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Kumar A, Dhar A, Srivastava A, Kumar R. A Prospective Comparative Analysis to Study the Impact on Voice Changes Following Endoscopic Thyroidectomy. Surg Laparosc Endosc Percutan Tech 2024; 34:407-412. [PMID: 38949300 DOI: 10.1097/sle.0000000000001297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 05/16/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Endoscopic approach has come up as a safe and feasible procedure for thyroidectomy with better cosmetic outcomes. However, concerns over its safety in terms of nerve injury and postoperative voice changes remain. This prospective study evaluated the role of vocal cord function assessment using laryngeal examination and voice analysis in patients who underwent endoscopic hemithyroidectomy either by the trans-oral endoscopic thyroidectomy vestibular approach (TOETVA) or the bilateral axillobreast approach (BABA). METHODS Thirty-nine consecutive patients were randomly allocated to either of the 2 groups of endoscopic hemithyroidectomy; 19 in TOETVA and 20 in the BABA groups. Vocal cord function was assessed subjectively using the GRBAS scale and objectively by acoustic analysis of parameters such as jitter, shimmer, mean frequency (F 0 ), noise-to-harmonic ratio (NHR), and maximum phonatory time (MPT) at baseline, postoperative day 10, and 3 months after surgery. RESULTS There were no significant differences in mean GRBAS scores and values of mean frequency, jitter and shimmer between the 2 groups and on postoperative day 10 and at 3 months compared with baseline. The mean NHR and MPT showed no differences between the 2 procedures. However, there was a significant decrease in their values on day 10 postsurgery, compared with baseline. These values returned to their baseline at 3 months. The other operative parameters were comparable between the 2 groups, except for the shorter mean operative time in the TOETVA group. CONCLUSIONS Perioperative quantitative voice parameters were comparable with no statistically significant difference between the 2 techniques of endoscopic thyroidectomy.
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Affiliation(s)
| | | | | | - Rakesh Kumar
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, New Delhi, India
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Hindawi MD, Ali AHG, Qafesha RM, Soliman W, Salem H, Bali E, Elrosasy A. Transoral endoscopic thyroidectomy submental vestibular approach for early-stage papillary thyroid carcinoma: a systematic review and meta-analysis. Langenbecks Arch Surg 2024; 409:204. [PMID: 38963576 PMCID: PMC11224072 DOI: 10.1007/s00423-024-03377-x] [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: 04/03/2024] [Accepted: 06/10/2024] [Indexed: 07/05/2024]
Abstract
PURPOSE Our study aimed to compare the effectiveness and complications of the transoral endoscopic thyroidectomy submental vestibular approach (TOETSMVA) versus the transoral endoscopic thyroidectomy vestibular approach (TOETVA) or conventional open thyroidectomy (COT) in patients with early-stage papillary thyroid carcinoma (PTC). METHODS We searched online databases up to January 2024. The outcomes were analyzed using RevMan 5.4 and inverse variance. RESULTS Seven studies (two RCTs and five retrospective cohort studies) were included. We established higher significance differences for TOETSMVA in comparison with TOETVA in terms of all primary outcomes; operation time, hospital stay, number of resected lymph nodes [MD -21.05, 95% CI= -30.98, -11.12; p < 0.0001], [MD -1.76, 95% CI= -2.21, -1.32, p < 0.00001], [MD -2.99, 95% CI= -19.75, 13.76, p < 0.73], [MD -0.83, 95% CI = -1.19 to -0.47; p < 0.00001], respectively, except the drainage volume, it showed no difference [MD -2.99, 95% CI= -19.75, 13.76, p < 0.73]. In secondary outcomes, it was favored only in mandibular numbness and return to normal diet outcomes. Additionally, TOETSMVA compared with COT showed a significant difference in drainage volume, pain, cosmetic effect, and satisfaction score. CONCLUSIONS TOETSMVA showed a significant improvement compared to the TOETVA in operation time, hospital stay, number of resected lymph nodes, mandibular numbness, and return to normal diet but did not show a difference in drainage volume. However, TOETSMVA was better in cosmetic effect, drainage volume, satisfaction, and pain scores compared with COT. Further RCTs with larger sample size, multicentral, and longer follow-up are necessary to evaluate the limitations.
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Affiliation(s)
| | - Ahmed Hamdy G Ali
- Faculty of Medicine, Ogarev Mordovia State University, Saransk, Russia
| | | | - Wesam Soliman
- Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Haitham Salem
- Faculty of medicine, Ain shams University, Cairo, Egypt
| | - Eslam Bali
- Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Amr Elrosasy
- Faculty of Medicine, Cairo University, Cairo, Egypt.
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Ding Y, Qiu C, Zhu C, Li Y, Geng X, Lv G, Yan X, Ju F, Wang S, Wu W. Comparison of gasless transaxillary endoscopic thyroidectomy, endoscopic thyroidectomy via areola approach and conventional open thyroidectomy in patients with unilateral papillary thyroid carcinoma. World J Surg Oncol 2024; 22:148. [PMID: 38840176 PMCID: PMC11151600 DOI: 10.1186/s12957-024-03433-2] [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: 02/27/2024] [Accepted: 06/01/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Gasless transaxillary endoscopic thyroidectomy (GTET) and endoscopic thyroidectomy via the areola approach (ETA) have emerged as minimally invasive surgical techniques for managing papillary thyroid carcinoma (PTC). This study aimed to assess the surgical efficacy of endoscopic thyroidectomy (ET) as compared to conventional open thyroidectomy (COT) in PTC patients. METHODS Between 2020 and 2022, 571 PTC patients underwent unilateral thyroidectomy accompanied by ipsilateral central lymph node dissection. This cohort comprised 72 patients who underwent GTET, 105 ETA, and 394 COT. The analysis encompassed a comprehensive examination of patient clinicopathologic characteristics and postoperative complaints. Furthermore, the learning curve of GTET was evaluated using the cumulative summation (CUSUM) method. RESULTS Patients in the ET group exhibited a lower mean age and a higher proportion of female individuals. Operation time in the ET group was significantly longer. No significant differences were observed in the incidence of postoperative complications among the three groups. With regard to postoperative complaints reported three months after surgery, GTET demonstrated superior alleviation of anterior chest discomfort and swallowing difficulties. Patients who underwent ET reported significantly higher cosmetic satisfaction levels. Additionally, the learning curve of GTET was 27 cases, and the operation time during the mature phase of the learning curve exhibited a significant reduction when compared to ETA. CONCLUSIONS The findings of this study affirm the safety and feasibility of employing GTET and ETA for the surgical management of PTC. GTET presents an attractive surgical option, particularly for patients with unilateral PTC who place a premium on cosmetic outcomes.
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Affiliation(s)
- Yu Ding
- Department of Thyroid Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou Jiangsu, 213000, China
| | - Chenjie Qiu
- Department of General Surgery, Changzhou Hospital of Traditional Chinese Medicine, Changzhou Jiangsu, 213000, China
| | - Chunfu Zhu
- Department of Thyroid Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou Jiangsu, 213000, China
| | - Yuan Li
- Department of Thyroid Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou Jiangsu, 213000, China
| | - Xiang Geng
- Department of Thyroid Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou Jiangsu, 213000, China
| | - Guojun Lv
- Department of Thyroid Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou Jiangsu, 213000, China
| | - Xiaoyi Yan
- Department of Thyroid Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou Jiangsu, 213000, China
| | - Feng Ju
- Department of Thyroid Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou Jiangsu, 213000, China
| | - Shijia Wang
- Department of Thyroid Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou Jiangsu, 213000, China
| | - Wenze Wu
- Department of Thyroid Surgery, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou Jiangsu, 213000, China.
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4
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Liu Y, Lin F, Yan W, Lin E, Kuang P, Hong X, Lu Y, Wu G, Li L. Comparison of endoscopic thyroidectomy via the oral vestibule approach and the areola approach for papillary thyroid carcinoma. BMC Surg 2024; 24:127. [PMID: 38678205 PMCID: PMC11055303 DOI: 10.1186/s12893-024-02413-3] [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: 09/19/2023] [Accepted: 04/12/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND The endoscopic thyroidectomy areola approach (ETAA) has been widely applied for papillary thyroid carcinoma (PTC), but leaves scars and is not truly minimally invasive. The oral vestibular approach (ETOVA) leaves no scars and is even more minimally invasive. However, there have been few comparative studies of ETAA and ETOVA for PTC. The purpose of our research was to compare two PTC treatment methods in terms of feasibility, safety, efficacy, and cosmetic results. METHODS A total of 129 patients with PTC underwent thyroidectomy combined with central lymph node dissection by the same surgeon. Among them, 79 patients underwent the ETOVA, and the others underwent the ETAA. We compared the two groups in terms of operative outcomes, postoperative complications, and cosmetic results. RESULTS No significant differences were found in the clinical characteristics between the ETOVA and ETAA groups. There were no significant differences in the number of removed lymph nodes (P = 0.279) or the number of positive lymph nodes (P = 0.569), but the ETOVA group had a higher number of removed lymph nodes. There was also no significant difference in blood loss volume(P = 0.180), postoperative drainage volume (P = 0.063), length of hospital stay (P = 0.182), transient RLN injury rate (P = 1.000), permanent RLN injury rate (P = 1.000), or recurrence rate (P = 1.000). The ETOVA was a longer operation than the ETAA was (P < 0.01). The ETOVA group had less pain (VAS 1: P < 0.01, VAS 3: P = 0.001), less neck discomfort (1 month after surgery: P = 0.009, 3 months after surgery: P = 0.033), and better cosmetic results (P = 0.001). CONCLUSIONS The ETOVA is not inferior to the ETAA in terms of safety and curability of PTC and is advantageous in terms of central lymph node dissection, minimal invasiveness, and cosmetic results. TRIAL REGISTRATION This study was approved by the Ethics Committee of Zhongshan Hospital of Xiamen University (2017 V1.0). No funding was received.
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Affiliation(s)
- Yingying Liu
- Department of Anesthesiology, Zhongshan Hospital of Xiamen University, Xiamen, China
| | - Fusheng Lin
- Department of General Surgery, Zhongshan Hospital of Xiamen University, 201-209 Hu Bin Nan Road, Xiamen, China
| | - Wei Yan
- Department of General Surgery, Zhongshan Hospital of Xiamen University, 201-209 Hu Bin Nan Road, Xiamen, China
| | - Ende Lin
- Department of General Surgery, Zhongshan Hospital of Xiamen University, 201-209 Hu Bin Nan Road, Xiamen, China
| | - Penghao Kuang
- Department of General Surgery, Zhongshan Hospital of Xiamen University, 201-209 Hu Bin Nan Road, Xiamen, China
| | - Xiaoquan Hong
- Department of General Surgery, Zhongshan Hospital of Xiamen University, 201-209 Hu Bin Nan Road, Xiamen, China
| | - Yizhuo Lu
- Department of General Surgery, Zhongshan Hospital of Xiamen University, 201-209 Hu Bin Nan Road, Xiamen, China
| | - Guoyang Wu
- Department of General Surgery, Zhongshan Hospital of Xiamen University, 201-209 Hu Bin Nan Road, Xiamen, China
| | - Lianghui Li
- Department of General Surgery, Zhongshan Hospital of Xiamen University, 201-209 Hu Bin Nan Road, Xiamen, China.
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Nguyen VC, Song CM, Ji YB, Oh S, Jeong JH, Tae K. Comparison of surgical outcomes of transoral robotic and endoscopic thyroidectomy: A systematic review and network meta-analysis. Head Neck 2024; 46:688-701. [PMID: 38229250 DOI: 10.1002/hed.27644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/07/2024] [Accepted: 01/08/2024] [Indexed: 01/18/2024] Open
Abstract
This study aimed to compare surgical outcomes of transoral robotic thyroidectomy (TORT) and transoral endoscopic thyroidectomy vestibular approach (TOETVA), concurrently compared with conventional transcervical thyroidectomy (CTT). A network meta-analysis, comprising 23 studies, was performed in this study. The operative time of the CTT group was significantly shorter than that of the TOETVA and TORT groups. The hospital stay of the TOETVA group was significantly longer than that of the CTT group. Rates of transient recurrent laryngeal nerve palsy and total complications were higher in association with TOETVA than with TORT. No significant differences were found between the three groups in intraoperative blood loss, retrieved lymph nodes, postoperative pain, and other complications. Cosmetic satisfaction was significantly superior with TORT and TOETVA than with CTT. Compared with CTT, TOETVA and TORT showed superior cosmesis but no significant difference in surgical outcomes except for operative time and hospital stay.
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Affiliation(s)
- Van Cuong Nguyen
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, South Korea
| | - Chang Myeon Song
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, South Korea
| | - Yong Bae Ji
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, South Korea
| | - Sukjoong Oh
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, South Korea
| | - Jin Hyeok Jeong
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, South Korea
| | - Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Hanyang University, Seoul, South Korea
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Elzahaby IA, Ali EA, Farid AM, Ghaffar Saleh MAE, Abdallah A. Endoscopic Thyroidectomy for Large-Sized Goiters: Merits of the Axillo-Breast Approach with Gas Insufflation. J Thyroid Res 2024; 2024:9487076. [PMID: 38356469 PMCID: PMC10864051 DOI: 10.1155/2024/9487076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/05/2024] [Accepted: 01/16/2024] [Indexed: 02/16/2024] Open
Abstract
Background Several minimal access approaches to the thyroid gland have been widely applied; nevertheless, such approaches are still challenging when dealing with large-sized thyroid nodules or goiters. We hereby evaluated the outcomes and highlighted the merits of endoscopic axillo-breast hemithyroidectomy (EABH) for large-sized unilateral goiters. Methods Patients underwent EABH for unilateral large thyroid nodules ≥6 cm in its greatest dimension or unilateral large goiter (≥60 ml sonographic volume) whatever the size of its contained nodules were identified from a prospectively maintained database. Their demographic data, clinicopathological profiles, and surgical and esthetic outcomes are reported and analyzed. Results Over a 2-year period, 33 patients matched the selection criteria. Their mean age was 34.75 ± 11.39 years. There were 30 women and 3 men. The majority of nodules were radiologically TIRADS3 and cytologically Bethesda 3. The mean sonographic dominant nodule greatest dimension was 5.29 ± 1.48 cm (range: 3-9.5 cm). The mean sonographic volume of the pathological lobe was 101.86 ± 54.45 ml (range: 60.11-236.88 ml). All cases were completed endoscopically with no conversion to open. The mean operative time was 110.76 ± 18.75 minutes. No significant postoperative complications were reported except for one case with temporary vocal cord paresis. Most (87.9%) of the patients were extremely satisfied with the procedure. Conclusion EABH with our suggested key steps could be considered an effective valid approach for unilateral large goiters in trained hands and in patients desirous for cosmesis.
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Kim DH, Kim SW, Kim GJ, Basurrah MA, Hwang SH. Efficacy and Safety of Minimally Invasive Thyroid Surgery: A Network Meta-Analysis. Laryngoscope 2023; 133:2470-2479. [PMID: 36892037 DOI: 10.1002/lary.30645] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 01/31/2023] [Accepted: 02/20/2023] [Indexed: 03/10/2023]
Abstract
OBJECTIVES Minimally invasive and remote surgical approaches for thyroid tumors have been developed primarily for cosmetic benefit. However, conventional meta-analysis could not provide comparative data between new techniques. This network meta-analysis would be able to provide data for clinicians and patients to compare cosmetic satisfaction and morbidity by comparing surgical methods. DATA SOURCES The PubMed, EMBASE, MEDLINE, SCOPUS, Web of Science, Cochrane Trials, and Google Scholar. REVIEW METHODS The nine interventions included minimally invasive video-assisted thyroidectomy (MIVA), endoscopic and robotic bilateral axillo-breast-approach thyroidectomy (EBAB and RBAB, respectively), endoscopic and robotic retro-auricular thyroidectomy (EPA and RPA, respectively), endoscopic or robotic transaxillary thyroidectomy (EAx and RAx, respectively), endoscopic and robotic transoral approaches (EO and RO, respectively), and a conventional thyroidectomy. We recorded the operative outcomes and perioperative complications; pairwise and network meta-analyses were performed. RESULTS EO, RBAB, and RO were associated with good patient cosmetic satisfaction. EAx, EBAB, EO, RAx, and RBAB were associated with significantly more postoperative drainage than the other methods. Postoperatively, more flap problems and wound infections were found in the RO than control group, and more transient vocal cord palsy was found in the EAx and EBAB groups. MIVA ranked first in terms of operative time, postoperative drainage amount, postoperative pain, and hospitalization, but cosmetic satisfaction was low. EAx, RAx, and MIVA ranked higher than the other approaches in terms of operative bleeding. CONCLUSION It was confirmed that minimally invasive thyroidectomy achieves high cosmetic satisfaction and is not inferior to conventional thyroidectomy in terms of surgical results or perioperative complications. Laryngoscope, 133:2470-2479, 2023.
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Affiliation(s)
- Do Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Won Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Geun-Jeon Kim
- Department of Otolaryngology-Head and Neck Surgery, Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Mohammed A Basurrah
- Department of Surgery, College of Medicine, Taif University, Taif, Saudi Arabia
| | - Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, Bucheon Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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8
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Kang YJ, Stybayeva G, Hwang SH. Surgical completeness and safety of minimally invasive thyroidectomy in patients with thyroid cancer: A network meta-analysis. Surgery 2023; 173:1381-1390. [PMID: 36973129 DOI: 10.1016/j.surg.2023.02.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 01/09/2023] [Accepted: 02/19/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND To assess the surgical outcomes of various minimally invasive and remote-access surgical approaches for thyroid cancer patients. METHODS We collected studies from January 2020 to July 2022 in 6 databases. Pairwise and network meta-analyses were performed for outcomes and complications of 9 minimally invasive interventions (minimally invasive video-assisted, endoscopic or robotic bilateral axillo-breast approach, endoscopic or robotic postauricular, endoscopic or robot transaxillary approach, transoral endoscopic thyroidectomy vestibular approach or robotic thyroidectomy) and conventional thyroidectomy (control). RESULTS Multiplicity and bilaterality of cancer, lymph node metastasis, and coincidence of thyroiditis showed no significant difference between minimally invasive interventions and control. However, larger tumor size (robotic bilateral axillo-breast approach standardized mean difference -1.3989, 95% confidence interval [-2.1717 to -0.6262]), higher body mass index (robot transaxillary approach standardized mean difference -0.5350, 95% confidence interval [-0.9557 to -0.1144], robotic bilateral axillo-breast approach standardized mean difference -0.2301, 95% confidence interval [-0.4389 to -0.0214]), and frequent extrathyroidal extension (robotic bilateral axillo-breast approach standardized mean difference 0.7435, 95% confidence interval [0.5602-0.9869]) were observed in control. In surgical outcomes and adverse effects, there was no significant difference in hospitalization or retrieved lymph node number between minimally invasive interventions and control. However, longer operative time was observed in the robotic bilateral axillo-breast approach(standardized mean difference 6.5393, 95% confidence interval [5.0476-8.0309]) and transoral robotic thyroidectomy (standardized mean difference 5.4946, 95% confidence interval [2.9984-7.9907]) groups than in control. In surgical completion, the rate of low postoperative serum thyroglobulin, postoperative thyroglobulin level, and postoperative radioactive iodine ablation dose showed no significant difference between minimally invasive interventions and control. CONCLUSION Minimally invasive thyroidectomy did not show inferior results compared to conventional thyroidectomy despite the longer operative time. Surgeons need to prudently consider all aspects of patients to determine the proper surgical approach for thyroid cancer.
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Affiliation(s)
- Yun Jin Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Gulnaz Stybayeva
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN
| | - Se Hwan Hwang
- Department of Otorhinolaryngology-Head and Neck Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Yuan Y, Sun C, Yin T, Shao C, Pan B, Lu D, Hou S, Lowe S, Bentley R, Chen S, Huang C, Cheng C, Li Y, King B, Zhou Q, Yan C, Zhang F. Comparison of endoscopic thyroidectomy by complete areola approach and conventional open surgery in the treatment of differentiated thyroid carcinoma: A retrospective study and meta-analysis. Front Surg 2022; 9:1000011. [PMID: 36605164 PMCID: PMC9807756 DOI: 10.3389/fsurg.2022.1000011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Background The feasibility of endoscopic thyroidectomy by complete areola approach (ETCA) remains controversial. This study was conducted by combining our clinical data with the data obtained from a systematic review literature search to examine the effectiveness and safety of ETCA compared with conventional open thyroidectomy (COT) in differentiated thyroid carcinoma (DTC). Methods A total of 136 patients with a diagnosis of DTC who underwent unilateral thyroidectomy with central neck dissection from August 2020 to June 2021 were enrolled. The enrolled patients were divided into the ETCA group (n = 73) and the COT group (n = 63). The operative time, intraoperative bleeding volume, number of removed lymph nodes, number of metastatic lymph nodes, postoperative drainage volume, length of postoperative hospital stay, postoperative parathyroid hormone (PTH) levels, and complications were analyzed. Then, a systemic review and comprehensive literature search were conducted by using PubMed, Google Scholar, Embase, Web of Science, CNKI, Wanfang, and VIP database up to June 2022. Review Manager software version 5.3 was used for the meta-analysis. Results The results of clinical data showed that there were significant differences between the two groups in the operative time, intraoperative bleeding volume, removed lymph nodes, and postoperative drainage volume. There were no statistical differences in the length of postoperative hospital stay, number of metastatic lymph nodes, postoperative PTH level, and complications. In the systematic review and meta-analysis, 2,153 patients from fourteen studies (including our data) were ultimately included. The results of the meta-analysis found that ETCA had a longer operative time, larger postoperative drainage volume, and lower intraoperative bleeding volume. In terms of the length of postoperative hospital stay, the number of removed lymph nodes, and surgical complications, there was no significant difference between the two groups. Conclusion ETCA poses lower surgical bleeding and better cosmetic appearance compared with COT, while the length of operation and postoperative drainage in ETCA is less favorable compared with COT. In addition, ETCA is not inferior to COT in terms of the postoperative hospitalization stay, the number of removed lymph nodes, and surgical complications. Given its overall advantages and risks, ETCA is an effective and safe alternative for patients with cosmetic concerns.
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Affiliation(s)
- Yuquan Yuan
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China,Graduate School of Medicine, Chongqing Medical University, Chongqing, China
| | - Chenyu Sun
- Department of Medicine, AMITA Health Saint Joseph Hospital Chicago, Chicago, IL, United States
| | - Tingjie Yin
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Cong Shao
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China
| | - Bin Pan
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China,Graduate School of Medicine, Chongqing Medical University, Chongqing, China
| | - Dengwei Lu
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China,Graduate School of Medicine, Chongqing Medical University, Chongqing, China
| | - Shaodong Hou
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China,Graduate School of Medicine, North Sichuan Medical College, Nanchong, China
| | - Scott Lowe
- College of Osteopathic Medicine, Kansas City University, Kansas, MO, United States
| | - Rachel Bentley
- College of Osteopathic Medicine, Kansas City University, Kansas, MO, United States
| | - Shuya Chen
- Foundation Program, Newham University Hospital, London, England, United Kingdom
| | - Christy Huang
- California Health Sciences University College of Osteopathic Medicine, Clovis, CA, United States
| | - Ce Cheng
- Hematology and Medical Oncology, St. Joseph Mercy Ann Arbor Hospital, Ypsilanti, MI, United States
| | - Yaru Li
- Internal Medicine, Swedish Hospital, Chicago, IL, United States
| | - Bethany King
- Internal Medicine, Mercy One Des Moines Medical Center, Des Moines, IA, United States
| | - Qin Zhou
- Radiation Oncology, Mayo Clinic, Rochester, MN, United States
| | - Cunye Yan
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China,Correspondence: Cunye Yan Fan Zhang
| | - Fan Zhang
- Department of Breast and Thyroid Surgery, Chongqing General Hospital, Chongqing, China,Graduate School of Medicine, Chongqing Medical University, Chongqing, China,Correspondence: Cunye Yan Fan Zhang
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10
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Xie F, Wang ZH, Wu SS, Gang TR, Gao GX, Qu X, Zhang ZT. Comparing outcomes of single-port insufflation endoscopic breast-conserving surgery and conventional open approach for breast cancer. World J Surg Oncol 2022; 20:335. [PMID: 36203177 PMCID: PMC9535932 DOI: 10.1186/s12957-022-02798-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 09/24/2022] [Indexed: 12/09/2022] Open
Abstract
Background In the surgical treatment of breast cancer, the goal of surgeons is to continually create and improve minimally invasive surgical techniques to increase patients’ quality of life. Currently, routine breast-conserving surgery is often performed using two obvious incisions. Here, we compare the clinical efficacy and aesthetic outcomes of a novel technique using one incision, called ‘single-port insufflation endoscopic breast-conserving surgery’ (SIE-BCS), vs. conventional breast-conserving surgery (C-BCS) in patients with early-stage breast cancer. Methods A total of 180 patients with stage I or stage II breast cancer participated in this study, of whom 63 underwent SIE-BCS and 117 underwent C-BCS. Logistic regression analysis was conducted to assess the risk of local recurrence and metastasis. Aesthetic outcomes were evaluated using the BREAST-Q scale. Results The mean operation time was significantly longer for SIE-BCS (194.9 ± 71.5 min) than for C-BCS (140.3 ± 56.9 min), but the mean incision length was significantly shorter for SIE-BCS than for C-BCS (3.4 ± 1.2 cm vs. 8.6 ± 2.3 cm). While both surgeries yielded similar BREAST-Q ratings for satisfaction with breasts and sexual well-being, SIE-BCS was associated with significantly better ratings for physical well-being (chest area) and psychological well-being. Additionally, SIE-BCS was associated with decreased rates of adverse effects of radiation. The preliminary analysis showed that SIE-BCS did not increase the risk of local recurrence or metastasis. Conclusion The novel single-port insufflation endoscopic assisted BCS technique is feasible, safe, and improves patients’ postoperative comfort and psychological well-being, as compared to the conventional technique.
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Affiliation(s)
- Fang Xie
- General Surgery Department, Beijing Friendship Hospital, Capital Medical University, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China.,Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, 23 Mei shu guan Back Street, Dong-Cheng District, Beijing, 100010, China
| | - Zi-Han Wang
- Department of Breast Disease, Peking University People's Hospital, 11 Xi zhi men South Street, Xi-Cheng District, Beijing, 100044, China
| | - Shan-Shan Wu
- Department of Clinical Epidemiology and Evidence-Based Medicine, Beijing Friendship Hospital, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China
| | - Tian-Ran Gang
- General Surgery Department, Beijing Friendship Hospital, Capital Medical University, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China
| | - Guo-Xuan Gao
- General Surgery Department, Beijing Friendship Hospital, Capital Medical University, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China
| | - Xiang Qu
- General Surgery Department, Beijing Friendship Hospital, Capital Medical University, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China.
| | - Zhong-Tao Zhang
- General Surgery Department, Beijing Friendship Hospital, Capital Medical University, 95 Yong-an Road, Xi-Cheng District, Beijing, 100050, China.
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Kang YJ, Cho JH, Stybayeva G, Hwang SH. Safety and Efficacy of Transoral Robotic Thyroidectomy for Thyroid Tumor: A Systematic Review and Meta-Analysis. Cancers (Basel) 2022; 14:cancers14174230. [PMID: 36077768 PMCID: PMC9454701 DOI: 10.3390/cancers14174230] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 12/05/2022] Open
Abstract
Simple Summary This systemic review and meta-analysis compared and analyzed the safety and effectiveness of transoral robotic thyroidectomy on the thyroid tumor with other thyroid approaches. Transoral robotic thyroidectomy showed similar results to other robotic-assisted thyroid surgeries. Compared to a conventional open thyroidectomy, transoral robotic thyroidectomy had longer operational times and hospitalization days, and worse postoperative pain, but a higher cosmetic satiation score. However, more randomized controlled studies need to be included and analyzed. Abstract Background: To assess the safety and effectiveness of transoral robotic thyroidectomy (TORT) in thyroid tumor. Methods: PubMed, Embase, Web of Science, SCOPUS, Cochrane database, and Google Scholar up to June 2022. Studies comparing outcomes and complications between TORT and control groups (robotic bilateral axillo-breast, trans-axillary, postauricular approach, conventional open thyroidectomy (OT), and transoral endoscopic approach) were analyzed. Results: Ten studies of 1420 individuals. The operative time (SMD 1.15, 95%CI [0.48; 1.89]) was significantly longer and the number of retrieved lymph nodes (LNs) (SMD −0.27, 95%CI [−0.39; −0.16]) was fewer in TORT than in the control group. The postoperative cosmetic satisfaction score (SMD 0.60, 95%CI [0.28; 0.92]) was statistically higher in TORT than in the control group. In subgroup analysis, there was no significant difference between robotic surgeries. However, TORT had significantly longer operative times (SMD 2.08, 95%CI [0.95; 3.20]) and fewer retrieved LNs (SMD −0.32, 95%CI [−0.46; −0.17]) than OT. TORT satisfied significantly more patients in cosmetic view. However, it increased hospitalization days and postoperative pain on the operation day and first day compared to OT. Conclusions: TORT is not inferior to other robotic-assisted approaches. Its operation time and hospitalization days are longer and postoperative pain is greater than OT, although its cosmetic satisfaction is high.
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Affiliation(s)
- Yun Jin Kang
- Department of Otolaryngology-Head and Neck Surgery, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Jin-Hee Cho
- Department of Otolaryngology-Head and Neck Surgery, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
| | - Gulnaz Stybayeva
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, USA
| | - Se Hwan Hwang
- Department of Otolaryngology-Head and Neck Surgery, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea
- Correspondence: ; Tel.: +82-32-340-7044
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12
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Chen Y, Wang C, Bai B, Ye M, Ma J, Zhang J, Li Z. Drainage Tube Placement May Not Be Necessary During Endoscopic Thyroidectomy Bilateral Areola Approach: A Preliminary Report. Front Surg 2022; 9:860130. [PMID: 35356502 PMCID: PMC8960029 DOI: 10.3389/fsurg.2022.860130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 02/15/2022] [Indexed: 01/19/2023] Open
Abstract
Background The endoscopic thyroidectomy bilateral areola approach (ETBAA) improved cosmetic outcomes significantly and is now widely applied. The usage of drainage tubes is controversial in conventional open thyroidectomy (COT), but studies about drainage placement decisions during ETBAA are still limited. This study aimed to determine the feasibility of having no drainage tube applied during ETBAA on patients with papillary thyroid carcinoma. Methods The clinical data of patients undergoing ETBAA from July 2018 to May 2021 was retrospectively collected. The patients were divided into two groups based on drain placement: no-drain and drain. The two groups were matched at a ratio of 1:1. Fifty-five patients from each group were finally included. Postoperative complications and follow-up data were compared between the two groups. Results No significant difference was observed between the two groups in the incidence of postoperative complications, including hemorrhage, surgical site infection, and subcutaneous seroma. Compared with the drain group, the operation time of the no-drain group was significantly shorter [(107.75 ± 24.59) min vs. (119.91 ± 34.05) min, P < 0.05]. The total and postoperative hospital stay was significantly shorter in the no-drain group [(2.40 ± 0.71) days vs. (4.78 ± 1.33) days, P < 0.001, (2.04 ± 0.19) days vs. (2.15 ± 0.36) days, P < 0.05], and the costs of surgical consumables were also significantly lower [(6,820.83 ± 164.29) CNY vs. (7,494.13 ± 216.7) CNY, P < 0.05]. The postoperative pain score of the no-drain group was significantly lower than the drain group [(1.58 ± 0.63) vs. (1.89 ± 0.76), P < 0.05]. Conclusions No drainage applied during ETBAA on papillary thyroid carcinoma is safe and feasible. This practice does not increase the risk of postoperative complications, but it does shorten the operation time and hospital stay, as well as reduce medical costs. Furthermore, it alleviates the suffering of patients.
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Affiliation(s)
- Yukai Chen
- Department of Thyroid Surgery, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Chengchen Wang
- Department of General Surgery, International Medical Center of Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Binglong Bai
- Department of Thyroid Surgery, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Mao Ye
- Department of Thyroid Surgery, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Junjie Ma
- Department of Thyroid Surgery, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Jingying Zhang
- Department of Thyroid Surgery, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
- *Correspondence: Jingying Zhang
| | - Zhiyu Li
- Department of Thyroid Surgery, Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
- Zhiyu Li
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Transaxillary gasless endoscopic thyroidectomy versus conventional open thyroidectomy: systematic review and meta-analysis. Wideochir Inne Tech Maloinwazyjne 2021; 16:482-490. [PMID: 34691299 PMCID: PMC8512510 DOI: 10.5114/wiitm.2021.105722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/18/2021] [Indexed: 02/06/2023] Open
Abstract
Aim This systematic review and meta-analysis evaluates surgical outcome and safety results of conventional (OT) versus endoscopic transaxillary gasless thyroidectomies (ET). Material and methods A systematic literature search was performed. The weighted mean differences or the odd ratios with corresponding 95% CIs were examined for surgical outcomes and complications. The results were analysed using fixed- or random-effects models. The heterogeneity was checked by the Cochran Q test and the extent of inconsistency was evaluated by the I2 statistic. Results Ten studies and 1597 patients were included. All studies found that ET required longer operative time. Postoperative pain was significantly lower after ET on day 1 and day 7. No statistical difference was found in complication rates. Conclusions ET has disadvantages such as longer surgery time, but it is a feasible and safe procedure with lower postoperative pain and comparable complication rates to OT. However, good quality prospective randomised studies are necessary to draw firmer conclusions.
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14
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Chen Y, Xu S, Zeng X, Liang Y, Xu J. Comparison of the effectiveness and safety between endoscopic-assisted lateral neck dissection and conventional open lateral neck dissection:A meta-analysis. Asian J Surg 2021; 45:1809-1816. [PMID: 34649793 DOI: 10.1016/j.asjsur.2021.09.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 09/23/2021] [Accepted: 09/30/2021] [Indexed: 11/02/2022] Open
Abstract
The objective of this study was to systematically evaluate the effectiveness and safety of endoscopic-assisted lateral neck dissection (EALND) compared with conventional open lateral neck dissection (COLND) for the treatment of thyroid cancer with positive lymph node metastases. Medical literature databases including PubMed, Embase, the Cochrane Library, CNKI, Wan Fang and VIP were systematically searched for articles that compared EALND and COLND for the treatment of thyroid carcinoma with lymph node metastasis, up to June 2019. The quality of included studies was evaluated using the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using RevMan 5.3 software after two evaluators independently screened the literature, extracted information and evaluated the methodological quality of included studies according to inclusion and exclusion criteria, resulting in the selection of seven studies with a total of 372 patients from six non-RCTs and an RCT. The results of meta-analysis showed that EALND was associated with a longer operative time (MD = 24.86, 95∗CI:21.76 to 27.96, P<0.05), with a shorter postoperative stay (MD = -1.45, 95%CI:-2.70 to -0.21,P = 0.02), reduced length of scar (MD = -8.14,95%CI:-8.41 to -7.88, P<0.00001) and a lower incidence of neck discomfort (OR = 0.19, 95%CI:0.07 to 0.58, P = 0.003) compared with COLND. The incidences in both groups of transient hypocalcemia (OR = 0.66,95%CI:0.28 to 1.55,P = 0.343), transient hoarseness (OR = 0.58,95%CI:0.17 to 1.93,P = 0.38),chylous fistula (OR = 0.69,95%CI:0.26 to 1.83,P = 0.45), choking on water (OR = 0.24,95%CI:0.04 to 1.31,P = 0.10) and the number of lymph nodes retrieved from the lateral cervical region (MD = 0.14,95%CI:-0.36 to 0.65,P = 0.59) were not statistically significant. It was concluded that EALND was safe and feasible compared with COLND, despite the longer operation time. The incision was more aesthetically pleasing and the postoperative recovery was quicker, which makes EALND a clinical procedure worthy of use in such cases.
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Affiliation(s)
- Yongqiang Chen
- Department of Thyroid Breast Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, 362000, PR China
| | - Shuangta Xu
- Department of Thyroid Breast Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, 362000, PR China
| | - Xiaoshan Zeng
- Department of Thyroid Breast Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, 362000, PR China
| | - Yinghui Liang
- Department of Thyroid Breast Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, 362000, PR China
| | - Jianhua Xu
- Department of Thyroid Breast Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, Fujian, 362000, PR China.
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15
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Chand G, Gupta N, Johri G, Mishra A, Mishra SK. Changing paradigms in endoscopic thyroid surgery: A comparison between scarless-in-the-neck axillo-breast approach and totally scarless transoral approach. J Minim Access Surg 2021; 17:509-512. [PMID: 34558426 PMCID: PMC8486047 DOI: 10.4103/jmas.jmas_11_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: To avoid cervical scar in thyroid surgery, various approaches have been proposed. The commonly used approach is combined axillo-breast approach (ABA). However, trans-orovestibular approach (TOVA) is getting popular. The aim of this study is to compare surgical outcomes of patients who underwent endoscopic hemithyroidectomy (EHT) by either ABA or TOVA. Patients and Methods: This was a retrospective analysis of clinical data of patients who underwent EHT from January 2013 to December 2018. Patients were divided into two groups: Group A – through ABA and Group B – through TOVA. Results: A total of eighty patients underwent EHT in Group A and 25 in Group B. In both groups, most patients were female (male: female = 1:4.7 in Group A and 1:7.33 in Group B, P = 0.515). In both groups, there was no difference in age (the mean age was 33.44 ± 10.44 years in Group A and 33.04 ± 14.01 years in Group B, P = 0.391) and in size of the nodule (Group A – 3.91 ± 1.17 cm and Group B – 3.6 ± 1.39 cm, P = 0.228). The operating time was significantly less in Group B (Group A – 152.25 ± 30.19 mins and Group B – 126.80 ± 22.94 mins, P ≤ 0.01). The post-operative hospital stay was significantly less in Group B (mean 3.17 ± 0.97 days in Group A and 2.24 ± 0.60 days in Group B, P ≤ 0.01). Conclusion: TOVA is associated with shorter operating time and hospital stay with comparable outcomes. Cosmetic outcome is excellent in TOVA, however requires further subjective evaluation.
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Affiliation(s)
- Gyan Chand
- Department of Endocrine Surgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Nitish Gupta
- Department of Endocrine Surgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Goonj Johri
- Department of Endocrine Surgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Anjali Mishra
- Department of Endocrine Surgery, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Saroj Kant Mishra
- Department of Endocrine Surgery, SGPGIMS, Lucknow, Uttar Pradesh, India
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Abstract
Technological developments have disrupted the practice of medicine throughout history. Endoscopic and robotic techniques in head and neck surgery have emerged over the past half-century and have been incrementally adapted to expanding indications within otolaryngology. Robotic and endoscopic surgery have an established role in treatment of oropharyngeal and laryngeal cancers, reducing surgical morbidity and improving survival relative to traditional open approaches. Surgical treatment of human papillomavirus-mediated oropharyngeal cancer via transoral robotic surgery offers equivalent oncologic and functional outcomes relative to radiotherapy. Newer iterations of single-port robotic systems continue to expand the scope of robotics in head and neck surgery.
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17
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Preliminary Study on the Clinical Significance and Methods of Using Carbon Nanoparticles in Endoscopic Papillary Thyroid Cancer Surgery. CONTRAST MEDIA & MOLECULAR IMAGING 2021; 2021:6652315. [PMID: 33994886 PMCID: PMC8096569 DOI: 10.1155/2021/6652315] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/19/2021] [Accepted: 04/16/2021] [Indexed: 12/12/2022]
Abstract
Purpose The purpose of this study was to find the clinical significance and methods of using CN in endoscopic treatment for PTC. Materials and Methods A total of 108 cases were randomly enrolled and divided into two groups, with 50 cases in the CN injection group who were injected with CN and 58 cases in the control group with no CN injection. All cases were analyzed with the size of carcinoma, the number of lymph node, and parathyroid gland injury. Results All operations were successfully completed. The lymph node dissection number was 274 for the control group and 322 (the rate of black stained was 87%) for the CN injection group. The average number of lymph nodes in the CN injection group was 6.44 ± 2.08, which was significantly higher than that in the control group (4.72 ± 1.89). The control group had a relatively higher incidence of incidental parathyroidectomy, compared to the CN injection group (27.6% in the control group vs. 12% in the CN injection group, P=0.045). However, the incidence of hypoparathyroidism failed to show the significant difference between the two groups. Conclusion Using CN in endoscopic PTC surgery could increase the detection rate of lymph nodes and reduce the injury of parathyroid glands to a certain extent.
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18
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de Vries LH, Aykan D, Lodewijk L, Damen JAA, Borel Rinkes IHM, Vriens MR. Outcomes of Minimally Invasive Thyroid Surgery - A Systematic Review and Meta-Analysis. Front Endocrinol (Lausanne) 2021; 12:719397. [PMID: 34456874 PMCID: PMC8387875 DOI: 10.3389/fendo.2021.719397] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/26/2021] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Conventional thyroidectomy has been standard of care for surgical thyroid nodules. For cosmetic purposes different minimally invasive and remote-access surgical approaches have been developed. At present, the most used robotic and endoscopic thyroidectomy approaches are minimally invasive video assisted thyroidectomy (MIVAT), bilateral axillo-breast approach endoscopic thyroidectomy (BABA-ET), bilateral axillo-breast approach robotic thyroidectomy (BABA-RT), transoral endoscopic thyroidectomy via vestibular approach (TOETVA), retro-auricular endoscopic thyroidectomy (RA-ET), retro-auricular robotic thyroidectomy (RA-RT), gasless transaxillary endoscopic thyroidectomy (GTET) and robot assisted transaxillary surgery (RATS). The purpose of this systematic review was to evaluate whether minimally invasive techniques are not inferior to conventional thyroidectomy. METHODS A systematic search was conducted in Medline, Embase and Web of Science to identify original articles investigating operating time, length of hospital stay and complication rates regarding recurrent laryngeal nerve injury and hypocalcemia, of the different minimally invasive techniques. RESULTS Out of 569 identified manuscripts, 98 studies met the inclusion criteria. Most studies were retrospective in nature. The results of the systematic review varied. Thirty-one articles were included in the meta-analysis. Compared to the standard of care, the meta-analysis showed no significant difference in length of hospital stay, except a longer stay after BABA-ET. No significant difference in incidence of recurrent laryngeal nerve injury and hypocalcemia was seen. As expected, operating time was significantly longer for most minimally invasive techniques. CONCLUSIONS This is the first comprehensive systematic review and meta-analysis comparing the eight most commonly used minimally invasive thyroid surgeries individually with standard of care. It can be concluded that minimally invasive techniques do not lead to more complications or longer hospital stay and are, therefore, not inferior to conventional thyroidectomy.
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Affiliation(s)
- Lisa H. de Vries
- Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Dilay Aykan
- Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Lutske Lodewijk
- Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Johanna A. A. Damen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Inne H. M. Borel Rinkes
- Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Menno R. Vriens
- Department of Surgical Oncology and Endocrine Surgery, University Medical Center Utrecht, Utrecht, Netherlands
- *Correspondence: Menno R. Vriens,
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Trends in Oncology: an Updated Review of Minimally Invasive Surgery vs. Traditional Open Surgery. JOURNAL OF INTERDISCIPLINARY MEDICINE 2020. [DOI: 10.2478/jim-2020-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objective: To review the recent trends in methodology for the most frequent oncological surgeries. More specifically, this paper will compare the minimally invasive methods to the conventional open method. It aims to find out whether minimally invasive surgeries are feasible treatments for certain types of cancers.
Methods: A review of retrospective studies searched in PubMed, Cochrane Library etc. was used to identify the studies published on this topic within a period of 6 years. Oncologic outcomes, postoperative complications/outcomes, and intraoperative outcomes were the main variables in the comparison to the surgical methods under review.
Conclusion: Despite the recent controversy with minimally invasive surgery being contraindicated for cervical cancer, it is still an acceptable method for other types of common cancers. However, there are limitations to the approach, and the surgeon should make a prudent selection between minimally invasive and open surgery depending on the type of tumor and patient characteristics. Further studies, especially with randomized control trials, must be conducted.
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20
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Endoscopic thyroidectomy via axillary-breast-shoulder approach: Early experience of 42 cases. Surg Oncol 2020; 34:318-323. [PMID: 32781312 DOI: 10.1016/j.suronc.2020.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 05/17/2020] [Accepted: 05/22/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Most patients in Indonesia present with large-sized thyroid nodules, which need surgical removal to exclude malignancy. Many surgeons prefer endoscopic thyroidectomy to avoid a large and visible surgical scar on the neck and to reduce postoperative complications. This study aims to evaluate and analyze surgical feasibility, safety, oncologic outcome, and patient satisfaction of endoscopic thyroidectomy via the axillary-breast-shoulder approach. METHODS Between August 2010 and September 2015, 42 endoscopic thyroidectomies via the axillary-breast-shoulder approach with carbon dioxide insufflation up to 8-10 mmHg were performed and retrospectively reviewed. RESULTS Mean tumor size and operative time were 3.11 ± 0.99 cm and 189 ± 45 min, respectively. Mean blood loss was 68.3 mL. There were temporary complications such as hoarseness (19%), emphysema (2.3%) and hematoma (2.3%). Mean hospital length of stay was 3.98 days. Most subjects (61.9%) were very satisfied with the postoperative scar. The visual analog score of postoperative pain decreased from 4.83 on day-1 to 2.28 on day-7. The tumor recurrence was 9.6%. CONCLUSIONS Endoscopic thyroidectomy via the axillary-breast-shoulder approach is feasible, safe, and minimally invasive with excellent postoperative results.
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21
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Imran M, Mehmood Z, Baloch MN, Altaf S. Endoscopic thyroid lobectomy vs Conventional open thyroid lobectomy. Pak J Med Sci 2020; 36:831-835. [PMID: 32494283 PMCID: PMC7260891 DOI: 10.12669/pjms.36.4.1604] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 11/05/2019] [Accepted: 04/08/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Surgical managements for these suspicious nontoxic swellings requires open conventional method of thyroidectomy by neck incisions that can result in prominent scars and immediate risk usually hemorrhage. However new technological innovations came into practiced that include video assisted minimal invasive endoscopy by axillo-breast approach that gives very promising results with excellent cosmesis. In this study, we compared conventional open surgery with minimal invasive endoscopic techniques and associate various complaints and complications that were encountered in surgery. METHODS Sixty patients were enrolled in this comparative study. It was conducted from period February 2018 to February 2019. The patients were randomized alternatively in two groups. Group-I patients underwent conventional lobectomy while Group-II patients were operated endoscopically, Patients having nodules less than 3cm and Thy 1 and 2 were included in this study. Patient having nodules greater than 3cm, Multinodular goiter, recurrent nodule and Thy 3-6 were excluded from the study. RESULTS Patients who underwent endoscopic lobectomy were much more satisfied about scar marks whereas some developed post-operative complications. It included hoarseness of voice in Three (13.62%) patients, two patients developed seroma (9.08%), three patients (13.62%) erythema, whereas no postoperative complications were seen in patients who underwent open thyroid lobectomy. No signs of hypocalcemia noted in both approaches. CONCLUSIONS The complications with endoscopic approaches are higher but they are minor and resolved spontaneously within maximum period of six weeks. However scar mark satisfaction was much higher in endoscopic lobectomy group.
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Affiliation(s)
- Mariam Imran
- Dr. Mariam Imran, Department of Surgery Ward 25, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Zahid Mehmood
- Dr. Zahid Mehmood, FCPS FRCS FACS. Department of Surgery Ward 25, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Muhammad Naseem Baloch
- Dr. Muhammad Naseem Baloch, FCPS FACS. Department of Surgery Ward 25, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Sehrish Altaf
- Dr. Sehrish Altaf, Department of Surgery Ward 25, Jinnah Postgraduate Medical Center, Karachi, Pakistan
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Kaliszewski K, Wojtczak B, Sutkowski K, Rudnicki J. Thyroid cancer surgery - in what direction are we going? A mini-review. J Int Med Res 2020; 48:300060520914803. [PMID: 32249645 PMCID: PMC7136939 DOI: 10.1177/0300060520914803] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 03/02/2020] [Indexed: 12/17/2022] Open
Abstract
The prevalence of thyroid cancer, especially in women, is increasing dramatically. Therefore, patients often undergo thyroidectomy upon diagnosis. However, the cosmetic outcome after surgery is of particular concern for many patients. Thus, minimally invasive procedures for treating thyroid disease have been established in recent decades. Total endoscopic and robotic procedures have been slowly and successively introduced while meeting all oncological criteria. Our analysis of the advantages and disadvantages of scarless surgical procedures suggests that the cosmetic aspects of these surgeries will continue to become more important. This review assesses the recent findings regarding the roles of endoscopic and robotic procedures in thyroid cancer surgery.
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Affiliation(s)
- Krzysztof Kaliszewski
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Beata Wojtczak
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Krzysztof Sutkowski
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Jerzy Rudnicki
- Department of General, Minimally Invasive and Endocrine Surgery, Wroclaw Medical University, Wroclaw, Poland
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Liu S, Zhang D, Chen L, Gao S, Huang X. Long non-coding RNA BRM promotes proliferation and invasion of papillary thyroid carcinoma by regulating the microRNA-331-3p/SLC25A1 axis. Oncol Lett 2020; 19:3071-3078. [PMID: 32218861 PMCID: PMC7068577 DOI: 10.3892/ol.2020.11418] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 08/30/2019] [Indexed: 12/12/2022] Open
Abstract
Long non-coding RNA BRM (lncBRM) was first identified in liver cancer stem cells and was reported to promote multiple cancer types. However, the function of lncBRM in papillary thyroid carcinoma (PTC) remains unclear. The primary focus of the present study was to determine the biological role of lncBRM in PTC. Reverse transcription-quantitative PCR assays revealed that lncBRM was upregulated in PTC tissues and cells. Cell Counting Kit-8, Transwell invasion and colony-formation assays were performed to assess cell proliferation, invasion and migration, respectively. Furthermore, high expression of lncBRM was associated with poor overall survival time in patients with PTC. lncBRM knockout significantly suppressed cell proliferation, migration and invasion. lncBRM was predicted to bind to microRNA (miR)-331-3p and targets SLC25A1. Overexpression of miR-331-3p or inhibition of SLC25A1 resulted in significantly suppressed proliferation, migration and invasion of PTC cells. Rescue assays demonstrated that inhibition of miR-331-3p significantly abrogated the effects of lncBRM knockout on PTC cell proliferation, migration and invasion. In conclusion, the present study suggests that lncBRM promotes PTC by regulating miR-331-3p and targeting SLC25A1.
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Affiliation(s)
- Shihong Liu
- Department of Nuclear Medicine, The People's Hospital of Tong Liang District, Chongqing 402560, P.R. China
| | - Deping Zhang
- Department of Nuclear Medicine, The People's Hospital of Tong Liang District, Chongqing 402560, P.R. China
| | - Li Chen
- Department of Nuclear Medicine, The People's Hospital of Tong Liang District, Chongqing 402560, P.R. China
| | - Shangfang Gao
- Department of Nuclear Medicine, The People's Hospital of Tong Liang District, Chongqing 402560, P.R. China
| | - Xiu Huang
- Department of Radiography, The People's Hospital of Tong Liang District, Chongqing 402560, P.R. China
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