Minimally invasive nonendoscopic thyroid surgery (original) (raw)
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Current surgical status of thyroid diseases
Journal of Multidisciplinary Healthcare, 2011
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Surgical Management of Thyroid Disease
Otolaryngologic Clinics of North America, 2010
Surgery of the thyroid gland has evolved in many ways since its modernization by Theodor Kocher in the late nineteenth century. Along with procedural modifications, the surgical indications for benign and malignant disease have also continued to evolve and have often been a source of controversy. Recently, the American Thyroid Association (ATA) and the National Comprehensive Cancer Network have developed task forces aimed at delineating the indications for surgery of both benign and malignant thyroid disease. The algorithms introduced in these guidelines were intended to simplify decisions on the surgical management of controversial issues. The authors at their institution use these guidelines, clinical experience, and informed patient preferences to perform appropriate surgical procedures. This article describes the indications, surgical management, and postoperative care for both benign and malignant processes of the thyroid gland. PREOPERATIVE PLANNING Before any surgical procedure, a detailed patient history, thyroid function testing, physical examination including laryngoscopy, and appropriate imaging studies should be performed. Patient history including family history, history of prior radiation exposure, and overall health should be solicited. If the patient or family history reveals findings suggestive of multiple endocrine neoplasia (MEN) IIA or IIB, a work-up for pheochromocytoma should be performed preoperatively. 1 To avoid unfavorable outcomes associated with a thyroid storm, preoperative screening thyroid functions tests should be performed. In addition, laryngoscopy should be performed routinely before surgery. Recurrent laryngeal nerve (RLN) compression or invasion may be
Clinical Benefits of Minimally Invasive Techniques in Thyroid Surgery
World Journal of Surgery, 2008
Background Recently there has been a strong impetus to develop minimally invasive techniques in endocrine neck surgery. This study was designed to investigate the potential benefits of two minimally invasive thyroidectomy procedures, namely video-assisted and open minimalincision thyroidectomy (VAT and MIT, respectively) when compared with conventional thyroidectomy. Methods Between May 2000 and June 2006, a prospective, nonrandomized study was performed on 957 consecutive patients undergoing thyroid surgery. Fifty-six (5.8%) patients underwent VAT, 214 (22.4%) underwent MIT, and 687 (71.8%) underwent a conventional procedure. Results Patients were selected for VAT when total thyroid volume was £30 ml and for MIT when total thyroid volume was [30 but £80 ml as determined by ultrasonography. The length of the central neck skin incision was 1.5-2 cm for VAT, 2.5-3.5 cm for MIT, and 6-10 cm for the conventional operation. The incidence of definitive hypoparathyroidism or recurrent laryngeal palsy after VAT or MIT was comparable with that occurring after conventional treatment. Patients having VAT or MIT experienced significantly less postoperative pain than patients undergoing conventional treatment. Less pain was also registered in the VAT patient cohort when compared with the MIT cohort. Patients having VAT or MIT were more satisfied with the cosmetic result than patients who underwent conventional treatment, but no significant differences in patient satisfaction were found between the VAT and MIT groups.
THYROID AND THYROIDECTOMY: A REPORT
IAJPS , 2023
The thyroid gland is a small butterfly-shaped gland located in front of the neck. It secretes hormones called thyroid hormones that regulate almost every function of the body. Enlargement of the thyroid gland is called goiter, also called "giller" or "ghudood" by the natives. Thyroidectomy is the surgical removal of all or part of the thyroid gland. It is performed for various reasons, such as cosmetic, functional, or oncological. Thyroidectomy is a challenging surgery that poses a major burden to the healthcare system in underdeveloped areas like Muzaffarabad, Azad Kashmir. Funding for investigations and procedure should be made available in each healthcare setup to investigate and treat the goiter in time. Proper training of surgeons as well as staff is also required to make thyroidectomy less challenging.
Changing trends in thyroidectomy
Irish medical journal, 2012
The objective of this study was to establish the indications, referral trends and demographics for thyroidectomies performed in our institutions over a 13-year period by a single surgeon. We conducted a retrospective chart review of 1003 consecutive thyroidectomies at our institutions during the period 1998 until 2010. The parameters incorporated to this study were age, sex, county, referral source, symptoms, thyroid status, procedure performed, histopathology and post-operative complications. The age range of patients was 4-87 years. There were 777 females and 226 males, with a sex ratio of 3.4:1. The mean age was 51 years. The commonest indications for surgery were a potential or definite neoplastic thyroid mass (781 cases--78%), compressive symptoms (119 cases-- 12%), thyrotoxicosis and endocrine related causes (103 cases--10%). 896 (89.3%) patients were euthyroid, 4 (0.4%) hypothyroid and 103 (10.3%) hyperthyroid. There were 739 partial thyroidectomies and 264 total thyroidectom...
Thyroid Gland Surgery in an Endemic Region
World Journal of Surgery, 1996
To assess the incidence, indications, and complications of (reoperative) thyroid gland surgery in an endemic region, we have retrospectively analyzed 1318 patients operated on between 1983 and 1994. There were 166 reoperations (13.5%). In comparison to the primary operation the indication for reoperation showed an increased rate of premalignant and malignant tumors (؉16%) and a decreased rate of hyperthyroid disorders (؊30%). The largest group operated on had benign multinodular goiters, with the same rate of indication for primary (57.4%) and secondary (57.8%) surgery. Permanent recurrent laryngeal nerve palsy rate following primary operation occurred at rates of 1.7% (1983-1990) and 0.7% (1991-1994) and for secondary operation 3.5% (1983-1990) and 5.6% (1991-1994), respectively. The change in recurrent nerve palsy rate in the later years was due to a more extensive resection policy at the primary operation and a more liberal approach to reoperative surgery. The high rate of reoperation for benign goiters (13%) and the new data of goitrogenesis have therefore directed our policy to more extensive resection of the thyroid tissue at the initial operation, increasing the rate of lobectomy from 27% (1982-1990) to > 90% (1991-1994) and at the same time lowering morbidity. Extensive resection of nodular tissue during the initial operation safely reduces the incidence of recurrent goiter and subsequently reduces the rate of reoperation and eliminates the high risk of morbidity associated with reoperative thyroid surgery. The indications for reoperation should be strict, and when unavoidable a modified lateral approach may be helpful.
A proposal for thyroid surgery: criteria to identify the references of endocrine surgery
Updates in surgery, 2017
Indicators of effectiveness and quality of care are needed to improve the outcomes in many surgical fields. International and national studies in thyroid surgery have not clearly documented an association between number of cases and outcome quality, but it is essential for the figure of a highly experienced surgeon, able to provide proof of positive outcomes. Therefore, we try to underline the structural and technical requirements in thyroid surgery. Moreover, the need for an accreditation program is outlined.
Thyroidectomy Indications and Complications
2019
Conclusions: The surgical techniques of thyroidectomy, as well as surgical technologies, remained to improve. Recently, several new instruments (for example, the introduction of harmonic technology) and advanced approaches like video-assisted thyroidectomy and robot-assisted thyroidectomy have improved. This review discusses the preoperative evaluation, intraoperative considerations, surgical technique(s), and postoperative concerns for patients undergoing thyroidectomy. Methodology: We did a systematic search for thyroidectomy using PubMed search engine (http://www.ncbi.nlm.nih.gov/) and Google Scholar search engine (https://scholar.google.com). All relevant studies were retrieved and discussed. We only included full articles. Aim of Work: In this review, we will discuss thyroidectomy. Introduction: The thyroid gland has been described for a long time but was first named by this name by the Romans because they noticed that it was "shield-shaped". Moreover, thyroid masses were described in the medical literature since the twelfth century, as in the year 1170, the physician Robert Frugardi described the examination of a goiter. Surgery of the thyroid was undertaken a long time before that thyroid gland diseases' pathophysiology was well understood. Surgical operations were usually fraught with adverse events, including major bleeding, surgical infections, and trauma to peripheral structures, all of which were linked to high morbidity and mortality rates that could reach forty percent.
World Journal of Surgery, 2008
Background Minimally invasive thyroidectomy techniques are being developed in an effort to minimize pain, shorten the length of hospital stay, and improve cosmesis. Various minimally invasive thyroid surgery (MITS) techniques have been shown to be safe and feasible with some benefits in terms of cosmesis and pain outcomes; however, no single technique has been broadly accepted. This study was designed to review the evidence in relation to MITS and our experience with the direct lateral mini-incision technique. Methods A review of literature published until December 2007 on minimally invasive thyroidectomy techniques was undertaken. Three issues were addressed: 1) Does MITS provide any benefit compared with conventional open thyroidectomy? 2) Is there any advantage to the use of endoscopic or video-assisted techniques compared with the direct mini-incision technique? 3) Is the lateral mini-incision technique safe and efficacious? Additional data in relation to the above issues was derived from a retrospective cohort study of patients undergoing mini-incision thyroid surgery within our unit. Results Issue 1: Five prospective randomized studies and eight studies at a lower level of evidence have demonstrated consistent advantages of MITS compared with open thyroid surgery in terms of reduced pain and improved cosmesis with equivalent operative safety. Issue 2: In compiling four level III and IV studies that compared open and videoassisted minimally invasive surgery, there do not seem to be significant differences in patient satisfaction with the incision. The video-assisted approaches require significantly longer operative times but also seem to be less painful. Issue 3: Three cohort studies (level IV) have demonstrated that the lateral mini-incision technique is both safe and efficacious compared with open surgery for hemi-thyroidectomy. Data from our cohort study of 1281 patients (open hemithyroidectomy 1054 vs. MITS 227) confirmed MITS to be a safe and effective procedure. The rate of postoperative hematoma formation and wound infection was equivalent between groups. The rate of permanent recurrent laryngeal nerve injury was 0.4% for MITS and 0.3% for CHT and not significantly different (p = 0.7). Conclusions MITS has demonstrated advantages over conventional open approaches for both hemi-and total thyroidectomy and the benefits do not depend on the open or video-assisted approach. For thyroid lobectomies, the lateral mini-incision approach can be performed with an operative time and postoperative complication profile equivalent to conventional hemi-thyroidectomy while providing excellent cosmesis with a 2-3 cm scar.