A comparison of the Thunderbeat and standard electrocautery devices in head and neck surgery:a prospective randomized controlled trial

PURPOSE: New energy-based sutureless vessel ligation devices, such as the Thunderbeat (Olympus Medical Systems Corp., Tokyo, Japan), could reduce operative time and limit blood loss in head and neck surgery; however, efficacy and safety in major head and neck surgery have not been investigated in a prospective, randomized study. METHODS: This prospective, double-arm, randomized controlled trial consisted of two parts: total laryngectomy (TL) and neck dissection (ND). Thirty patients planned for TL were randomized in two groups. For the ND part, forty-two operative sides were likewise randomized. In both parts, Thunderbeat was used in addition to the standard instrumentation in the intervention groups, while only standard instrumentation was used in the control groups. Primary outcome values were blood loss, operative time and complication rate. RESULTS: For the TL part there was no difference in mean blood loss (p = 0.062), operative time (p = 0.512) and complications (p = 0.662) between both hemostatic techniques. For the neck dissection part, there was a reduction in blood loss (mean 210 mL versus 431 mL, p = 0.046) and in operative time (median 101 (IQR 85-130) minutes versus 150 (IQR 130-199) minutes, p = 0.014) when Thunderbeat was used. There was no difference in complication rate between both hemostatic systems (p = 0.261). CONCLUSION: The Thunderbeat hemostatic device significantly reduces operative blood loss and operative time for neck dissections, without increase in complications. In TL, blood loss using Thunderbeat was comparable with the standard technique, but the operative time tended to be shorter. TRIAL REGISTRATION: UMCG Research Register, Reg. no. 201700041, date of registration: 18/1/2017

Virtual 3D planning of tracheostomy placement and clinical applicability of 3D cannula design:A three-step study

AIM: We aimed to investigate the potential of 3D virtual planning of tracheostomy tube placement and 3D cannula design to prevent tracheostomy complications due to inadequate cannula position. MATERIALS AND METHODS: 3D models of commercially available cannula were positioned in 3D models of the airway. In study (1), a cohort that underwent tracheostomy between 2013 and 2015 was selected (n = 26). The cannula was virtually placed in the airway in the pre-operative CT scan and its position was compared to the cannula position on post-operative CT scans. In study (2), a cohort with neuromuscular disease (n = 14) was analyzed. Virtual cannula placing was performed in CT scans and tested if problems could be anticipated. Finally (3), for a patient with Duchenne muscular dystrophy and complications of conventional tracheostomy cannula, a patient-specific cannula was 3D designed, fabricated, and placed. RESULTS: (1) The 3D planned and post-operative tracheostomy position differed significantly. (2) Three groups of patients were identified: (A) normal anatomy; (B) abnormal anatomy, commercially available cannula fits; and (C) abnormal anatomy, custom-made cannula, may be necessary. (3) The position of the custom-designed cannula was optimal and the trachea healed. CONCLUSIONS: Virtual planning of the tracheostomy did not correlate with actual cannula position. Identifying patients with abnormal airway anatomy in whom commercially available cannula cannot be optimally positioned is advantageous. Patient-specific cannula design based on 3D virtualization of the airway was beneficial in a patient with abnormal airway anatomy

Clinical feasibility study of protrach dualcare a new speaking valve with heat and moisture exchanger for tracheotomized patients

Objective: The aim of this study was to evaluate the clinical feasibility of the ProTrach DualCare (Atos Medical, Hörby, Sweden), a device combining a hands-free speaking valve and a Heat and Moisture Exchanger (HME) for tracheotomized patients. Study Design: A non-randomized, prospective single center feasibility study. Methods: Sixteen adult tracheotomized patients were included. Participants were asked to test the DualCare for two weeks while continuing their normal activities. After these two weeks, participants could choose whether or not to take part in the long-term evaluation. The EuroQOL-5D, Borg scale and questionnaires on speaking, pulmonary function and patient preference were used. During the long-term evaluation, a minor redesign was implemented and all participants were asked to test the new device again for one week, with a potential long-term evaluation. Eleven decided to participate. Results: The device was well-tolerated. Speaking noise was reduced (p = 0.020) and speech was considered to sound more natural compared to previously used devices according to the users (p = 0.020). Overall 11 participants preferred the DualCare to their standard device. No serious adverse events were reported. Conclusion: Overall, 11 of 16 participants preferred the DualCare to their standard speaking valve or HME. Users of the DualCare were able to use hands free speech with the benefits of an HME and the device was considered clinically feasible and has the potential to improve quality of life of tracheotomized patients. Level of Evidence: 2b

Prospective evaluation of voice outcome during the first two years in male patients treated by radiotherapy or laser surgery for T1a glottic carcinoma

In this prospective cohort study, we assessed voice outcome in patients before and up to 2 years after treatment for early glottic cancer either by radiotherapy or by laser surgery; 106 male patients, treated for T1aN0M0 glottic cancer either by endoscopic laser surgery (n = 67) or by radiotherapy (n = 39), participated in the study. Patients’ voices were recorded and analysed pre-treatment and 3, 6, 12 and 24 months post-treatment at their routine visit at the outpatient clinic. Average fundamental frequency (F0), percent jitter, percent shimmer and normalized noise energy (NNE) were determined. After 2 years, local control rate was 95% in the radiotherapy group and 97% in the laser surgery group. Larynx preservation rate was 95% after radiotherapy and 100% after laser surgery. Voice outcome recovers more quickly in patients treated with laser surgery in comparison to radiotherapy: 3 months after laser surgery there is no longer a difference with regard to normal voices except for the fundamental frequency, which remains higher pitched, even in the longer term. For patients treated with radiotherapy it takes longer for jitter, shimmer and NNE to become normal, where jitter remains significantly different from normal voices even after 2 years. According to these results, we believe that laser surgery is the first treatment of choice in the treatment of selected cases of T1a glottic carcinomas with good functional and oncological results

Visualization of small glottic laryngeal cancer using methyl-labeled C-11-methionine positron emission tomography

Despite abundant literature on the use of PET in head and neck cancer, a little is known about the visualization of small laryngeal cancer. Moreover, most literature deals with the radiopharmaceutical F-18-fludeoxyglucose (FDG), whereas only a few papers address the use of C-11 labeled amino acids. This study was performed to evaluate the feasibility of C-11-labeled methionine in visualizing small laryngeal cancer. Ten patients with a de novo small laryngeal cancer (7 T1, 3 T2) underwent a MET PET at least 3 weeks after biopsy but prior to further treatment. Static scans were made in 'whole body' mode, covering the head from the external auditory meatus downwards to the whole thorax. The resulting images were judged by experienced specialists in nuclear medicine, who assessed the relative visibility of each tumor on a 3-point scale. Nine tumors were visualized (5 clearly, 4 moderately). One (T1) was not visualized. Small laryngeal cancer can be visualized with C-11-methionine PET. (C) 2008 Elsevier Ltd. All rights reserved

Short- and long-term complications of surgical and percutaneous dilatation tracheotomies: a large single-centre retrospective cohort study

ObjectivesThe aim of this study was to determine and compare the incidence of long- and short-term complications of percutaneous dilatation tracheotomies (PDT) and surgical tracheotomies (ST).DesignA single-centre retrospective study.Participants305 patients undergoing a tracheotomy (PDT or ST) in the University Medical Center Groningen from 2003 to 2013 were included. Data were gathered from patient files.Main outcome measuresShort-term and long-term complications including tracheal stenosis.ResultsThe incidence of short- and long-term complications, including tracheal stenosis, was similar in both groups. Analysis of a small high-risk subgroup showed no difference in long-term complications.ConclusionsThe rate of short- and long-term complications, including tracheal stenosis, is equal in PDT and ST. PDT is a safe alternative for ST in selected patients

Value of resection of pulmonary metastases in head and neck cancer patients

Literature shows no data about a complete cohort of head and neck cancer patients who developed pulmonary metastases. In this study, we investigate factors related to survival, with emphasis on the role of a pulmonary metastasectomy. A retrospective review of 138 patients who developed pulmonary metastases (5.5% of all head and neck cancer patients) in the period 1978 to 1994 is presented. In a stepwise regression analysis (Cox), factors were identified related to survival. Also investigated was whether the prognostic value of potential prognosticators differed between the group that underwent metastasectomy and the group that did not. One hundred thirty-eight patients had metastases originating from head and neck cancer. The 5-year survival rate for all these patients was 13%. Younger patients (P = .011), patients with a longer disease-free interval (DFI) (P = .011), patients with a longer disease-free interval (DFI) (P = .016), and patients with a nonsquamous cell carcinoma (P = .038) did better. No evidence of a relationship between survival and sex or survival and number of metastases was found. Twenty-one patients underwent surgical resection of their pulmonary metastases. In 18 patients the resection was complete. The 5-year survival rate for patients who underwent a metastasectomy was 59%, compared with 4% in the nonmetastasectomy group (P = .0033). Isolated pulmonary metastases from head and neck cancer are potentially curable by surgical resection. Preconditions for this approach are locoregional control of the primary lesion and technical resectability of the pulmonary metastases. Patients with a long interval between primary treatment and the diagnosis of pulmonary metastases may benefit more from resection therap

Early feeding after total laryngectomy results in shorter hospital stay without increased risk of complications:a retrospective case-control study

Objectives: To evaluate the effects of a reduced nil per os (NPO) period after total laryngectomy (TLE) on general and wound-related post-operative complications, swallowing function and duration of hospital stay. Design, setting and participants: In a retrospective case-control study in 71 patients after TLE with primary closure (i e. without reconstruction with tissue transfer), complications and hospitalisation in 36 patients who started oral feeding on days 3-5 (early feeding) were compared with 30 patients who started oral feeding on days 7-10 (late feeding). Main outcome measures: Incidence of complications, swallowing function and duration of hospitalisation. Results: There were no significant differences between the early-and late-feeding groups in the occurrence of pharyn-gocutaneous fistulae, neopharyngeal stenosis or wound complications in general. Swallowing function was comparable for both groups. Mean overall hospitalisation was 2 days shorter in the early-feeding group (mean: 17.4 days) as compared to the late-feeding group (mean: 19.4 days) (P <0.05). Conclusions: Early feeding after TLE without flap reconstruction did not contribute to an increase in complications and led to a shorter hospital stay