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Platysmal Lineaments of the Neck With Emphasis on Endoscopic Endocrine Surgery. Surg Laparosc Endosc Percutan Tech 2021; 30:300-304. [PMID: 32398447 DOI: 10.1097/sle.0000000000000792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND In endoscopic neck endocrine surgery, the subplatysmal plane is an anatomic key structure that must be identified and preserved, to progress with the dissection. We define the prevalence of platysma, in the intermediate plane of the anterior cervical region, and evaluate potential statistical correlations with clinical and pathologic variables. MATERIALS AND METHODS The study included patients who had thyroid surgery. Morphologies, asymmetry, and patterns of the platysma were described. The analysis of the different considered variables was quantitative and qualitative, using multiple data reports. RESULTS A total of 23 men and 90 women, aged 19 to 70 (median 41±19) years constituted the study cohort. Their neck circumference and height were 388.5±45 mm (334 to 479 mm) and 200±30 mm (160 to 270 mm), respectively. The hemi-platysmal muscle was bilaterally identified in 109 (96.4%). The mean platysmal thickness was 2.7±1.7 mm (range: 0.7 to 8.2 mm). The intermediate plane between the platysmal muscles was classified into 4 types, depending on the muscle features in the midline: Type A: the left and right platysmal fibers were interlaced with each other in the midline (7%); type B: the platysmal fibers were disconnected by <1 cm (27%); type C: between 1 and 3 cm (52%); and type D separated >3 cm (14%). CONCLUSIONS We provide descriptive characteristics of the cervical platysma. A better understanding of the anatomic variability in cervical platysma may be useful in performing a more accurate dissection in endoscopic endocrine neck surgery.
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Panchangam RB, Mayilvaganan S. Mediastinal Videothoracoscopic Parathyroidectomy for Primary Sporadic Hyperparathyroidism—a Case Series Analysis. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02577-1] [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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Bhargav PRK, Sabaretnam M, Amar V. Endoscopic Thyroidectomy Through Oro-Vestibular Route (ETOVR). Indian J Surg 2020. [DOI: 10.1007/s12262-020-02072-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Paspala A, Spartalis E, Nastos C, Tsourouflis G, Dimitroulis D, Pikoulis E, Nikiteas N. Robotic-assisted parathyroidectomy and short-term outcomes: a systematic review of the literature. J Robot Surg 2020; 14:821-827. [PMID: 32661866 DOI: 10.1007/s11701-020-01119-x] [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: 12/22/2019] [Accepted: 07/09/2020] [Indexed: 11/27/2022]
Abstract
Minimal invasive techniques in endocrine surgery were lately adopted by surgical teams due to significant complications related to inadequate operative space and high risk of injuring crucial surrounding structures, such as vessels and nerves. Over the last years, technological improvements introduced robotic systems and approaches in endocrine surgery. Several case reports and series have described the safety and efficacy of these procedures such as robotic thyroidectomy and robotic parathyroidectomy. In the current review, we included 15 studies which described robotic-assisted parathyroidectomy for cervical parathyroid adenoma, in patients diagnosed with primary hyperparathyroidism or secondary hyperparathyroidism. No significant negative short-term outcomes were observed, in terms of postoperative complications, such as temporary or permanent injury of RLN, postoperative hypoparathyroidism and blood loss. The cosmetic result was, definitely, superior in comparison to conventional open parathyroidectomy. Despite the fact that RAP is an effective and curative method for patients with PHPT or secondary hyperparathyroidism, there are no available randomized clinical trials to establish this modern procedure as a gold-standard treatment strategy for these patients.
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Affiliation(s)
- A Paspala
- Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, Athens, Greece.
- 3rd Department of Surgery, Medical School, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece.
| | - E Spartalis
- Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, Athens, Greece
| | - C Nastos
- 3rd Department of Surgery, Medical School, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - G Tsourouflis
- Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, Athens, Greece
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - D Dimitroulis
- Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, Athens, Greece
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - E Pikoulis
- 3rd Department of Surgery, Medical School, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - N Nikiteas
- Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, Athens, Greece
- 2nd Department of Propaedeutic Surgery, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Endoscopic parathyroidectomy: a retrospective review of 27 cases. Surg Endosc 2020; 35:1288-1295. [PMID: 32166546 DOI: 10.1007/s00464-020-07500-z] [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] [Received: 09/25/2019] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Primary hyperparathyroidism is a common endocrine disorder with adenomas being the most frequent cause. The condition is conventionally treated by a bilateral neck exploration through a cervical incision with removal of the affected glands. Intra-operative parathyroid hormone (IOPTH) monitoring and pre-operative Tc99m MIBI scans are facilitating focused approaches like minimally invasive video-assisted parathyroidectomy (MiVAP) and totally endoscopic parathyroidectomy (TOEP). METHODS Patients with primary hyperparathyroidism were tested for location of diseased gland and accordingly selected for endoscopic parathyroidectomy by either trans-vestibular or trans-axillary approach. Those having undergone prior neck surgery or irradiation and those with an enlarged thyroid were excluded. All patients underwent IOPTH measurement to confirm the completeness of diseased gland resection. RESULTS Eleven cases meeting selection criteria underwent endoscopic trans-vestibular parathyroidectomy and 16 cases underwent endoscopic trans-axillary parathyroidectomy. The mean operative time and blood loss were 104 min and 34 mL in trans-vestibular approach, respectively, while they were 47 min and 68 mL for the trans-axillary approach. All patients had post-operative resolution of hypercalcaemia. A single conversion to cervical approach was performed due to unsatisfactory IOPTH fall. A single patient suffered transient recurrent laryngeal nerve palsy which resolved with steroids. CONCLUSION Endoscopic parathyroidectomy is a safe and feasible surgical procedure when combined with pre-operative imaging and intra-operative parathyroid hormone monitoring. There is a steady rise in the number of patients with primary hyperparathyroidism, a majority of whom have solitary gland affliction. Focused exploration is the current standard, wherein endoscopic surgery can be an important tool to improve outcomes.
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Video-assisted neck surgery (VANS) using a gasless lifting procedure for thyroid and parathyroid diseases: "The VANS method from A to Z". Surg Today 2019; 50:1126-1137. [PMID: 31728730 PMCID: PMC7501127 DOI: 10.1007/s00595-019-01908-4] [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: 03/11/2019] [Accepted: 09/04/2019] [Indexed: 12/20/2022]
Abstract
Purpose To describe and evaluate our video-assisted neck surgery (VANS) method for thyroid and parathyroid diseases. Methods We describe in detail the VANS method for enucleation, lobectomy, total (nearly total) thyroidectomy, and lymph node dissection for malignancy and Graves’ disease. In collaboration with the Japan Society of Endoscopic Surgery (JSES), we evaluated several aspects of this method. The JSES evaluated the method for working-space formation and surgical complications, whereas we examined the learning curve of the surgeons, and the cosmetic satisfaction of the patients and the degree of numbness and pain they experienced. We also asked patients who underwent conventional surgery whether they would have selected VANS had it been available. Results The working space for 81.5% of the procedures in Japan was created using the gasless lifting method. The learning curve, considering both blood loss and operating time, decreased after 30 cases. Both factors improved for tumors smaller than 5 cm in diameter. Over 60% of the patients who underwent conventional surgery stated that they would have selected VANS, had it been available. Postoperative pain was worse after conventional surgery than after VANS, but neck numbness after VANS was more frequent than expected. Conclusions The VANS method is a feasible, safe, and cost-effective procedure with clear cosmetic advantages over conventional surgery.
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Lessons Learned From a Faulty Transoral Endoscopic Thyroidectomy Vestibular Approach. Surg Laparosc Endosc Percutan Tech 2019; 28:e94-e99. [PMID: 29975356 DOI: 10.1097/sle.0000000000000555] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Transoral endoscopic thyroidectomy via vestibular approach (TOETVA) is currently considered the most promisingly scarless approach to the thyroid and has gained more acceptance. MATERIALS AND METHODS We described a case of faulty TOETVA. RESULTS The faulty TOETVA resulted in pneumomediastinum, diffuse subcutaneous emphysema, prolonged surgery, and anesthesia. CONCLUSIONS The important technical considerations during TOETVA, including the use of external retraction, the identification of the subplatysmal plane of dissection, CO2 insufflation settings, the learning curve, and patient selection, were described and discussed.
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Early experiences with robot-assisted prosthetic breast reconstruction. Arch Plast Surg 2019; 46:79-83. [PMID: 30685946 PMCID: PMC6369051 DOI: 10.5999/aps.2018.00052] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 07/10/2018] [Indexed: 11/28/2022] Open
Abstract
Robotic surgery facilitates surgical procedures by employing flexible arms with multiple degrees of freedom and providing high-quality 3-dimensional imaging. Robot-assisted nipplesparing mastectomy with immediate reconstruction is currently performed to avoid breast scars. Four patients with invasive ductal carcinoma underwent robot-assisted nipple-sparing mastectomy and immediate robot-assisted expander insertion. Through a 6-cm incision along the anterior axillary line, sentinel lymph node biopsy and nipple-sparing mastectomy were performed by oncologic surgeons. The pectoralis major muscle was elevated, an acellular dermal matrix (ADM) sling was created with robotic assistance, and an expander was inserted into the subpectoral, sub-ADM pocket. No patients had major complications such as hematoma, seroma, infection, capsular contracture, or nipple-areolar necrosis. The mean operation time for expander insertion was 1 hour and 20 minutes, and it became shorter with more experience. The first patient completed 2-stage prosthetic reconstruction and was highly satisfied with the unnoticeable scar and symmetric reconstruction. We describe several cases of immediate robot-assisted prosthetic breast reconstruction. This procedure is a feasible surgical option for patients who want to conceal surgical scars.
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Park HS, Kim JH, Lee DW, Song SY, Park S, Kim SI, Ryu DH, Cho YU. Gasless Robot-Assisted Nipple-Sparing Mastectomy: A Case Report. J Breast Cancer 2018; 21:334-338. [PMID: 30275863 PMCID: PMC6158155 DOI: 10.4048/jbc.2018.21.e45] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 08/14/2018] [Indexed: 01/30/2023] Open
Abstract
Robotic surgical systems enhance surgical accuracy and efficiency by applying advanced technologies such as artificial arm joints to provide higher degrees of freedom of movement and high-quality three-dimensional images. However, the application of robotic surgical systems to breast surgery has not been widely attempted. The robotic system would improve cosmesis by enabling surgery using a single small incision. We report the first case of a gasless robot-assisted nipple-sparing mastectomy and immediate reconstruction in a patient with early breast cancer.
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Affiliation(s)
- Hyung Seok Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Joo Heung Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Department of Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Dong Won Lee
- Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Yong Song
- Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seho Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Il Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Hyun Ryu
- Department of Plastic and Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Young Up Cho
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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Lyu YJ, Shen F, Zhang H, Chen GX. Utility of a novel elastic traction system in endoscopic thyroidectomy via breast approach: initial experience with 34 patients. J Int Med Res 2018; 46:3200-3208. [PMID: 29792101 PMCID: PMC6134654 DOI: 10.1177/0300060518774138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 04/10/2018] [Indexed: 11/25/2022] Open
Abstract
Objective To summarize our experiences in using an elastic traction, space-making technique for endoscopic thyroidectomy via breast approach in the treatment of early-stage differentiated papillary thyroid carcinoma. Methods A retrospective analysis was performed on patients who underwent endoscopic thyroidectomy via breast approach for thyroid carcinoma in our department. We used our self-developed "mini elastic traction space-maker" in a group of 34 patients; another 45 patients who underwent the procedure with the conventional CO2 insufflation method were enlisted as the control group. Results All patients had successful unilateral lobectomy and central lymph node dissection (CLND) surgeries. The adoption of the intraoperative elastic traction system increased the height of the subcutaneous working space (by 1 cm) and significantly decreased the times required for lobectomy and CLND compared with the controls (46.7 ± 4.7 min vs. 50.7 ± 4.9 min). However, there was no significant difference between the two groups in the set-up time to create the working space. Conclusions The elastic traction, space-making technique is a safe and feasible technique for endoscopic thyroidectomy via breast approach.
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Affiliation(s)
- Yi-Jun Lyu
- Department of Thyroid and Breast Surgery, Ningbo Medical Center Lihuili Eastern Hospital, Ningbo, Zhejiang, China
- Department of Thyroid and Breast Surgery, Taipei Medical University Ningbo Medical Center, Ningbo, Zhejiang, China
| | - Fang Shen
- Department of Orthopaedic Surgery, Spine Division, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, Zhejiang, China
| | - Hai Zhang
- Department of Thyroid and Breast Surgery, Ningbo Medical Center Lihuili Eastern Hospital, Ningbo, Zhejiang, China
- Department of Thyroid and Breast Surgery, Taipei Medical University Ningbo Medical Center, Ningbo, Zhejiang, China
| | - Gao-Xiang Chen
- Department of Thyroid and Breast Surgery, Ningbo Medical Center Lihuili Eastern Hospital, Ningbo, Zhejiang, China
- Department of Thyroid and Breast Surgery, Taipei Medical University Ningbo Medical Center, Ningbo, Zhejiang, China
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Minimally Invasive Video-Assisted Thyroidectomy (MIVAT) in the Era of Minimal Access Thyroid Surgery. ACTA ACUST UNITED AC 2017. [DOI: 10.5812/minsurgery.42470] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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The advantages of extended subplatysmal dissection in thyroid surgery-the "mobile window" technique. Langenbecks Arch Surg 2017; 402:257-263. [PMID: 28050728 DOI: 10.1007/s00423-016-1545-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Minimal access thyroidectomy, using various techniques, is widely known, but respective data on thyroidectomy for thyroid cancer with lymphadenectomy is scarce. The present study aims to evaluate the feasability of extended subplatysmal dissection in combination with a small incision ("mobile window" technique). METHODS A retrospective study was performed analysing data from 93 patients. All patients suffered from thyroid carcinoma and underwent (total) thyroidectomy, bilateral cervico-central (levels VI and VII) and functional lateral neck dissection (levels II to V) on the side of the malignancy. In group A, consisting of 47 patients, the operation was performed by a traditional Kocher incision (minimal range 6-7 cm), in 46 patients (group B) a mini-incision (≤4 cm) was made. Intra- and postoperative morbidity as well as oncological accuracy were assessed. RESULTS There was no significant difference between the two groups comparing postoperative pathological diagnosis, intra- and postoperative complications and the number of removed lymph nodes. However, operating time was slightly longer in group A and thyroid weight was heavier in group B. CONCLUSIONS Extended subplatymsal dissection allows thyroidectomy and even lateral lymphadenectomy for thyroid carcinoma via "mobile" mini-incision. The procedure is safe, of equivalent oncological accuracy compared to traditional incision and the cosmetic results are excellent.
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Abstract
Recent technologic advances have engendered alternative and innovative approaches to thyroid surgery aimed at reducing cosmetic sequelae. Minimally invasive techniques via small anterior cervical incisions hidden in natural skin creases and remote access approaches that eliminate anterior neck incisions entirely have emerged as viable options for patients who regard cosmesis as a priority. The safe application of these techniques to both benign and malignant thyroid disease has been evaluated.
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Affiliation(s)
- William S Duke
- Department of Otolaryngology, Georgia Regents University, 1120 Fifteenth Street, BP-4109, Augusta, GA 30912-4060, USA
| | - Katrina Chaung
- Department of Otolaryngology, Georgia Regents University, 1120 Fifteenth Street, BP-4109, Augusta, GA 30912-4060, USA
| | - David J Terris
- Department of Otolaryngology, Georgia Regents University, 1120 Fifteenth Street, BP-4109, Augusta, GA 30912-4060, USA.
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Ouyang DQ, Su YX, Zheng GS, Liang YJ, Zhang SE, Liao GQ. Long-term outcomes of endoscopic neck dissection in the treatment of early-stage oral cancer: a pilot study. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:546-52. [PMID: 25442490 DOI: 10.1016/j.oooo.2014.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Revised: 06/14/2014] [Accepted: 07/01/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study aimed to investigate the feasibility and safety of endoscopic neck dissection in the treatment of early-stage oral cancer and to evaluate the long-term clinical outcomes. STUDY DESIGN Six patients with early-stage oral cancer were enrolled in this pilot study from December 2006 to May 2007. All the patients underwent endoscopic selective neck dissection (levels I-IV) of the ipsilateral neck and partial glossectomy or hemiglossectomy as the primary treatment. RESULTS All endoscopic procedures were successfully performed, with important neck structures identified and preserved. All the patients survived with no persistent or recurrent disease during the 76- to 83-month follow-up. CONCLUSIONS Our preliminary results indicated that endoscopic neck dissection is a technically feasible and safe technique for treating early-stage oral cancer. The oncologic indications and validation should be further confirmed in patients with clinically positive neck lymph nodes in a future study.
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Affiliation(s)
- Dai-Qiao Ouyang
- Oral and Maxillofacial Surgeon, Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yu-Xiong Su
- Associate Professor, Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Guang-Sen Zheng
- Attending Physician, Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yu-Jie Liang
- Attending Physician, Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Si-En Zhang
- Oral and Maxillofacial Surgeon, Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Gui-Qing Liao
- Professor and Chairman, Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangzhou, Guangdong, China; Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, Guangdong, China.
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Abstract
Advances in surgical technology and patient-driven demands have fueled exploration into methods to improve cosmetic outcomes in thyroid surgery. This exploration has produced 2 fundamentally different pathways for reducing the visible thyroidectomy scar. Minimally invasive anterior cervical approaches use small incisions hidden in natural skin creases and reduce the overall extent of dissection required to remove the thyroid. Remote access approaches remove the incision from the anterior neck completely but require more extensive dissection to access the thyroid compartment.
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Affiliation(s)
- William S Duke
- Department of Otolaryngology, GRU Thyroid Center, Georgia Regents University, 1120 Fifteenth Street, BP-4109, Augusta, GA 30912-4060, USA
| | - David J Terris
- Department of Otolaryngology, GRU Thyroid Center, Georgia Regents University, 1120 Fifteenth Street, BP-4109, Augusta, GA 30912-4060, USA.
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Yang TL, Ko JY, Lou PJ, Wang CP, Hsiao TY. Gland-preserving robotic surgery for benign submandibular gland tumours: a comparison between robotic and open techniques. Br J Oral Maxillofac Surg 2014; 52:420-4. [DOI: 10.1016/j.bjoms.2014.02.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 02/17/2014] [Indexed: 11/24/2022]
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Robotic surgery for primary hyperparathyroidism. Surg Endosc 2014; 28:2702-7. [PMID: 24771196 DOI: 10.1007/s00464-014-3531-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 03/21/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Open cervical parathyroidectomy is the standard of care for the treatment of primary hyperparathyroidism (PHP). However, in patients with a history of keloid or hypertrophic scar formation, the cosmetic result may sometimes be unsatisfactory. Furthermore, in the presence of mediastinal glands, a more morbid approach is sometimes necessary, involving a sternal split or thoracotomy. Robotic parathyroidectomy, either transaxillary or transthoracic, could be an alternative in both settings. METHODS Between 2008 and 2013, 14 patients with PHP and a well-localized single adenoma underwent robotic transaxillary cervical (TAC) (n = 8) or transthoracic mediastinal (TTM) (n = 6) parathyroidectomy at an academic tertiary medical center and their outcomes were analyzed. RESULTS All 14 operations were completed successfully as planned. For TAC and TTM parathyroidectomies, mean operative time was 184 and 168 min, respectively. With the exception of one TTM patient, intraoperative PTH determination indicated a >50 % drop in all patients 10 min after excision and no patients presented with recurrent disease on follow-up. Average length of hospital stay was 1 day after TAC parathyroidectomy and 2.2 days after TTM. On a visual analog pain scale (0-10), average pain scores after TAC were 6/10 on postoperative day 1 and 1/10 on day 14, compared to 7.7/10 and 1.5/10, respectively, after TTM. Complications included development of seroma in 1 patient in the TAC group and pericardial and pleural effusion in 1 patient in the TTM cohort. CONCLUSIONS This initial study shows that robotic TAC and TTM parathyroidectomy are feasible in selected PHP patients with preoperatively well-localized disease. Although the TAC approach offers a potential cosmetic benefit in patients with a history of keloid or hypertrophic scar formation, a more generalized use cannot be recommended based on current evidence. The robotic TTM approach presents a minimally invasive alternative to resections previously performed through thoracotomy and sternotomy.
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Noureldine SI, Yao L, Wavekar RR, Mohamed S, Kandil E. Thyroidectomy for Graves' disease: a feasibility study of the robotic transaxillary approach. ORL J Otorhinolaryngol Relat Spec 2014; 75:350-6. [PMID: 24457627 DOI: 10.1159/000354266] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 07/08/2013] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Graves' disease (GD) is considered a relative contraindication for endoscopic approaches to the thyroid gland, due to a larger gland size and increased vascularity. METHODS A retrospective analysis of a single surgeon's experience was performed. We included all patients who underwent thyroidectomy for the treatment of GD over a 3-year period. RESULTS Twenty-five patients with GD were identified. Twelve of them underwent robotic thyroidectomy and 13 patients underwent conventional thyroidectomy. Age, gender, and BMI were similar in both groups (p > 0.05). The conventional approach allowed for resection of larger thyroid volumes (147.3 ± 153.6 ml), as compared to the robotic approach (62.3 ± 47.8 ml, p = 0.08). The average total operative times were similar in both groups (p = 0.98). There was no difference with respect to intraoperative blood loss (p = 0.49), duration of hospital stay (p = 0.38), and complication rates (p = 0.99). CONCLUSION Robotic thyroidectomy is feasible and can be safely performed in appropriately selected patients with GD.
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Affiliation(s)
- Salem I Noureldine
- Division of Endocrine and Oncological Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, La., USA
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Noureldine SI, Abdelghani R, Saeed A, Cortes N, Abbas A, Aslam R, Kandil E. Is robotic hemithyroidectomy comparable to its conventional counterpart? Surgery 2013; 154:363-8. [DOI: 10.1016/j.surg.2013.04.066] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Accepted: 04/26/2013] [Indexed: 11/26/2022]
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Lee SN, Lee JH, Lee EJ, Lee JY, Kim JI, Son YB. Anesthetic course and complications that were encountered during endoscopic thyroidectomy -A case report-. Korean J Anesthesiol 2012; 63:363-7. [PMID: 23115692 PMCID: PMC3483498 DOI: 10.4097/kjae.2012.63.4.363] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 10/12/2011] [Accepted: 10/23/2011] [Indexed: 11/25/2022] Open
Abstract
Endoscopic thyroidectomy is gaining popularity, but it can increase the risk of certain complications. Carbon dioxide insufflation in the neck may cause adverse effects on hemodynamic and ventilatory aspects. We report the anesthetic course and complications that were encountered during endoscopic thyroidectomy. Although the surgery was successful, the patient developed signs of hypercarbia, subcutaneous emphysema and pneumothorax.
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Affiliation(s)
- Su-Nam Lee
- Department of Anesthesiology and Pain Medicine, Korea Cancer Center Hospital, Seoul, Korea
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Kim HY, Choi YJ, Yu HN, Yoon SZ. Optimal carbon dioxide insufflation pressure during robot-assisted thyroidectomy in patients with various benign and malignant thyroid diseases. World J Surg Oncol 2012; 10:202. [PMID: 23017080 PMCID: PMC3506561 DOI: 10.1186/1477-7819-10-202] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 09/13/2012] [Indexed: 11/10/2022] Open
Abstract
Background Currently, data are not available concerning a safe insufflation pressure that provides a proper view of the surgical field without adverse metabolic and hemodynamic changes in humans undergoing the robot-assisted thyroidectomy bilateral axillo-breast approach (BABA) using the da Vinci robotic surgical system. The purpose of this study was to determine the optimal carbon dioxide (CO2) insufflation pressure in patients with various benign and malignant thyroid diseases when using the da Vinci robotic surgical system. Methods A total of 32 patients underwent thyroid surgery at 6 (n = 15), 9 (n = 15), and 12 (n = 2) mmHg. The partial pressure of carbon dioxide (PaCO2), pH, cardiac output, heart rate, and mean arterial pressure were measured at baseline, 30 min and 1, 1.5, and 2 hours after CO2 insufflation, and 30 min after desufflation. Results CO2 insufflation of 12 mmHg caused severe facial subcutaneous emphysema, hypercarbia, and acidosis during robot-assisted thyroidectomy with BABA. The study was stopped before completion for the patients’ safety in accordance with the study protocol. Applying 6- or 9- mmHg of CO2 insufflation pressure caused increases in PaCO2 and decreases in arterial pH. However, vital signs were stable and pH and PaCO2 were within the physiologic range during the surgery in the 6- and 9-mmHg groups. Conclusions We propose that a CO2 insufflation pressure under 10 mmHg in robot-assisted thyroidectomy with BABA is the optimal insufflation pressure for patient safety.
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Affiliation(s)
- Hoon Yub Kim
- Department of Surgery, College of Medicine, Korea University, Seoul, South Korea
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Lee MC, Mo JA, Choi IJ, Lee BC, Lee GH. New endoscopic thyroidectomy via a unilateral axillo-breast approach with gas insufflation: Preliminary report. Head Neck 2012; 35:471-6. [PMID: 22514023 DOI: 10.1002/hed.22984] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2012] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Invasiveness of endoscopic thyroidectomy has been in debate. The purpose of this study was to introduce new endoscopic thyroidectomy via a unilateral axillo-breast approach (UABA) with gas insufflation to lessen invasiveness. METHODS We performed 68 cases of hemithyroidectomy via a UABA with gas insufflation from January to July 2011. The following variables were studied: operation time, pain score, drainage amount, drainage day, perioperative complications, pathological outcomes, and cosmetic satisfaction. RESULTS Mean postoperative pain visual analogue scale (VAS) scores were 2.75 ± 0.93 and 2.07 ± 0.79 at 1 and 3 days after surgery. The mean amount of drainage over the first 3 postoperative days was 144.35 ± 51.64 mL, and the mean time to drain removal was 3.75 ± 0.81 days. Two cases (2.9%) of transient vocal cord palsy and 2 cases (2.9%) of seroma were identified. All patients were satisfied with the cosmetic results. CONCLUSION Endoscopic thyroidectomy via a UABA with gas insufflation is a feasible and less invasive option for selected patients.
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Affiliation(s)
- Myung-Chul Lee
- Department of Otorhinolaryngology, Korea Cancer Center Hospital, Seoul, Korea.
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Choi JY, Lee KE, Chung KW, Kim SW, Choe JH, Koo DH, Kim SJ, Lee J, Chung YS, Oh SK, Youn YK. Endoscopic thyroidectomy via bilateral axillo-breast approach (BABA): review of 512 cases in a single institute. Surg Endosc 2011; 26:948-55. [PMID: 22052422 DOI: 10.1007/s00464-011-1973-x] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Accepted: 09/23/2011] [Indexed: 01/18/2023]
Abstract
BACKGROUND Various techniques for endoscopic thyroidectomy have been introduced in the past decade, and the cosmetic superiority of these techniques has been universally acknowledged. We developed the endoscopic thyroidectomy via bilateral axillo-breast approach (BABA) and have performed more than 500 operations. The aims of this study are to analyze the surgical outcomes and to evaluate the effectiveness and safety of BABA endoscopic thyroidectomy. PATIENTS AND METHODS Between February 2004 and March 2008, 512 patients with thyroid diseases underwent BABA endoscopic thyroidectomy. The criteria analyzed were clinicopathologic characteristics, types of operation, operation time, tumor-node-metastasis (TNM) stage on the basis of the 7th edition of the American Joint Committee on Cancer (AJCC), results after radioactive ablation therapy, and recurrence of disease in these patients. RESULTS Of 512 patients, 397 had a malignant tumor and 115 had benign thyroid disease. Eight patients were diagnosed with Graves' disease, and nine patients underwent completion thyroidectomy. Three cases were subjected to open thyroidectomy due to uncontrolled bleeding. Mean operation time was 151.2 ± 38.1 min for total and near-total thyroidectomy, and 141.7 ± 50.1 min for subtotal thyroidectomy and lobectomy. Regarding postoperative complications, transient hypocalcemia occurred in 31.1% of patients and permanent hypoparathyroidism occurred in 4.2% of patients. Transient hoarseness occurred in 20.3% of patients, and permanent vocal cord palsy occurred in 1.7%. Mean hospital stay after operation was 3.34 ± 0.8 days (range 3-7 days), and mean follow-up period was 57.1 ± 17.6 months (range 38.5-71.7 months). There were eight cases of recurrent thyroid carcinoma, and no mortality has occurred up to the present time. CONCLUSIONS Endoscopic thyroidectomy via bilateral axillo-breast approach is a safe and effective method that gives good surgical completeness, a low rate of postoperative complications and recurrence, and an excellent cosmetic result. Therefore, this method is a good choice for patients with surgical thyroid diseases.
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Affiliation(s)
- June Young Choi
- Department of Surgery, Seoul National University College of Medicine, 101, Daehang-no, Chongno-gu, Seoul, 110-744, Korea
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False-positive F-18 FDG PET/CT from foreign body reaction on anterior chest wall after endoscopic total thyroidectomy via axillo-breast approach for thyroid cancer: two case reports. Clin Nucl Med 2011; 36:1036-8. [PMID: 21975398 DOI: 10.1097/rlu.0b013e31821c99f5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Genc V, Agcaoglu O, Berber E. Robotic endocrine surgery: technical details and review of the literature. J Robot Surg 2011; 6:85-97. [PMID: 27628272 DOI: 10.1007/s11701-011-0298-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 07/14/2011] [Indexed: 11/25/2022]
Abstract
Over the last decade, robotic technology has been used in multiple general surgical procedures. Endocrine surgeons have embraced this technology and subsequently transformed neck operations into more cosmetically acceptable procedures and improved ergonomics. Technical details of various robotic endocrine surgical procedures have recently been described. The aim of this review is to illustrate these technical details and analyze the current data to propose an evidence-based approach to robotic endocrine surgery.
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Affiliation(s)
- Volkan Genc
- Department of Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - Orhan Agcaoglu
- Division of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, 9500 Euclid Avenue/F20, Cleveland, OH, 44195, USA
| | - Eren Berber
- Division of Endocrine Surgery, Endocrinology and Metabolism Institute, Cleveland Clinic, 9500 Euclid Avenue/F20, Cleveland, OH, 44195, USA.
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27
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Minimally invasive thyroidectomy: A comprehensive appraisal of existing techniques. Surgery 2011; 150:17-24. [DOI: 10.1016/j.surg.2011.02.018] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 02/17/2011] [Indexed: 11/18/2022]
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28
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Kandil E, Winters R, Aslam R, Friedlander P, Bellows C. Transaxillary gasless robotic thyroid surgery with nerve monitoring: Initial two experince in a North American center. MINIM INVASIV THER 2011; 21:90-5. [DOI: 10.3109/13645706.2011.561862] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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29
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Critchley LAH, Ho AMH. Surgical emphysema as a cause of severe hypercapnia during laparoscopic surgery. Anaesth Intensive Care 2011; 38:1094-100. [PMID: 21226444 DOI: 10.1177/0310057x1003800622] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Surgical emphysema is a well-recognised complication of laparoscopic surgery, but its impact on end-tidal carbon dioxide levels and carbon dioxide elimination is seldom reported and may not be fully appreciated by anaesthetists. Four cases are presented where extensive surgical emphysema occurred during laparoscopic surgery. The visual display of the anaesthetic record using the software program Monitor showed substantial rises in end-tidal carbon dioxide levels and allowed calculation of the carbon dioxide elimination, which increased two- to three-fold above normal levels. Having a visual record of carbon dioxide changes facilitated the recognition of surgical emphysema in three out of the four cases. Strategies such as estimating and tracking changes in carbon dioxide elimination from the minute ventilation and end-tidal carbon dioxide levels may assist in early identification, and palpating for surgical emphysema is recommended during laparoscopy if other causes of increased carbon dioxide levels are excluded.
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Affiliation(s)
- L A H Critchley
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
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Irawati N. Endoscopic right lobectomy axillary-breast approach: a report of two cases. Int J Otolaryngol 2010; 2010:958764. [PMID: 21253488 PMCID: PMC3022208 DOI: 10.1155/2010/958764] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Accepted: 12/06/2010] [Indexed: 11/23/2022] Open
Abstract
Background. We reported our two initial experiences in the treatment of thyroid disease with endoscopic thyroidectomy. Minimally invasive video-assisted technique (MIVAT) was initially introduced by Miccoli. The modification was made by using axillary and breast technique. Method. Two young women patients, with 4 and 5 cm right lobe thyroid disease suspected to be benign. From physical examination, sonography, and FNAB findings, the two cases were categorized as benign. We performed endoscopic right lobectomy through incision of 5-10 mm on axillary line and breast using CO2 insufflation. Result. Duration of first operation was 300 minutes and the second one was 120 minutes, with minimal blood loss and no major complication. Patients were discharged 24 hours after operation. Cosmetic result was excellent. Postoperative complications were shoulder discomfort and neck swelling. Conclusion. We reported two cases of endoscopic right lobectomy as a safe, reproducible technique with an indication in a minority of patients candidates for thyroidectomy and is characterized by less postoperative discomfort.
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Affiliation(s)
- Nina Irawati
- Awal Bros Hospital, Batam, Riau Island, Indonesia
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31
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The endoscopic approach to the neck: a review of the literature, and overview of the various techniques. Surg Endosc 2010; 25:1358-63. [PMID: 21136119 DOI: 10.1007/s00464-010-1452-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Accepted: 09/14/2010] [Indexed: 12/27/2022]
Abstract
BACKGROUND The endoscopic surgical approach to the neck has reached the head and neck surgeons' view with a certain delay, compared to other fields of endoscopic procedures. This may be attributed to the tight work space and plenty of vital structures in the operating field. Since study groups described first attempts with endoscopic or video assisted removals of thyroid glands in the late nineties, selective neck dissections on animal models or cadaveric dissections were performed in 2003. METHOD The review consists of a Medline Search regarding the terms of endoscopic, video- assisted neck dissections, excision of neck lesions, thyroidectomy and submandibular resection and minimal access surgery. The three main procedures (selective neck dissection, submandibular resection and thyroidectomy) are described and reviewed in the following test. RESULTS Various techniques have been performed successfully and led to good clinical results. The studies described in literature other than for thyroidectomy often do not exceed the level of small series or case-reports. CONCLUSION With a good proof of indication gasless lifting techniques, video assisted endoscopical techniques and subcutaneous approaches with gas filling procedures are feasible in neck surgery. All methods depending on the surgeons' experience describe no significantly extended operation times, a better and faster wound-healing and an optimized cosmetic outcome, compared to open approaches. Surgeons should always be aware of the limitations of the minimal invasive techniques regarding the complications or modifications during neck dissection/thyroidectomy.
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Kuppersmith RB, Holsinger FC. Robotic thyroid surgery: an initial experience with North American patients. Laryngoscope 2010; 121:521-6. [PMID: 21344427 DOI: 10.1002/lary.21347] [Citation(s) in RCA: 148] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Accepted: 09/01/2010] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To review the initial experience of gasless transaxillary robot-assisted endoscopic thyroid surgery in a series of patients and describe modifications of the technique for the North American patients, selection criteria, and other issues related to this technology. METHODS Retrospective review of the first 31 consecutive cases at a single institution. RESULTS Thirty-one patients underwent robotic thyroid surgery. Twenty thyroid lobectomies and 11 total thyroidectomies were performed. Improvements in the length of time to perform components of the procedure were noted from the early group of cases to later group of cases. No major or permanent complications occurred. CONCLUSIONS Robotic thyroid surgery is feasible in North American patients and can be safely performed. The procedure has potential complications and a definite learning curve exists for both surgeons and operating room staff. Training methods need to be validated to ensure safe adoption. More studies need to be performed to further evaluate the relative benefits of this technique.
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Affiliation(s)
- Ronald B Kuppersmith
- Texas Institute for Thyroid and Parathyroid Surgery, College Station, Texas 77845, USA.
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Minimally invasive thyroidectomy in the treatment of well differentiated thyroid cancers: indications and limits. Curr Opin Otolaryngol Head Neck Surg 2010; 18:114-8. [PMID: 20182356 DOI: 10.1097/moo.0b013e3283378239] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To summarize recent papers in the literature with respect to minimally invasive thyroidectomy and discuss indications and limits of the endoscopic/video-assisted treatment of differentiated thyroid carcinoma. RECENT FINDINGS During the 1990s, with the general tendency to develop minimally invasive operations, an endoscopic approach was applied to neck surgery for both parathyroidectomy and thyroidectomy. The most wide spread minimally invasive technique for thyroidectomy is minimally invasive video-assisted thyroidectomy (MIVAT). SUMMARY Papillary carcinoma is the main indication for MIVAT, this cancer usually being found in normal glands of young women. In contrast, for locally invasive carcinomas, lymph node metastasis or both, the procedure must be immediately converted to the conventional technique. MIVAT also is not indicated for the treatment of medullary and anaplastic carcinomas. Recent prospective randomized studies clearly demonstrate that MIVAT allows the same clearance to be achieved at the thyroid bed level and the same outcome as with the conventional technique, when dealing with 'low-risk' papillary carcinoma. At the same time, patients can benefit from the main advantages of this minimally invasive technique: less postoperative pain, faster postoperative recovery and excellent cosmetic outcome.
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Lewis CM, Chung WY, Holsinger FC. Feasibility and surgical approach of transaxillary robotic thyroidectomy without CO(2) insufflation. Head Neck 2010; 32:121-6. [PMID: 19998442 DOI: 10.1002/hed.21318] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Our objective was to evaluate the anatomic basis for robotic-assisted transaxillary thyroidectomy and to determine its feasibility in a prospective clinical trial. METHODS AND RESULTS Using the da Vinci Surgical Robotic System, we performed 5 cadaveric dissections, via transaxillary approach without gas insufflation. Once the safety and feasibility of this approach had been demonstrated in cadavers, it was utilized to perform a thyroid lobectomy in a patient. The da Vinci system provided excellent visualization of the recurrent and superior laryngeal nerves, parathyroid glands, and paratracheal lymphatics. After the 5 cadaver dissections, the procedure time diminished from >90 minutes to <30 minutes. CONCLUSION Robotic-assisted transaxillary thyroidectomy is feasible with proper instrumentation and an understanding of the surgical anatomy. Based on this preclinical laboratory study and our experience in 1 patient, further evaluation of this approach in the setting of a prospective clinical trial is warranted to determine standardized criteria identifying patients who would benefit from this approach.
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Affiliation(s)
- Carol M Lewis
- Department of Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
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35
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Seybt MW, Terris DJ. Minimally Invasive Thyroid and Parathyroid Surgery: Where Are We Now and Where Are We Going? Otolaryngol Clin North Am 2010; 43:375-80, ix. [DOI: 10.1016/j.otc.2010.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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36
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Rodríguez-Navarro MA, Victoria Conesa J, Marante Fuertes N, Marquina Peñalver C. [Persistent subcutaneous emphysema after laparoscopic prostatectomy: take care not to extubate too early]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2009; 56:582-583. [PMID: 20112556 DOI: 10.1016/s0034-9356(09)70469-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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37
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Kuppersmith RB, Salem A, Holsinger FC. Advanced Approaches for Thyroid Surgery. Otolaryngol Head Neck Surg 2009; 141:340-2. [DOI: 10.1016/j.otohns.2009.05.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2009] [Accepted: 05/20/2009] [Indexed: 12/01/2022]
Abstract
Over the past several years, new surgical approaches to the thyroid have been described, and efforts to further refine thyroid surgery continue. These new approaches can be classified by the anatomic location that access is obtained and whether CO2 insufflation is necessary for the procedure to be performed. While these new approaches provide the potential for exciting innovation, more work should be done to refine some of these techniques and study the implications of adopting them from the perspective of patient outcomes and cost.
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Affiliation(s)
- Ronald B. Kuppersmith
- Texas ENT and Allergy, College Station, TX
- Texas A&M Health Science Center College of Medicine
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38
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Miccoli P, Materazzi G, Berti P. Natural orifice surgery on the thyroid gland using totally transoral video-assisted thyroidectomy: report of the first experimental results for a new surgical method: are we going in the right direction? Surg Endosc 2009; 24:957-8; author reply 959-60. [DOI: 10.1007/s00464-009-0677-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2009] [Accepted: 07/04/2009] [Indexed: 10/20/2022]
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39
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Koh YW, Park JH, Kim JW, Lee SW, Choi EC. Endoscopic hemithyroidectomy with prophylactic ipsilateral central neck dissection via an unilateral axillo-breast approach without gas insufflation for unilateral micropapillary thyroid carcinoma: preliminary report. Surg Endosc 2009; 24:188-97. [PMID: 19688395 DOI: 10.1007/s00464-009-0646-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Revised: 03/17/2009] [Accepted: 05/01/2009] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recently, various endoscopic approaches have been applied to thyroid surgery. However, few specific data exist on endoscopic thyroidectomy with central neck dissection (CND) for micropapillary thyroid carcinoma. This study aimed to evaluate the feasibility and safety of endoscopic hemithyroidectomy (HT) plus CND. METHODS In this study, 29 consecutive patients underwent endoscopic HT with ipsilateral CND via a unilateral axillo-breast approach (endo group), and 30 matched control patients underwent conventional open HT with ipsilateral CND (open group). The following variables were compared between these two groups: perioperative complications, surgery-related outcomes, and pathologic outcomes. RESULTS The operating time in the endo group was longer than in the open group (p = 0.012). In terms of parathyroid gland (PTG) preservation, there were no statistically significant differences between the two groups. The mean numbers of dissected central lymph nodes and metastatic central lymph nodes were similar in the two groups (p = 0.506 vs. 0.975). The endo group had a significantly longer mean hospital stay (6.21 +/- 0.94 days) than the open group (4.30 +/- 1.02 days; p = 0.000). No significant difference was observed in the overall perioperative complications between the two groups. CONCLUSIONS This study demonstrates that the endoscopic approach of CND plus HT is feasible for selected unilateral, intrathyroidal, micropapillary carcinomas. In the future, prospective and comparative studies on the surgical techniques of total thyroidectomy and CND are needed to verify their oncologic safety.
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Affiliation(s)
- Yoon Woo Koh
- Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon, Korea
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40
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Video-assisted submandibular resection: two-step technique. Surg Endosc 2009; 23:2785-9. [PMID: 19452218 DOI: 10.1007/s00464-009-0492-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Revised: 03/05/2009] [Accepted: 03/29/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND The relative delay in the development of endoscopic neck surgery has been attributed to the relatively narrow operative field and to the presence of many vital structures in it. For endoscopic neck surgery to be feasible, it is essential to create a comfortable working space. A method of creating a working space is the gasless skin-lifting technique. To date, there have been only few reports on the transcervical endoscopic approach to the submandibular gland. AIM Assessment of a new modification in the technique of video-assisted submandibular sialadenectomy aiming at improving the visibility and safety of the operation. METHODS The study included 12 adult patients indicated for sialadenectomy. Patients having large, hard or fixed submandibular gland were excluded. Laboratory work-up and ultrasound of the neck were obtained in all patients. All patients had video-assisted submandibular sialadenectomy, using a "two-step resection" technique: A 15-20-m skin incision was performed. The superficial part of the submandibular gland down to the plane of the mylohyoid muscle was dissected free and excised, leaving behind a roomy working space and a clearer view to the deeper part (step 1). The remaining deep part of the gland was then dissected and removed (step 2). A gasless skin lifting was adopted using Army-Navy retractors. Dissection was performed using ultrasonic sealing device. RESULTS Mean operative time was 89.67 ± 37.97 min. Mean blood loss was 45 ± 19.78 ml. There was no permanent nerve injury. CONCLUSION The two-step submandibular sialadenectomy using skin-lifting gasless technique offers good visibility and good working space that allow safer dissection.
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Kania R, Parodi M, Coste A, Herman P, Tran Ba Huy P, Papon JF. La chirurgie thyroïdienne endoscopique par techniques vidéo-assistées et totalement endoscopiques. ACTA ACUST UNITED AC 2009; 126:82-93. [DOI: 10.1016/j.aorl.2009.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Accepted: 01/29/2009] [Indexed: 01/10/2023]
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Lombardi CP, Raffaelli M, Traini E, De Crea C, Corsello SM, Bellantone R. Video-Assisted Minimally Invasive Parathyroidectomy: Benefits and Long-Term Results. World J Surg 2009; 33:2266-81. [DOI: 10.1007/s00268-009-9931-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Park HS, Lee SI, Shin HW, Choi SU, Park JY, Lee HW, Lim HJ, Yoon SM, Chang SH. Tracheal laceration detected by high end-tidal CO 2during endoscopic thyroidectomy. Korean J Anesthesiol 2009; 56:703-705. [DOI: 10.4097/kjae.2009.56.6.703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Han Suk Park
- Department of Anesthesiology and Pain Medicine, Korea University, Anam Hospital, Seoul, Korea
| | - Sang Ik Lee
- Department of Anesthesiology and Pain Medicine, Korea University, Anam Hospital, Seoul, Korea
| | - Hye Won Shin
- Department of Anesthesiology and Pain Medicine, Korea University, Anam Hospital, Seoul, Korea
| | - Sung Uk Choi
- Department of Anesthesiology and Pain Medicine, Korea University, Anam Hospital, Seoul, Korea
| | - Ji Yong Park
- Department of Anesthesiology and Pain Medicine, Korea University, Anam Hospital, Seoul, Korea
| | - Hye Won Lee
- Department of Anesthesiology and Pain Medicine, Korea University, Anam Hospital, Seoul, Korea
| | - Hae Ja Lim
- Department of Anesthesiology and Pain Medicine, Korea University, Anam Hospital, Seoul, Korea
| | - Suk Min Yoon
- Department of Anesthesiology and Pain Medicine, Korea University, Anam Hospital, Seoul, Korea
| | - Seong Ho Chang
- Department of Anesthesiology and Pain Medicine, Korea University, Anam Hospital, Seoul, Korea
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Abstract
We investigate the current status of endoscopic thyroidectomy in Korea. A representative questionnaire was sent to 21 members of the Korean Association of Endocrine Surgeons who were thought to be performing endoscopic thyroidectomy. All the reply letters were collected and analyzed. The response rate was 95%. A total of 1616 cases of endoscopic thyroidectomy were performed from the year 1998 to the year 2005. The patients included 71 men and 1545 women, with a mean age of 36.17 years. The mean operation time was 124.18 minutes and overall length of hospital stay was 4.31 days. Thyroid lobectomy and nodular hyperplasia were the most common procedures and prominent pathologic findings. Axillary approach was the most popular operative approach method. Gas insufflation and skin-lifting gasless method were used in 800 cases and 816 cases, respectively. Postoperative complication rate was 14.2%. Skin paresthesia was the most common complication. Conversion rate to conventional thyroidectomy was 2.2%. Korean experiences show that endoscopic thyroidectomy is a technically safe and feasible procedure. It is considered to be an important surgical tool that can be further progressed and that also has an excellent potential in a management of thyroid neoplasm.
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45
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Slotema ET, Sebag F, Henry JF. What is the evidence for endoscopic thyroidectomy in the management of benign thyroid disease? World J Surg 2008; 32:1325-32. [PMID: 18327525 PMCID: PMC2480507 DOI: 10.1007/s00268-008-9505-0] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Endoscopic thyroidectomy (ET) is a demanding surgical technique in which dissection of the gland is entirely performed with an endoscope, in a closed area maintained by insufflation or mechanical retraction. ET by direct cervical approach (anterior or lateral) is minimally invasive, but ET using an extracervical access (chest wall, breast, or axillary) is not. No technique seems to be universally accepted yet. This review was designed to clarify the existing evidence for performing endoscopic thyroid resections in the management of benign thyroid nodules. Methods A database search was conducted in PubMed and Embase from which summaries and abstracts were screened for relevant data, matching our definition. Publications were further assessed and assigned their respective levels of evidence. Additional data derived from our own unit’s experience with endoscopic thyroidectomy were included. Results Thirty mainly retrospective cohort studies have been published in which morbidity, such as unilateral vocal cord palsy, is poorly evaluated. ET takes from 90 to 280 minutes for lobectomy by cervical access and total thyroidectomy by chest wall approach, respectively. Cosmetic outcome in extracervical approach is less troubled by size of the resected specimen compared with direct cervical approach. Extracervical approach avoids a neck scar but implies invasiveness in terms of dissection and postoperative discomfort. Long-term cosmetic outcome comparisons with conventional thyroidectomy have not been published. Conclusions Currently it is not possible to recommend the application of ET based on evidence. Reported complications stress the importance of advanced endoscopic skills. ET should only be offered to carefully selected patients and, therefore, a high volume of patients requiring thyroid surgery is needed. Superiority of endoscopic to conventional thyroidectomy has yet to be demonstrated. Possible advantages of endoscopic thyroid techniques and our patient’s desire for the highest cosmetic outcome possible justify further development of ET in expert hands of endocrine surgeons.
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Affiliation(s)
- E Th Slotema
- Department of Endocrine Surgery University Hospital Marseille, Service de Chirurgie Générale et Endocrinienne, CHU-Hôpital de la Timone, 264 Rue Saint-Pierre, 13385, Marseille cedex 05, France.
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Jeryong K, Jinsun L, Hyegyong K, Eilsung C, Jiyoung S, Insang S, Moonsang A, Jiyeon K, Jaeeun H. Total Endoscopic Thyroidectomy with Bilateral Breast Areola and Ipsilateral Axillary (BBIA) Approach. World J Surg 2008; 32:2488-93. [DOI: 10.1007/s00268-008-9693-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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47
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Koh YW, Kim JW, Lee SW, Choi EC. Endoscopic thyroidectomy via a unilateral axillo-breast approach without gas insufflation for unilateral benign thyroid lesions. Surg Endosc 2008; 23:2053-60. [DOI: 10.1007/s00464-008-9963-3] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2008] [Revised: 03/15/2008] [Accepted: 04/05/2008] [Indexed: 10/22/2022]
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48
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Sesterhenn AM, Folz BJ, Werner JA. Surgical technique of endoscopic sentinel lymphadenectomy in the N0 neck. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.otot.2008.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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49
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Invisible scar endoscopic thyroidectomy by the dorsal approach: experimental development of a new technique with human cadavers and preliminary clinical results. Surg Endosc 2008; 22:813-20. [DOI: 10.1007/s00464-008-9761-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2007] [Revised: 10/07/2007] [Accepted: 10/21/2007] [Indexed: 11/27/2022]
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New Technologies in Surgery: Diagnosis and Treatment of Complications of Mivat (Minimally Invasive Video-Assisted Thyroidectomy). POLISH JOURNAL OF SURGERY 2008. [DOI: 10.2478/v10035-008-0063-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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