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Choi WK, Shin HY, Park YJ, Lee SH, Lee AY, Hong JS. Analysis of trends and status of evaluation methods in thyroid scar. Heliyon 2024; 10:e29301. [PMID: 38720695 PMCID: PMC11076647 DOI: 10.1016/j.heliyon.2024.e29301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 03/29/2024] [Accepted: 04/04/2024] [Indexed: 05/12/2024] Open
Abstract
Background The incidence of thyroid cancer has increased over the decades, and patients prefer short thin scars after thyroidectomy due to their cosmetic visibility. Several scar assessment methods have been used to determine the most cosmetically optimal surgical method, but a widely accepted measurement tool is still lacking. This study investigates the usage status in the thyroid scar scale according to time, region, and study method. Methods The authors searched for articles on thyroid scars published between January 2000 and September 2022 in the PubMed database. The study included clinical studies that mentioned thyroid scar and scar scale, excluding articles that did not evaluate neck scars. Statistical analysis was performed using IBM SPSS Statistics 29. Results A total of 35 studies were included. Among them, 17 used the Vancouver Scar Scale (VSS), 17 used the Patient and Observer Scar Assessment Scale (POSAS), four used the Manchester Scar Scale (MSS), and four used the Stony Brook Scar Evaluation Scale (SBSES). VSS and POSAS were the most commonly used scar evaluation methods. VSS tended to be used frequently in Asia, while POSAS was used frequently in Europe and in randomized controlled trials. Conclusion VSS and POSAS are popular thyroid scar assessment methods, with regional variations. Standardization is needed for meaningful comparisons. Patient's subjective evaluations should be considered, given the cosmetic importance of thyroid scars.
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Affiliation(s)
- Woo Kyoung Choi
- Department of Dermatology, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang, South Korea
| | - Hui Young Shin
- Department of Dermatology, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang, South Korea
| | - Yu Jeong Park
- Department of Dermatology, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang, South Korea
| | - Seung Ho Lee
- Department of Dermatology, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang, South Korea
| | - Ai-Young Lee
- Department of Dermatology, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang, South Korea
| | - Jong Soo Hong
- Department of Dermatology, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang, South Korea
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Shi XT, Shen J, Sun YY. Bibliometric analysis of research trends and hotspots on robot-assisted thyroid surgery. Medicine (Baltimore) 2024; 103:e37588. [PMID: 38579095 PMCID: PMC10994498 DOI: 10.1097/md.0000000000037588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 02/22/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Thyroid surgery involves the partial or complete removal of the thyroid gland and is a frequently performed surgical procedure. The adoption of robots, equipped with flexible and stable operating systems, has garnered acceptance among numerous surgeons for their capability to enable precise anatomical dissection in thyroid surgery. To gain a comprehensive insight into the present research landscape of robot-assisted thyroid surgery, this paper endeavored to conduct a thorough analysis of the field through bibliometric analysis. METHODS Relevant literature pertaining to robot-assisted thyroid surgery was retrieved from the Web of Science Core Collection (WOSCC) database, spanning from the inception of WOSCC to October 17, 2022. Visual analyses of publication quantity, distribution across countries/regions, institutions/organizations, authorship, journals, references, and keywords were conducted using Microsoft Excel, the bibliometrix package in R, Citescape, and VOSviewer software. RESULTS A total of 505 articles from 406 institutions in 36 countries/regions were included. South Korea emerged with highest number of publications. Notably, Professor CHUNG WY from Yonsei University in South Korea and the journal "Surg Endosc" stood out with the most publications. The current research landscape indicated significant interest in endoscopic thyroidectomy, surgical procedures, and the axillary approach. In addition, transoral robotic thyroidectomy (TROT), and learning curve (LC) were recognized as research frontiers, representing potential future hotspots in this field. CONCLUSION This study marks the first bibliometric analysis of the literature on robot-assisted thyroid surgery. The results highlight endoscopic thyroidectomy, surgical procedures, and the axillary approach as current research hotspots, with TROT and LC identified as potential future research hotspots.
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Affiliation(s)
- Xiao-Tong Shi
- Department of Head and Neck, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jun Shen
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ya-Yu Sun
- Department of Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
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3
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Agne GR, Kohler HF, Lira RB, Belli M, Bento GN, Viana A, Kowalski LP. Aesthetic Perceptions Regarding a Thyroidectomy Scar and Transvestibular Approach in Brazil. Laryngoscope 2024. [PMID: 38411345 DOI: 10.1002/lary.31372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/05/2024] [Accepted: 02/15/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVE We investigated motivation levels across the general Brazilian population and subgroups and their willingness to spend for surgery without a cervical scar. METHODS This random-sample survey was performed by a specialized third-party research institute. In this study, we created a hypothetical thyroidectomy scenario, and the transcervical and transoral endoscopic thyroidectomy vestibular approach (TOETVA) were used. The survey included sociocultural data and questions regarding participants' surgical preferences. RESULTS Data were obtained from 1250 participants; 42.4% were of the opinion that a cervical scar affects social or professional life. Young and childless women were most likely to be affected (p <0.001). All respondents accepted the transoral approach to avoid cervical scarring. However, 30.7% and 31.9% of respondents maintained their preference for TOETVA despite understanding the risks of a hypothetical increase in complications and unfavorable oncological outcomes and 98.6% were of the opinion that this approach was likely associated with greater postoperative pain. Only 16.2% were unwilling to spend for TOETVA. The variable that most affected patients' willingness to spend was a salary greater than 10 Brazilian minimum wages (odds ratio 9.797, 95% confidence interval, p <0.005). Upper class respondents were 10 times more likely to spend for TOETVA than lower class patients. CONCLUSION This study highlights patients' interest in TOETVA. Cervical scar perception is affected by concerned about appearance, particularly in certain societal subgroups. Our study population showed significant motivation to undergo TOETVA, which was emphasized by their acceptance of the complication rate, poor postoperative outcomes, greater postoperative pain, and willingness to spend on surgery with an invisible scar. LEVEL OF EVIDENCE 4 Laryngoscope, 2024.
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Affiliation(s)
| | - Hugo Fontan Kohler
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Renan Bezerra Lira
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Marcelo Belli
- Department of Head and Neck Surgery, PESCOP Group, Balneário Camboriú, Brazil
| | - Gustavo Nunes Bento
- Department of Head and Neck Surgery, PESCOP Group, Balneário Camboriú, Brazil
| | - Acklei Viana
- Department of Head and Neck Surgery, NICAP Group, Florianópolis, Brazil
| | - Luiz Paulo Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo, Brazil
- Department of Head and Neck Surgery, Universidade de São Paulo, São Paulo, Brazil
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4
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Au VH, Miller LE, Mitchell MB, Larson AR, Lin DT, Feng AL, Richmon JD. Neck scar perception after neck dissection in HPV-associated oropharyngeal squamous cell carcinoma. Am J Otolaryngol 2024; 45:104074. [PMID: 37865986 DOI: 10.1016/j.amjoto.2023.104074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 09/29/2023] [Indexed: 10/24/2023]
Abstract
IMPORTANCE While there has been an increased understanding of the impact of visible neck scars in some patients with certain diseases, this has not yet been explored in the HPV+ OPSCC population. OBJECTIVE To understand patients' perception of their scar and the impact on their quality of life (QOL) at least 6 months after neck dissection (ND) for HPV+ oropharyngeal squamous cell carcinoma (OPSCC). DESIGN, SETTING, AND PARTICIPANTS In this retrospective case-control study, patients who underwent primary transoral robotic surgery (TORS) and ND for HPV+ OPSCC between 2016 and 2021 at a single tertiary care center were identified. Data analysis was performed in January 2022. MAIN OUTCOMES AND MEASURES Dermatology Life Quality Index was modified (mDLQI) to assess patients' perceptions of their scars. The primary outcome was the mean mDLQI survey score with higher scores corresponding to worse perceptions. Three questions adapted from the Self-Consciousness Scale (SCS) were also included to assess awareness of appearance. All questions were scaled on a 0-3 Likert Scale. Tweedie generalized linear model was used to understand the relationship between mDLQI score and patient- and procedure-specific factors (including the three SCS survey questions). An additional exploratory logistic regression was performed to understand the risk factors for clinically significant mDLQI score change. RESULTS A total of 67 patients (response rate 57 %) completed the survey with a mean mDLQI survey score of 0.84 (max 30). Although there was a statistically significant negative association between private insurance and mDLQI survey score (95 % Confidence Interval [CI]: -2.72 - -0.38), and a positive association between the SCS score and mDLQI survey score (95 % CI: 0.23-0.81) (p < 0.05), these variables were not found to be risk factors for a clinically significant difference in mDLQI on multivariable analysis. CONCLUSION The majority of patients felt their neck scars did not interfere with their daily lives. Patient perceptions of neck scars were consistent despite differing patient characteristics and treatment regimens.
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Affiliation(s)
- Vivienne H Au
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States of America; Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, United States of America
| | - Lauren E Miller
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States of America; Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, United States of America
| | - Margaret B Mitchell
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States of America; Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, United States of America
| | - Andrew R Larson
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States of America; Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, United States of America
| | - Derrick T Lin
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States of America; Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, United States of America
| | - Allen L Feng
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States of America; Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, United States of America
| | - Jeremy D Richmon
- Department of Otolaryngology - Head and Neck Surgery, Massachusetts Eye and Ear, Boston, MA, United States of America; Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Boston, MA, United States of America.
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5
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Chen L, He Q, Tian H, Zhu Q, Shen Y, Fang Y, Zhu F, Zhu L, Chen L, Pan J, Du Y, Yan X, Zhang Q, Zhou X, Tian W, Wu Y. Sternomastoid intermuscular approach has better postoperative cosmesis and less neck discomfort than linea alba cervicalis approach in hemithyroidectomy: a randomized clinical trial. Int J Surg 2023; 109:2672-2679. [PMID: 37379168 PMCID: PMC10498877 DOI: 10.1097/js9.0000000000000505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 05/11/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Surgery is still the most important treatment method for thyroid cancer. The classic linea alba cervicalis approach caused obvious neck scarring. This study explored an alternative open operative approach with concealed incision for hemithyroidectomy, and demonstrated whether it was non-inferior to traditional approach in postoperative complications and operation efficiency. METHODS Patients ( n =220) from November 2019 to November 2020 willing to undergo hemithyroidectomy because of differentiated thyroid cancer were randomly divided into the sternocleidomastoid intermuscular approach (SMIA) group ( n =110), and the linea alba cervicalis approach (LACA) group ( n =110). The incidence of postoperative complications within 3 months and operation efficiency indicator R0 resection rate were recorded as primary endpoint, while scar apperance was assessed as secondary endpoint. The data were statistically analyzed. RESULTS The baseline data of these two groups were comparable, with no significant difference ( P >0.05). As primary endpoint, R0 resection rate was 100% in both groups. In the 1-month follow-up period, the SMIA group had a lower score for neck discomfort compared with that of the LACA group (1.01±0.1648 vs. 0.5657±0.0976, P =0.0217). The SMIA group's scar had better results from the observer scar assessment compared to that of the LACA group as secondary endpoint. Within the 3-month follow-up, the total complications were calculated, and it was demonstrated that SMIA was non-inferior to traditional LACA operation ( P of non-inferiority=0.0048). CONCLUSIONS Compared with LACA group, surgery through the SMIA is safe, effective, and has non-inferior postoperative complications. SMIA can be considered an alternative approach to classic LACA in hemithyroidectomy.
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Affiliation(s)
- Linghui Chen
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Qiwen He
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Hedi Tian
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Qinsheng Zhu
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Yibin Shen
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Yun Fang
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Feng Zhu
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Lixian Zhu
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Liang Chen
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Jun Pan
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Yehui Du
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Xiaochuan Yan
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Qijun Zhang
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Xueyu Zhou
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Wen Tian
- Department of General Surgery, Chinese PLA General Hospital, Beijing, P.R. China
| | - Yijun Wu
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
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6
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Alci E, Kim SY, Yun HJ, Gozener S, Ozdemir M, Turk Y, Hassoy H, Lee YS, Kim SM, Icoz G, Chang HS, Makay O. Evaluation of public's perception of scar cosmesis after thyroidectomy: results of a survey of Turkish versus South Korean individuals. Ann Surg Treat Res 2023; 105:119-125. [PMID: 37693291 PMCID: PMC10485354 DOI: 10.4174/astr.2023.105.3.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/07/2023] [Accepted: 08/14/2023] [Indexed: 09/12/2023] Open
Abstract
Purpose Visible scars on the neck caused by thyroid surgery give rise to significant aesthetic, functional, and psychosocial problems. The objective of this study is to comparatively investigate the public perception of neck scar cosmesis in Turkish and South Korean populations. Methods This survey was prepared to collect participants' demographic and socioeconomic data and determine their perception of scar cosmesis on the neck and consisted of 15 questions. One thousand thirty-nine individuals who did not undergo thyroid surgery completed the survey. The P-values of <0.05 were deemed to indicate statistical significance. Results There were 1,039 respondents, of whom 525 (50.5%) were Turkish and 514 (49.5%) were South Korean. South Korean respondents stated that they would be significantly more uncomfortable with the thought of having a scar due to thyroid surgery, compared to the Turkish respondents (P < 0.001). The South Korean respondents stated that they would be significantly more concerned about the scar's length, thickness, and darkening color, compared to the Turkish respondents (P < 0.001 for all cases). Conclusion Patients' expectations, which are affected by various sociodemographic factors and cultural characteristics, are as important as the medical condition when deciding on the type of thyroid surgery. The study findings clearly indicated that the South Korean population would be significantly more uncomfortable with having a scar on the neck, compared to the Turkish population. Therefore, in selected cases, a scarless thyroidectomy approach, such as transoral endoscopic thyroidectomy, vestibular approach may be preferable for societies like South Korea.
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Affiliation(s)
- Erman Alci
- Department of General Surgery, School of Medicine, Balikesir University, Balikesir, Türkiye
| | - Soo Young Kim
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital and Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, Korea
| | - Hyeok Jun Yun
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital and Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, Korea
| | - Seda Gozener
- Department of Anatomy, İstanbul Medipol University, School of Medicine, Izmir, Türkiye
| | - Murat Ozdemir
- Division Endocrine Surgery, Department of General Surgery, Ege University Hospital, Izmir, Türkiye
| | - Yigit Turk
- Division Endocrine Surgery, Department of General Surgery, Ege University Hospital, Izmir, Türkiye
| | - Hur Hassoy
- Department of Public Health, School of Medicine, Ege University, Izmir, Türkiye
| | - Yong Sang Lee
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital and Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, Korea
| | - Seok-Mo Kim
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital and Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, Korea
| | - Gokhan Icoz
- Division Endocrine Surgery, Department of General Surgery, Ege University Hospital, Izmir, Türkiye
| | - Hang-Seok Chang
- Department of Surgery, Thyroid Cancer Center, Gangnam Severance Hospital and Institute of Refractory Thyroid Cancer, Yonsei University College of Medicine, Seoul, Korea
| | - Ozer Makay
- Division Endocrine Surgery, Department of General Surgery, Ege University Hospital, Izmir, Türkiye
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Zeng HH, Huang DH. Single-port endoscopy-assisted thyroidectomy via cervical gas-insufflation approach for papillary thyroid carcinoma: A pilot retrospective comparative study. Am J Otolaryngol 2023; 44:103903. [PMID: 37148848 DOI: 10.1016/j.amjoto.2023.103903] [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: 03/04/2023] [Accepted: 04/13/2023] [Indexed: 05/08/2023]
Abstract
PURPOSE This study aims to investigate the safety and efficacy of our novel technique of single-port endoscopy-assisted thyroidectomy via cervical gas-insufflation approach (SPEAT, also called the Huang procedure) in the treatment of papillary thyroid carcinoma (PTC). MATERIALS AND METHODS We perform a retrospective comparative study from a prospectively maintained database. A cohort of 82 patients with PTC who underwent total thyroidectomy and central neck dissection were included. Of these patients, 48 underwent SPEAT and 34 underwent conventional open thyroidectomy (COT). The differences in surgical outcome and oncological completeness were compared. RESULTS Compared with the COT group, the SPEAT group had obviously shorter incision (P < 0.001), less postoperative pain (P = 0.036), better cosmetic satisfaction (P = 0.001)and slightly longer operating time (P = 0.041). In intraoperative bleeding, postoperative drainage, postoperative hospital stay, surgical complications, number of dissected or positive lymph nodes per patient, and postoperative non-stimulated or stimulated thyroglobulin levels, there were no significant differences. CONCLUSIONS SPEAT (the Huang procedure) is a minimally invasive, safe and oncologically complete surgical option for PTC in selected patients.
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Affiliation(s)
- Huan-Hong Zeng
- Department of Basic Surgery, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou City, Fujian Province 350001, PR China
| | - Dong-Hang Huang
- Department of Basic Surgery, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University, Fuzhou City, Fujian Province 350001, PR China.
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Vanermen M, Vander Poorten V, Meulemans J. Remote-access robotic thyroidectomy: A systematic review. Int J Med Robot 2023:e2511. [PMID: 36799913 DOI: 10.1002/rcs.2511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/29/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Recently, robotic surgery has been introduced as a new surgical approach to the thyroid. OBJECTIVES The primary objective of this systematic review is to critically examine safety and feasibility of the different robotic approaches. METHODS The literature on robotic thyroidectomy was systematically reviewed. Primary endpoints were surgery duration, length of hospital stay, complications, postoperative pain and cosmetic satisfaction. RESULTS Sixty-eight studies with a total of 14433 patients were included. Depending on the robotic approach used, operative duration ranged between 89 and 230 min and hospitalisation stay between 0.1 and 5.6 days. Complication rates varied between 7.3% and 29%. Postoperative pain visual analogue scores (VAS) ranged from 0.6 to 4.71. CONCLUSION Robotic thyroidectomy results in high cosmetic satisfaction and quality of life. No differences in complication rates between robotic and traditional approaches are observed, supporting safety and feasibility of these robotic techniques.
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Affiliation(s)
- Margaux Vanermen
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Vincent Vander Poorten
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
| | - Jeroen Meulemans
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium.,Department of Oncology, Section Head and Neck Oncology, KU Leuven, Leuven, Belgium
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Eltelety AM, Terris DJ. Minimally invasive thyroid and parathyroid surgery: modifications for low-resource environments. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2022. [DOI: 10.1186/s43163-022-00341-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
AbstractMinimally invasive thyroidectomy (MIT) and parathyroidectomy (MIP) are gaining popularity in the current surgical practice. The need for specific equipment and technology is an obstacle in the low-resource environment. This article provides simple and practical guidance for surgeons practicing in low-resource environments to help them attain quality surgical practice, maintain patient safety, preserve available resources, and achieve the best outcomes.
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10
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Bach K, Prince S, Pitt SC, Robbins S, Connor NP, Macdonald C, Sippel RS, Long KL. Time Heals Most Wounds - Perceptions of Thyroidectomy Scars in Patients With Thyroid Cancer. J Surg Res 2022; 270:437-443. [PMID: 34798426 PMCID: PMC8712385 DOI: 10.1016/j.jss.2021.09.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/23/2021] [Accepted: 09/23/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Patients understandably have concerns about thyroidectomy scars. This study aimed to characterize patients' perceptions of their thyroidectomy scar before and up to 1-y after surgery. METHODS Patients with papillary thyroid cancer (n = 83) completed semi-structured interviews before and at 2-wks, 6-Wk, 6-mo, and 1-y post-thyroidectomy. Interviews probed about scar concerns and appearance. Content analysis was used to identify themes. RESULTS The majority of participants did not express concerns about scar appearance. When expressed, preoperative concerns often stemmed from previous surgery experiences or unease with neck incisions. Postoperatively, concerns about scar appearance decreased over time throughout the healing period with most patients being satisfied with their scar appearance by 6-mo after surgery. CONCLUSIONS Patients with papillary thyroid cancer express few concerns about scar thyroidectomy appearance. Surgeons can reassure patients who have preoperative concerns that most patients are satisfied with their scar appearance by 6-mo after surgery.
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Affiliation(s)
- Kathy Bach
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison Wisconsin USA, 53792
| | - Samantha Prince
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison Wisconsin USA, 53792
| | - Susan C. Pitt
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison Wisconsin USA, 53792
| | - Sarah Robbins
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison Wisconsin USA, 53792
| | - Nadine P. Connor
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison Wisconsin USA, 53792
| | - Cameron Macdonald
- Qualitative Health Research Consultants,111 King St #23, Madison Wisconsin USA 53703
| | - Rebecca S. Sippel
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison Wisconsin USA, 53792
| | - Kristin L. Long
- Division of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison Wisconsin USA, 53792
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11
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Hussain I, Zulfiqar F, Li X, Ahmad S, Aljammal J. Safety and Efficacy of Radiofrequency Ablation of Thyroid Nodules-Expanding Treatment Options in the United States. J Endocr Soc 2021; 5:bvab110. [PMID: 34258495 PMCID: PMC8271212 DOI: 10.1210/jendso/bvab110] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Indexed: 12/15/2022] Open
Abstract
CONTEXT Radiofrequency ablation (RFA) has only recently gained popularity in the United States for treatment of thyroid nodules (TNs), with a limited number of patients having undergone the procedure in this country. OBJECTIVE To evaluate the safety and efficacy of RFA of TNs performed in an outpatient setting in the United States. METHODS This is a retrospective, single-center study of 53 patients who underwent RFA of 58 TNs between November 2018 and January 2021. The reduction in volume of nodule, cosmetic and symptomatic improvement, effect on thyroid function, and complications following RFA were assessed. RESULTS Eleven out of 53 patients were excluded from the analysis. A total of 47 benign TNs (23 nonfunctioning thyroid nodules [NFTNs] and 24 autonomously functioning thyroid nodules [AFTNs]), were assessed after RFA. The median reduction in volume was 70.8% after a median follow-up period of 109 days, with symptomatic and cosmetic improvement (P < 0.0001). Compared with larger nodules, smaller nodules had greater volume reduction (P = 0.0266). RFA improved thyrotropin (TSH) in AFTNs (P value = 0.0015) and did not affect TSH in NFTNs (P value = 0.23). There were no major complications; however, 1 patient had self-limited local bleeding and another had transient voice change that recovered in 6 months. CONCLUSION RFA is a safe and efficacious treatment for symptomatic NFTNs and AFTNs in our population and is especially effective for smaller nodules. RFA should be considered an alternative for TNs in patients who cannot or do not want to undergo surgery.
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Affiliation(s)
- Iram Hussain
- Division of Endocrinology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390-8537, USA
| | | | - Xilong Li
- Division of Biostatistics, Department of Population and Data Science, University of Texas Southwestern Medical Center, Dallas, TX 75390-8537, USA
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Chung JH, Kim DS, Cheon JH, Yoon JM, Baek SK, Jung KY, Yoon ES, Park SH. Current Protocol for Aesthetic Scar Management in Thyroid Surgery. Laryngoscope 2021; 131:E2188-E2195. [PMID: 33567135 DOI: 10.1002/lary.29441] [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: 11/17/2020] [Revised: 12/31/2020] [Accepted: 01/28/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS We compared the scar quality when different protocols were applied, and eventually aim to find the optimal scar management protocol. STUDY DESIGN We conducted a prospective, randomized, and blinded comparison of different scar management protocols in a single center. METHODS We allocated 126 patients who underwent thyroidectomy via collar neck incision randomly into three groups. Patients in group A were treated with tissue adhesive only. Patients in group B were treated by means of subcuticular suturing and early scar management with a non-ablative fractional laser (NAFL) and intralesional triamcinolone injection (ILI). Patients in group C had skin closure with tissue adhesive and early scar management. At 6 months after the operation, the Patient and Observer Scar Assessment Scale (POSAS) and the width of the final scar were compared. RESULTS Comparing the sum of PSAS, groups B and C showed significant higher satisfaction than did group A (22.81 ± 11.66 in group A, 10.9 ± 5.14 in group B, and 15.19 ± 9.98 in group C). In the sum of OSAS, group B also showed a significant difference than did groups A and C (17.74 ± 6.75 in group A, 10.26 ± 3.60 in group B, and 14.52 ± 6.48 in group C). Also, group B showed a narrower scar width than did groups A and C. CONCLUSIONS Our finding suggests that subcuticular suturing using barbed suture material and early treatment with a combination therapy using NAFL and ILI showed a favorable aesthetic outcome for both patients and operators. Based on our algorithmic approach for thyroidectomy scar, we anticipate an optimal aesthetic outcome. LEVEL OF EVIDENCE II Laryngoscope, 131:E2188-E2195, 2021.
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Affiliation(s)
- Jae-Ho Chung
- Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Da-Som Kim
- Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jeong-Hyun Cheon
- Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jeong-Min Yoon
- Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Seung-Kuk Baek
- Department of Otorhinolaryngology, Head and Neck Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Kwang-Yoon Jung
- Department of Otorhinolaryngology, Head and Neck Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Eul-Sik Yoon
- Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Seung-Ha Park
- Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
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Abstract
Increasing emphasis in the literature is recently being put on controlling rotational stability in patients with an anterior cruciate ligament rupture by addressing the anterolateral complex during anterior cruciate ligament reconstruction. Many different techniques for lateral extra-articular tenodesis have been described, with the (modified) Lemaire technique being widely favored. Recent literature does report that lateral extra-articular tenodesis leads to a reduction in persistent rotatory laxity and graft rupture rate, but also may be associated with increased pain, reduced quadriceps strength, reduced subjective functional recovery, and cosmetic complaints. Thus this article aims to describe our minimally invasive technique for a modified Lemaire tenodesis.
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14
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Sukpanich R, Sanglestsawai S, Seib CD, Gosnell JE, Shen WT, Roman SA, Sosa JA, Duh QY, Suh I. The Influence of Cosmetic Concerns on Patient Preferences for Approaches to Thyroid Lobectomy: A Discrete Choice Experiment. Thyroid 2020; 30:1306-1313. [PMID: 32204688 DOI: 10.1089/thy.2019.0821] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background: Newer transoral thyroidectomy techniques that aim to avoid scars in the neck and maximize cosmetic outcomes have become more prevalent. We conducted a discrete choice experiment (DCE) to evaluate the influence of cosmetic concerns and other factors on patients' decision-making processes when choosing among different thyroidectomy approaches. Methods: A questionnaire was developed to identify key attributes driving patient preferences around thyroidectomy approaches using mixed analyses of patient focus groups, expert opinion, and literature review. These attributes included (i) risk of recurrent laryngeal nerve (RLN) injury, (ii) risk of mental nerve injury, (iii) travel distance for surgery, (iv) out-of-pocket cost, and (v) incision site. Using fractional factorial design, discrete choice sets consisting of randomly generated hypothetical scenarios across all attributes were created. A face-to-face DCE survey was administered to patients being evaluated in clinic for thyroid lobectomy for noncancerous thyroid disease. Participants chose among scenarios constructed from the choice sets of attributes. Analyses were conducted using a mixed logit model, and the trade-offs between different attributes that patients were willing to accept were quantified. Results: The DCE was completed by 109 participants (86 [79%] women; mean age 51.3 ± 3.0 years). Overall, the risk of having RLN and/or mental nerve injury, travel distance, and cost were the most influential attributes. Participants aged ≤60 years significantly preferred an approach without a neck incision and were willing to accept an additional $2332 USD in out-of-pocket cost, 693 miles of travel distance, 0.6% increased risk of RLN injury, and 2.2% risk of mental nerve injury. Patients aged >60 years significantly preferred a conventional neck incision and were willing to pay an additional $3401 out-of-pocket and travel 1011 miles to avoid a scarless approach. Conclusions: The risk of nerve injury, travel distance, and cost were the most important drivers for patients choosing among surgical approaches for thyroidectomy. Cosmetic considerations also influenced patient choices, but in opposing ways depending on patient age.
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Affiliation(s)
- Rupporn Sukpanich
- Endocrine Surgery Section, Department of Surgery, University of California, San Francisco, San Francisco, California, USA
- Department of General Surgery, Rajavithi Hospital, Rangsit University, Bangkok, Thailand
| | - Santi Sanglestsawai
- Department of Agricultural and Resource Economics, Kasetsart University, Bangkok, Thailand
| | - Carolyn D Seib
- Department of Surgery, Stanford University, Stanford, California, USA
| | - Jessica E Gosnell
- Endocrine Surgery Section, Department of Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Wen T Shen
- Endocrine Surgery Section, Department of Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Sanziana A Roman
- Endocrine Surgery Section, Department of Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Julie A Sosa
- Endocrine Surgery Section, Department of Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Quan-Yang Duh
- Endocrine Surgery Section, Department of Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Insoo Suh
- Endocrine Surgery Section, Department of Surgery, University of California, San Francisco, San Francisco, California, USA
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15
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Qiu TY, Lau J, Wong O, Oh HB, Boon TW, Parameswaran R, Ngiam KY. Preoperative scar perception study comparing 'scarless' in the neck endoscopic thyroidectomy with open thyroidectomy: a cross-sectional study. Ann R Coll Surg Engl 2020; 102:737-743. [PMID: 32820638 DOI: 10.1308/rcsann.2020.0174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Open thyroidectomy is the most common approach to thyroid surgery. However, 'scarless' (in the neck) endoscopic thyroidectomy, consisting of endoscopic and robotic surgery, is progressively being adopted for its perceived cosmetic benefits. This study aims to determine the patient's preferred surgical approach and to identify the factors that influence their decision. MATERIALS AND METHODS A pilot study consisting of 100 patients with a surgical thyroid disorder were prospectively recruited from a single tertiary centre. An interviewer-administered survey was conducted. Demographic, socioeconomic status, scar perception and an adapted body image scale were evaluated to identify factors that shaped the patient's perception of the surgical approach. RESULTS The mean age of participants was 54.5 ± 13.0 years; 72% were women and 87% Chinese. Of the 100 patients, 75 patients considered scarless endoscopic thyroidectomy as their preferred surgical approach while 25 patients opted for open thyroid surgery. Improvement in scar perception score between scarless endoscopic thyroidectomy and open thyroid surgery is associated with an increased willingness to choose scarless endoscopic thyroidectomy. The mean body image scale score was 6.9 ± 2.8, indicating no statistical difference between the surgical approaches. On multivariate analysis, improvement in scar perception score (odds ratio 3.38, 95% confidence interval 1.11-10.29) and having surgeon recommendation (odds ratio 6.38, 95% confidence interval 1.80-22.63) were independently associated with interest in scarless endoscopic thyroidectomy. CONCLUSION Patients interest in undergoing scarless endoscopic thyroidectomy is driven by improved scar perception and surgeon's recommendation compared with open thyroid surgery.
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Affiliation(s)
- T Y Qiu
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jwl Lau
- National University Hospital, National University Health System, Singapore
| | - O Wong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - H B Oh
- Ng Teng Fong General Hospital, National University Health System, Singapore
| | - T W Boon
- National University Hospital, National University Health System, Singapore
| | - R Parameswaran
- National University Hospital, National University Health System, Singapore
| | - K Y Ngiam
- National University Hospital, National University Health System, Singapore
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Singaporewalla RM, Rao AD. Minimally invasive video-assisted thyroidectomy in Asian patients: experience from Singapore. ANZ J Surg 2020; 90:1721-1726. [PMID: 32734637 DOI: 10.1111/ans.16201] [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: 03/05/2020] [Revised: 06/03/2020] [Accepted: 07/11/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Minimally invasive video-assisted thyroidectomy (MIVAT) although well established in Europe has not yet gained widespread acceptance in Asia. We describe our learning experience in the first reported series of 105 cases from Singapore. METHODS A retrospective analysis of outcomes in 105 patients who underwent MIVAT from April 2011 to 2018 was performed. The inclusion criteria were - symptomatic benign thyroid pathologies and follicular lesions or neoplasms needing a hemi-thyroidectomy. A thyroid lobe volume less than 35 mL was used as cut-off. Patients underwent surgeon-performed thyroid ultrasound with biopsy of solid nodules. All cases were operated by one surgeon using standard Miccoli technique with energy device used in all cases. RESULTS From a total of 424 patients with nodular goitres undergoing thyroidectomy, 105 (24%) symptomatic eligible patients underwent the MIVAT procedure (M:F - 23:82). The mean incision lengths at start and completion were 1.7 cm (range 1.5-2 cm) and 2.4 cm (range 2-2.7 cm), respectively. Mean operating time was 97 min (range 59-160 min). There were four conversions (3.8%) in the first 25 cases and four patients (3.8%) experienced transient hoarseness with full recovery. Visual analogue pain scores at 6 and 24 h post-operatively were 2.7 and 1.1, respectively. Scar satisfaction was reported as excellent (75%), satisfactory (23%) and poor (2%). CONCLUSION Although technically more demanding, MIVAT is a safe and useful operation in a thyroid surgeon's armamentarium. The limitation of goitre size, however, allows only a small percentage of symptomatic patients to undergo this procedure.
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Affiliation(s)
| | - Anil D Rao
- Endocrine Surgical Service, Department of Surgery, Khoo Teck Puat Hospital, Singapore
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Kohta M, Nishigaki C. Internet-based survey of the perceptions of surgical scars of Japanese patients. Scars Burn Heal 2020; 6:2059513120928515. [PMID: 32577308 PMCID: PMC7290269 DOI: 10.1177/2059513120928515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Introduction: The adverse aesthetic effects of post-surgical scars frequently impose a psychological burden on patients. We conducted an Internet-based questionnaire survey of Japanese individuals to explore patient satisfaction with respect to surgical scars and to identify the factors that affect their interest and experience of scar care. Method: A cross-sectional study was conducted for the previous year on patients who had undergone the following surgeries: gastrointestinal; orthopaedic; obstetric; gynaecological; and plastic. The questionnaire included: (1) measures of participant characteristics; (2) measures of interest, experience and satisfaction with scar care; (3) measures of current and desired scar condition; and (4) measures of communication with physicians or nurses. Results: A total of 214 participants were enrolled. Of these, only 90 individuals had experienced any treatment or self-care, and only 30 were satisfied with their experience. We found a significant gap between the current and desired thickness and colour of the scar (P < 0.01). On logistic regression analysis, scars located at a visible site and size of the scar were significant factors that affected the interest and experience of scar care. Only 40% of participants answered that their physician or nurse adequately understands their concerns pertaining to the scar condition. Conclusion: Only a small proportion of individuals were satisfied with their experience of scar care. Additional research in following areas is required: (1) mutual communication between patients and medical providers; and (2) development of a new care programme for the management of scars.
Scar formation at the site of surgery is a natural biological response. The cosmetic effects of scar have an adverse psychological impact on the patient owing to the visible difference between the normal skin and scar. In the present study, we explored scar satisfaction and identified the factors that affect the patient’s interest and experience with respect to scar care. An Internet-based questionnaire survey of Japanese residents was conducted. The target population included patients who underwent gastrointestinal, orthopaedic, obstetrics and gynaecological, and plastic surgery. Out of 214 participants, 90 had experienced any treatment or self-care for scar care and only 30 were satisfied with their experience. There was a gap between the current and desired condition of thickness and colour in a scar. Scars located on visible parts of the body and size of scar had the greatest impact on the patient’s interest and experience of scar care. Additional research is required in the following areas: (1) better communication between patients and medical providers; and (2) development of new care program for scar management.
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Affiliation(s)
- Masushi Kohta
- Medical Engineering Laboratory, ALCARE Co., Ltd., Sumida-ku, Tokyo, Japan
| | - Chihiro Nishigaki
- Medical Engineering Laboratory, ALCARE Co., Ltd., Sumida-ku, Tokyo, Japan
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Liao D, Ishii LE, Chen LW, Chen J, Juarez M, Darrach HM, Kumar AR, Russell JO, Tufano RP, Ishii M. Transoral neck surgery prevents attentional bias towards the neck compared to open neck surgery. Laryngoscope 2019; 130:1603-1608. [PMID: 31660610 DOI: 10.1002/lary.28305] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 08/01/2019] [Accepted: 08/27/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Measure attentional distraction of neck scars after open neck surgery compared to transoral endoscopic thyroidectomy via a vestibular approach (TOETVA) or transoral endoscopic parathyroidectomy via a vestibular approach (TOEPVA) using eye-tracking technology. METHODS Casual observers viewed facial images of patients who underwent open neck surgery, TOETVA/TOEPVA, or no surgery (controls). An eye-tracking monitor recorded eye fixations in real time. Multivariate Hotelling's analysis followed by post-hypothesis testing compared fixation durations for predefined regions of interest, including the eyes, nose, mouth, neck, and remaining face between open neck surgery patients, transoral neck surgery patients, and controls. RESULTS One hundred forty observers completed the experiment. The majority of their attention was directed towards the central triangle (eyes, nose, mouth). On multivariate analysis, distribution of attention was significantly different on the faces of those who underwent open neck surgery versus TOETVA/TOEPVA (T2 = 43.66; F[32,131] = 14.5389, P < .0001). Observers attended significantly more to the neck (0.20 seconds, P < .0001; 95% CI, 0.13, 0.26 s) and less to the peripheral face (-0.24 seconds, P = .0031; 95% CI, -0.39, -0.08 s) of open neck surgery patients. In patients who followed up months after surgery, significant differences persisted (T2 = 13.97; F[3451] = 4.6377, P = .0033). By contrast, fixation patterns for TOETVA/TOEPVA patients were not significantly different from controls (T2 = 5.59, F[31,186] = 1.8602, P = .1345). Observer race and gender did not significantly affect attention to neck scars. CONCLUSION Scars following open neck surgery draw attention in casual observers. This attentional distraction is prevented in TOETVA/TOEPVA patients due to the absence of a scar, even months after surgery. Moreover, visual processing of TOETVA/TOEPVA patients' faces is similar to that of controls. These data support the effectiveness of transoral neck surgery in giving patients a cosmetic result that does not distract the attention of observers. LEVEL OF EVIDENCE NA Laryngoscope, 130:1603-1608, 2020.
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Affiliation(s)
- David Liao
- Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Lisa E Ishii
- Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Lena W Chen
- Division of Head and Neck Endocrine Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Jonlin Chen
- Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Michelle Juarez
- Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Halley M Darrach
- Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Anisha R Kumar
- Division of Facial Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Jonathon O Russell
- Division of Head and Neck Endocrine Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Ralph P Tufano
- Division of Head and Neck Endocrine Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
| | - Masaru Ishii
- Division of Rhinology, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, U.S.A
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Kazmer DO, Eaves FF. Force Modulating Tissue Bridges for Reduction of Tension and Scar: Finite Element and Image Analysis of Preclinical Incisional and Nonincisional Models. Aesthet Surg J 2018; 38:1250-1263. [PMID: 29635348 PMCID: PMC6195176 DOI: 10.1093/asj/sjy079] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Force modulating tissue bridges (FMTB) represent a new class of combined wound closure and scar reduction device designed to optimize the tension milieu of the healing wound. Objectives Engineering analysis and testing in both intact skin and incisional models was undertaken to assess changes in tissue tension associated with device placement and compare to standard suture closure. Methods Nonlinear, large deformation finite element analyses (FEA) were performed to compare the strains applied to tissues with sutures and FMTB. In the incisional model, a freshly euthanized Yorkshire pig received full thickness cutaneous incisions followed by alternating closure with sutures and FMTBs. FMTBs were also applied to intact adult human skin after pattern application. In each of the experiments, photographs were taken preapplication and postapplication and the resultant dot grid pattern changes were analyzed by image recognition algorithms to calculate applied strains. Results FEA indicate compressive stresses at the tissue:suture interface on the order of 4000 mmHg and 20 mmHg at the tissue:FMTB interface. Strain analysis of the sutures and FMTBs applied in the incisional lab testing indicated imposed strains on the tissues of around 40%, with FMTBs providing 10% more compression than sutures and 25% more compression between the applied devices (P = 0.000057). In the longitudinal study, tension reduction of the order of 30% was maintained over the treatment period of 10 days to verify device efficacy. Conclusions FMTBs provide wounds while simultaneously modulating skin tension and thus have the potential to improve scar appearance.
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Affiliation(s)
- David O Kazmer
- Department of Plastics Engineering, UMass Lowell, Lowell, MA
| | - Felmont F Eaves
- Division of Plastic Surgery, Emory University
- Medical Director of the Emory Aesthetic Center and Emory Ambulatory Surgery Center, Atlanta, GA
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20
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Senne M, Zein R, Falch C, Kirschniak A, Koenigsrainer A, Müller S. Randomized clinical trial of platysma muscle suture versus no suture for wound closure after thyroid surgery. Br J Surg 2018; 105:645-649. [DOI: 10.1002/bjs.10829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/18/2017] [Accepted: 12/28/2017] [Indexed: 11/08/2022]
Abstract
Abstract
Background
Suturing the platysma muscle during wound closure after thyroid surgery is frequently described in the literature. There is no prospective evidence to support its use or benefit. The aim of this study was to evaluate how a platysma muscle suture influences initial postoperative pain following thyroid surgery.
Methods
Patients were assigned randomly to receive a platysma suture or no platysma suture in this prospective, patient-blinded trial. The duration of follow-up was 6 months. The primary endpoint was wound-specific pain 24 h after thyroid resection. Secondary endpoints were intraoperative and perioperative analgesia requirement, postoperative pain and complications until postoperative day 14, and Patient and Observer Scar Assessment Score (POSAS) 6 months after surgery.
Results
Forty-one patients were randomized to each group. Visual analogue scale scores for wound-specific pain were lower in patients without a platysma suture 24 h after surgery (mean(s.d.) 3·15(1·46) versus 2·17(1·41) in groups with and without suture respectively; P = 0·002). There were no differences in the perioperative and postoperative need for analgesics, postoperative wound complications or cervical scar cosmesis 6 months after surgery (mean(s.d.) POSAS 23·99(9·53) versus 26·51(8·69); P = 0·148).
Conclusion
Omitting the platysma muscle suture after thyroid surgery resulted in less wound-specific pain initially, with no difference in postoperative wound complications or cosmetic results. Registration number: NCT02951000 (http://www.clinicaltrials.gov).
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Affiliation(s)
- M Senne
- Clinic for Visceral, General and Transplant Surgery, Tuebingen University Hospital, Hoppe-Seyler Strasse 3, 72076 Tuebingen, Germany
| | - R Zein
- Clinic for Visceral, General and Transplant Surgery, Tuebingen University Hospital, Hoppe-Seyler Strasse 3, 72076 Tuebingen, Germany
| | - C Falch
- Clinic for Visceral, General and Transplant Surgery, Tuebingen University Hospital, Hoppe-Seyler Strasse 3, 72076 Tuebingen, Germany
| | - A Kirschniak
- Clinic for Visceral, General and Transplant Surgery, Tuebingen University Hospital, Hoppe-Seyler Strasse 3, 72076 Tuebingen, Germany
| | - A Koenigsrainer
- Clinic for Visceral, General and Transplant Surgery, Tuebingen University Hospital, Hoppe-Seyler Strasse 3, 72076 Tuebingen, Germany
| | - S Müller
- Clinic for Visceral, General and Transplant Surgery, Tuebingen University Hospital, Hoppe-Seyler Strasse 3, 72076 Tuebingen, Germany
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