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Docimo G, Filograna Pignatelli M, Ferrandes S, Monaco A, Calisti F, Ruggiero R, Tolone S, Lucido FS, Brusciano L, Parisi S, Conzo G, Docimo L, Gambardella C. Role of Absorbable Polysaccharide Hemostatic Powder in the Prevention of Bleeding and Wound Events after Thyroid Surgery. J Clin Med 2023; 12:5684. [PMID: 37685750 PMCID: PMC10488928 DOI: 10.3390/jcm12175684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/06/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Bleeding is one of the most fearsome and life-threatening complications after thyroid surgery. Several medical devices and haemostatic agents have been proposed to improve haemostasis during total and hemi-thyroidectomy. Resorbable polysaccharide powder (HaemoCer™) is a plant-based polymer that is helpful in terms of the coagulation cascade becoming a gel and forming a barrier to prevent further bleeding, having tested for haemostasis in different districts. The aim of the current study was the evaluation of drain output, the presence of significant postoperative blood loss and complications in patients treated with or without resorbable polysaccharide powder during thyroid surgery. METHODS From January to December 2022, postoperative bleeding, drainage output and the postoperative wound events of patients undergoing thyroid surgery, in a tertiary centre, with haemostasis completion with resorbable polysaccharide powder (Group A) or not (Group B), were retrospectively analysed. RESULTS Eighty-one patients in Group A received a haemostasis improvement with the use of reabsorbable polysaccharide powder, and 96 patients in Group B received thyroid surgery alone. Patients in Group A presented lower drainage output (0.005), lower incidence of neck haematoma (0.005) and seroma (0.021), confirmed also by multivariate analysis. CONCLUSIONS The resorbable polysaccharide powder, in the current series, appeared to be an effective agent in achieving haemostasis in thyroidectomies, reducing the postoperative drainage output, and also neck events such as neck haematoma and seroma, improving the postoperative comfort of the patients. Further larger comparative studies are needed to address this issue.
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Affiliation(s)
- Giovanni Docimo
- Unit of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.D.); (M.F.P.); (S.F.); (A.M.); (F.C.)
| | - Marcello Filograna Pignatelli
- Unit of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.D.); (M.F.P.); (S.F.); (A.M.); (F.C.)
| | - Sonia Ferrandes
- Unit of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.D.); (M.F.P.); (S.F.); (A.M.); (F.C.)
| | - Alessandro Monaco
- Unit of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.D.); (M.F.P.); (S.F.); (A.M.); (F.C.)
| | - Francesco Calisti
- Unit of Thyroid Surgery, Department of Medical and Advanced Surgical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (G.D.); (M.F.P.); (S.F.); (A.M.); (F.C.)
| | - Roberto Ruggiero
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (R.R.); (S.T.); (F.S.L.); (L.B.); (S.P.); (G.C.); (L.D.)
| | - Salvatore Tolone
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (R.R.); (S.T.); (F.S.L.); (L.B.); (S.P.); (G.C.); (L.D.)
| | - Francesco Saverio Lucido
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (R.R.); (S.T.); (F.S.L.); (L.B.); (S.P.); (G.C.); (L.D.)
| | - Luigi Brusciano
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (R.R.); (S.T.); (F.S.L.); (L.B.); (S.P.); (G.C.); (L.D.)
| | - Simona Parisi
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (R.R.); (S.T.); (F.S.L.); (L.B.); (S.P.); (G.C.); (L.D.)
| | - Giovanni Conzo
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (R.R.); (S.T.); (F.S.L.); (L.B.); (S.P.); (G.C.); (L.D.)
| | - Ludovico Docimo
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (R.R.); (S.T.); (F.S.L.); (L.B.); (S.P.); (G.C.); (L.D.)
| | - Claudio Gambardella
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (R.R.); (S.T.); (F.S.L.); (L.B.); (S.P.); (G.C.); (L.D.)
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Risk factors for difficult thyroidectomy and postoperative morbidity do not match: retrospective study from an endocrine surgery academic referral centre. Updates Surg 2022; 74:1943-1951. [PMID: 36063287 DOI: 10.1007/s13304-022-01371-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/25/2022] [Indexed: 10/14/2022]
Abstract
Hyperthyroidism, goiter and thyroiditis have been associated with complex thyroidectomy. Difficult thyroidectomies may implicate longer operating times and higher complication rates, while literature on quantification and prediction of difficulty in thyroidectomy is scant. We aim at assessing the impact of preoperative and intraoperative factors on the technical difficulty of total thyroidectomy (TT) and on the incidence of postoperative complications. We conducted a retrospective study on 197 TT from 343 thyroidectomies performed with intraoperative neuromonitoring between October 2019 and June 2022 (excluding lobectomies, nodal dissection, extra-thyroidal procedures). Operating time (surrogate of TT difficulty), postoperative hypocalcaemia, recurrent laryngeal nerve palsy and postoperative bleeding were assessed in relation to pre- and intraoperative characteristics. Vocal fold palsy(VFP) was defined as recovering < 12 months postoperatively. There were 87 thyroid cancers and 110 multinodular goiters (21 hyperfunctioning, 51 mediastinal). Median operating time was 136 min (range 51-310). Within 17.4 months overall median follow-up we recorded two transient VFPs and 12% symptomatic transient hypocalcaemia. At univariable analysis male sex (p = 0.005), BMI (p < 0.001), thyroiditis (p < 0.05), hypervascular goiter (p = 0.003) and thyroid adhesions to surrounding anatomical structures (p < 0.001) were associated with longer operating time. At multivariable analysis male male sex (p = 0.01), obesity (p = 0.001) and thyroid adhesions (p = 0.008) were factors for prolonged operating time. Above-normal anti-thyroid peroxidase antibodies correlated to transient symptomatic hypocalcemia (p < 0.001). Risk factors for complex TT were identified and did not correlate with morbidity rates. Results from this study may help optimizing operating room schedule and inform case selection criteria for training programs in thyroid surgery. Further research is required to confirm these findings.
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Tarallo M, Crocetti D, Gurrado A, Iorio O, Iossa A, Caruso D, Bononi M, Stabilini C, Bracale U, Chiappini A, Testini M, Avenia N, Polistena A, Cavallaro G. Achieving the learning curve in total thyroidectomy: a prospective evaluation on resident's training by CUSUM and KPSS analysis. Ann R Coll Surg Engl 2022; 104:414-420. [PMID: 35175830 PMCID: PMC9157995 DOI: 10.1308/rcsann.2021.0318] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Total thyroidectomy (TT) is one of the most common procedures among general and endocrine surgeons worldwide. The conventional approach by neck incision is still the most frequently used, despite the growth of mini-invasive approaches. Controversies exist about the optimal learning curve for resident surgeons approaching this procedure. The aim of this study was to compare TT performed by experienced surgeons and residents in two academic hospitals, to define the correct shape of the specific learning curve. METHODS Between January 2016 and December 2018 patients undergoing TT in two academic departments were prospectively enrolled. In each department patients were divided into four groups: a reference group (A), consisting of 50 consecutive patients operated on by a senior surgeon, and three other groups (B, C, D) of 50 patients each where thyroidectomy was carried out by three different general surgery residents in their last 3 years of residency, respectively. Data were analysed by CUSUM and KPSS tests in order to compare operative time (OT) and its stabilisation during the learning curve. RESULTS Data from CUSUM test reported that residents could perform TT with OT similar to the senior surgeon after approximately 25-30 procedures, while the KPSS test showed that residents became more stable after 30 procedures, with no increase in perioperative complications. CONCLUSIONS This prospective study shows how a specific training in thyroid surgery can be reliable thanks to experienced tutors, and confirmed that the effect of dedicated and programmed training may result in positive outcomes for patients requiring thyroidectomy.
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Affiliation(s)
| | | | | | - O Iorio
- A. Spaziani Hospital, Frosinone (FR), Italy
| | - A Iossa
- Sapienza University, Rome, Italy
| | - D Caruso
- Sapienza University, Rome, Italy
| | - M Bononi
- Sapienza University, Rome, Italy
| | | | - U Bracale
- Federico II University Hospital, Naples, Italy
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Wondwosen M, Bekele M, Abebe K, Tantu T, Zewdu D. Factors associated with thyroidectomy complications in resource-limited settings: An observational study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2022.100468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Tan BKJ, Raghupathy J, Song HJJMD, Yeo BSY, Samuel M, See A, Parameswaran R. Trainee participation does not adversely affect the safety of thyroid surgery: A systematic review and meta-analysis. Head Neck 2021; 44:262-274. [PMID: 34708904 DOI: 10.1002/hed.26900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/13/2021] [Accepted: 10/07/2021] [Indexed: 11/06/2022] Open
Abstract
Surgical traineeship is essential but must be safe for patients. In thyroid surgery, surgeon volume correlates with improved clinical/economic outcomes. However, it is presently unclear how far does trainee participation affect post-thyroidectomy complication rates in real-world and randomized data. We systematically searched four databases for associations of trainee participation with any post-thyroidectomy outcome. We conducted univariate meta-analyses, sensitivity analyses, and assessed publication bias qualitatively and quantitatively. We included 1 randomized and 15 observational studies from 3755 records, comprising 34 774 thyroid surgical patients. Trainee participation was associated with 12 min longer operative time, but not higher complication rates (hypoparathyroidism, recurrent laryngeal nerve palsy, hematoma, blood loss, return to operating room, hospitalization duration, readmission, and mortality). Sensitivity, publication bias, and multivariate analyses did not change our findings. Real-world and limited randomized data suggest that trainee participation in thyroid surgery is safe, given adequate consultant supervision and appropriate case selection.
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Affiliation(s)
| | | | | | - Brian Sheng Yep Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Miny Samuel
- Research Support Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Anna See
- Department of Otorhinolaryngology-Head & Neck Surgery, Singapore General Hospital, Singapore
| | - Rajeev Parameswaran
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Thyroid & Endocrine Surgery, Department of Surgery, National University Hospital, Singapore
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Na'ara S, Aronov M, Gil Z, Gordin A. Can Tonsillectomy Be Safely Performed by Residents? A Comparative Retrospective Study. Ann Otol Rhinol Laryngol 2021; 130:1340-1344. [PMID: 33825504 DOI: 10.1177/00034894211007057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess whether a surgeon's level of training is associated with outcomes in pediatric tonsillectomy. DESIGN A retrospective cohort study of the outcomes of pediatric tonsillectomies performed between 2006 and 2016 by senior surgeons versus resident surgeons under the supervision of senior surgeons. SETTING An otolaryngology department in a tertiary academic hospital. PATIENTS Children younger than 18 years who underwent bilateral tonsillectomy with or without adenoidectomy. MAIN OUTCOME MEASURES Intraoperative bleeding, initiation of oral intake, and intraoperative and postoperative complications. RESULTS Of 785 children, 397 (50.5%) were operated on by a resident surgeon and 388 (49.5%) by a senior surgeon. Patient demographics and surgical techniques were similar between the groups. The mean surgical time was 33.2 minutes in the residents' group and 27.1 minutes in the seniors' group (P = .032). The groups were similar in intraoperative bleeding, while same-day initiation of oral intake was 71% for children in the residents' group versus 61% in the seniors' group (P = .28). Reports of postoperative bleeding necessitating readmission and revised operations were similar for both groups (3.0% and 0.7%, respectively, in the residents' group; and 2.5% and 1.0%, respectively, in the seniors' group). CONCLUSION Children undergoing tonsillectomy showed similar short-term outcomes, whether the operations were performed by a senior surgeon or a resident surgeon supervised by an attending surgeon. This study demonstrates the safety of pediatric tonsillectomy performed by resident surgeons supervised by attending physicians.
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Affiliation(s)
- Shorook Na'ara
- The Laboratory for Applied Cancer Research, Haifa, Israel.,Department of Otolaryngology-Head and Neck Surgery, The Head and Neck Center, Rambam Health Care Campus, Clinical Research Institute at Rambam, Rappaport Institute of Medicine and Research, The Technion, Israel Institute of Technology, Haifa, Israel
| | - Michael Aronov
- Department of Otolaryngology-Head and Neck Surgery, The Head and Neck Center, Rambam Health Care Campus, Clinical Research Institute at Rambam, Rappaport Institute of Medicine and Research, The Technion, Israel Institute of Technology, Haifa, Israel
| | - Ziv Gil
- The Laboratory for Applied Cancer Research, Haifa, Israel.,Department of Otolaryngology-Head and Neck Surgery, The Head and Neck Center, Rambam Health Care Campus, Clinical Research Institute at Rambam, Rappaport Institute of Medicine and Research, The Technion, Israel Institute of Technology, Haifa, Israel
| | - Arie Gordin
- Department of Otolaryngology-Head and Neck Surgery, The Head and Neck Center, Rambam Health Care Campus, Clinical Research Institute at Rambam, Rappaport Institute of Medicine and Research, The Technion, Israel Institute of Technology, Haifa, Israel
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Lorenz K, Raffaeli M, Barczyński M, Lorente-Poch L, Sancho J. Volume, outcomes, and quality standards in thyroid surgery: an evidence-based analysis-European Society of Endocrine Surgeons (ESES) positional statement. Langenbecks Arch Surg 2020; 405:401-425. [PMID: 32524467 PMCID: PMC8275525 DOI: 10.1007/s00423-020-01907-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 05/28/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Continuous efforts in surgical speciality aim to improve outcome. Therefore, correlation of volume and outcome, developing subspecialization, and identification of reliable parameters to identify and measure quality in surgery gain increasing attention in the surgical community as well as in public health care systems, and by health care providers. The need to investigate these correlations in the area of endocrine surgery was identified by ESES, and thyroid surgery was chosen for this analysis of the prevalent literature with regard to outcome and volume. MATERIALS AND METHODS A literature search that is detailed below about correlation between volume and outcome in thyroid surgery was performed and assessed from an evidence-based perspective. Following presentation and live data discussion, a revised final positional statement was presented and consented by the ESES assembly. RESULTS There is a lack of prospective randomized controlled studies for all items representing quality parameters of thyroid surgery using uniform definitions. Therefore, evidence levels are low and recommendation grades are based mainly on expert and peer evaluation of the prevalent data. CONCLUSION In thyroid surgery a volume and outcome relationship exists with respect to the prevalence of complications. Besides volume, cumulative experience is expected to improve outcomes. In accordance with global data, a case load of < 25 thyroidectomies per surgeon per year appears to identify a low-volume surgeon, while > 50 thyroidectomies per surgeon per year identify a high-volume surgeon. A center with a case load of > 100 thyroidectomies per year is considered high-volume. Thyroid cancer and autoimmune thyroid disease predict an increased risk of surgical morbidity and should be operated by high-volume surgeons. Oncological results of thyroid cancer surgery are significantly better when performed by high-volume surgeons.
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Affiliation(s)
- Kerstin Lorenz
- Department of Visceral, Vascular, and Endocrine Surgery, Martin-Luther University of Halle-Wittenberg, Ernst-Grube Strasse, 40 06120, Halle an der Saale, Germany.
| | - Marco Raffaeli
- U.O.C. Chirurgia Endocrina e Matabolica, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marcin Barczyński
- Department of Endocrine Surgery, Third Chair of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Leyre Lorente-Poch
- Secció del Servei de Cirurgia General de l'Hospital del Mar, Barcelona, Spain
| | - Joan Sancho
- Secció del Servei de Cirurgia General de l'Hospital del Mar, Barcelona, Spain
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Gimm O, Barczyński M, Mihai R, Raffaelli M. Training in endocrine surgery. Langenbecks Arch Surg 2019; 404:929-944. [PMID: 31701231 PMCID: PMC6935392 DOI: 10.1007/s00423-019-01828-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/20/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND/PURPOSE In Europe, the Division of Endocrine Surgery (DES) determines the number of operations (thyroid, neck dissection, parathyroids, adrenals, neuroendocrine tumors of the gastro-entero-pancreatic tract (GEP-NETs)) to be required for the European Board of Surgery Qualification in (neck) endocrine surgery. However, it is the national surgical boards that determine how surgical training is delivered in their respective countries. There is a lack of knowledge on the current situation concerning the training of surgical residents and fellows with regard to (neck) endocrine surgery in Europe. METHODS A survey was sent out to all 28 current national delegates of the DES. One questionnaire was addressing the training of surgical residents while the other was addressing the training of fellows in endocrine surgery. Particular focus was put on the numbers of operations considered appropriate. RESULTS For most of the operations, the overall number as defined by national surgical boards matched quite well the views of the national delegates even though differences exist between countries. In addition, the current numbers required for the EBSQ exam are well within this range for thyroid and parathyroid procedures but below for neck dissections as well as operations on the adrenals and GEP-NETs. CONCLUSIONS Training in endocrine surgery should be performed in units that perform a minimum of 100 thyroid, 50 parathyroid, 15 adrenal, and/or 10 GEP-NET operations yearly. Fellows should be expected to have been the performing surgeon of a minimum of 50 thyroid operations, 10 (central or lateral) lymph node dissections, 15 parathyroid, 5 adrenal, and 5 GEP-NET operations.
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Affiliation(s)
- Oliver Gimm
- Department of Surgery and Department of Clinical and Experimental Medicine (IKE), Linköping University, 58183 Linköping, Sweden
| | - Marcin Barczyński
- Department of Endocrine Surgery, Third Chair of Surgery, Jagiellonian University Medical College, 37 Prądnicka Street, 31-202 Kraków, Poland
| | - Radu Mihai
- Department of Endocrine Surgery, Churchill Cancer Centre, Oxford University Hospital NHS Foundation Trust, Oxford, OX3 7DU United Kingdom
| | - Marco Raffaelli
- U.O. Chirurgia Endocrina e Metabolica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Istituto di Semeiotica Chirurgica, Università Cattolica del Sacro Cuore, Rome, Italy
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Leader BA, Wiebracht ND, Meinzen‐Derr J, Ishman SL. The impact of resident involvement on tonsillectomy outcomes and surgical time. Laryngoscope 2019; 130:2481-2486. [DOI: 10.1002/lary.28427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/21/2019] [Accepted: 11/04/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Brittany A. Leader
- Department of Otolaryngology–Head & Neck Surgery University of Cincinnati College of Medicine Cincinnati Ohio U.S.A
| | - Nathan D. Wiebracht
- Department of Otolaryngology–Head & Neck Surgery University of Cincinnati College of Medicine Cincinnati Ohio U.S.A
| | - Jareen Meinzen‐Derr
- Division of Biostatistics & Epidemiology Cincinnati Children's Hospital Medical Center Cincinnati Ohio U.S.A
| | - Stacey L. Ishman
- Department of Otolaryngology–Head & Neck Surgery University of Cincinnati College of Medicine Cincinnati Ohio U.S.A
- Division of Pediatric Otolaryngology Cincinnati Children's Hospital Medical Center Cincinnati Ohio U.S.A
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Al-Hakami HA, Al Garni MA, Malas M, Abughanim S, Alsuraihi A, Al Raddadi T. Surgical Complications After Thyroid Surgery: A 10-Year Experience at Jeddah, Saudi Arabia. Indian J Otolaryngol Head Neck Surg 2019; 71:1012-1017. [PMID: 31742111 DOI: 10.1007/s12070-019-01695-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/24/2019] [Indexed: 11/29/2022] Open
Abstract
To evaluate the incidence and predictive risk factors of complications in patients who underwent thyroid surgery at our hospital with a residency training program. This retrospective cohort study analyzed the complications in all patients who underwent thyroid surgery between January 2008 and December 2017. Demographic data, preoperative diagnosis based on fine needle aspiration cytology, surgical approach, permanent pathology, postoperative complications, and factors associated with complications were recorded. At our hospital, 456 patients underwent thyroidectomy. The most common surgical complications were asymptomatic biochemical hypocalcemia and symptomatic hypocalcemia in 109 (23.9%) and 50 (11%) patients, respectively. Other surgical complications included permanent hypocalcemia, transient vocal cord palsy, permanent vocal cord palsy, hematoma, seroma, chyle fistula, and Horner's syndrome. Mean age > 45 years and more extensive surgery were significantly associated with overall complications (P = 0.003; < 0.001). Mean age > 50 years and vitamin D level < 25 nmol/L (< 10 ng/mL) were significantly associated with hypocalcemia (P = 0.008; < 0.001). Moreover, the extent of surgery and advanced thyroid carcinoma were significantly associated with vocal cord palsy (P < 0.001; 0.05). Hypocalcemia and vocal cord palsy are the most significant complications. Thyroid surgery can be performed safely by senior residents in the residency training program under the direct supervision of an experienced surgeon.
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Affiliation(s)
- Hadi A Al-Hakami
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, National Guard Health Affairs, P.O. Box 9515, Jeddah, 21423 Saudi Arabia
| | - Mohammed A Al Garni
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, National Guard Health Affairs, P.O. Box 9515, Jeddah, 21423 Saudi Arabia
| | - Moayyad Malas
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, National Guard Health Affairs, P.O. Box 9515, Jeddah, 21423 Saudi Arabia
| | - Sultan Abughanim
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, National Guard Health Affairs, P.O. Box 9515, Jeddah, 21423 Saudi Arabia
| | - Anas Alsuraihi
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, National Guard Health Affairs, P.O. Box 9515, Jeddah, 21423 Saudi Arabia
| | - Thamer Al Raddadi
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, National Guard Health Affairs, P.O. Box 9515, Jeddah, 21423 Saudi Arabia
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Yin C, Wang X, Sun S. Reduction in postoperative hypoparathyroidism following carbon nanoparticle suspension injection combined with parathyroid gland vasculature preservation. J Int Med Res 2019; 48:300060519866606. [PMID: 31429346 PMCID: PMC7105282 DOI: 10.1177/0300060519866606] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective We evaluated the effectiveness of carbon nanoparticle suspension injection
combined with parathyroid gland vasculature preservation to identify and
preserve the parathyroid gland to reduce postoperative hypoparathyroidism
following thyroidectomy. Material and Methods Fifty patients with thyroid tumors received carbon nanoparticle suspension
injection combined with parathyroid gland vasculature preservation (group
A). Serum calcium and PTH levels were recorded and compared with those of 50
control patients who underwent a standard thyroidectomy procedure (group
B). Results The serum calcium level in group A was significantly higher than that in
group B at day 1 (2.20 ± 0.02 vs 2.11 ± 0.03 mmol/L) and day 30 (2.27 ± 0.01
vs 2.21 ± 0.02 mmol/L) after surgery. The PTH level in group A was also
significantly higher than that in group B at day 1 (33.5 ± 2.36 vs.
25.31 ± 2.98 pg/mL) after surgery. The incidence of hypoparathyroidism was
significantly higher in group B than in group A at day 1 after surgery (19
vs. 7 patients). Conclusion When combined with parathyroid gland vasculature preservation, carbon
nanoparticle suspension injection can effectively reduce the incidence of
temporary parathyroidism following thyroid surgery.
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Affiliation(s)
- Chuanchang Yin
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Xiaoyan Wang
- Department of General Pathology, The First Affiliated Hospital, School of Medicine, Yangtze University, Jingzhou, Hubei Province, China
| | - Shengrong Sun
- Department of Breast and Thyroid Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
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Vieni S, Graceffa G, Rizzo GEM, Latteri F, Latteri MA, Cipolla C. An evaluation score of the difficulty of thyroidectomy considering operating time and preservation of recurrent laryngeal nerve. Updates Surg 2018; 71:569-577. [DOI: 10.1007/s13304-018-0604-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 11/08/2018] [Indexed: 12/20/2022]
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Hamour AF, Mendez AI, Harris JR, Biron VL, Seikaly H, Côté DWJ. A High-Definition Video Teaching Module for Thyroidectomy Surgery. JOURNAL OF SURGICAL EDUCATION 2018; 75:481-488. [PMID: 28780314 DOI: 10.1016/j.jsurg.2017.07.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 06/21/2017] [Accepted: 07/18/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE With the changing landscape of postgraduate surgical education to competency-based curricula, there emerges a need for alternative forms of training. Video teaching modules have been shown to be effective tools in surgical education, complementing traditional postgraduate curricula. There is a lack of validated modules described in the literature, specifically for teaching thyroidectomy. The primary objective of this study was to develop and validate a high definition video-based teaching module instructing thyroidectomy surgery to Otolaryngology-Head and Neck Surgery trainees. DESIGN This prospective study included intermediate to senior Otolaryngology-Head and Neck Surgery residents. Each participant first performed a thyroid lobectomy, serving as the initial assessment. After a washout period of at least 3 weeks, each participant was given the teaching module. The 15-minute module was developed using a 3-camera system and detailed a step-by-step approach to the surgery. After exposure to the module, each trainee performed the same procedure. Recordings of both procedures were deidentified and reviewed by a blinded, independent evaluator. Scoring was done using the Observational Clinical Human Reliability Assessment (OCHRA) system. SETTING University of Alberta Hospital and Royal Alexandra Hospital, Edmonton, Alberta, Canada. PARTICIPANTS A total of 6 intermediate to senior Otolaryngology-Head and Neck Surgery residents entered and completed the study. RESULTS The mean error rate was 8.8 errors per procedure before module exposure and 4.5 errors per procedure after exposure, representing a 49% decrease in error occurrence (p < 0.05). The mean staff takeover event rate was 10.5 takeovers per procedure prior to module exposure and 5.0 takeovers per procedure after exposure, representing a 52% decrease in error occurrence (p < 0.05). CONCLUSION High-definition video teaching modules are a useful complement to traditional surgical training. In a climate where new innovations for teaching thyroid surgery are needed, properly constructed and validated video teaching modules can serve as important tools in supplementing traditional surgical training.
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Affiliation(s)
- Amr F Hamour
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
| | - Adrian I Mendez
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jeffrey R Harris
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Vincent L Biron
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Hadi Seikaly
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - David W J Côté
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
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Swallowing disorders after thyroidectomy: What we know and where we are. A systematic review. Int J Surg 2017; 41 Suppl 1:S94-S102. [DOI: 10.1016/j.ijsu.2017.03.078] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/24/2017] [Accepted: 03/28/2017] [Indexed: 01/18/2023]
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Abstract
Hypocalcaemia is one of the most common complications after thyroidectomy; however, it is still unclear what preoperative factors could predict this event. The aim of this study was to evaluate the role of risk factors for hypocalcaemia after total thyroidectomy (TT). Consecutive patients who underwent total thyroidectomyat our institution between January 2014 and January 2016 were enrolled. The clinical and pathologic characteristics and surgical details of normocalcemic and hypocalcemic patients were compared. Univariate and multivariate analyses to estimate risk ratio were assessed. A total of 328 patients underwent TT; histology revealed benign and malignant disease in 83 and 17% of cases, respectively. Central-compartment neck dissection (CCND) was performed in 36 subjects (10.9%). Parathyroid glands were observed in 23% (76) of specimens. Laboratory asymptomatic hypocalcaemia was observed in 92 (28%) patients; symptomatic hypocalcaemia occurred in 26 (7.9%). Transient hypocalcaemia has been observed in 48 (14.6%) patients; permanent hypocalcaemia occurred in two subjects (0.6%). On univariate analysis, malignant pathology (p < 0.001), CCND (p < 0.05), female gender (p < 0.001), presence of at least two parathyroid glands in specimens (p < 0.002), and operative time longer than 120 min (p < 0.05) were factors that significantly increased the risk of developing asymptomatic and transient hypocalcaemia. After logistic regression analysis, malignant pathology (p < 0.000; p < 0.001) and CCND (p < 0.005; p = 0.013) were the significant factors that affected the development of symptomatic and transient hypocalcaemia. The presence of malignant pathology and CCND was found to be significant risks factors for postoperative hypocalcaemia. In patients in whom this pathological features are present, attention should be paid to rapidly start an adequate therapy.
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Folsom C, Serbousek K, Lydiatt W, Rieke K, Sayles H, Smith R, Panwar A. Impact of resident training on operative time and safety in hemithyroidectomy. Head Neck 2017; 39:1212-1217. [DOI: 10.1002/hed.24742] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 12/08/2016] [Accepted: 01/03/2017] [Indexed: 01/28/2023] Open
Affiliation(s)
- Craig Folsom
- Department of Otolaryngology - Head and Neck Surgery; Naval Medical Center Portsmouth; Portsmouth Virginia
| | - Kimberly Serbousek
- Division of Head and Neck Surgery, Department of Otolaryngology - Head and Neck Surgery; University of Nebraska Medical Center; Omaha Nebraska
| | - William Lydiatt
- Head and Neck Surgical Oncology; Nebraska Methodist Hospital; Omaha Nebraska
| | - Katherine Rieke
- College of Public Health; University of Nebraska Medical Center; Omaha Nebraska
| | - Harlan Sayles
- College of Public Health; University of Nebraska Medical Center; Omaha Nebraska
| | - Russell Smith
- Head and Neck Surgical Oncology; Nebraska Methodist Hospital; Omaha Nebraska
| | - Aru Panwar
- Division of Head and Neck Surgery, Department of Otolaryngology - Head and Neck Surgery; University of Nebraska Medical Center; Omaha Nebraska
- Head and Neck Surgical Oncology; Nebraska Methodist Hospital; Omaha Nebraska
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Cavallaro G, Iorio O, Centanni M, Gargano L, Del Duca S, Gurrado A, Porta N, Petrozza V, Testini M, De Toma G. Parathyroid reimplantation with PR-FaST technique in unselected patients during thyroidectomy. A case series with long term follow up confirming graft vitality and parathormone production. Int J Surg 2017; 39:202-205. [PMID: 28167381 DOI: 10.1016/j.ijsu.2017.01.117] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Parathyroid damage or unintentional excision still affect thyroid surgery and may cause permanent hypoparathyroidism. The only way to recover the excised or ischemic gland functionality is still reimplantation. Many sites of reimplantation have been described, each of one showing both advantages and drawbacks. The aim of this study is to verify results of a new procedure called PR-FaST: Parathyroid Reimplantation in Forearm Subcutaneous Tissue, in a series of unselected patients after long-term follow-up. MATERIALS AND METHODS From January 2013 to October 2015, 296 consecutive total thyroidectomies have been performed) to treat both benign and malignant thyroid diseases. in 42 cases (14.1%), due to an insufficient blood supply or accidental removal, one parathyroid gland was reimplanted with the PR-FaST technique. Post-operative evaluation was carried out by: total serum calcium (Ca), magnesium (Mg) and phosphorus (P) analysis in the 1st and 2nd postoperative days; Ca, Mg, P and serum iPTH from both arms analysis one week after surgery; Ca and iPTH measurement from both arms 1 months, 3, 6 and 12 months after surgery. RESULTS We observed transient hypocalcemia requiring calcium replacement therapy in 5 on 42 (11.9%) patients submitted to PR-FaST. No case of permanent hypoparathyroidism was reported. At 1 week after surgery, only 20 patients (47.6%) showed graft vitality, while the number of patients showing graft vitality arised to 33 (79%) after 1 month and to 39 (92.8%) after three and six months. At 1 year 38 (90.5%) patients showed good graft functionality. Considering levels of serum iPTH from both arms, we observed that in case of graft functionality, samples from reimplanted arm revealed in almost all cases values at least 2-3 folds higher than in non reimplanted arm. CONCLUSIONS Results from this prospective evaluation suggest that PR-FaST is a safe and effective procedure, with potential advantages when compared to other techniques of parathyroid reimplantation, that are mainly the possibility to evaluate graft functionality in the follow-up and the easy and well reproducible technique. Furthermore, it can be applied, when needed, to potentially all patients undergoing thyroidectomy.
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Affiliation(s)
| | - Olga Iorio
- Department of Surgery "P. Valdoni", Sapienza University, Rome, Italy
| | - Marco Centanni
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Lucilla Gargano
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Susanna Del Duca
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Angela Gurrado
- Department of Biomedical Sciences and Human Oncology, University of Bari, Italy
| | - Natale Porta
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Vincenzo Petrozza
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
| | - Mario Testini
- Department of Biomedical Sciences and Human Oncology, University of Bari, Italy
| | - Giorgio De Toma
- Department of Surgery "P. Valdoni", Sapienza University, Rome, Italy
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Influence of change in surgical practice for benign thyroid disease on postsurgical outcome-Single-center experience in 1400 patients. Asian J Surg 2016; 41:39-46. [PMID: 27659020 DOI: 10.1016/j.asjsur.2016.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/30/2016] [Accepted: 07/11/2016] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the rate of surgical complications during the change from subtotal resection to hemithyroidectomy or thyroidectomy over a period of 17 years. METHODS All operations for benign goiter at our hospital were analyzed for the periods 1996-2002 (Group 1) and 2003-2012 (Group 2). The groups were compared for recurrent laryngeal nerve damage, hypocalcemia, and other surgical complications directly postoperatively. RESULTS In total, 1462 patients were operated on for goiter between 1996 and 2012. There were 1219 patients who underwent a primary thyroid operation, whereas 50 patients had surgery for recurrence. Postoperative histology revealed thyroid cancer in 193 patients (13.2%). In Group 1, 42.7% of all operated lobes were performed as lobectomies and 57.3% as subtotal resections; in Group 2, 74.4% were performed as lobectomies and 25.6% as subtotal resections. No differences were found for reduced vocal cord function (2.4% vs. 1.9%, p = 0.746) and recurrent laryngeal nerve paralysis in the postoperative laryngoscopy (2.9% vs. 1.8%, p = 0.675). Postoperative hypoparathyroidism was detected in 13.66% in Group 1 and in 19.80% in Group 2 after bilateral resections (p = 0.037). There was no difference in the rate of reoperations for cancer between both groups (43.4% vs. 52.1%, p = 0.182). CONCLUSION Surgical practice changed from subtotal to lobectomies for benign goiter over a period of 17 years without change in laryngeal nerve damage but with increasing rates of postoperative hypocalcemia.
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