Video-assisted thyroidectomy

BACKGROUND: In 1998, we developed a technique for video-assisted thyroidectomy (VAT). In this article we report on the entire series of patients who underwent VAT and discuss the results obtained. STUDY DESIGN: Forty-seven patients were selected for VAT. Eligibility criteria were: thyroid nodules of 35 mm or less in maximum diameter; estimated thyroid volume within normal range or slightly enlarged; small, low-risk papillary carcinomas; neither previous neck surgery nor irradiation; and no thyroiditis. After a learning period, VAT was proposed also for completion thyroidectomy (of previous video-assisted lobectomy) and nodules with maximum diameter up to 45 mm. The procedure is performed by a totally gasless video-assisted technique through a single 1.5- to 2.0-cm skin incision. Dissection is performed under endoscopic vision using a technique very similar to conventional operation. RESULTS: Fifty-three VATs were attempted on 47 patients. Thirty-three lobectomies, 10 total thyroidectomies, and 6 completion thyroidectomies were successfully performed. Six patients with papillary carcinoma underwent central neck lymph node removal by the same access. Mean operative time was 86.8 minutes for lobectomy, 116.0 minutes for total thyroidectomy, and 77.5 minutes for completion thyroidectomy. Conversion rate was 7.5%. Postoperative complications included one transient recurrent nerve palsy, three transient symptomatic postoperative hypocalcemias, and one wound infection. The cosmetic result was considered excellent by most of the patients who successfully underwent VAT. CONCLUSIONS: VAT is feasible and safe and allows for an excellent cosmetic result. Not all patients are eligible for this procedure, but in selected cases it can be a valid option for the surgical treatment of thyroid diseases

Neuromonitoring in endoscopic and robotic thyroidectomy

Intraoperative neuromonitoring (IONM) has proven effective for intraoperative verification of RLN function in the conventional thyroid surgery. However, no studies have performed a systematic evidence-based assessment of this novel health technology in endoscopic and robotic thyroidectomy. Evidence-based criteria were used in a systematic review of relevant literature for years 2000\ue2\u80\u932015. Four electronic databases (CENTRAL, MEDLINE, Cochrane and EMBASE) were used to retrieve relevant reports published from January 1, 2000 to September 1, 2016. The search terms included \ue2\u80\u9cendoscopic thyroidectomy\ue2\u80\u9d, \ue2\u80\u9crobotic thyroidectomy\ue2\u80\u9d, \ue2\u80\u9cIONM\ue2\u80\u9d, \ue2\u80\u9ccontinuous IONM (CIONM)\ue2\u80\u9d, \ue2\u80\u9cneural monitoring\ue2\u80\u9d, \ue2\u80\u9crecurrent laryngeal nerve monitoring\ue2\u80\u9d, and \ue2\u80\u9csuperior laryngeal monitoring\ue2\u80\u9d. The following data were retrieved from eligible studies of patients undergoing endoscopic or robotic thyroidectomy: objective of study, design and setting of study, population, intervention examined, quality of data, follow-up and dropout rate, risk of bias, and outcomes assessed. Of 160 studies retrieved, only 9 (5%) studies used IONM. Eight studies reported 522 nerve at risk (NAR) with IONM. Only three were prospective randomized studies. Reports of IONM endoscopic and robotic procedures included their use for re-surgery and use in both benign and malignant cases. None of the IONM endoscopic procedures involved bilateral palsy. Two studies reported the use of a staged strategy. The rates of recurrent laryngeal palsy were 0\ue2\u80\u933.6% for transient and 0\ue2\u80\u930.4% for permanent. Only 30% of the studies performed vagus nerve stimulation, and only 25% performed superior laryngeal nerve monitoring. In addition to the use of IONM as an assistive technology for navigating the anatomy in challenging procedures such as endoscopic and robotic thyroidectomy, IONM has potential use as a routine adjunct to the conventional video-assisted nerve identification in thyroidectomy

Video-assisted versus conventional total thyroidectomy and central compartment neck dissection for papillary thyroid carcinoma

BACKGROUND:Although video-assisted (VA) thyroidectomy emerged as effective treatment for selected patients with papillary thyroid carcinoma (PTC), some concerns remain about obtaining adequate central neck node clearance. We compared patients who underwent VA and conventional total thyroidectomy (TT) and central compartment dissection (CCD) for PTC. METHODS: A total of 52 consecutive patients successfully underwent VA-TT and VA-CCD for PTC (VA group) were compared to 52 controls who underwent conventional TT and CCD (C group) for PTC. RESULTS: The two groups were matched for age (p = 0.75), sex (p = 0.07), and tumor size (p = 1.0). Operating time (p = 0.23), overall postoperative complications (p = 0.41), pT (p = 0.44), and pN (p = 0.84) were similar in the two groups. The mean number of removed nodes was similar (10.6 \ub1 4.6 in VA group vs. 12.2 \ub1 5.6 in C group) (p = 0.11).Mean postoperative serum thyroglobulin (sTg) off levothyroxine (LT4) suppressive treatment was 3.2 \ub1 5.0 ng/ ml in the VA group and 2.6 \ub1 7.4 ng/ml in the C-group (P = 0.67). Mean postoperative radioiodine uptake (RAIU) was similar in the two groups (1.5 \ub1 1.3 vs. 1.7 \ub1 1.3%) (p = 0.49). When pN1a patients alone were considered, no difference was found between the VA group (21 patients) and the controls (24 patients) concerning the mean number of removed nodes (10.3 \ub1 4.1 vs. 12.4 \ub1 5.6) (p = 0.16), the mean sTg off LT4 (4.4 \ub1 6.0 vs. 1.9 \ub1 2.7 ng/ml) (p = 0.07) and the mean RAIU (1.9 \ub1 1.5 vs. 1.7% \ub1 1.3%) (p = 0.63). CONCLUSIONS: The results of VA-TT and CCD in selected cases of PTC appear to be comparable to those of conventional surgery. A longer follow-up and larger series are necessary to draw definitive conclusions concerning longterm outcomes

Video-assisted thyroidectomy significantly reduces the risk of early postthyroidectomy voice and swallowing symptoms

BACKGROUND: Voice and swallowing symptoms are frequently reported after thyroidectomy even in absence of objective voice alterations. We evaluated the influence of the video-assisted approach on voice and swallowing outcome of thyroidectomy. METHODS: Sixty-five patients undergoing total thyroidectomy (TT) were recruited. Eligibility criteria were: nodule size<or=30 mm, thyroid volume<or=30 ml, no previous neck surgery. Exclusion criteria were: younger than aged 18 years and older than aged 75 years, vocal fold paralysis, history of voice, laryngeal or pulmonary diseases, malignancy other than papillary thyroid carcinoma. Patients were randomized for video-assisted (VAT) or conventional (CT) thyroidectomy. Videostrobolaryngoscopy (VSL), acoustic voice analysis (AVA), and maximum phonation time (MPT) evaluation were performed preoperatively and 3 months after TT. Subjective evaluation of voice (voice impairment score=VIS) and swallowing (swallowing impairment score=SIS) were obtained preoperatively, 1 week, 1 month, and 3 months after TT. RESULTS: Fifty-three patients completed the postoperative evaluation: 29 in the VAT group, and 24 in the CT group. No laryngeal nerves injury was shown at postoperative VSL. Mean postoperative MPT, F0, Flow, Fhigh, and the number of semitones were significantly reduced in the CT group but not in the VAT group. Mean VIS 3 months after surgery was significantly higher than preoperatively in CT group but not in the VAT group. Mean SIS was significantly decreased 1 and 3 months after VAT but not after CT. CONCLUSIONS: The incidence and the severity of early voice and swallowing postthyroidectomy symptoms are significantly reduced in patients who undergo VAT compared with conventional surgery

Mammella

Benign and malignant diseases of brest are describe

Prospective electromyographic evaluation of functional postthyroidectomy voice and swallowing symptoms

Voice and swallowing symptoms following thyroidectomy in the absence of any demonstration of laryngeal nerves injury are usually considered a functional outcome of uncomplicated operations, mainly related to scar formation and emotional reaction. They could be related to unapparent laryngeal nerve or cricothyroid (CT) muscle injuries detectable only by laryngeal electromyography (LEMG). We correlated such symptoms with LEMG patterns

Synchronous Bilateral Adrenalectomy for Cushing's Syndrome: Laparoscopic Versus Posterior Retroperitoneoscopic Versus Robotic Approach.

BACKGROUND: Synchronous endoscopic bilateral adrenalectomy (BilA) can effectively provide definitive cure of hypercortisolism in ACTH-dependent Cushing's syndrome and in primary adrenal bilateral disease. We compared three different approaches for BilA: transabdominal laparoscopic BilA (TL-BilA), simultaneous posterior retroperitoneoscopic BilA (PR-BilA), and robot-assisted BilA (RA-BilA). METHODS: All patients who underwent BilA between January 1999 and December 2012 at two referral centers (one performing TL-BilA and PR-BilA and one performing RA-BilA) were included. A comparative analysis was performed. RESULTS: Twenty-nine patients were included: 5 underwent TL-BilA, 11 underwent PR-BilA, and 13 underwent RA-BilA. No significant difference was found concerning age, gender, diagnosis, and previous abdominal surgery. No conversion to open approach was registered. Operative time was significantly shorter for the PR-BilA group than for the TL-BilA and RA-BilA groups (157.4 \ub1 54.6 vs 256.0 \ub1 43.4 vs 221.5 \ub1 42.2 min, respectively) (P < 0.001). No significant difference was found concerning intraoperative and postoperative complications rate and time to first flatus. Drains were used routinely after PR-BilA and TL-BilA and electively in four RA-BilA patients (P < 0.001). Hospital stay was longer in the TL-BilA and PR-BilA groups than in the RA-BilA group (12.0 \ub1 5.7 vs 10.8 \ub1 3.7 vs 4.4 \ub1 1.7 days, respectively) (P < 0.001). No recurrence or disease-related death was registered. CONCLUSIONS: Operative time was significantly shorter in the PR-BilA group, because it eliminates the need to reposition the patient. The number of drains and the length of hospital stay were reduced after RA-BilA, but this was likely related to different management protocols in different settings. Because no significant difference was found in terms of postoperative outcome, none of the three operative approaches can be considered the preferable one

Video-Assisted Thyroidectomy: Report On The Experience Of A Single Center In More Than Four Hundred Cases

Abstract Background. We report on our series of patients selected for video-assisted thyroidectomy (VAT) over a 7-years period and discuss about the results obtained. Methods. VAT is a gasless procedure performed under endoscopic vision through a single 1-5-2.0 cm skin incision, using a technique very similar to conventional surgery. Eligibility criteria were: thyroid nodules < 35 mm; thyroid volume <30ml; no previous conventional neck surgery. Small low risk papillary thyroid carcinomas (PTC) were considered eligible. Results. 473 VATs were attempted on 459 patients. Loco-regional anesthesia was used in 15 patients. Conversion was necessary 6 times (difficult dissection in 1 case, large nodule size in 3, gross lymph node metastases in 2). Thyroid lobectomy was successfully performed in 110 cases, total thyroidectomy in 343 and completion thyroidectomy in 14. In 66 patients with carcinoma central neck nodes were removed through the same access. Concomitant parathyroidectomy was performed in 14 patients. Pathology showed benign diseases in 277 cases, PTC in 175 and medullary microcarcinoma in 1. Postoperative complications included: 8 transient recurrent nerve palsies, 64 transient hypocalcemias, 3 definitive hypocalcemias, 1 post-operative haematoma and 2 wound infections. Postoperative pain was minimal and cosmetic result excellent. In patients with PTC no evidence of recurrent or residual disease was shown. Conclusions. Indications for VAT are still limited (20% of patients who require thyroidectomy). Nonetheless, in selected patients, it seems a valid option for thyroidectomy and it could be considered even preferable to conventional surgery because of its significant advantages, especially in terms of cosmetic result

Risk factors for local recurrence following lateral neck dissection for papillary thyroid carcinoma

Purpose: We aimed to evaluate risk factors for local recurrence following lateral neck dissection (LND) for papillary thyroid carcinoma (PTC). Methods: Two hundred and nine patients who underwent therapeutic primary or reoperative LND for PTC were included. Results: One hundred eighty-one patients underwent primary LND at our Institution, the remaining 28 were referred for recurrence following LND outside the Institution. Comparing patients who required reoperation for recurrent lateral neck disease with those who did not recur, no significant difference was found concerning sex, tumor size, multifocal disease, extracapsular invasion, histological variant, pT stage (P = NS). At univariate analysis, age, mean number of removed lateral neck nodes at first operation, the extent of initial LND and surgery performed outside the Institution were risk factors for recurrence (P < 0.001). Conclusions: Limited LND and surgery performed at non referral Centers were non tumor-related risk factors for recurrence following therapeutic LND for PTC

Diagnostic and Prognostic Role of HBME-1, Galectin-3, and \u3b2-Catenin in Poorly Differentiated and Anaplastic Thyroid Carcinomas.

AIM:: Thyroid cancer represents the first endocrine malignant neoplasm, accounting for 1% of human malignancy. The majority of which are well-differentiated cancer representing up to 90% of thyroid cancer and pursuing a favorable clinical course. The groups of poorly differentiated thyroid cancer (PDC) and anaplastic thyroid cancer (ATC) have a poor outcome and need a strict clinical surveillance. MATERIALS AND METHODS:: Thirty-four cases including 23 PDC/insular cancer and 9 ATC were examined for the expression of an immunohistochemical panel made up by HBME-1, galectin-3, and \u3b2-catenin and correlated either with histologic prognostic parameters or the overall surveillance. RESULTS:: HBME-1 and galectin-3 were expressed in 100% of the PDC/insular cases and in none of the ATC cases. The data for \u3b2-catenin pointed out an 80% expression (12/15) in the PDCs and only a focal and nonspecific positivity in the ATCs. A \u3b2-catenin-positive expression was found in all patients with a worse outcome/death and in the presence of vascular invasion and metastatic disease. All 3 PDC patients with \u3b2-catenin negativity are alive, whereas only 41% (5/12) are alive in the \u3b2-catenin-positive group. CONCLUSIONS:: Our data set up the idea that PDC represents an intermediate step in the biological process of dedifferentiation of thyroid tumors toward ATC. This shift is underlined by the \u3b2-catenin expression, which seems to be related to a worse prognostic behavior. HBME-1 and galectin-3 show a similar pattern in PDC compared with well-differentiated carcinoma, whereas they are not expressed, as well as \u3b2-catenin, in anaplastic carcinomas