Transoral robotic-assisted thyroidectomy with central neck dissection: preclinical cadaver feasibility study and proposed surgical technique

Recently, a transoral robotic-assisted technique to access the thyroid gland has been introduced. Despite the advantages this approach may have over other minimally invasive and robotic-assisted techniques, we found that the placement of the camera through the floor of mouth led to restricted freedom of movement. We describe our modification to this technique to overcome this problem. In a study using two fresh human cadavers, the camera port of the da Vinci robot was placed in the midline oral vestibule instead of the floor of the mouth. A transoral thyroidectomy and central neck dissection was successfully performed. Our modification led to an unfettered view of the central neck and allowed for a total thyroidectomy and central neck dissection. Our modification of transoral robotic-assisted thyroidectomy provides superior access to the central compartment of the neck over other robotic-assisted thyroidectomy techniques

St. Michaels association for special education new facility and master plan: final report

St. Michael's Association for Special Education, located near Window Rock, AZ, is an institution that has been established for the schooling and therapy of approximately 100 mentally and physically challenged Navajo children and adults. The existing school buildings are located on a 20 acre site are structurally unsound, crowded and poorly equipped to handle the daily functions of the school. FBM has outlined criteria by which the ideal solution to the problems at St. Michael's maybe resolved. The selected design alternative is a single, one story, 70,600 square foot multipurpose building that addresses site, structural, electrical, HVAC, plumbing, fire protection, and other concerns of the students, faculty, and staff of St. Michael's. The building is located on the previously developed portion of St. Michael's site. The site is regraded in order to accommodate the building materials and methods chosen and to add to the long term stability of the structure. Architectural features of the building fall in line with the client's preferences. Masonry bearing walls and steel KCS joists make up the superstructure of the building and are supported by continuous footings. Pilasters are employed for lateral support. A ground source heat pump is employed for HVAC. Solar power supplements 509,000 kWh per year of electricity supplied to the building. Our design brings about a safe, efficient building that promotes a healing and nurturing school environment at a cost of about $7 million

St. Michaels association for special education new facility and master plan: final report

St. Michael's Association for Special Education, located near Window Rock, AZ, is an institution that has been established for the schooling and therapy of approximately 100 mentally and physically challenged Navajo children and adults. The existing school buildings are located on a 20 acre site are structurally unsound, crowded and poorly equipped to handle the daily functions of the school. FBM has outlined criteria by which the ideal solution to the problems at St. Michael's maybe resolved. The selected design alternative is a single, one story, 70,600 square foot multipurpose building that addresses site, structural, electrical, HVAC, plumbing, fire protection, and other concerns of the students, faculty, and staff of St. Michael's. The building is located on the previously developed portion of St. Michael's site. The site is regraded in order to accommodate the building materials and methods chosen and to add to the long term stability of the structure. Architectural features of the building fall in line with the client's preferences. Masonry bearing walls and steel KCS joists make up the superstructure of the building and are supported by continuous footings. Pilasters are employed for lateral support. A ground source heat pump is employed for HVAC. Solar power supplements 509,000 kWh per year of electricity supplied to the building. Our design brings about a safe, efficient building that promotes a healing and nurturing school environment at a cost of about $7 million

Remote Access Robotic Facelift Thyroidectomy: A Multi-institutional Experience

BACKGROUND: Robotic facelift thyroidectomy (RFT) was developed as a new surgical approach to the thyroid gland using a remote incision site. Early favorable results led to this confirmatory multi-institutional experience. METHODS: Prospectively collected data on consecutive patients undergoing RFT in five North American academic endocrine surgical practices were compiled. Surgical indications, operative times, final pathology, nodule size, complications, and postoperative management (drain use and length of hospital stay) were evaluated. RESULTS: A total of 102 RFT procedures were undertaken in 90 patients. All but one of the patients (98.9 %) were female, and the mean age was 41.9 ± 13.1 years (range 12-69 years). The indication for surgery was nodular disease in 91.2 % of cases; 8.8 % were completion procedures performed for a diagnosis of cancer. The mean size of the largest nodule was 1.9 cm (range 0-5.6 cm). The mean total operative time for a thyroid lobectomy was 162 min (range 82-265 min). No permanent complications occurred. There were 4 cases (3.9 %) of transient recurrent laryngeal nerve weakness, no cases of hypocalcemia, and 3 (2.9 %) hematomas. There were no conversions to an anterior cervical approach. The majority of patients were managed on an outpatient basis (61.8 %) and without a drain (65.7 %). CONCLUSIONS: RFT is technically feasible and safe in selected patients. RFT can continue to be offered to carefully selected patients as a way to avoid a visible cervical scar. Future prospective studies to compare this novel approach to other remote access approaches are warranted

A novel surgeon credentialing and quality assurance process using transoral surgery for oropharyngeal cancer in ECOG-ACRIN Cancer Research Group Trial E3311.

PURPOSE: Understanding the role of transoral surgery in oropharyngeal cancer (OPC) requires prospective, randomized multi-institutional data. Meticulous evaluation of surgeon expertise and surgical quality assurance (QA) will be critical to the validity of such trials. We describe a novel surgeon credentialing and QA process developed to support the ECOG-ACRIN Cancer Research Group E3311 (E3311) and report outcomes related to QA. PATIENTS AND METHODS: E3311 was a phase II randomized clinical trial of transoral surgery followed by low- or standard-dose, risk-adjusted post-operative therapy with stage III-IVa (AJCC 7th edition) HPV-associated OPC. In order to be credentialed to accrue to this trial, surgeons were required to demonstrate active hospital credentials and technique-specific surgical expertise with ≥20 cases of transoral resection for OPC. In addition, 10 paired operative and surgical pathology reports from the preceding 24 months were reviewed by an expert panel. Ongoing QA required RESULTS: 120 surgeons trained in transoral minimally invasive surgery applied for credentialing for E3311 and after peer-review, 87 (73%) were approved from 59 centers. During QA on E3311, positive final pathologic margins were reported in 19 (3.8%) patients. Grade III/IV and grade V oropharyngeal bleeding was reported in 29 (5.9%) and 1 (0.2%) of patients. CONCLUSIONS: We provide proof of concept that a comprehensive credentialing process can support multicenter transoral head and neck surgical oncology trials, with low incidence of positive margins and *grade III/V oropharyngeal bleeding