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Huang BL, Carneiro-Pla D. Intraoperative Adjuncts in Thyroid Surgery. Surg Clin North Am 2024; 104:767-777. [PMID: 38944497 DOI: 10.1016/j.suc.2024.02.006] [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] [Indexed: 07/01/2024]
Abstract
Thyroidectomy is relatively safe and often can be done as a minimally invasive procedure. Although they may be associated with a learning curve, thoughtful use of intraoperative adjuncts such as energy devices, recurrent laryngeal nerve monitoring, and parathyroid autofluorescence have the potential to make incremental improvements in the safety and efficiency of thyroid surgery. Perhaps many of these adjuncts may be of greatest benefit when used routinely by less experienced surgeons or selectively in higher-risk operations, although their adoption in practice continues to increase overall.
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Affiliation(s)
- Bernice Liying Huang
- Section of Endocrine Surgery, Division of Surgical Oncology, Department of Surgery at the Medical University of South Carolina, 30 Courtenay Drive, Suite 240, MSC 295, Charleston, SC 29425, USA
| | - Denise Carneiro-Pla
- Section of Endocrine Surgery, Division of Surgical Oncology, Department of Surgery at the Medical University of South Carolina, 30 Courtenay Drive, Suite 240, MSC 295, Charleston, SC 29425, USA.
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Montori G, Botteri E, Ortenzi M, Gerardi C, Allocati E, Giordano A, Vettoretto N, Arezzo A, Huo B, Bergamini C, Podda M, Agresta F. Systematic review and meta-analysis of the use of high-energy devices for thyroid surgery. Langenbecks Arch Surg 2024; 409:217. [PMID: 39017727 DOI: 10.1007/s00423-024-03399-5] [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: 12/11/2023] [Accepted: 06/26/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND We conducted a systematic review and meta-analysis to evaluate the role of High Energy Devices (HEDs) versus conventional clamp and tie technique in thyroidectomy. This work is endorsed by the Italian Society of Surgical Endoscopy (Italian Society of Endoscopic Surgery and new technologies-SICE) in the broader project on the evaluation of the role of HEDs in different surgical settings with the full health technology assessment report. MEHODS Inclusion criteria were adult patients (≥ 18 years old) undergoing Thyroidectomy/Parathyroidectomy conducted with High Energy Devices (as ultrasonic (US), radiofrequency (RF), and hybrid energy (H-US/RF)) in the setting of thyroid surgery (both partial and total) for benign and malign diseases. However, some variability was found in included studies and described in the text. This systematic review and meta-analysis were performed according to the Cochrane handbook for systematic reviews, and the recommendations of the 2020 updated Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines were pursuit. Selection of abstracts was performed in Ryyan system by 2 independent reviewers, and doubts were solved by another independent reviewer. At the end of literature research, Randomized controlled trials and observational studies were included. Risk of Bias was assessed with ROB2 for RCTs, and New Castle Ottawa Scale for Observational studies. RESULTS The literature search yielded 47 studies, including 29 RCTs and 18 observational studies. Meta-analysis was performed for 29 randomized clinical trials. Outcomes included in the comparison between High Energy Devise and conventional technique groups were operative time, operative blood loss, overall post-operative drainage volume, length of stay, complications, and costs. HED significantly reduced operative time (28 studies, 3097patients; MD -128.8; 95% CI -34.4 to -23.20; I2 = 96%, p < 0.00001, Random-effect), intra-operative blood loss (13 studies, 642 vs 519 patients; SMD -0.82; 95% CI -1.33 to -0.32; I2 = 93%, p < 0.00001, Random-effect), LOS (22 studies, 2808 vs 2789 patients; MD -0.38, 95% CI -0.59 to -0.17; I2 = 98%, p < 0.00001 Random-effect), and healthcare costs (8 studies, 1138 vs 1129 patients, SMD 1.05; 95% CI -0.06 to 2.16; I2 = 99%, p < 0.00001 Random-effect). The rate of overall intraoperative complications was significantly different between both groups (25 studies, 2804 vs 2775 patients; RR 0.88, 95% CI 0.80 to 0.97; I2 = 38%, p = 0.03 Random-effect), but the sensitivity analysis did not find a statistically significant difference (6 studies, 605 vs 594 patients, RR; 95% CI to; I2 = 0%, p = 0.50, Random-effect). There was no difference in the subgroup analysis for the occurrence of transient and permanent RLN palsy, nor hematoma formation and hypocalcaemia. DISCUSSION Though findings of our systematic review and metanalysis are limited by heterogeneous data, surgeons, hospital managers, and policymakers should note that the use of High Energy Devices compared to conventional clamp and tie technique have reduced operative times, intra-operative blood loss, length of stay, and hospital costs in patients underwent to tyroid surgery. Future work must explore issues of equity to mitigate barriers to patient access to safe thyroid surgical care and define better this initial results.
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Affiliation(s)
- Giulia Montori
- Department of General and Emergency Surgery, Vittorio Veneto Hospital, Vittorio Veneto (Treviso), Italy.
| | - Emanuele Botteri
- General Surgery, ASST Spedali Civili Di Brescia PO Montichiari, Brescia, Montichiari, Italy
| | - Monica Ortenzi
- Department of General Surgery, Università Politecnica Delle Marche, Piazza Roma 22, 60121, Ancona, Italy
| | - Chiara Gerardi
- Istituto Di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Alessio Giordano
- Department of Emergency, Emergency General Surgery Unit, AOU Careggi, Florence, Italy
| | - Nereo Vettoretto
- General Surgery, ASST Spedali Civili Di Brescia PO Montichiari, Brescia, Montichiari, Italy
| | - Alberto Arezzo
- Department of Surgical Sciences, University of Torino, Turin, Italy
| | - Bright Huo
- Division of General Surgery, Department of Surgery, Ma, Hamilton, Canada
| | - Carlo Bergamini
- Department of Emergency, Emergency General Surgery Unit, AOU Careggi, Florence, Italy
| | - Mauro Podda
- Department of Surgical Science, Emergency Surgery Unit, University of Cagliari, Cagliari, Italy
| | - Ferdinando Agresta
- Department of General and Emergency Surgery, Vittorio Veneto Hospital, Vittorio Veneto (Treviso), Italy
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Chen H, Xu K, Peng X, Min X. Key points for protecting the external branch of the superior laryngeal nerve in open thyroidectomy: A possible exploration technique. Surg Oncol 2024; 53:102059. [PMID: 38461616 DOI: 10.1016/j.suronc.2024.102059] [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: 08/27/2023] [Revised: 01/29/2024] [Accepted: 02/28/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE Injury of the external branch of the superior laryngeal nerve (EBSLN) is easily overlooked in thyroidectomy, and voice changes caused by the injury have a negative effect on an increasing number of patients. This study aimed to reduce the injury rate of EBSLN by expanding the sternothyroid-laryngeal triangle and standardizing the exploration procedure. METHODS A total of 520 patients who had undergone thyroidectomy at the First Affiliated Hospital of Nanchang University between September 2021 and April 2022 were analyzed. During the operation, the exposure rate of the EBSLN before and after sternothyroid-laryngeal triangle expansion was compared, and all EBSLNs were anatomically classified. RESULTS The exposure rate of EBSLN after sternothyroid-laryngeal triangle expansion reached 82.7%, which is much higher than that before sternothyroid-laryngeal triangle expansion (33.7%), and voice change caused by injury of the EBSLN was reported in one case (the injury rate was 0.2%). The classification and proportion of the EBSLN were as follows: Type 1 (55.3%), the nerve ran within 1 cm above the STP, but no coincidence or crossover with blood vessels was observed in this region; Type 2 (14.7%), the nerve travelled within 1 cm above the STP and overlapped or intersected with blood vessels in this region; Type 3 (12.7%), the EBSLN ran below the level of the STP; and Type 4 (17.3%), no EBSLN was observed within 1 cm above the STP. CONCLUSION In thyroidectomy, injury to the EBSLN can be effectively reduced by expanding the sternothyroid-laryngeal triangle and exploring the upper pole area of the thyroid as far as possible, which has great clinical significance in reducing postoperative voice box injury.
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Affiliation(s)
- Hang Chen
- Department of Day Ward, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, China
| | - Keyi Xu
- Department of Day Ward, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, China
| | - Xueying Peng
- Department of Day Ward, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, China
| | - Xiang Min
- Department of Day Ward, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, China.
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Kloosterman R, Wright GWJ, Salvo-Halloran EM, Ferko NC, Mennone JZ, Clymer JW, Ricketts CD, Tommaselli GA. An umbrella review of the surgical performance of Harmonic ultrasonic devices and impact on patient outcomes. BMC Surg 2023; 23:180. [PMID: 37386399 PMCID: PMC10308659 DOI: 10.1186/s12893-023-02057-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/25/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND For thirty years, the Harmonic scalpel has been used for precise dissection, sealing and transection. There are numerous meta-analyses on individual surgical procedures with Harmonic, but no overarching review covering all the areas. This umbrella review seeks to summarize the clinical results from the use of Harmonic across surgical fields and broadly quantify its effects on patient outcomes. METHODS MEDLINE, EMBASE, and Cochrane Databases were searched for meta-analyses (MAs) of randomized controlled trials (RCTs) comparing Harmonic devices to conventional techniques or advanced bipolar (ABP) devices. For each procedure type, the most comprehensive MAs were evaluated. RCTs not already analysed in a MA were also included. Operating time, length of stay, intraoperative blood loss, drainage volume, pain, and overall complications were evaluated, and the methodological quality and certainty of evidence were assessed. RESULTS Twenty-four systematic literature reviews were identified on colectomy, hemorrhoidectomy, gastrectomy, mastectomy, flap harvesting, cholecystectomy, thyroidectomy, tonsillectomy, and neck dissection. There were also 83 RCTs included. In every MA evaluated, Harmonic devices were associated with either statistically significant or numerical improvements in every outcome compared with conventional techniques; most MAs reported a reduction in operating time of ≥ 25 min. Harmonic versus ABP device MAs in colectomy and thyroidectomy showed no significant differences in outcomes. CONCLUSION Across surgical procedures, Harmonic devices demonstrated improved patient outcomes for operating time, length of stay, intraoperative bleeding, drainage volume, pain, and overall complications compared to conventional techniques. Additional studies are required to assess differences between Harmonic and ABP devices.
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Affiliation(s)
| | | | | | - Nicole C. Ferko
- EVERSANA, 113-3228 South Service Rd., Burlington, ON L7N 3H8 Canada
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Sarda H, Arora V, Sachdeva T, Jain SK. Systematic Review of Comparison of use of Ultrasonic Scalpel Versus Conventional Haemostatic Techniques in Performing Thyroid Surgery. Indian J Otolaryngol Head Neck Surg 2022; 74:6285-6291. [PMID: 36742765 PMCID: PMC9895553 DOI: 10.1007/s12070-021-03026-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 10/02/2021] [Indexed: 02/07/2023] Open
Abstract
Haemostasis during any surgical procedure is fundamental for attaining a positive patient outcome. Safe thyroid surgery requires meticulous attention for careful control of bleeding and safe guarding important structures like recurrent laryngeal nerve. Many methods such as ligation and suturing, electro ligation sealing, coagulation, and ultrasonic coagulation have been put to use for achieving haemostasis. The objective of this systemic review was to compare and review the surgical outcomes between harmonic (ultrasonic) scalpel and conventional ligature techniques in performing thyroid surgery. The systematic review was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and checklist with a total of 11 studies selected for qualitative analysis. The statistical software Review Manager 5.4.1 provided by the Cochrane Collaboration was used for performing the analysis on the two groups. It was concluded that the use of harmonic scalpel for thyroid surgery is useful for reducing operative time, postoperative pain, drainage volume and transient hypocalcemia, hence can be a reliable and a safe tool compared to conventional techniques often used for surgery.
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Affiliation(s)
- Hitesh Sarda
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
| | - Viresh Arora
- ENT Consultant Sandwell & West Birmingham NHS Hospital Trust, Birmigham, UK
| | - Tejasi Sachdeva
- Department of Radiotherapy, Maulana Azad Medical College, New Delhi, India
| | - Sudhir Kumar Jain
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
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Spartalis E, Giannakodimos A, Giannakodimos I, Ziogou A, Papasilekas T, Patelis N, Schizas D, Troupis T. The role of LigaSure™ and Harmonic Scalpel in the preservation of recurrent laryngeal nerve during thyroidectomy. Ann R Coll Surg Engl 2021; 104:324-329. [PMID: 34415202 DOI: 10.1308/rcsann.2021.0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Transient or permanent damage to the recurrent laryngeal nerve (RLN) during thyroidectomy is of paramount importance for patient quality of life. The aim of this study is to systematically review the literature concerning the role of the most popular energy-based vessel-sealing devices (LigaSure™ (LS) and Harmonic Scalpel (HS)) in preservation of the RLN during thyroidectomy. The safety and inferiority or superiority of LS and HS compared with conventional haemostatic techniques are highlighted. METHODS A systematic search of the literature was performed. Clinical trials, prospective and retrospective studies that significantly compared the use of LS and HS with conventional haemostasis regarding the postoperative incidence of RLN palsy were included. FINDINGS The search resulted in 43 studies, including 17,953 patients treated using energy-based devices or conventional haemostatic methods. Concerning the incidence of RLN palsy, 40 studies showed no significant difference between the energy-based device and conventional groups, whereas two studies demonstrated a significant superiority in performance for LS and HS compared with conventional haemostasis. Only one study exhibited significant inferiority of LS and HS compared with conventional methods. No statistical relationship was observed between energy-based devices and conventional techniques regarding permanent damage to the RLN. CONCLUSION The performance of both LS and HS shows no inferiority compared with conventional haemostatic techniques, regarding damage to the laryngeal nerve. Further well-designed studies are needed to investigate their potential benefit in preservation of the RLN.
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Affiliation(s)
- E Spartalis
- National and Kapodistrian University of Athens, Greece
| | | | | | - A Ziogou
- National and Kapodistrian University of Athens, Greece
| | - T Papasilekas
- National and Kapodistrian University of Athens, Greece
| | - N Patelis
- National and Kapodistrian University of Athens, Greece
| | - D Schizas
- National and Kapodistrian University of Athens, Greece
| | - T Troupis
- National and Kapodistrian University of Athens, Greece
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Traus Thyroidectomy (Trans Retroauricular Approach Ultrasonic Surgery) Using Thunderbeat™—a Technical Note. Indian J Surg 2020. [DOI: 10.1007/s12262-020-02633-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Jiang J, Shen M, Lu H. Ultrasonic scalpel with knot tying protects parathyroid function for total thyroidectomy with central neck dissection. Gland Surg 2020; 9:192-199. [PMID: 32420242 DOI: 10.21037/gs.2020.01.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background Hypoparathyroidism might be due to collateral thermal injury induced by harmonic scalpel (HS) after total thyroidectomy (TT) with central neck dissection (CND). The current study aimed to evaluate whether a clamp and tie (CAT) technique used to preserve parathyroid glands in situ could reduce damage to parathyroid function in HS patients undergoing TT plus unilateral or bilateral CND. Methods Medical records of 537 HS-operated patients with papillary thyroid carcinoma (PTC) undergoing TT plus unilateral or bilateral CND were retrospectively evaluated. Patients were divided into HS and HS-CAT groups based on whether the CAT techniques were used near parathyroid glands. Patients' characteristics such as age, sex, tumour size, operative time, pre- and post-operative levels of parathyroid hormone (PTH) and complications were analysed. Results For patients undergoing TT plus unilateral CND, operative time was significantly shorter (P<0.001), but there were significantly higher incidences of transient hypoparathyroidism (P=0.002) on postoperative day 1 and incidental parathyroidectomy (P=0.036) in the HS group. There was no significant difference in permanent hypoparathyroidism. For patients undergoing TT plus bilateral CND, a significantly shorter operative time and sharper postoperative PTH decline was found in the HS group (P=0.029). However, there were no significant differences regarding incidences of incidental parathyroidectomy, transient or permanent hypoparathyroidism. Conclusions The CAT technique applied near parathyroid glands was a practical surgical application for decreasing the incidence of postoperative transient hypoparathyroidism for TT plus unilateral CND.
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Affiliation(s)
- Jun Jiang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Meiping Shen
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Hui Lu
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
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Fraga TS, Köhler HF, Chulam TC, Kowalski LP. Impact of scalpel type on operative time and acute complications in thyroidectomies. Braz J Otorhinolaryngol 2019; 87:205-209. [PMID: 31668788 PMCID: PMC9422565 DOI: 10.1016/j.bjorl.2019.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/01/2019] [Accepted: 08/13/2019] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Thyroidectomy is the most common surgery in the cervical region. Currently, several techniques are available for intraoperative hemostasis. OBJECTIVE To compare the performance of three techniques (monopolar and bipolar electrical and ultrasonic) on operative time and postoperative complications. METHODS Patients submitted to total thyroidectomy without prior treatment were included in this prospective series study, using a scientific design. RESULTS A total of 834 patients were included; 661 women (79.3%) and 173 men (20.7%). The diagnosis was malignant neoplasia in 528 patients (63.3%) and benign disease in 306 patients (36.7%). The monopolar electric scalpel was used in 280 patients (33.6%), bipolar scalpel in 210 patients (25.2%) and ultrasonic scalpel in 344 patients (41.3%). The operative time was significantly shorter with the ultrasonic or bipolar scalpel when compared to the electric scalpel. In a linear regression model, gender, malignancy diagnosis and power energy type were significant for the procedure duration. Patients who underwent surgery with an ultrasound or bipolar scalpel had a significantly lower incidence of hypoparathyroidism. CONCLUSION The use of ultrasonic or bipolar scalpel significantly reduces operative time and the incidence of transient hypoparathyroidism.
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Affiliation(s)
- Tamires Santos Fraga
- A.C. Camargo Câncer Center, Departamento de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia, São Paulo, SP, Brazil
| | - Hugo Fontan Köhler
- A.C. Camargo Câncer Center, Departamento de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia, São Paulo, SP, Brazil.
| | - Thiago Celestino Chulam
- A.C. Camargo Câncer Center, Departamento de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia, São Paulo, SP, Brazil
| | - Luiz Paulo Kowalski
- A.C. Camargo Câncer Center, Departamento de Cirurgia de Cabeça e Pescoço e Otorrinolaringologia, São Paulo, SP, Brazil
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Arslan K, Erenoglu B, Dogru O, Ovet G, Turan E, Atay A, Koksal H. Is the superior laryngeal nerve really safe when using harmonic focus in total thyroidectomy? A prospective randomized study. Asian J Surg 2017; 41:222-228. [PMID: 28185774 DOI: 10.1016/j.asjsur.2016.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 11/18/2016] [Accepted: 12/15/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Harmonic focus (HF) was introduced in thyroid surgery in an effort to reduce operation time and complications. OBJECTIVE The present study aimed to compare function of superior laryngeal nerve and incidence of other postoperative complications in total thyroidectomies using HF and conventional ligation (CL). METHODS The trial is a randomized single-center, single-blinded study. Patients aged ≥ 18 years scheduled for total thyroidectomy were considered for participation. An ultrasonic dissector was used for coagulation and cutting in the HF group, while the standard technique was used in the CL group. Demographic, surgical data, and complications were recorded. Data were analyzed using SPSS for Windows. RESULTS Of 244 eligible patients, data of 206 patients who completed the study were analyzed. The groups were similar in terms of age, sex, and indication for operation. The mean operative time in the HF group was significantly shorter than that in CL group (p=0.01). Drain necessity, duration of drainage, duration of postoperative hospitalization, and the incidence of postoperative complications was similar in the groups (p>0.05). The external branch of the superior laryngeal nerve and recurrent laryngeal nerve palsy were noted in three and two patients in the HF group and in two and one patients in the CL group at 6 months. CONCLUSION To the best of our knowledge, this is the first study comparing conventional technique with HF in total thyroidectomy, focusing on the function of the external branch of the superior laryngeal nerve using laryngostroboscopy; results showed that HF is as safe as the conventional technique.
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Affiliation(s)
- Kemal Arslan
- Department of General Surgery, Sağlık Bilimleri University, Konya Training and Research Hospital, Turkey.
| | - Bulent Erenoglu
- Department of General Surgery, Sağlık Bilimleri University, Konya Training and Research Hospital, Turkey
| | - Osman Dogru
- Department of General Surgery, Sağlık Bilimleri University, Konya Training and Research Hospital, Turkey
| | - Gultekin Ovet
- Department of Otorhinolaryngology, Konya Training and Research Hospital, Konya, Turkey
| | - Ersin Turan
- Department of General Surgery, Sağlık Bilimleri University, Konya Training and Research Hospital, Turkey
| | - Arif Atay
- Department of General Surgery, Sağlık Bilimleri University, Konya Training and Research Hospital, Turkey
| | - Hande Koksal
- Department of General Surgery, Sağlık Bilimleri University, Konya Training and Research Hospital, Turkey
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Biaoxue R, Xiguang C, Hua L, Wenlong G, Shuanying Y. Thoracic perfusion of recombinant human endostatin (Endostar) combined with chemotherapeutic agents versus chemotherapeutic agents alone for treating malignant pleural effusions: a systematic evaluation and meta-analysis. BMC Cancer 2016; 16:888. [PMID: 27842514 PMCID: PMC5109813 DOI: 10.1186/s12885-016-2935-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 10/28/2016] [Indexed: 11/21/2022] Open
Abstract
Background Endostar is a new endogenous angiogenic inhibitor with implicated anti-tumor activity. This study was to investigate whether thoracic perfusion of Endostar could be used to control malignant pleural effusions (MPE). Methods We searched the databases of MEDLINE, Web of Science, EMBASE, Goggle, Cochrance Library and CNKI to select the studies regarding the efficacy of Endostar to treat MPE. A total of 13 randomised controlled trials (RCTs) with 1066 patients were included. Results The overall response rate (ORR) (P < 0.001; odds ratio = 3.58) and disease control rate (DCR) (P < 0.001; odds ratio = 2.97) of Endostar combined with chemotherapeutic agents were significantly higher than those of chemotherapeutic agents alone. In addition, Endostar combined treatment remarkably promoted quality of life (QOL) of patients (P < 0.001; odds ratio = 3.04) compared with that of chemotherapeutic agents alone. Moreover, Endostar combined treatment did not have an impact on the incidence of adverse reactions (AEs) (P < 0.05). Conclusions The efficacy of Endostar combined chemotherapeutic agents was superior to chemotherapeutic agents alone through thoracic perfusion in treating MPE, which indicated that Endostar could be an effective agent for controlling MPE.
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Affiliation(s)
- Rong Biaoxue
- Department of Respiratory Medicine, First Affiliated Hospital, Xi'an Medical University, 48 Fenghao West Road, Xi'an, 710077, China.
| | - Cai Xiguang
- Department of Respiratory Medicine, Gansu Provincial Hospital, Lanzhou, China
| | - Liu Hua
- Department of Respiratory Medicine, Gansu Provincial Hospital, Lanzhou, China
| | - Gao Wenlong
- Department of Statistics and Epidemiology, Medical College, Lanzhou University, Lanzhou, China
| | - Yang Shuanying
- Department of Respiratory Medicine, Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
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Chavez KV, Barajas EM, Ramírez J, Pantoja JP, Sierra M, Velázquez-Fernandez D, Herrera MF. Comparative analysis between a bipolar vessel sealing and cutting device and the tie and suture technique in thyroidectomy: A randomized clinical trial. Surgery 2016; 161:477-484. [PMID: 27614416 DOI: 10.1016/j.surg.2016.07.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/16/2016] [Accepted: 07/27/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Advanced bipolar and ultrasonic devices have shown significant reduction in the surgical time of thyroid operations. This randomized, controlled trial assessed if operative time and other relevant outcomes are different for thyroidectomies performed either with a second-generation advanced bipolar device or traditional tie and suture technique. METHODS Forty-one patients were randomized into 2 groups (advanced bipolar device and traditional tie and suture). Secondary end points included estimated blood loss, postoperative hemorrhage or hematoma requiring operative reintervention, recurrent laryngeal nerve injury, hypoparathyroidism, pain intensity, number of ligatures, analgesia usage, and loss of signal during recurrent laryngeal nerve monitoring. RESULTS Preoperative characteristics were similar between both groups. Mean operative time in the advanced bipolar device group was reduced by 32.5 minutes compared with the traditional tie and suture group (P = .006). Intraoperative blood loss was similar in both groups. Four patients presented postoperative vocal cord dysmotility, 3 in the traditional tie and suture group and 1 in the advanced bipolar device group (P = ns). Two of these 4 patients also had a >50% amplitude decrease during continuous intraoperative neuromonitoring, 1 in each group. Pain intensity, 12 hours after operation, was significantly greater in the traditional tie and suture group (P = .015), even though pain medication requirements during the initial 24 hours after operation were similar between groups (P = .97). There were no cases of postoperative hemorrhage or hematoma requiring reintervention. Postoperative, symptomatic hypocalcemia occurred in 6 patients, 4 in the traditional tie and suture, and 2 in the advanced bipolar device group. One of them developed permanent hypocalcemia. CONCLUSION The use of an advanced bipolar device in thyroid operation reduces operative time by >30 minutes, with a similar postoperative outcome profile when compared with the traditional tie and suture technique.
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Affiliation(s)
- K Verónica Chavez
- Service of Endocrine Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - E Manuel Barajas
- Service of Endocrine Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Jaqueline Ramírez
- Otolaryngology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Juan Pablo Pantoja
- Service of Endocrine Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Mauricio Sierra
- Service of Endocrine Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - David Velázquez-Fernandez
- Service of Endocrine Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México
| | - Miguel F Herrera
- Service of Endocrine Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México.
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Cheng H, Soleas IM, Ferko NC, Cameron CG, Clymer JW, Amaral JF. Hospital costs associated with thyroidectomy performed with a Harmonic device compared to conventional techniques: a systematic review and meta-analysis. J Med Econ 2016; 19:750-8. [PMID: 26999563 DOI: 10.3111/13696998.2016.1168826] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Harmonic devices have become a world-wide standard for dissection and hemostasis in thyroidectomy. Numerous systematic reviews have reported superior operating times, blood loss, post-operative pain, length of stay, and overall safety outcomes. What has not been extensively evaluated in a robust manner is their economic impact. The purpose of this study is to evaluate the hospital costs associated with open thyroidectomy using Harmonic devices compared with conventional techniques for hemostasis. METHODS A systematic review of Medline, Scopus, and CENTRAL was performed from January 1, 2000 to May 23, 2014 without language restrictions for randomized clinical trials comparing Harmonic surgical devices to conventional methods in thyroidectomy. The main outcome measure was total reported costs. Costs were pooled using the ratio of means and a random effects model. Sensitivity analyses assessed whether differences in patient and trial characteristics, healthcare setting, or choice of statistical model affected outcomes. RESULTS Seven studies met the inclusion criteria. A total of 476 participants had procedures performed with Harmonic devices and 478 with conventional monopolar electrosurgery and clamp, cut and tie techniques. Compared with conventional techniques, Harmonic devices reduced total reported costs by 10% (p = 0.007), resulting in a $229 US dollars (USD) absolute reduction from mean baseline costs. Results remained relatively robust to additional sensitivity analyses. CONCLUSIONS This systematic review and meta-analysis demonstrates that the Harmonic family of surgical devices is associated with a reduction in total reported costs in thyroidectomy compared with conventional techniques. A large portion of the overall savings derives from a reduction in operative costs.
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Upadhyaya A, Hu T, Meng Z, Li X, He X, Tian W, Jia Q, Tan J. Harmonic versus LigaSure hemostasis technique in thyroid surgery: A meta-analysis. Biomed Rep 2016; 5:221-227. [PMID: 27446546 DOI: 10.3892/br.2016.691] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 05/18/2016] [Indexed: 01/21/2023] Open
Abstract
Harmonic scalpel and LigaSure vessel sealing systems have been suggested as options for saving surgical time and reducing postoperative complications. The aim of the present meta-analysis was to compare surgical time, postoperative complications and other parameters between them in for the open thyroidectomy procedure. Studies were retrieved from MEDLINE, Cochrane Library, EMBASE and ISI Web of Science until December 2015. All the randomized controlled trials (RCTs) comparing Harmonic scalpel and LigaSure during open thyroidectomy were selected. Following data extraction, statistical analyses were performed. Among the 24 studies that were evaluated for eligibility, 7 RCTs with 981 patients were included. The Harmonic scalpel significantly reduced surgical time compared with LigaSure techniques (8.79 min; 95% confidence interval, -15.91 to -1.67; P=0.02). However, no significant difference was observed for the intraoperative blood loss, postoperative blood loss, duration of hospital stay, thyroid weight and serum calcium level postoperatively in either group. The present meta-analysis indicated superiority of Harmonic Scalpel only in terms of surgical time compared with LigaSure hemostasis techniques in open thyroid surgery.
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Affiliation(s)
- Arun Upadhyaya
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Heping, Tianjin 300052, P.R. China
| | - Tianpeng Hu
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Heping, Tianjin 300052, P.R. China
| | - Zhaowei Meng
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Heping, Tianjin 300052, P.R. China
| | - Xue Li
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Heping, Tianjin 300052, P.R. China
| | - Xianghui He
- Department of General Surgery, Tianjin Medical University General Hospital, Heping, Tianjin 300052, P.R. China
| | - Weijun Tian
- Department of General Surgery, Tianjin Medical University General Hospital, Heping, Tianjin 300052, P.R. China
| | - Qiang Jia
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Heping, Tianjin 300052, P.R. China
| | - Jian Tan
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Heping, Tianjin 300052, P.R. China
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Differences in Thyroidectomy Outcomes Based on Surgical Method: A Comparison of LigaSure Precise, Harmonic Focus, and Traditional Methods. Int Surg 2016. [DOI: 10.9738/intsurg-d-15-00176.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
New surgical devices have been developed to improve haemostatic control and vascular closure in thyroid surgery. Here, we compare the efficacy and clinical outcomes of 3 surgical methods, Harmonic Focus, LigaSure Precise, and the traditional suture-ligation method, in patients undergoing total thyroidectomies. This retrospective study compared total thyroidectomies performed between July 2008 and August 2012. Thyroidectomies were performed in 243 patients using Harmonic Focus (n = 81), LigaSure Precise (n = 81), and traditional suture-ligation (n = 81). No significant differences were observed among groups in terms of patient demographics, thyroid weight, pathological diagnoses, pre- and postoperative calcium levels, postoperative complications, length of hospitalization, and clinical outcomes. The Harmonic Focus approach showed an ∼15% shortening in operating time relative to the suture-ligation group; no statistically significant differences were detected between the LigaSure and traditional suture-ligation groups. All 3 methods were found to be both safe and effective. Operating time was significantly shorter in the Harmonic Focus group; no differences in terms of postoperative complications were observed among groups.
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Polistena A, Sanguinetti A, Lucchini R, Galasse S, Monacelli M, Avenia S, Triola R, Bugiantella W, Rondelli F, Cirocchi R, Avenia N. Surgical approach to mediastinal goiter: An update based on a retrospective cohort study. Int J Surg 2015; 28 Suppl 1:S42-6. [PMID: 26708863 DOI: 10.1016/j.ijsu.2015.12.058] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 05/06/2015] [Accepted: 05/20/2015] [Indexed: 10/22/2022]
Abstract
AIM Surgery for mediastinal goiters (MG) is indicated for compression symptoms and risk of malignancy. Total thyroidectomy by cervicotomy is universally considered the standard surgical approach to MG. In selected cases sternotomy or a thoracotomy are used. Options of the operative technique and practical surgical problems are analysed. METHODS A retrospective analysis of twenty-eight-years on 1767 cases of MG in a referral centre for endocrine surgery was carried out. All patients underwent standard preoperative study and CT based surgical planning. Surgery was performed by an experienced surgical team with standard technique via cervical approach or in selected case via sternotomy or thoracotomy. Clinical records were examined. RESULTS Total thyroidectomy was performed in all cases. A cervical approach was used in almost 99% of patients. Significant shorter surgical time was observed for surgery via the cervical approach vs sternotomy and thoracotomy. Benign struma was observed in 1503 patients and a carcinoma in 264. We observed postoperative bleeding in 0.5% of cases, permanent monolateral recurrent laryngeal nerve palsy occurred in 1.3%, bilateral palsy in 0.6%, transient and permanent hypoparathyroidism in 14% and 4.1% respectively. CONCLUSION MG may be approached by a cervicotomic access only with a clear knowledge of potential risk and complications of the surgical manoeuvres. Sternotomy or of a thoracotomy are indicated only in selected cases but their inapplicability may be really dangerous in those MG not otherwise resectable. MG should be referred only to specialized centre.
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Affiliation(s)
- Andrea Polistena
- Department of General Surgery and Surgical Disciplines, University of Perugia, Italy.
| | | | | | - Sergio Galasse
- Unit of Endocrine Surgery, S. Maria University Hospital, Italy.
| | - Massimo Monacelli
- Department of General Surgery and Surgical Disciplines, University of Perugia, Italy.
| | | | - Roberta Triola
- Unit of Endocrine Surgery, S. Maria University Hospital, Italy.
| | | | - Fabio Rondelli
- Department of General Surgery and Surgical Disciplines, University of Perugia, Italy.
| | - Roberto Cirocchi
- Department of General Surgery and Surgical Disciplines, University of Perugia, Italy.
| | - Nicola Avenia
- Department of General Surgery and Surgical Disciplines, University of Perugia, Italy.
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Biaoxue R, Shuxia M, Wenlong G, Shuanying Y. Thoracic perfusion of matrine as an adjuvant treatment improves the control of the malignant pleural effusions. World J Surg Oncol 2015; 13:329. [PMID: 26631104 PMCID: PMC4668654 DOI: 10.1186/s12957-015-0729-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 11/02/2015] [Indexed: 11/12/2022] Open
Abstract
Background Many studies have investigated the efficacy and safety of matrine in treating malignant pleural effusion by thoracic perfusion. This study is an analytic value of available evidence. Methods Twelve studies were analyzed in this study. Pooled odds ratios and hazard ratio with 95 % confidence intervals were calculated using the fixed effects model. Results Overall response rate of matrine combined with other medications in treating malignant pleural effusion (MPE) was significantly higher than those of other medications alone (p < 0.05). Time to pleural effusion relief and quality of life were improved after the treatment of matrine combined with other medications (p < 0.05). Moreover, matrine combined with other medications had a lower incidence of adverse reactions (p < 0.05). Conclusions Matrine combined with other medications improves the control of the malignant pleural effusions and decreases the incidence of adverse reactions.
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Affiliation(s)
- Rong Biaoxue
- Department of Respiratory Medicine, The Second Affiiated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Ma Shuxia
- Department of Elderly Respiratory Medicine, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Gao Wenlong
- Department of Statistics and Epidemiology, Medical College, Lanzhou University, Lanzhou, China
| | - Yang Shuanying
- Department of Respiratory Medicine, The Second Affiiated Hospital, Xi'an Jiaotong University, Xi'an, China.
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Cheng H, Soleas I, Ferko NC, Clymer JW, Amaral JF. A systematic review and meta-analysis of Harmonic Focus in thyroidectomy compared to conventional techniques. Thyroid Res 2015; 8:15. [PMID: 26430471 PMCID: PMC4589949 DOI: 10.1186/s13044-015-0027-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 09/21/2015] [Indexed: 11/16/2022] Open
Abstract
Introduction Several meta-analyses have been performed comparing the use of a variety of ultrasonic devices in thyroidectomy to conventional procedures. These studies have shown the superiority of ultrasonic devices for most outcomes studied including faster operative time and less blood loss, and equivalent or better safety for recurrent laryngeal nerve paresis and hypocalcemia. The current work is the first to examine a single ultrasonic device specifically designed for thyroid surgery, the Harmonic Focus, in order to confirm its efficacy and safety in thyroidectomy. Methods A comprehensive literature search without language restrictions was performed for randomized clinical trials comparing Harmonic Focus and conventional clamp, cut and tie in thyroidectomy. Outcome measures included operating time, blood loss, post-operative pain, length of hospital stay, hypocalcemia and recurrent laryngeal nerve paresis. Risk of bias was analyzed for all studies. Meta-analysis was performed using random effects models with the inverse-variance method for mean differences of continuous variables and the Mantel-Haenszel method for risk ratios of dichotomous variables. Results A total of 14 studies met the inclusion criteria. Harmonic Focus reduced operative time by 29 min, a 31 % decrease (p < 0.001), intra-operative blood loss by 45 ml (p < 0.001), post-operative pain (p < 0.001), length of hospital stay by 0.68 days (p = 0.005), drainage volume by 29 ml (p = 0.01), and occurrence of transient hypocalcemia by 40 % (p = 0.001). There were no significant differences between Harmonic Focus and conventional procedures in rate of persistent hypocalcemia, or rates of transient and persistent recurrent laryngeal nerve paresis. Conclusion This is the first meta-analysis of Harmonic Focus in thyroid surgery. In agreement with meta-analyses previously performed on ultrasonic devices, use of the Harmonic Focus has been shown to be a more effective surgical procedure compared to conventional methods in thyroidectomy. The low occurrence of hypocalcemia and recurrent laryngeal nerve paresis confirms that Harmonic Focus can improve thyroidectomy efficiency without increasing the risk of complications.
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Affiliation(s)
- Hang Cheng
- Ethicon Inc, 4545 Creek Rd, Cincinnati, OH 45242 USA
| | - Ireena Soleas
- Cornerstone Research Group, 204-3228 South Service Road, Burlington, ON L7N 3H8 Canada
| | - Nicole C Ferko
- Cornerstone Research Group, 204-3228 South Service Road, Burlington, ON L7N 3H8 Canada
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Rong B, Zhao C, Gao W, Yang S. Matrine promotes the efficacy and safety of platinum-based doublet chemotherapy for advanced non-small cell lung cancer. Int J Clin Exp Med 2015; 8:14701-14717. [PMID: 26628952 PMCID: PMC4658841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/10/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE Many studies have investigated the efficacy of matrine combined with platinum-based doublet chemotherapy (PBDC) versus PBDC alone for treating advanced non-small cell lung cancer (NSCLC). This study is an analytic value of available evidence. METHODS twenty-two studies reporting matrine combined with PBDC versus PBDC alone for treating advanced NSCLC were reviewed. Pooled odds ratios and hazard ratio with 95% confidence intervals were calculated using either the fixed effects model or random effects model. RESULTS The overall response rate (ORR) and disease control rate (DCR) of matrine combined with PBDC for treating NSCLC were significantly higher than those of PBDC alone, with 15.1% and 19.7% improvement, respectively (P < 0.00001). In addition, the mean survival time (MST) and quality of life (QOL) were improved after the treatment of matrine combined with PBDC (P < 0.00001). The main adverse effects found in this review were hematological reactions, nausea and vomiting. Matrine combined with PBDC had a lower incidence of adverse reactions compared with PBDC alone (P < 0.05). CONCLUSIONS Matrine combined with PBDC was associated with higher RR, DCR, and MST as well as superior QOL profiles compared with PBDC alone. Matrine combined with PBDC decrease the incidence of adverse reactions compared with PBDC alone.
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Affiliation(s)
- Biaoxue Rong
- Department of Oncology, The First Affiiated Hospital of Xi’an Medical UniversityXi’an, China
| | - Chongchong Zhao
- Department of Neurology, Lanzhou University Second HospitalLanzhou, China
| | - Wenlong Gao
- Department of Statistics and Epidemiology, Medical College, Lanzhou UniversityLanzhou, China
| | - Shuanying Yang
- Department of Oncology, The First Affiiated Hospital of Xi’an Medical UniversityXi’an, China
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Wong P, Chieh Liew GH, Kothandan H. Anaesthesia for goitre surgery: A review. PROCEEDINGS OF SINGAPORE HEALTHCARE 2015. [DOI: 10.1177/2010105815596095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Goitres are relatively common and, in extreme cases, present unique challenges (particularly in airway management) for the anaesthetist. There are no specific guidelines from the Difficult Airway Society (United Kingdom) or the American Society of Anesthesiologists for the management of the obstructed airway. We therefore present the principles governing the provision of safe anaesthesia for goitre surgery including formulating a plan ABC for patients with a stable airway and for those presenting with acute airway obstruction.
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Affiliation(s)
- Patrick Wong
- Department of Anaesthesiology, Singapore General Hospital, Singapore
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Cirocchi R, Trastulli S, Randolph J, Guarino S, Di Rocco G, Arezzo A, D'Andrea V, Santoro A, Barczyñski M, Avenia N. Total or near-total thyroidectomy versus subtotal thyroidectomy for multinodular non-toxic goitre in adults. Cochrane Database Syst Rev 2015; 2015:CD010370. [PMID: 26252202 PMCID: PMC9587693 DOI: 10.1002/14651858.cd010370.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Total thyroidectomy (TT) and subtotal thyroidectomy (ST) are worldwide treatment options for multinodular non-toxic goitre in adults. Near TT, defined as a postoperative thyroid remnant less than 1 mL, is supposed to be a similarly effective but safer option than TT. ST has been shown to be marginally safer than TT, but it may leave an undetected thyroid cancer in place. OBJECTIVES The objective was to assess the effects of total or near-total thyroidectomy compared to subtotal thyroidectomy for multinodular non-toxic goitre. SEARCH METHODS We searched the Cochrane Library, MEDLINE, PubMed, EMBASE, as well as the ICTRP Search Portal and ClinicalTrials.gov. The date of the last search was 18 June 2015 for all databases. No language restrictions were applied. SELECTION CRITERIA Two review authors independently scanned the abstract, title or both sections of every record retrieved to identify randomised controlled trials (RCTs) on thyroidectomy for multinodular non-toxic goitre for further assessment. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data, assessed studies for risk of bias and evaluated overall study quality utilising the GRADE instrument. We calculated the odds ratio (OR) and corresponding 95% confidence interval (CI) for dichotomous outcomes. A random-effects model was used for pooling data. MAIN RESULTS We examined 1430 records, scrutinized 14 full-text publications and included four RCTs. Altogether 1305 participants entered the four trials, 543 participants were randomised to TT and 762 participants to ST. A total of 98% and 97% of participants finished the trials in the TT and ST groups, respectively. Two trials had a duration of follow-up between 12 and 39 months and two trials a follow-up of 5 and 10 years, respectively. Risk of bias across studies was mainly unknown for selection, performance and detection bias. Attrition bias was generally low and reporting bias high for some outcomes. In the short-term postoperative period no deaths were reported for both TT and ST groups. However, longer-term data on all-cause mortality were not reported (1284 participants; 4 trials; moderate quality evidence). Goiter recurrence was lower in the TT group compared to ST. Goiters recurred in 0.2% (1/425) of the TT group compared to 8.4% (53/632) of the ST group (OR 0.05 (95% CI 0.01 to 0.21); P < 0.0001; 1057 participants; 3 trials; moderate quality evidence). Re-intervention due to goitre recurrence was lower in the TT group compared to ST. Re-intervention was necessary in 0.5% (1/191) of TT patients compared to 0.8% (3/379)of ST patients (OR 0.66 (95% CI 0.07 to 6.38); P = 0.72; 570 participants; 1 trial; low quality evidence). The incidence of permanent recurrent laryngeal nerve palsy was lower for ST compared with TT. Permanent recurrent laryngeal nerve palsy occurred in 0.8% (6/741) of ST patients compared to 0.7% (4/543) of TT patients (OR 1.28, (95% CI 0.38 to 4.36); P = 0.69; 1275 participants; 4 trials; low quality evidence). The incidence of permanent hypoparathyroidism was lower for ST compared with TT. Permanent hypoparathyroidism occurred in 0.1% (1/741) of ST patients compared to 0.6% (3/543) of TT patients (OR 3.09 (95% CI 0.45 to 21.36); P = 0.25; 1275 participants: 4 trials; low quality evidence). The incidence of thyroid cancer was lower for ST compared with TT. Thyroid cancer occurred in 6.1% (41/669) of ST patients compared to 7.3% (34/465)of TT patients (OR 1.32 (95% CI 0.81 to 2.15); P = 0.27; 1134 participants; 3 trials; low quality evidence). No data on health-related quality of life or socioeconomic effects were reported in the included studies. AUTHORS' CONCLUSIONS The body of evidence on TT compared with ST is limited. Goiter recurrence is reduced following TT. The effects on other key outcomes such as re-interventions due to goitre recurrence, adverse events and thyroid cancer incidence are uncertain. New long-term RCTs with additional data such as surgeons level of experience, treatment volume of surgical centres and details on techniques used are needed.
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Affiliation(s)
- Roberto Cirocchi
- University of PerugiaDepartment of General SurgeryTerniItaly05100
| | | | - Justus Randolph
- Mercer UniversityTift College of Education3001 Mercer University Dr.AtlantaGAUSA30341
| | - Salvatore Guarino
- Sapienza University of RomeDepartment of Surgical SciencesViale Regina Elena 324RomeItaly00161
| | - Giorgio Di Rocco
- Sapienza University of RomeDepartment of Surgical SciencesViale Regina Elena 324RomeItaly00161
| | - Alberto Arezzo
- University of TorinoDepartment of Surgical SciencesCorso Achille Mario Dogliotti 14TurinItaly10126
| | - Vito D'Andrea
- Sapienza University of RomeDepartment of Surgical SciencesViale Regina Elena 324RomeItaly00161
| | - Alberto Santoro
- Sapienza University of RomeDepartment of Surgical SciencesViale Regina Elena 324RomeItaly00161
| | - Marcin Barczyñski
- Jagiellonian University, Medical CollegeDepartment of Endocrine Surgery, Third Chair of General Surgery37 Pradnicka StreetKrakowPoland31‐202
| | - Nicola Avenia
- University of PerugiaDepartment of Endocrine SurgeryTerniTerniItaly
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Liu SYW, Wong SKH, Chiu PWY, Ng EKW. Endoscopic thyroid lobectomy using bilateral axillo-breast approach: Surgical techniques and outcomes. SURGICAL PRACTICE 2015. [DOI: 10.1111/1744-1633.12124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Shirley Yuk-Wah Liu
- Department of Surgery; Prince of Wales Hospital; The Chinese University of Hong Kong; Hong Kong
| | - Simon Kin-Hung Wong
- Department of Surgery; Prince of Wales Hospital; The Chinese University of Hong Kong; Hong Kong
| | - Philip Wai-Yan Chiu
- Department of Surgery; Prince of Wales Hospital; The Chinese University of Hong Kong; Hong Kong
| | - Enders Kwok-Wai Ng
- Department of Surgery; Prince of Wales Hospital; The Chinese University of Hong Kong; Hong Kong
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Surgical management of mediastinal goiter in the elderly. Int J Surg 2014; 12 Suppl 2:S148-S152. [PMID: 25157987 DOI: 10.1016/j.ijsu.2014.08.360] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/15/2014] [Indexed: 11/21/2022]
Abstract
AIM Mediastinal goiter (MG) is characterized by compression symptoms such choking, dyspnea, sleeping apnea and dysphagia. It is significantly observed in elderly patients who due to comorbidity are associated to increased surgical risk. Total thyroidectomy is indicated to treat tracheal compression. Cervicotomy is the most used surgical access. AIM of the study was the evaluation of the role of surgery in the treatment of MG in the elderly. METHODS A retrospective analysis of twenty-eight-years on 1721 (390 over 80-years-old) cases of MG in a referral center for endocrine surgery was carried out. CT was used as a standard in the preoperative study. Surgery was performed by an experienced surgical team with standard technique via cervical approach or in selected cases via sternotomy or thoracotomy. Clinical records were examined. RESULTS Patients were divided into two groups: older and younger than 80-years-old. Total thyroidectomy was performed in all cases and via a cervical approach in almost 99% of patients. Tracheal dislocation and tracheomalacia were prevalent in elderly patients and were treated conservatively. Benign struma was observed in 1463 patients and a carcinoma in 258. Larger thyroid weight was observed in the elderly. The rate of complications was similar between groups. CONCLUSION Total thyroidectomy via cervical approach is the treatment of choice for MG in the elderly. It should be treated only in referral centers with adequate caution for elderly patients to achieve complete cure with limited complications.
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Guarino S, Sorrenti S, Greco R, Di Marco C, Nardi M, Filippini A, de Antoni E, Catania A. Staples versus subcuticular closure in cervicotomy incisions. Int J Surg 2014; 12 Suppl 1:S170-2. [DOI: 10.1016/j.ijsu.2014.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 05/03/2014] [Indexed: 11/29/2022]
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Efficacy of combined treatment for anaplastic thyroid carcinoma: results of a multinstitutional retrospective analysis. Int J Surg 2014; 12 Suppl 1:S178-82. [PMID: 24866070 DOI: 10.1016/j.ijsu.2014.05.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 05/03/2014] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Anaplastic thyroid carcinoma (ATC) is a killer tumor, characterized by local invasiveness, risk of recurrence and very poor prognosis. Due to its rarity, clinical case studies concerning management are lacking. METHODS We retrospectively reviewed a multinstitutional clinical series of 114 consecutive patients treated between 1996 and 2012 for ATC. The outcomes of a combined treatment were analyzed considering the impact of surgery and radiotherapy on survival. RESULTS Patients were divided in groups A and B considering tumor size (tumor lesser and larger than 5 cm). Surgery was carried out in 71 patients, radiotherapy in 89 patients. Tracheostomy and endoprothesis were used respectively in 48.7% and in 25.6% of patients. The mean survival was 5.35 (±3.2) months with no significant difference in group A vs group B. A better survival was observed in both groups of patients undergone a surgical treatment compared to no treated patients (p = 0.001 and p = 0.0001) or to patients undergone radiotherapy alone (p = 0.047 and p = 0.0001). Combination of surgery and radiotherapy significantly improved outcome (p = 0.017). DISCUSSION Despite disappointing results from single therapeutic approach, multimodal strategy has progressively become the treatment of choice in ATC, with surgery being the cornerstone of the management. CONCLUSION Although dismal prognosis, the combined treatment might significantly improves locoregional disease control, achieving acceptable survival in selected patients and adequate palliation of the symptoms.
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da Silva FB, Limoeiro ACDO, Del Bianco J, Teich V, Teich N, Teixeira JC, Vasconcelos AL, Sardenberg C. Impact of the use of vessel sealing or harmonic scalpel on intra-hospital outcomes and the cost of thyroidectomy procedures. EINSTEIN-SAO PAULO 2013; 10:354-9. [PMID: 23386017 DOI: 10.1590/s1679-45082012000300017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 07/02/2012] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To analyze the operative time, length of hospitalization and cost, as well as the bleeding and pain observed during the postoperative period, of thyroidectomy procedures using vessel sealing, harmonic scalpel or the conventional technique. METHODS Retrospective analysis of thyroidectomies performed between 2007 and 2010 using either the conventional technique or minimally invasive techniques involving vessel sealing or a harmonic scalpel. Gender, age, primary diagnosis and procedure type were analyzed. The outcomes analyzed included the length of the procedure, length of hospital stay, need for blood product transfusions, pain and cost of hospitalization. The findings were based on a significance level of 5%, and statistical analyses were performed using the R software. RESULTS The use of the vessel sealing increased the duration of the surgery by approximately 47 minutes compared to the conventional technique (p<0.001), and the use of the harmonic scalpel decreased the duration of the surgery by approximately 32 minutes compared to the conventional technique (p<0.001). No statistically significant difference was found between the groups regarding the use of blood products and pain score. Procedures involving vessel sealing or a harmonic scalpel cost more than those using the conventional technique. CONCLUSION The use of harmonic scalpel was favorable in terms of reducing the surgical time, but there was no reduction in hospitalization time. The cost of the procedure was higher than that of the conventional technique. The use of vessel sealing offered no advantages in terms of the outcomes assessed, and the cost of the procedure was greater than that of the conventional technique.
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Contin P, Gooßen K, Grummich K, Jensen K, Schmitz-Winnenthal H, Büchler MW, Diener MK. ENERgized vessel sealing systems versus CONventional hemostasis techniques in thyroid surgery--the ENERCON systematic review and network meta-analysis. Langenbecks Arch Surg 2013; 398:1039-56. [PMID: 24240627 DOI: 10.1007/s00423-013-1137-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 10/25/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE Energized vessel-sealing systems have been proposed to save operation time and reduce post-operative complications. The aim of the present systematic review was to compare operation time and postoperative morbidity for ultrasonic and electrothermal bipolar-activated devices with conventional hemostasis techniques and with each other in open thyroidectomy. METHODS A systematic literature search (MEDLINE, Cochrane Library, EMBASE and ISI Web of Science) was performed to identify randomised controlled trials (RCTs) comparing conventional hemostasis techniques, ultrasonic devices (Harmonic® scalpel) and/or electrothermal bipolar-activated vessel sealing systems (Ligasure®) during open thyroidectomy. For the primary endpoint (operation time), a network meta-analysis with Bayesian random effects model was performed. Pairwise meta-analyses with random effects were calculated for primary and secondary endpoints. RESULTS One hundred sixteen publications were evaluated for eligibility; 35 RCTs (4,061 patients) were included. There was considerable methodological and clinical heterogeneity of included trials. The Harmonic scalpel significantly reduced operation time compared with conventional techniques (22.26 min, 22.7 min in the inconsistency model). The use of Ligasure significantly reduced operation time in total thyroidectomy (13.84 min in the consistency model, 12.18 min in the inconsistency model). In direct comparison, operations with the Harmonic scalpel were faster than with Ligasure (8.42 min in the consistency model, 2.45 min in the inconsistency model). The rates of recurrent nerve palsy and postoperative hypocalcaemia did not significantly differ in the intervention groups. CONCLUSIONS This meta-analysis shows superiority of ultrasonic devices in terms of operation time compared with conventional hemostasis techniques in thyroid surgery, with no detriment to safety outcomes.
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Affiliation(s)
- Pietro Contin
- Department of General-, Visceral- and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
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Garas G, Okabayashi K, Ashrafian H, Shetty K, Palazzo F, Tolley N, Darzi A, Athanasiou T, Zacharakis E. Which hemostatic device in thyroid surgery? A network meta-analysis of surgical technologies. Thyroid 2013; 23:1138-50. [PMID: 23470035 DOI: 10.1089/thy.2012.0588] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Energy-based hemostatic devices are increasingly being used in thyroid surgery. However, there are several limitations with regard to the existing evidence and a paucity of guidelines on the subject. The goal of this review is to employ the novel evidence synthesis technique of a network meta-analysis to assess the comparative effectiveness of surgical technologies in thyroid surgery and contribute to enhanced governance in the field of thyroid surgery. METHODS Articles published between January 2000 and June 2012 were identified from Embase, Medline, Cochrane Library, and PubMed databases. Randomized controlled trials of any size comparing the use of ultrasonic coagulation (harmonic scalpel) or Ligasure either head-to-head or against the "clamp-and-tie" technique were included. Two reviewers independently critically appraised and extracted the data from each study. The number of patients who experienced postoperative events was extracted in dichotomous format or continuous outcomes. Odds ratios were calculated by a Bayesian network meta-analysis, and metaregression was used for pair-wise comparisons. Indirect and direct comparisons were performed and inconsistency was assessed. RESULTS Thirty-five randomized controlled trials with 2856 patients were included. Ultrasonic coagulation ranked first (followed by Ligasure and then clamp-and-tie) with the lowest risk of postoperative hypoparathyroidism (odds ratio 1.43 [95% confidence interval (CI) 0.77-2.67] and 0.70 [CI 0.43-1.13], ultrasonic coagulation vs. Ligasure and ultrasonic coagulation vs. clamp-and-tie, respectively), least blood loss (-0.25 [CI -0.84 to -0.35] and -1.22 [CI -1.85 to -0.59]), and drain output (0.28 [CI -0.35 to -0.91] and -0.36 [CI -0.70 to -0.03]). From a health technology viewpoint, ultrasonic coagulation was associated with the shortest operative time (-0.66 [CI -1.17 to -0.14] and -1.29 [CI -1.59 to -1.00]) and hospital stay (-0.28 [CI -0.78 to 0.22] and -0.56 [CI -1.28 to 0.15]). The only exception occurs with the clinically important complication of recurrent laryngeal nerve paralysis, where the reverse trend applies (1.36 [CI 0.25-7.46] and 1.74 [CI 0.94-3.26]). CONCLUSIONS The comparative effectiveness of ultrasonic coagulation in thyroid surgery outcomes seems superior to other techniques with the exception of recurrent laryngeal nerve injury. This network meta-analysis, one of a handful in a surgical field, offers preliminary and robust evidence to guide clinical decisions and policy makers to adopt safer thyroid operations.
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Affiliation(s)
- George Garas
- 1 Department of Otorhinolaryngology and Head & Neck Surgery, Imperial College London , London, United Kingdom
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Lang BHH, Yih PCL, Hung GKY. Does using an energized device in open thyroidectomy reduce complications? J Surg Res 2013; 181:e23-9. [DOI: 10.1016/j.jss.2012.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 05/12/2012] [Accepted: 06/04/2012] [Indexed: 01/03/2023]
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Cirocchi R, Trastulli S, Guarino S, Barczyñski M, Avenia N. Total versus subtotal thyroidectomy for multinodular non-toxic goitre in adults. Cochrane Database Syst Rev 2013. [DOI: 10.1002/14651858.cd010370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Systematic review and meta-analysis of Endostar (rh-endostatin) combined with chemotherapy versus chemotherapy alone for treating advanced non-small cell lung cancer. World J Surg Oncol 2012; 10:170. [PMID: 22917490 PMCID: PMC3517896 DOI: 10.1186/1477-7819-10-170] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 07/27/2012] [Indexed: 11/21/2022] Open
Abstract
Background Many studies have investigated the efficacy of Endostar combined with platinum-based doublet chemotherapy (PBDC) versus PBDC alone for treating advanced non-small cell lung cancer (NSCLC). This study is a meta-analysis of available evidence. Methods Fifteen studies reporting Endostar combined with PBDC versus PBDC alone for treating advanced NSCLC were reviewed. Pooled odds ratios and hazard ratio with 95% confidence intervals were calculated using either the fixed effects model or random effects model. Results The overall response rate (ORR) and disease control rate (DCR) of Endostar combined with PBDC for treating NSCLC were significantly higher than those of PBDC alone, with 14.7% and 13.5% improvement, respectively (P < 0.00001). In addition, the time to progression (TTP) and quality of life (QOL) were improved after the treatment of Endostar combined with PBDC (P < 0.00001). The main adverse effects found in this review were hematological reactions, hepatic toxicity, and nausea/vomiting. Endostar combined with PBDC had a similar incidence of adverse reactions compared with PBDC alone (P < 0.05). Conclusions Endostar combined with PBDC was associated with higher RR, DCR, and TTP as well as superior QOL profiles compared with PBDC alone. Endostar combined with PBDC had a similar incidence of adverse reactions compared with PBDC alone.
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Kurmann A, Martens F, Inglin R, Schmid SW, Candinas D, Seiler CA. Impact of surgical technique on operative morbidity and its socioeconomic benefit in thyroid surgery. Langenbecks Arch Surg 2012; 397:1127-31. [PMID: 22806174 DOI: 10.1007/s00423-012-0980-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 07/04/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this retrospective cohort study was to evaluate the rate of complications in relation to the extent of surgery and some of its consequences. METHODS Between 1972 and 2010, a total of 5,277 consecutive thyroid gland surgeries with 7,383 nerves at risk were performed at our teaching institution. Data of all patients undergoing thyroidectomy were collected prospectively. A total of 2,867 subtotal resections (first study period from 1972 to 1990) were compared with 2,410 extended thyroid resections involving at least a hemithyroidectomy (second period from 1991 to 2010). RESULTS The incidence of permanent recurrent laryngeal nerve palsy in primary operations was significantly higher in the first period compared to the second period (3.6 vs. 0.9 %; p < 0.001). Permanent hypoparathyroidism decreased from 3.2 % in the first period to 0.8 % in the second period (p < 0.001). The incidence of recurrent goiter surgery decreased from 11.1 % in the first period to 8.1 % in the second period (p < 0.001). No significant difference was found in permanent recurrent laryngeal nerve palsy in recurrent disease between the two periods. The socioeconomic benefits of an extended thyroid resection in our patient population are 360 preventable operations, 90 preventable permanent recurrent laryngeal nerve palsies, and 58 preventable cancers. Furthermore, 37 preventable radioiodine ablations and 15 preventable deaths were associated with more radical thyroid resection. CONCLUSION Improvements in surgical technique and change in surgical strategy significantly decreased the prevalence of recurrent laryngeal nerve palsy, hypoparathyroidism, and recurrent disease as well as reduced public health costs associated with recurrent goiter.
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Affiliation(s)
- Anita Kurmann
- Department of Visceral Surgery and Medicine, Inselspital University Hospital Bern, University of Bern, CH-3010, Bern, Switzerland
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Cirocchi R, Boselli C, Guarino S, Sanguinetti A, Trastulli S, Desiderio J, Santoro A, Rondelli F, Conzo G, Parmeggiani D, Noya G, De Toma G, Avenia N. Total thyroidectomy with ultrasonic dissector for cancer: multicentric experience. World J Surg Oncol 2012; 10:70. [PMID: 22540914 PMCID: PMC3412706 DOI: 10.1186/1477-7819-10-70] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2011] [Accepted: 04/27/2012] [Indexed: 11/10/2022] Open
Abstract
Background We conducted an observational multicentric clinical study on a cohort of patients undergoing thyroidectomy for thyroid carcinoma. The aim of this study was to evaluate the benefits of the use of ultrasonic dissector (UAS) vs. the use of a conventional technique (vessel clamp and tie) in patients undergoing thyroid surgery for cancer. Methods From June 2009 to May 2010 we evaluated 321 consecutive patients electively admitted to undergo total thyroidectomy for thyroid carcinoma. The first 201 patients (89 males, 112 females) presenting to our Department underwent thyroidectomy with the use of UAS while the following 120 patients (54 males, 66 females) underwent thyroidectomy performed with a conventional technique (CT): vessel clamp and tie. Results The operative time (mean: 75 min in UAS vs. 113 min in CT, range: 54 to 120 min in UAS vs. 68 to 173 min in CT) was much shorter in the group of thyroidectomies performed with UAS. The incidence of transient laryngeal nerve palsy (UAS 3/201 patients (1.49%); CT 1/120 patients (0.83%)) was higher in the group of UAS; the incidence of permanent laryngeal nerve palsy was similar in the two groups (UAS 2/201 patients (0.99%) vs. CT 2/120 patients (1.66%)). The incidence of transient hypocalcaemia (UAS 17/201 patients (8.4%) vs. CT 9/120 patients (7.5%)) was higher in the UAS group; no relevant differences were reported in the incidence of permanent hypocalcaemia in the two groups (UAS 5/201 patients (2.48%) vs. 2/120 patients (1.66%)). Also the average postoperative length of stay was similar in two groups (2 days). Conclusion The only significant advantage proved by this study is represented by the cost-effectiveness (reduction of the usage of operating room) for patients treated with UAS, secondary to the significant reduction of the operative time. The analysis failed to show any advantages in terms of postoperative transient complications in the group of patients treated with ultrasonic dissector: transient laryngeal nerve palsy (1.49% in UAS vs. 0.83% in CT) and transient hypocalcaemia (8.4% in UAS vs. 7.5%in CT). No significant differences in the incidence of permanent laryngeal nerve palsy (0.8% in UAS vs. 1.04% in CT) and permanent hypocalcaemia (2.6% in UAS vs. 2.04% in CT) were demonstrated. The level of surgeons’ expertise is a central factor, which can influence the complications rate; the use of UAS can only help surgical action but cannot replace the experience of the operator.
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Affiliation(s)
- Roberto Cirocchi
- Department of General Surgery, S, Maria Hospital, University of Perugia, Terni, Italy.
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Endoscopic resection of skull base tumours utilising the ultrasonic dissector. The Journal of Laryngology & Otology 2012; 126:625-9. [DOI: 10.1017/s0022215112000588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:We report the use and benefits of the ultrasonic dissector in the resection of difficult skull base lesions.Method:Five case reports are presented, and the utilisation of ultrasonic dissectors in otorhinolaryngology is reviewed.Results:The ultrasonic dissector was found to be a useful tool during the endoscopic resection of poorly accessible skull base tumours. Safe dissection and complete removal of all five lesions were achieved without any vascular injury. To our knowledge, this is the first report of the use of the ultrasonic dissector for the resection of sinonasal and skull base tumours.Conclusion:The ultrasonic dissector was found to be particularly useful during the endoscopic transnasal approach to the petrous apex. During minimally invasive endonasal surgery, benefits include the length of the instrument, speed and precision of dissection, and low risk of vascular injury.
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Bove A, Papanikolaou I, Bongarzoni G, Mattei P, Markogiannakis H, Chatzipetrou M, D'Addetta V, Di Renzo R, Fiordaliso M, Corbellini L. Thyroid surgery with harmonic focus, ligasure precise and conventional technique: a retrospective case-matched study. Hippokratia 2012; 16:154-159. [PMID: 23935272 PMCID: PMC3738418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND New surgical technologies have been introduced in thyroid surgery, to achieve vessel sealing and hemostasis. The aim of the study was to examine their effectiveness and compare the outcome of total thyroidectomy using the Harmonic Focus™, the LigaSure® Precise and the conventional technique of suture ligation. METHODS A retrospective case-matched study of all total thyroidectomies between October 2008 through May 2010 was conducted. Patients (n=240) underwent total thyroidectomy using three different methods; the Harmonic Focus™ (Group F, n=80), the LigaSure Precise® (Group L, n=80) and the conventional technique of suture ligation (Group C, n=80). RESULTS No significant differences were identified between the 3 groups in terms of demographics, thyroid gland weight, pathologic diagnosis, preoperative and postoperative calcium levels, postoperative complications, duration of hospital stay, and final outcome. The operative time was shorter with Harmonic Focus® by about 15%. Statistical analysis revealed a statistically significant difference between operations with F (62.7±14.1 minutes) and C (72.7±13.6minutes) with (p=0.019). CONCLUSION Both devices were safe and efficient. A significant reduction of the operative time was found with Harmonic Focus® compared to the other two techniques with no statistically significant differences in postoperative complications in the 3 groups.
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Affiliation(s)
- A Bove
- Department of Surgical Sciences, Medical School, University of Chieti-Pescara, Chieti, Italy
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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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Sözen S, Topuz O, Tükenmez M, Keçeli M. The use of fibrin sealant after total thyroidectomy for benign disease obviates the need for routine drainage. Results of a randomized controlled trial. Hippokratia 2011; 15:247-251. [PMID: 22435023 PMCID: PMC3306032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Drains are usually left after thyroid surgery to prevent formation of hematoma and seroma in the thyroid bed. This prospective randomized clinical trial was conducted to evaluate the necessity of drainage after total thyroidectomy for benign thyroidal disorders. METHODS The patients were assigned randomly into two groups (group 1: with suction drain, group 2: fibrin glue). In the study, operating time, postoperative pain, the total amount of intramuscular analgesic administration, hospital stay, complications (such as wound infection, seroma, bleeding, hematoma, recurrent laryngeal nerve palsy or hypoparathyroidism), were recorded. RESULTS The drained group (group 1) consisted of 2 men and 48 women with a mean age of 47.76±11.22 years. The nondrained (plus fibrin sealant)( group 2) (comprised of 10 men and 40 women with a mean age of 44.72±11.32 years. There was no significant difference in the gender, age, hormonal status and histopathological results of the patients between the two groups (P=0.18, P=0.36, P=0.28 and P=0.40, respectively). The operations performed were total thyroidectomy in all patients. Twenty-five patients (50%) in the non-drained group did not need intramuscular analgesic, whereas 15 patients (30%) did not in the drained group (P=0.01). In addition, the mean amount of intramuscular analgesic requirement was significantly less in the non-drained group than in the drained group (P=0.02). The complication rates were similar between the two groups. One case of hematoma (2%), two cases of seroma (4%) and three cases of transient hypoparathyroidism (6%) occurred in the non-drained group, whereas one case of hematoma (2%), two cases of seroma (4%), two cases of wound infections (4%) and two cases of transient hypoparathyroidism (4%) occurred in the drained group (P=0.69). No patient needed surgical revision or re-operation for any complication and all complications were successfully managed conservatively. CONCLUSION Routine drainage of thyroid bed following thyroid surgery may not be necessary. Not draining the wound results in lesser morbidity and decreased hospital stay.
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Affiliation(s)
- S Sözen
- Kayseri Training and Research Hospital General Surgery, Talas/ Kayseri, Turkey
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