroid gland manipulation, surgical stress response, and postoperative outcome in cases of video-assisted thyroidectomy (VAT) and conventional thyroidectomy were compared to verify the safety of VAT. METHODS Twenty consenting patients were randomly assigned to undergo VAT or conventional thyroidectomy. Serum thyroglobulin levels were monitored as indicators of thyroid manipulation, and C-reactive protein and white blood cell count were monitored to assess surgical stress response. Thyroid capsule integrity and the presence of spilled cells in the thyroid bed were verified. RESULTS No significant differences were found in the indicators of thyroid gland manipulation and surgical stress response between groups. No thyroid capsules ruptured, and no spilled thyroid cells were found. Patients who had VAT experienced less pain, required fewer analgesics, and were more satisfied with the cosmetic result and the surgical outcome. CONCLUSIONS VAT is as safe as conventional thyroidectomy and is characterized by a less painful postoperative course and by better cosmetic results and postoperative outcome.
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Affiliation(s)
- Celestino Pio Lombardi
- Divisione di Endocrinochirurgia, Istituto di Clinica Chirurgica, Dipartimento di Scienze Chirurgiche, Università Cattolica del Sacro Cuore, L.go A. Gemelli 8, 00168 Rome, Italy
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