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Issa PP, Cironi K, Rezvani L, Kandil E. Radiofrequency ablation of thyroid nodules: a clinical review of treatment complications. Gland Surg 2024; 13:77-86. [PMID: 38323235 PMCID: PMC10839694 DOI: 10.21037/gs-22-539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 05/31/2023] [Indexed: 02/08/2024]
Abstract
Radiofrequency ablation (RFA) is a minimally invasive ablative modality for the treatment of thyroid nodules. Reports of RFA use have demonstrated an impressive safety profile and excellent volume reduction rates between 60-90%. Given its increased popularity in the United States as well as globally, numerous recent works have been published and a discussant of relevant complications incorporating recent insight may assist practitioners in minimizing complications and optimizing patient outcomes. Herein, we provide a comprehensive and updated review of the reported complications and side effects following RFA, summarizing their frequency and clinical presentation. We also describe a means of minimizing such complications and/or side effects. Overall, the safety profile of RFA is impressive and superior to that of thyroid surgery. The overall risk of complication is reportedly 2-3%. The risk of permanent complication or severe injury is very unlikely, below 1%. Complications are infrequent, but may be nerve-related, endocrine-related, or iatrogenic-related, and consequences of localized heat delivery. The vast majority of complications related to RFA can be managed conservatively, without need for invasive measures. This review will assist surgeons and clinicians in recognizing and treating the various complications and side effects in clinical practice.
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Affiliation(s)
- Peter P. Issa
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
- Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA
| | | | - Leely Rezvani
- Tulane University School of Medicine, New Orleans, LA, USA
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
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Issa PP, Kandil E, Lee GS. Radiofrequency ablation as a treatment modality for primary hyperparathyroidism: a systematic literature review. Gland Surg 2024; 13:87-99. [PMID: 38323227 PMCID: PMC10839703 DOI: 10.21037/gs-22-546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 05/19/2023] [Indexed: 02/08/2024]
Abstract
Background Primary hyperparathyroidism (pHPT) is an endocrine disorder typically characterized by elevated serum calcium and elevated parathyroid hormone (PTH). While parathyroidectomy is the standard treatment, non-operative intervention such as radiofrequency ablation (RFA) has been adopted as an alternative for the management of pHPT, as it has been utilized in other endocrine glands such as thyroid and adrenal. In this literature review, we aim to evaluate the current practice of RFA for pHPT. Methods A systematic literature search using PubMed, Web of Science, and Embase through June 2022 was conducted. Studies included in the review consisted of patient cohorts who had an unequivocal diagnosis of pHPT and underwent the treatment of pHPT with RFA. When more than one study was published from a similar cohort of patients, only the study with the most number of patients was considered. Studies included were assessed for bias using the critical appraisal instruments from the Joanna Briggs Institute (JBI) System. Results A total of 14 studies describing 167 parathyroid glands treated in 163 patients were reviewed. The overall cure rate was 91.2%, with 5 patients undergoing more than one ablation. The most common adverse effect encountered was temporary dysphonia. Incomplete ablation and missed multiglandular disease were the most common reasons for RFA treatment failure. Conclusions RFA may be an effective and safe alternative to parathyroidectomy in select patients with a well-localized, well-located parathyroid adenoma. Additional long-term data are needed to refine its role in the pHPT treatment algorithm.
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Affiliation(s)
- Peter P. Issa
- Louisiana State University Health Sciences Center School of Medicine, New Orleans, LA, USA
| | - Emad Kandil
- Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA
| | - Grace S. Lee
- Department of Surgery, Yale University School of Medicine, New Haven, CT, USA
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Dolidze DD, Shabunin AV, Mumladze RB, Vardanyan AV, Covantsev SD, Shulutko AM, Semikov VI, Isaev KM, Kazaryan AM. A Narrative Review of Preventive Central Lymph Node Dissection in Patients With Papillary Thyroid Cancer - A Necessity or an Excess. Front Oncol 2022; 12:906695. [PMID: 35847927 PMCID: PMC9278848 DOI: 10.3389/fonc.2022.906695] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/03/2022] [Indexed: 02/05/2023] Open
Abstract
ObjectiveThis review article summarises the latest evidence for preventive central lymph node dissection in patients with papillary thyroid cancer taking into account the possible complications and risk of recurrence.BackgroundPapillary thyroid cancer is the most frequent histological variant of malignant neoplasms of the thyroid gland. It accounts for about 80-85% of all cases of thyroid cancer. Despite good postoperative results and an excellent survival rate in comparison with many other malignant diseases, tumor metastases to the cervical lymph nodes are frequent. Most researchers agree that the presence of obvious metastases in the lymph nodes requires careful lymph node dissection. It was suggested to perform preventive routine lymphadenectomy in all patients with malignant thyroid diseases referred to surgery.MethodsIt was performed the literature review using the “papillary thyroid cancer”, “central lymph node dissection”, “hypocalcemia”, “recurrent laryngeal nerve paresis”, “metastasis”, “cancer recurrence” along with the MESH terms. The reference list of the articles was carefully reviewed as a potential source of information. The search was based on Medline, Scopus, Google Scholar, eLibrary engines. Selected publications were analyzed and their synthesis was used to write the review and analyse the role of preventive central lymph node dissection in patients with papillary thyroid cancer.ConclusionsThe necessity of preventive central lymph node dissection in patients with differentiated papillary thyroid carcinoma is still controversial. There is much evidence that it increases the frequency of transient hypocalcemia. Due to the fact that this complication is temporary, its significance in clinical practice is debatable. It can also be assumed that an extant of surgery in the neck area is associated with an increased risk of recurrent laryngeal nerve injury. However, most studies indicate that this injury is associated more with thyroidectomy itself than with lymph node dissection. Recurrent laryngeal nerve dysfunction is also a temporary complication in the vast majority of cases. At the same time, a large amount of data shows that central lymph node dissection reduces the risk of thyroid cancer recurrence in two times.
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Affiliation(s)
- David D. Dolidze
- Department of Surgery, Russian Medical Academy of Continuous Professional Education, Moscow, Russia
- Department of Surgery, S.P. Botkin City Clinical Hospital, Moscow, Russia
| | - Alexey V. Shabunin
- Department of Surgery, Russian Medical Academy of Continuous Professional Education, Moscow, Russia
- Department of Surgery, S.P. Botkin City Clinical Hospital, Moscow, Russia
| | - Robert B. Mumladze
- Department of Surgery, Russian Medical Academy of Continuous Professional Education, Moscow, Russia
- Department of Surgery, S.P. Botkin City Clinical Hospital, Moscow, Russia
| | - Arshak V. Vardanyan
- Department of Surgery, Russian Medical Academy of Continuous Professional Education, Moscow, Russia
- Department of Surgery, S.P. Botkin City Clinical Hospital, Moscow, Russia
| | | | - Alexander M. Shulutko
- Department of Faculty Surgery №2, I.M.Sechenov First Moscow State Medical University, Moscow, Russia
| | - Vasiliy I. Semikov
- Department of Faculty Surgery №2, I.M.Sechenov First Moscow State Medical University, Moscow, Russia
| | - Khalid M. Isaev
- Department of Surgery, Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| | - Airazat M. Kazaryan
- Department of Faculty Surgery №2, I.M.Sechenov First Moscow State Medical University, Moscow, Russia
- Department of Gastrointestinal Surgery, Østfold Hospital Trust, Grålum, Norway
- Department of Surgery, Fonna Hospital Trust, Odda, Norway
- Intervention Centre, Oslo University Hospital – Rikshospitalet, Oslo, Norway
- Department of Surgery №1, Yerevan State Medical University after M.Heratsi, Yerevan, Armenia
- *Correspondence: Airazat M. Kazaryan,
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Gualniera P, Scurria S, Mondello C, Asmundo A, Sapienza D, Gianlorenzo D. Narrative review of proving the causal link of recurrent laryngeal nerve injury and thyroidectomy: a medico legal appraisal. Gland Surg 2020; 9:1564-1572. [PMID: 33224832 PMCID: PMC7667053 DOI: 10.21037/gs-20-203] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 09/10/2020] [Indexed: 11/06/2022]
Abstract
The recurrent laryngeal nerve (RLN) injuries are frequent complications related to thyroid surgery determining patient complaints and malpractice litigations. In the present work, the authors provide a brief review on the peculiarities of RLN injuries associated with thyroidectomy to highlight the various aspects of medicolegal assessment of causal link between surgery and nerve damage. The characteristics of thyroid disease, the anatomical peculiarities of surgery site and the nerve identification and preservation are factors that mostly influence the liability admission or rejection. In this context, the clinical records are fundamental, representing the most important probative tool. The possibility of having a set of information collected by clinical records, which allows for analysis and comparison to be made regarding the adherence to standards for thyroid surgery, is essential to set any medico-legal deliberation. However, the medicolegal evaluation can be very difficult. The practitioners involved in the medicolegal analysis of patient complaints related to this thyroidectomy complication need an in-depth knowledge of surgical technique, damage prevention activities and related clinical picture. To this must be added an adequate competence in the evaluation of the causal link (relation between the event and the injury and between that injury and the temporary/permanent impairment) based on the rigorous application of the medicolegal method.
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Affiliation(s)
- Patrizia Gualniera
- Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Serena Scurria
- Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Cristina Mondello
- Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Alessio Asmundo
- Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Daniela Sapienza
- Section of Legal Medicine, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Dionigi Gianlorenzo
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University of Messina, Messina, Italy
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Waseem T, Ahmed SZ, Baig H, Ashraf MH, Azim A, Azim KM. Truncal vs Branch Ligation of Inferior Thyroid Arteries in Total Thyroidectomy: Does It Affect Postoperative Hypoparathyroidism? Otolaryngol Head Neck Surg 2020; 164:759-766. [PMID: 32957817 DOI: 10.1177/0194599820957283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Postthyroidectomy hypoparathyroidism remains a significant challenge. Truncal ligation of the inferior thyroid arteries (ITAs) may lead to an increased risk of hypoparathyroidism; however, dissection along the thyroid capsule with branch ligation of the thyroid arteries could be a safer option. This study's objective was to compare the effect of truncal versus branch ligation of the ITAs on the rate of postoperative hypoparathyroidism. STUDY DESIGN Randomized prospective trial in line with the CONSORT guidelines. SETTING The study was conducted at a high-volume tertiary care setting. METHODS We randomized 319 patients into 2 groups: truncal ITA ligation (n = 157) and branch ITA ligation (n = 162). The primary outcomes were serum calcium and parathormone levels on the second postoperative day, followed by the levels on months 1, 3, 6, and 12. The need for exogenous replacements was noted. The secondary outcomes, such as operative time, blood loss, and other complications, were also recorded. RESULTS Our study revealed a significant difference in the incidence of transient hypocalcemia in patients undergoing truncal ITA ligation and branch ITA ligation (22.9% vs 3.1%, P < .05). The results showed that the levels of serum calcium and parathormone dropped on the second postoperative day and that 36 patients from the truncal ITA ligation group required exogenous calcium and vitamin D replacement. In contrast, only 5 patients from the branch ITA ligation group required the same. CONCLUSIONS This is the largest randomized trial of patients undergoing thyroidectomy, and it shows that dissection along the thyroid capsule with branch ligation of the ITAs is more likely to preserve parathyroid function as opposed to truncal ligation of ITAs.
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Affiliation(s)
- Talat Waseem
- Shalamar Endocrine and Surgical Oncology Center, Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Shalamar Medical and Dental College, Lahore, Pakistan
| | - Safia Zahir Ahmed
- Shalamar Endocrine and Surgical Oncology Center, Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Shalamar Medical and Dental College, Lahore, Pakistan
| | - Hadia Baig
- Shalamar Endocrine and Surgical Oncology Center, Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Shalamar Medical and Dental College, Lahore, Pakistan
| | - Muhammad Hasham Ashraf
- Shalamar Endocrine and Surgical Oncology Center, Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Shalamar Medical and Dental College, Lahore, Pakistan
| | - Asad Azim
- Shalamar Endocrine and Surgical Oncology Center, Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Shalamar Medical and Dental College, Lahore, Pakistan
| | - Khawaja M Azim
- Shalamar Endocrine and Surgical Oncology Center, Division of Surgical Oncology and Endocrine Surgery, Department of Surgery, Shalamar Medical and Dental College, Lahore, Pakistan
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Akil F, Yollu U, Ayral M, Turgut F, Yener M. The Anatomical Relationship Between Recurrent Laryngeal Nerve and First Tracheal Ring in Males and Females. Clin Exp Otorhinolaryngol 2016; 10:104-108. [PMID: 27337947 PMCID: PMC5327592 DOI: 10.21053/ceo.2015.01746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 01/26/2016] [Accepted: 03/01/2016] [Indexed: 11/30/2022] Open
Abstract
Objectives Despite the modern advances in thyroid surgery, recurrent laryngeal nerve (rln) paralysis is still a critical problem. In order to decrease the rate of this complication, rln anatomy has been studied intensively. In our study, we aimed to recognize the relationship of rln and landmarks of the first tracheal ring. Methods Eighty-six female and 18 male patients who were undergone total thyroidectomy were included in this study. Trachea vertical height (tvh), right recurrent laryngeal nerve height (rrh), left recurrent laryngeal nerve height (lrh), right recurrent laryngeal nerve to trachea anterior face median raphe distance (rrd), left recurrent laryngeal nerve to trachea anterior face median raphe distance (lrd), right recurrent laryngeal nerve respect to trachea ratio (rrtr), and left recurrent laryngeal nerve respect to trachea ratio (lrtr) parameters of all patients were measured and compared in males and females using independent t-test and measurements on both right and left sides were compared statistically without sex discrimination. Results There were no significant differences between groups in tvh, rrh, rrd, lrd, rrtr, and lrtr parameters. Lrh parameter was significantly higher in males than in females (P<0.04). Comparison of right and left sides revealed that lrh was significantly higher than rrh (P<0.001), lrd was significantly higher than rrd (P<0.001), and rrtr was significantly higher than lrtr (P<0.001). Conclusion In this study, we have shown that in all cases the rln was located around the lower half of trachea vertical length and at this level left rln was located significantly deeper than the right side.
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Affiliation(s)
- Ferit Akil
- Otolaryngology Department, Diyarbakir Selahaddin Eyyubi Public Hospital, Diyarbakir, Turkey
| | - Umur Yollu
- Otolaryngology Clinic, Gumushane Public Hospital, Gumushane, Turkey
| | - Muhammed Ayral
- Otolaryngology Department, Gazi Yasargil Education and Research Hospital, Diyarbakir, Turkey
| | - Faith Turgut
- Otolaryngology Department, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Murat Yener
- Otolaryngology Department, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
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