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Bonati E, Mullineris B, Del Rio P, Loderer T, De Gennaro F, Esposito G, Menduni N, Pedrazzi G, Piccoli M. Mini-invasive video-assisted thyroidectomy vs robot-assisted transaxillary thryoidectomy: analisys and comparison of safety and outcomes. Updates Surg 2024; 76:573-587. [PMID: 38198118 DOI: 10.1007/s13304-023-01732-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 12/12/2023] [Indexed: 01/11/2024]
Abstract
Thyroid surgery is characterized by large volumes and typically affects a young female population. Mini-invasive or remote access surgical techniques are born driven by the desire to improve aesthetic outcomes of the traditional technique, following technological advances that have upset the surgical world in the last 20 years. In our multicenter, retrospective observational study, we first compared an endoscopic technique with a robotic one: minimally invasive video-assisted thyroidectomy (MIVAT) and robot-assisted transaxillary thyroidectomy (RATT). We evaluated intraoperative features, complications, and cosmetic outcomes in a cohort of 609 patients. The efficacy and safety of these techniques are proven by a large literature and the comparison made in our study does not show inferiority of one technique compared to the other. Even the aesthetic results tend to be equal in the long term. It is desirable that further prospective and randomized studies are conducted to evaluate the outcomes of these procedures and the cost-benefit ratio.
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Affiliation(s)
- Elena Bonati
- General Surgical Clinic, University Hospital of Parma, Gramsci 14 Str., Parma, Italy.
| | - Barbara Mullineris
- Unit of General Surgery, Emergency and New Technologies of the Civil Hospital of Baggiovara, University Hospital of Modena, Modena, Italy
| | - Paolo Del Rio
- General Surgical Clinic, University Hospital of Parma, Gramsci 14 Str., Parma, Italy
| | - Tommaso Loderer
- General Surgical Clinic, University Hospital of Parma, Gramsci 14 Str., Parma, Italy
| | - Flavia De Gennaro
- General Surgical Clinic, University Hospital of Parma, Gramsci 14 Str., Parma, Italy
| | - Giuseppe Esposito
- Unit of General Surgery, Emergency and New Technologies of the Civil Hospital of Baggiovara, University Hospital of Modena, Modena, Italy
| | - Nunzia Menduni
- Unit of General Surgery, Emergency and New Technologies of the Civil Hospital of Baggiovara, University Hospital of Modena, Modena, Italy
| | - Giuseppe Pedrazzi
- Neuroscience Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Micaela Piccoli
- Unit of General Surgery, Emergency and New Technologies of the Civil Hospital of Baggiovara, University Hospital of Modena, Modena, Italy
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Zhou D, Zhang Z, Dou X, Xia F, Li X. Advances in the assessment of cosmetic outcomes, sensory alteration in surgical areas, and health-related quality of life of endoscopic thyroidectomy. World J Surg Oncol 2024; 22:52. [PMID: 38347606 PMCID: PMC10863152 DOI: 10.1186/s12957-024-03307-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/13/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Endoscopic thyroidectomy has been preliminarily proven effective and safe for thyroid diseases. The cosmetic outcomes and life quality are critical contents of postoperative assessment. This review will primarily focus on the assessment methods and results related to cosmetic outcomes, sensory alteration of surgical area, and quality of life following endoscopic thyroidectomy. METHODS A comprehensive search of published articles within the last decade was conducted using the terms "endoscopic/robotic thyroidectomy," "patient satisfaction scores," "questionnaire," "quality of life," and "cosmetic" in PubMed. RESULTS Assessment methods for postoperative cosmetic satisfaction and sensory alterations encompassed verbal/visual analog scales, scar evaluations, Semmes-Weinstein monofilament tests, and more. The evaluation of postoperative quality of life in endoscopic thyroidectomy involved tools such as SF-36, SF-12, thyroid-specific questionnaires, thyroid cancer-specific quality of life questionnaires (THYCA-QOL), as well as assessments related to voice and swallow function. The cosmetic results of endoscopic thyroidectomy generally surpassed those of open thyroidectomy, while the quality of life in endoscopic procedures was either superior or equivalent to that in open thyroidectomy, especially with respect to general health, role emotion, and vitality. CONCLUSIONS Assessments of cosmetic outcomes and sensory alterations following endoscopic thyroidectomy predominantly relied on patients' subjective feelings. The objective and subjective perspectives of scar assessments remain underutilized. In addition, postoperative laryngoscopy and voice function assessments in endoscopic thyroidectomy procedures require more attention.
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Affiliation(s)
- Di Zhou
- Division of Thyroid Surgery, Department of General Surgery, Xiangya Hospital of Central South University, Changsha, China
| | - Zeyu Zhang
- Division of Thyroid Surgery, Department of General Surgery, Xiangya Hospital of Central South University, Changsha, China
| | - Xiaolin Dou
- Division of Thyroid Surgery, Department of General Surgery, Xiangya Hospital of Central South University, Changsha, China
| | - Fada Xia
- Division of Thyroid Surgery, Department of General Surgery, Xiangya Hospital of Central South University, Changsha, China.
| | - Xinying Li
- Division of Thyroid Surgery, Department of General Surgery, Xiangya Hospital of Central South University, Changsha, China
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Shi Y, Zhang L, Liu C, Wang Y, Zhang H, Lin X. Comparison of surgical outcomes between patients undergoing trans-oral endoscopic thyroid surgery combined with trans-thoracoareolar approach and conventional open surgery. Front Surg 2022; 9:916874. [PMID: 36157433 PMCID: PMC9492955 DOI: 10.3389/fsurg.2022.916874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 08/05/2022] [Indexed: 11/14/2022] Open
Abstract
Over the past decades, remote-access thyroid surgery has been widely developed in the treatment of thyroid carcinoma, which can help patients to avoid cosmetically displeasing scarring. In this research, we collected and review our experience with endoscopic thyroidectomy with neck dissection via trans-thoracoareolar approach combined with trans-oral approach over a 3-year period. They were all diagnosed with thyroid carcinoma, and two of them had a complication of Hashimoto's thyroiditis. No patients were dissatisfied with the postoperative cosmetic results. One patient had numbness in the lower lip, but the symptom disappeared 1 month later. No infection, hemorrhage, or air embolism occurred. Pain and numbness in the endoscopic thyroid surgery group were slighter than in those who had open surgery. The present study aims to compare the feasibility and safety of trans-thoracoareolar approach combined with trans-oral approach to conventional open surgery.
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Affiliation(s)
- Youyuan Shi
- Department of Head and Neck Surgery, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Lu Zhang
- Department of Head and Neck Surgery, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Chang Liu
- Department of Head and Neck Surgery, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Yong Wang
- Department of Head and Neck Surgery, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
| | - Hailin Zhang
- Department of Head and Neck Surgery, Hunan Cancer Hospital, Changsha, China
- Correspondence: Hailin Zhang Xiuan Lin
| | - Xiuan Lin
- Department of Head and Neck Surgery, Fujian Medical University Cancer Hospital, Fujian Cancer Hospital, Fuzhou, China
- Correspondence: Hailin Zhang Xiuan Lin
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Kudpaje A, Subash A, Subramaniam N, Palme CE, US VR, Arakeri G. Remote Access Thyroid Surgery: A Review of Literature. Indian J Surg Oncol 2022; 13:191-198. [PMID: 35462662 PMCID: PMC8986942 DOI: 10.1007/s13193-021-01364-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 06/01/2021] [Indexed: 11/26/2022] Open
Abstract
Since the first description of endoscopic thyroid lobectomy in 1997, a variety of techniques have been developed to avoid the visible cervical scar conventionally been associated with thyroidectomy. These "remote access" approaches, which typically use either endoscopic or robotic instrumentation, have successfully avoided the anterior neck scar, which has a measurable impact on the patient's quality of life (Graves and Suh Surgery 168(5):845-850, 2020; Sakorafas World J Surg 34(8):1793-1804, 2010). The main advantage of these techniques is better cosmesis compared to conventional transcervical approaches (Graves and Suh Surgery 168(5):845-850, 2020) However, these techniques have failed to gain widespread acceptance in the surgical community because of the technical challenges, scepticism about oncological safety and cost factors. This review presents an overview of the various methods of remote access thyroid surgery (RATS) and also evaluates the selection criteria, oncological efficacy, training requirements and key advantages of this technique.
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Affiliation(s)
- Akshay Kudpaje
- Department of Head and Neck Surgical Oncology, HCG Cancer Centre, Bengaluru, Karnataka India
| | - Anand Subash
- Department of Head and Neck Surgical Oncology, HCG Cancer Centre, Bengaluru, Karnataka India
| | - Narayana Subramaniam
- Department of Head and Neck Surgical Oncology, Mazumdar Shaw Cancer Centre, Narayana Health, Bengaluru, Karnataka India
| | - Carsten E. Palme
- Department of Head and Neck Surgery, The Sydney Head and Neck Cancer Institute, Chris O’Brien Lifehouse, Sydney, Australia
| | - Vishal Rao US
- Department of Head and Neck Surgical Oncology, HCG Cancer Centre, Bengaluru, Karnataka India
| | - Gururaj Arakeri
- Department of Head and Neck Surgical Oncology, HCG Cancer Centre, Bengaluru, Karnataka India
- Department of Oral and Maxillofacial Surgery, Novodaya Dental College and Hospital, Raichur, India
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Chen Y, Xu S, Zeng X, Liang Y, Xu J. Comparison of the effectiveness and safety between endoscopic-assisted lateral neck dissection and conventional open lateral neck dissection:A meta-analysis. Asian J Surg 2021; 45:1809-1816. [PMID: 34649793 DOI: 10.1016/j.asjsur.2021.09.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 09/23/2021] [Accepted: 09/30/2021] [Indexed: 11/02/2022] Open
Abstract
The objective of this study was to systematically evaluate the effectiveness and safety of endoscopic-assisted lateral neck dissection (EALND) compared with conventional open lateral neck dissection (COLND) for the treatment of thyroid cancer with positive lymph node metastases. Medical literature databases including PubMed, Embase, the Cochrane Library, CNKI, Wan Fang and VIP were systematically searched for articles that compared EALND and COLND for the treatment of thyroid carcinoma with lymph node metastasis, up to June 2019. The quality of included studies was evaluated using the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using RevMan 5.3 software after two evaluators independently screened the literature, extracted information and evaluated the methodological quality of included studies according to inclusion and exclusion criteria, resulting in the selection of seven studies with a total of 372 patients from six non-RCTs and an RCT. The results of meta-analysis showed that EALND was associated with a longer operative time (MD = 24.86, 95∗CI:21.76 to 27.96, P<0.05), with a shorter postoperative stay (MD = -1.45, 95%CI:-2.70 to -0.21,P = 0.02), reduced length of scar (MD = -8.14,95%CI:-8.41 to -7.88, P<0.00001) and a lower incidence of neck discomfort (OR = 0.19, 95%CI:0.07 to 0.58, P = 0.003) compared with COLND. The incidences in both groups of transient hypocalcemia (OR = 0.66,95%CI:0.28 to 1.55,P = 0.343), transient hoarseness (OR = 0.58,95%CI:0.17 to 1.93,P = 0.38),chylous fistula (OR = 0.69,95%CI:0.26 to 1.83,P = 0.45), choking on water (OR = 0.24,95%CI:0.04 to 1.31,P = 0.10) and the number of lymph nodes retrieved from the lateral cervical region (MD = 0.14,95%CI:-0.36 to 0.65,P = 0.59) were not statistically significant. It was concluded that EALND was safe and feasible compared with COLND, despite the longer operation time. The incision was more aesthetically pleasing and the postoperative recovery was quicker, which makes EALND a clinical procedure worthy of use in such cases.
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Affiliation(s)
- Yongqiang Chen
- Department of Thyroid Breast Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, 362000, PR China
| | - Shuangta Xu
- Department of Thyroid Breast Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, 362000, PR China
| | - Xiaoshan Zeng
- Department of Thyroid Breast Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, 362000, PR China
| | - Yinghui Liang
- Department of Thyroid Breast Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, 362000, PR China
| | - Jianhua Xu
- Department of Thyroid Breast Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, 362000, PR China.
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Rossi L, Materazzi G, Bakkar S, Miccoli P. Recent Trends in Surgical Approach to Thyroid Cancer. Front Endocrinol (Lausanne) 2021; 12:699805. [PMID: 34149628 PMCID: PMC8206549 DOI: 10.3389/fendo.2021.699805] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 05/19/2021] [Indexed: 12/12/2022] Open
Abstract
Over the past decade, the incidence of thyroid cancer has rapidly increased worldwide, and thyroid surgery has become one of the most common performed surgical procedure. Even though conventional open thyroidectomy remains the gold standard, this approach leaves a neck scar which could be worrying mainly for young women. The recent progress in surgical technology, as well as patient cosmetic requests, have led to the development of alternative access to the thyroid lodge. Thus, alternative techniques have been established in order to potentially provide a more appealing cosmetic result, both with a minimally-invasive cervical or remote-access approach. However, the introduction of these new techniques was initially approached with caution due to technical challenges, the introduction of new complications and, above all, skepticism about the oncologic effectiveness. Among several alternative approaches proposed, the minimally invasive video-assisted thyroidectomy and the robot-assisted transaxillary thyroidectomy became popular and obtained the favor of the scientific community. Moreover, the recent introduction of the trans-oral endoscopic thyroidectomy with vestibular approach, although the safety and the efficacy are still under discussion, deserves particular attention since it represents the only technique truly scarless and provides the best cometic result. The purpose of this article is to provide an overview of the current main alternative approaches for the treatment of thyroid cancer with particular focus on the oncological effectiveness of the procedures.
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Affiliation(s)
- Leonardo Rossi
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Gabriele Materazzi
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Sohail Bakkar
- Department of Surgery, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Paolo Miccoli
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
- *Correspondence: Paolo Miccoli,
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Trends of robotic-assisted surgery for thyroid, colorectal, stomach and hepatopancreaticobiliary cancer: 10 year Korea trend investigation. Asian J Surg 2020; 44:199-205. [PMID: 32571714 DOI: 10.1016/j.asjsur.2020.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/05/2020] [Accepted: 05/13/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The current position of robotic surgery in the field of minimally invasive surgery remains ambiguous. We evaluated long-term trends of robotic general surgery and the future direction of its development. METHODS Data on robotic cancer surgeries between 2005 and 2014 were retrospectively collected by volunteer institutions in the Republic of Korea. Spearman's correlation and logistic regression analyses were used to compare robotic and laparoscopic surgery trends in general surgery. RESULTS The odds that robotic surgery was performed instead of laparoscopic surgery significantly decreased in the fields of colorectal, stomach, and hepato-biliary-pancreatic surgery (odds ratio [OR]: 0.95, 95% confidence interval [CI]: 0.93-0.97; OR: 0.90, 95% CI: 0.88-0.92; and OR: 0.71, 95% CI: 0.65-0.78, respectively), except for thyroid surgery (OR: 1.28, 95% CI: 1.25-1.30). Of the total numbers of each procedure, proportions of robotic intersphincteric resections, abdominoperineal resections, and pylorus-preserving surgery performed significantly increased (r = 0.98, P < .001; r = 0.78, P = .01; and r = 0.86, P = .007, respectively). CONCLUSIONS The use of robotic surgery failed to preponderate that of laparoscopic surgery, except for thyroid surgery. Robotic surgery is increasingly preferred for limited fields or complex surgeries, but the use of robotics in simple surgeries has decreased.
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Juarez MC, Ishii L, Nellis JC, Bater K, Huynh PP, Fung N, Darrach H, Russell JO, Ishii M. Objectively measuring social attention of thyroid neck scars and transoral surgery using eye tracking. Laryngoscope 2019; 129:2789-2794. [DOI: 10.1002/lary.27933] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 02/17/2019] [Accepted: 02/25/2019] [Indexed: 12/31/2022]
Affiliation(s)
| | - Lisa Ishii
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
- Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
| | - Jason C. Nellis
- Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
| | - Kristin Bater
- Johns Hopkins School of Medicine Baltimore Maryland U.S.A
| | | | - Nicholas Fung
- Johns Hopkins School of Medicine Baltimore Maryland U.S.A
| | - Halley Darrach
- Johns Hopkins School of Medicine Baltimore Maryland U.S.A
| | - Jonathon O. Russell
- Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
- Division of Head and Neck Endocrine Surgery, Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
| | - Masaru Ishii
- Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
- Division of Rhinology, Department of Otolaryngology–Head and Neck SurgeryJohns Hopkins University School of Medicine Baltimore Maryland U.S.A
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Wu GY, Fu JB, Lin FS, Luo YZ, Lin ED, Yan W. Endoscopic Central Lymph Node Dissection via Breast Combined with Oral Approach for Papillary Thyroid Carcinoma: A Preliminary Study. World J Surg 2017; 41:2280-2282. [DOI: 10.1007/s00268-017-4015-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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10
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Kim MJ, Lee J, Lee SG, Choi JB, Kim TH, Ban EJ, Lee CR, Kang SW, Jeong JJ, Nam KH, Jo YS, Chung WY. Transaxillary robotic modified radical neck dissection: a 5-year assessment of operative and oncologic outcomes. Surg Endosc 2016; 31:1599-1606. [PMID: 27572060 DOI: 10.1007/s00464-016-5146-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 07/20/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Robotic modified radical neck dissection (MRND) using a gasless transaxillary approach has been reported to be a safe and meticulous technique in patients with papillary thyroid carcinoma (PTC) and lateral neck node metastasis (N1b). Few studies, however, have attempted to assess the long-term oncologic outcomes of robotic MRND in these patients. This study aimed to compare perioperative and 5-year oncologic outcomes of robotic MRND with conventional open procedures in patients with N1b PTC. METHODS Between September 2007 and February 2010, 193 patients with N1b PTC underwent total thyroidectomy and MRND by a single surgeon. Of these, 42 (21.8 %) underwent robotic procedures and 151 (78.2 %) underwent conventional open procedures. All patients received 3.7- to 5.5-GBq radioactive iodine (RAI) ablation, post-therapy whole-body scans (TxWBSs), and diagnostic WBS (DxWBSs) during follow-up. An exact 1:3 matching for age and stage was performed to minimize selection bias, and perioperative and 5-year oncologic outcomes were compared in the matched groups. RESULTS The mean follow-up period was 66.0 months (range 60-90 months). Number of retrieved cervical lymph nodes (LNs) (p = .102) and postoperative ablation success rates (p = .864) were similar between the two groups. TSH-suppressed serum Tg concentrations after 5 years (0.7 ± 1.5 vs. 2.4 ± 14.1 ng/ml; p = .471) and recurrence rates in the robotic and open groups (1/41 [2.4 %] vs. 3/102 [2.9 %]; p = .864) were similar for the 5-year follow-up period. Four patients experienced recurrence: Three exhibited regional lymph node metastasis, and one showed bilateral lung metastases. CONCLUSION The perioperative and 5-year oncologic outcomes were similar after robotic and conventional open MRND. Large, prospective randomized controlled trials with long-term follow-up data are needed to validate these results.
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Affiliation(s)
- Min Jhi Kim
- Department of Surgery, Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jandee Lee
- Department of Surgery, Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Seul Gi Lee
- Department of Surgery, Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Bum Choi
- Department of Surgery, Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Hyung Kim
- Department of Surgery, Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Jeong Ban
- Department of Surgery, Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Cho Rok Lee
- Department of Surgery, Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Wook Kang
- Department of Surgery, Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Ju Jeong
- Department of Surgery, Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Kee-Hyun Nam
- Department of Surgery, Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Young Suk Jo
- Department of Internal Medicine, Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Woong Youn Chung
- Department of Surgery, Open NBI Convergence Technology Research Laboratory, Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
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THY3 cytology: What surgical treatment? Retrospective study and literature review. Int J Surg 2016; 28 Suppl 1:S59-64. [DOI: 10.1016/j.ijsu.2015.05.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Revised: 05/06/2015] [Accepted: 05/22/2015] [Indexed: 12/28/2022]
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12
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Comparison of conventional thyroidectomy and endoscopic thyroidectomy via axillo-bilateral breast approach in papillary thyroid carcinoma patients. Surg Endosc 2015; 30:3419-25. [PMID: 26511120 DOI: 10.1007/s00464-015-4624-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 10/16/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Endoscopic thyroidectomy has been applied to solve the cosmetic problems that resulted from conventional thyroidectomy. The aim of this study was to evaluate and compare the surgical outcomes of conventional and endoscopic thyroidectomies via axillo-bilateral-breast approach (ABBA) in patients with papillary thyroid carcinoma (PTC). METHODS Between May 2007 and February 2011, 1003 patients with PTC underwent thyroidectomies. The eight hundred and thirty patients underwent conventional thyroidectomy and 173 patients underwent endoscopic thyroidectomy via ABBA. Clinicopathologic characteristics, complications, and surgical completeness were analyzed. RESULTS The mean age was 49.53 years who received a conventional thyroidectomy and 38.90 years in endoscopic thyroidectomy (P < 0.0001). The conventional thyroidectomy group underwent more extensive surgery than the endoscopic thyroidectomy group but the operation time was longer in the endoscopic thyroidectomy group (P < 0.0001). The mean hospitalization length was 6.98 days following open thyroidectomy and 6.40 days after endoscopic thyroidectomy (P = 0.003). The tumor size was larger in the conventional thyroidectomy group than the endoscopic thyroidectomy group and a lesser number of lymph nodes were retrieved in the endoscopic thyroidectomy group compared to the conventional thyroidectomy group (P < 0.0001). The postoperative complications and thyroglobulin levels in both groups were not significantly different. CONCLUSION These results suggest that conventional and endoscopic thyroidectomy via ABBA has similar surgical outcomes in PTC patients. Therefore, endoscopic thyroidectomy via ABBA may be an appropriate surgical alternative to conventional thyroidectomy for treating PTC in selected patients.
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Piniek A, Schuhmann R, Coerper S. [Minimally invasive video-assisted thyroidectomy: establishment in a thyroid center]. Chirurg 2014; 85:246-52. [PMID: 24218083 DOI: 10.1007/s00104-013-2624-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND This study retrospectively evaluated a series of patients who underwent minimally invasive video-assisted thyroidectomy (MIVAT) during the introduction stage of this surgical technique at the Martha-Maria Hospital in Nuremberg. PATIENTS AND METHODS The eligibility criteria for MIVAT were a thyroid volume < 25 ml, nodules < 30 mm, no thyroiditis, no preoperative evidence of carcinoma and no previous neck surgery. A retrospective evaluation was performed together with a control group of patients who underwent conventional thyroid surgery during the same time period and included a follow-up for general patient satisfaction and cosmetic results. RESULTS Between August 2008 and July 2009 a total of 55 patients underwent MIVAT including 8 conversions to open surgery and 45 patients who underwent conventional surgery served as matched controls. No significant differences in terms of perioperative complication rates were found (e.g. recurrent laryngeal nerve palsy, hypocalcemia or secondary hemorrhage). The mean operating time was significantly longer in the MIVAT group (96.8 ± 3.7 min vs. 69.8 ± 2.3 min, p = 0.001) whereas a significant decrease in the mean operating time for hemithyroidectomy after 5 months was observed (98.1 ± 3.77 min vs. 76.0 ± 4.98 min, p = 0.013). Patients in the MIVAT group were more satisfied with the cosmetic outcome (8.5 ± 0.3 vs. 8.2 ± 0.2, p = 0.05) as well as with the overall surgical procedure (9.0 ± 0.3 vs. 8.6 ± 0.2, p = 0.02). CONCLUSION During introduction of the MIVAT procedure a learning effect can be observed which is hallmarked by a decrease in operating time and conversion rate to open surgery. Moreover, no significant differences in terms of main postoperative complications were found so that MIVAT can be considered a safe and feasible technique under the conditions of correct eligibility criteria.
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Affiliation(s)
- A Piniek
- Chirurgisches Schilddrüsen- und Nebenschilddrüsenzentrum, Klinik für Allgemein-, Visceral- und Gefäßchirurgie, Krankenhaus Martha-Maria, Stadenstr. 58, 90491, Nürnberg, Deutschland,
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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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Kania R, Kania R, Hammami H, Vérillaud B, Blancal JP, Sauvaget E, Tran H, Leclerc N, Altabaa K, Herman P, Pons Y. Minimally invasive video-assisted thyroidectomy: tips and pearls for the surgical technique. Ann Otol Rhinol Laryngol 2014; 123:409-14. [PMID: 24671545 DOI: 10.1177/0003489414526845] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The objectives of this study were first to show principles of the minimally invasive video-assisted thyroidectomy (MIVAT), based on a video highlighting critical steps, and second to discuss tips and pearls to assist surgical teams that would like to start using this technique. METHODS Based on a video, we described tips and pearls of a MIVAT. RESULTS MIVAT includes 5 main steps: (1) skin incision and identification of the common carotid artery, (2) dissection and ligation of the upper pedicle, (3) identification of the inferior laryngeal nerve and parathyroid glands, (4) isthmectomy and lobe extraction, and (5) closure. DISCUSSION Coordination between the surgeon and the 2 assistants is of paramount importance for the performance of MIVAT. Appropriate material is also required. The magnification and tissue contrast emphasizes the identification of the vessels, the superior and inferior laryngeal nerves, and parathyroid glands, on a large-view screen.
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Cosmetic Result and Overall Satisfaction after Minimally Invasive Video-assisted Thyroidectomy (MIVAT) versus Robot-assisted Transaxillary Thyroidectomy (RATT): A Prospective Randomized Study. World J Surg 2014; 38:1282-8. [DOI: 10.1007/s00268-014-2483-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Tori M. Hybrid-type endoscopic thyroidectomy (HET: Tori's method) for differentiated thyroid carcinoma including invasion to the trachea. Surg Endosc 2013; 28:902-9. [PMID: 24263457 PMCID: PMC3931932 DOI: 10.1007/s00464-013-3245-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 09/25/2013] [Indexed: 11/30/2022]
Abstract
Background Endoscopic thyroidectomy (ET) or robotic thyroidectomy is yet to be applied to thyroid carcinoma invasive to the trachea and to wide lymph node node metastasis. On the other hand, small-incision thyroidectomy lacks sufficient working space and clear vision. The author has newly developed hybrid-type endoscopic thyroidectomy (HET) to overcome these problems. Methods From March 2011 to February 2012, HET was performed for 85 patients. Clinicopathologic characteristics were analyzed. To evaluate the superiority of HET for malignancy representatively, conventional lobectomy with central compartment node dissection (CCND) performed 1 year previously was compared with HET. In lobectomy and node dissection, a single skin incision (1.5 cm) is made above the clavicle, with a port incision (5 mm) made 3 cm below the clavicle. Then CCND is performed directly through the incision by lifting up the isthmus. To obtain sufficient working space for the lobectomy, the strap muscles are taped and pulled toward the head, then hung by the cradle. The thyroid lobe is retracted to the midline with a retractor, followed by isolation of the inferior laryngeal nerve and transection of the inferior thyroid vessels with the monitor of the scope. Lateral lymph nodes dissection can be performed at the same time, if necessary. In total thyroidectomy, the same procedure is performed at the opposite side. The scalpel can be used to shave through each incision in case of tracheal invasion. Results Of the 85 cases, 62 were malignant, involving papillary thyroid carcinoma (PTC), and 23 were benign. Total thyroidectomy was performed for 22 of the PTC cases and CCND for 49 of the cases. Shaving for tracheal invasion was performed for eight patients. No mortality, complications, recurrence, or metastasis was found 1–2 years after the operation. Compared with conventional thyroidectomy, HET was superior in blood loss, visual analog scale, and postoperative hospital stay. Conclusion The author’s method (Tori’s method) might be less invasive, cosmetically excellent, and moreover, safe and feasible for differentiated thyroid carcinoma including invasion to the trachea.
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Affiliation(s)
- Masayuki Tori
- Department of Endocrine Surgery, Osaka Police Hospital, 10-31 Kitayama-cho, Tennouji-ku, Osaka, 543-0035, Japan,
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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: 19] [Impact Index Per Article: 1.6] [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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Implantation at Sternocleidomastoid and Chest Wall After Endoscopic Thyroid Carcinoma Surgery. Surg Laparosc Endosc Percutan Tech 2012; 22:e239-42. [DOI: 10.1097/sle.0b013e318259f43b] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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20
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Pons Y, Vérillaud B, Blancal JP, Sauvaget E, Cloutier T, Le Clerc N, Herman P, Kania R. Minimally invasive video-assisted thyroidectomy: Learning curve in terms of mean operative time and conversion and complication rates. Head Neck 2012; 35:1078-82. [PMID: 22791472 DOI: 10.1002/hed.23081] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2012] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the learning curve for minimally invasive video-assisted thyroidectomy (MIVAT). METHODS Fifty consecutive patients were prospectively included in groups corresponding to their surgical order (10 patients in each group). RESULTS The mean operation times between 2 neighboring groups were 33.9 minutes longer in group 1 than in group 2 (p = .01) and 25.8 minutes longer in group 3 than in group 4 (p = .002). The conversion rate for technical difficulties in group 1 was 6% (3 of 50). The definitive complication rate was 2% (1 of 50). CONCLUSIONS In terms of operative time, 10 patients represented the early stage of the learning curve, and 30 patients represented the number of procedures required to reach an advanced level of skill. Considering the low conversion and complication rates, improved aesthetic results and postoperative course, MIVAT should become a tool in the repertoire of high-volume thyroid surgeons.
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Affiliation(s)
- Yoann Pons
- Head and Neck Surgery Department, Hôpital Lariboisière, Paris, France.
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Touzopoulos P, Karanikas M, Zarogoulidis P, Mitrakas A, Porpodis K, Katsikogiannis N, Zervas V, Kouroumichakis I, Constantinidis TC, Mikroulis D, Tsimogiannis KE. Current surgical status of thyroid diseases. J Multidiscip Healthc 2011; 4:441-9. [PMID: 22247619 PMCID: PMC3256004 DOI: 10.2147/jmdh.s26349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Thyroid nodules are a common clinical problem for surgeons. The clinical importance of nodules is the need to exclude thyroid cancer, which occurs in 5%–15% of patients. If fine needle aspiration cytology is positive, or suspicious for malignancy, surgery is recommended. During the past decade, with the tendency to develop smaller incisions, an endoscopic approach has been applied to thyroid surgery, called minimally invasive video-assisted thyroidectomy. This approach was immediately followed by other minimally invasive or scarless neck techniques, such as the breast approach, axillary-breast approach, and robot-assisted method. All these techniques follow the same principles of surgery and oncology. This review presents the current surgical management of the thyroid gland, including the surgical techniques and compares them by describing benefits and drawbacks of each one.
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Affiliation(s)
- Panagiotis Touzopoulos
- First Surgery Department, University General Hospital of Alexandroupolis, Democritus University of Alexandroupolis, Greece
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He Q, Zhuang D, Zheng L, Zhou P, Chai J, Lv Z. Harmonic focus in total thyroidectomy plus level III-IV and VI dissection: a prospective randomized study. World J Surg Oncol 2011; 9:141. [PMID: 22040180 PMCID: PMC3248841 DOI: 10.1186/1477-7819-9-141] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 10/31/2011] [Indexed: 12/17/2022] Open
Abstract
The aim of this study was to compare operating time, postoperative outcomes, and surgical complications of total thyroidectomy plus level III-IV and VI dissection between the no-tie technique using the Harmonic Focus and classic suture ligation for hemostasis. Fifty-four patients underwent total thyroidectomy plus level III-IV and VI dissection by classic suture ligation and 51 patients by the Harmonic Focus. There was obvious distinction as to the operating time between the Focus and classic group (102.8 and 150.1 minutes, respectively, P < 0.05). Drainage volume (202.7 ± 187.0 mL vs 299.7 ± 201.4 mL, P < 0.05) were significantly lower in the Focus group. Transient hypoparathyroidism had no statistically significant difference between the groups (17.6% vs 18.5%, P > 0 .05). No patient experienced nerve injury or permanent hypocalcemia. The use of Harmonic Focus for the control of thyroid vessels during thyroid surgery is reliable and safe. The device can offer extraordinary capabilities for delicate tissue grasping and dissection.
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Affiliation(s)
- Qingqing He
- Department of Thyroid and Breast Surgery, Jinan Military General Hospital, Jinan, People's Republic of China.
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Abstract
Surgery is often needed to diagnose thyroid cancer, but is also the initial therapeutic modality. Several current imaging techniques are important for preoperative risk stratification. By optimizing initial thyroidectomy and lymphadenectomy, accurate and appropriate imaging can help minimize operative morbidity and potentially reduce the risk of recurrent disease.
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Affiliation(s)
- Linwah Yip
- Section of Endocrine Surgery, Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
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Toll EC, Loizou P, Davis CR, Porter GC, Pothier DD. Scars and satisfaction: do smaller scars improve patient-reported outcome? Eur Arch Otorhinolaryngol 2011; 269:309-13. [DOI: 10.1007/s00405-011-1613-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 04/12/2011] [Indexed: 12/01/2022]
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Mamais C, Charaklias N, Pothula V, Dias A, Hawthorne M, Nirmal Kumar B. Introduction of a new surgical technique: minimally invasive video-assisted thyroid surgery. Clin Otolaryngol 2011; 36:51-6. [DOI: 10.1111/j.1749-4486.2011.02254.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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