Ultrasonic technology facilitates minimal access thyroid surgery

OBJECTIVES: Options for controlling the vasculature during thyroid surgery include suture ligatures, vessel clips, and bipolar cautery. Ultrasonic technology represents an alternative to conventional techniques in which the vessels are simultaneously sealed and divided. We sought to determine the safety and efficacy of thyroidectomy with ultrasonic technology. DESIGN: Nonrandomized, prospective analysis of a series of patients undergoing thyroidectomy at the Medical College of Georgia. METHODS AND MATERIALS: The records of 51 consecutive patients who underwent thyroid surgery between December 2004 and June 2005 were reviewed. Patients in whom ultrasonic technology (Harmonic-ACE, Ethicon Endo-Surgery, Cincinnati, OH) was used comprised the study population. RESULTS: Forty-four of 51 patients underwent thyroidectomy with the assistance of ultrasonic technology. There were 4 males and 40 females with a mean age of 43.5 +/- 15.8 years. Twenty-two patients had a total thyroidectomy, 18 underwent unilateral lobectomy, and 4 underwent completion thyroidectomy. The overall mean incision length was 5.0 +/- 2.6 (range 2-12) cm. A subgroup of patients underwent minimally invasive video-assisted thyroidectomy (n = 13) and had a mean incision length of 29.3 +/- 0.8 mm. There were no cases of permanent injury to the recurrent laryngeal nerve and no cases of persistent hypoparathyroidism. Blood loss ranged from 5 mL to 100 mL, with a mean of 26.7 +/- 21.8 mL. CONCLUSIONS: Ultrasonic technology facilitates thyroid surgery, particularly when a minimally invasive approach is undertaken. It reliably seals and divides the thyroid vasculature and will likely replace other methods of managing the thyroid blood supply.     

Minimally invasive thyroidectomy: basic and advanced techniques

OBJECTIVE: Minimal access surgery in the thyroid compartment has evolved considerably over the past 10 years and now takes many forms. We advocate at least two distinct approaches, depending on the disease process and multiple patient factors. The technical aspects are explored in depth with liberal use of videographic demonstration. METHODS: The authors conducted a comparison of two distinct surgical techniques with photographic and videographic documentation of two distinct minimal access approaches to the thyroid compartment termed minimally invasive thyroidectomy (MITh) and minimally invasive video-assisted thyroidectomy (MIVAT). Both historic and previously unpublished data (age, gender, pathology, incision length, and complications) are systematically analyzed. RESULTS: Patients who underwent minimally invasive thyroidectomy (n = 31) had a mean age of 39.4 +/- 10.7 years; seven were male and 24 were female. The most common diagnosis was follicular or Hürthle cell adenoma (29%), followed by papillary or follicular cancer (26%). The mean incision length was 4.9 +/- 1.0 cm. One patient developed a hypertrophic scar and one patient developed thrombophlebitis of the anterior jugular vein. There were 14 patients in the MIVAT group with a mean age of 43.7 +/- 11.4 years; one was male and 13 were female. The majority of patients had follicular adenoma (42.9%) or papillary carcinoma (21.4%) as their primary diagnosis. The mean incision length was 25 +/- 4.3 mm (range, 20-30 mm), and there were no complications. CONCLUSIONS: Two distinct approaches to minimal access thyroid surgery are now available. The choice of approach depends on a number of patient and disease factors. Careful patient selection will result in continued safe and satisfactory performance of minimally invasive thyroid surgery.     

Cosmetic thyroid surgery: defining the essential principles

OBJECTIVES: Minimally invasive thyroid surgery is rapidly becoming a common approach in busy endocrine surgery practices. The surgical concepts necessarily include a number of principles found within the realm of plastic surgery. DESIGN: The study was a prospective, nonrandomized analysis of a consecutive series of thyroid surgical patients. METHODS AND MATERIALS: All patients who underwent thyroid surgery at the Medical College of Georgia in the Department of Otolaryngology were prospectively evaluated. Recommendations for endoscopic thyroidectomy, minimally invasive nonendoscopic thyroidectomy (MINET), or conventional thyroid surgery were based on patient and disease parameters as previously described. Specific factors contributing to improved cosmetic outcomes were sought. RESULTS: Two hundred forty-eight patients underwent thyroidectomy between September 2003 and June 2006. There were 50 males and 198 females, with a mean age of 44.9 +/- 14.6 years. Seventy-seven (31.0%) patients underwent conventional thyroidectomy (group A), 120 (48.4%) patients had MINET (group B), and the remaining 51 (20.6%) patients underwent thyroidectomy with an endoscopic technique (Group C). Incision lengths were 92.4 +/- 22.3 mm in Group A, 46.4 +/- 9.9 mm in Group B, and 24.3 +/- 5.9 mm in Group C. The factors that contributed most to an optimal cosmetic result were marking the patient while he or she was sitting up prior to surgery, resecting skin edges during closure, avoidance of subplatysmal flap elevation and drains, and use of Dermabond. CONCLUSIONS: Achieving an optimal cosmetic result when performing thyroid surgery is easiest when oneapplies a number of principles, including elements normally associated with plastic surgery.     

Minimally invasive thyroidectomy using the Sofferman technique

OBJECTIVES: Access to the thyroid compartment has traditionally been achieved by a Kocher incision followed by subplatysmal flap elevation and strap muscle retraction. A combination of novel access techniques was used to allow for minimally invasive thyroidectomy (MITh). METHODS AND MATERIALS: A prospective, nonrandomized evaluation of consecutive patients undergoing thyroidectomy was performed. A minimally invasive incision (< or =6 cm) was used in conjunction with the Sofferman technique (transection of the strap muscles) and videoendoscopic assistance to perform hemithyroidectomy or total thyroidectomy in eligible patients. Prospectively collected data include age, sex, pathology, incision length, duration of surgery, and blood loss and complications were considered. RESULTS: Forty-four patients underwent 48 thyroid surgeries between September 2003 and May 2004. There were 13 men and 31 women, with a mean age of 41.9 (range 19-73) years. Thirty-one (64.6%) of these were eligible to be performed by MITh; the remainder (n = 17, 35.4%) underwent conventional thyroidectomy. The mean incision length in the MITh cohort was 4.9 +/- 1.0 cm compared with 9.1 +/- 1.5 cm for conventional thyroidectomy. The mean surgical time for minimally invasive hemithyroidectomy was 115.7 minutes (n = 23), and for total thyroidectomy was 147.4 minutes (n = 8). There were no cases of permanent hypocalcemia or recurrent laryngeal nerve paralysis in either group. No patients in the MITh group had to be converted to a conventional thyroidectomy. The cosmetic results were excellent, although one patient in the MITh group developed a mildly hypertrophic scar that responded to triamcinolone injection. CONCLUSIONS: MITh is safe in carefully selected patients and probably results in more rapid wound healing. The cosmetic result is superior to that achieved with conventional thyroidectomy.     

Minimally invasive video-assisted thyroidectomy: a multi-institutional North American experience

OBJECTIVE: To report the results of a multi-institutional experience with the minimally invasive video-assisted thyroidectomy, which was conceived in Europe and Asia and has only recently been embraced in the United States. DESIGN: Prospective, nonrandomized analysis. SETTING: Four academic thyroid surgical practices. PATIENTS: Consecutive series of 228 patients who required thyroid surgery and were deemed at surgeon discretion to be eligible for a minimal access surgery. INTERVENTIONS: Minimally invasive video-assisted thyroidectomy was performed in 216 patients. MAIN OUTCOME MEASURES: The data, which were recorded prospectively, included age, sex, indication for surgery, incision length, and complications of surgery. RESULTS: Because conversion to an open approach was required in 12 of the 228 patients, the study group comprised 216 patients (25 men and 191 women; mean [SD] age, 44.5 [14.1] years). There were no hematomas and no cases of permanent hypoparathyroidism or permanent vocal cord paralysis. Nine patients had a transient vocal cord paresis (3.2% of nerves at risk); 5 patients experienced temporary hypocalcemia (8.1% of total thyroidectomies); 1 patient reported a change in voice pitch; and 1 patient required a scar revision. CONCLUSIONS: Use of the minimally invasive video-assisted thyroidectomy technique has been adopted cautiously in the United States. The safety of the procedure represented by the data from this multi-institutional experience would support its expanded adoption by high-volume thyroid surgeons.     

Prospective evaluation of endoscopic approaches to the thyroid compartment

OBJECTIVE: To compare a number of endoscopic approaches to the thyroid compartment. DESIGN: Prospective, nonrandomized, experimental investigation in a porcine model. METHODS: We performed a consecutive series of 13 endoscopic thyroidectomies using 5 distinct approaches. The procedures differed by the direction of the approach, incision placement, and use of facilitative maneuvers. The parameters assessed included procedure duration, estimated blood loss, heart rate, blood pressure, temperature, oxygen saturation, and arterial blood gas levels. The thyroid specimens were weighed and examined histologically. RESULTS: Four of the endoscopic approaches were successfully used for resection of the thyroid (12 of 13 animals). The mean operative times were as follows: superior approach (n = 4), 47 +/- 14.6 minutes; lateral axillary approach (n = 4), 67 +/- 11.8 minutes; and superficial axillary (n = 3), 67.7 +/- 22.3 minutes. The one axillary approach took 84 minutes. The precordial approach (n = 1) lasted 47 minutes and then required open conversion. The overall median estimated blood loss was 0 (range 0-100) mL. The mean change in blood pressure and pH from the beginning to the end of the procedure was -0.5 +/- 24.1 mm Hg and 0.16 +/- 0.07, respectively. The thyroid glands weighed 4.3 +/- 0.9 g and had normal glandular architecture with no evidence of significant tissue trauma or thermal injury. There were no cases of pneumothorax, subcutaneous emphysema, or air embolism. CONCLUSION: A number of approaches to the thyroid compartment are conceivable. The superior approach proved to be the fastest and easiest, whereas the lateral axillary and superficial axillary were the best approaches from a cosmetic and clinical standpoint.     

经胸乳入路的内镜甲状腺切除术500例

目的探讨经胸乳入路内镜甲状腺手术的技术方法、安全性和优缺点。方法2002年3月至2006年12月行胸乳入路内镜甲状腺切除术500例，其中原发性甲状腺机能亢进（简称甲亢）76例、甲状腺腺瘤111例、结节性甲状腺肿291例（10例有1～2次开放手术史）和甲状腺癌22例。结果成功完成手术492例，手术时间40～270min（平均74．5min）。其中行甲状腺肿瘤切除50例，甲状腺单叶次全切除214例，双叶次全切除212例（含原发性甲亢手术治疗73例）。22例甲状腺癌中，单叶腺体次全切除4例，根治性切除16例，另2例转开放手术。甲状腺肿块长径最大8．0em。术中失血3～250ml（平均5．5m1），未输血。术后2～3d拔除引流管。术后住院时间3～8d（平均4．2d），住院费用为7600～13500元（平均10510元），本院同期开放甲状腺手术患者住院费用平均为5700元，两者差异比较有统计学意义（t=13．755，P〈0．05）。术后并发症方面，术后手术通道出血3例，皮肤灼伤1例，切口感染2例，皮肤淤血3例，皮下积液6例，1例出现甲亢危象，暂时性喉返神经麻痹2例，无神经或甲状旁腺永久性损伤等严重并发症，并发症发生率为3．6％（18／492）。术后随访，失访42例，458例随访3～57个月（中位时间27个月），3例结节性甲状腺肿术后复发小结节，1例原发性甲亢术后复发。患者均对手术的美容效果满意。8例因为出血、腺体过大、甲状腺癌侵犯气管等原因中转为开放手术。22例甲状腺癌目前仍生存，1例甲状腺乳头状癌术后半年出现同侧颈淋巴转移，行开放颈清扫术后已无瘤生存至今3年，并继续随访。结论经胸乳入路内镜甲状腺切除术是一种安全而可行的手术方法，手术视野清晰，显露神经清楚，且具有显著的美容效果。此外，该方法仍有一定的并发症发生率，且费用较开放手术高。因此，本方法有待进一步改进。     

Thyroid surgery: changing patterns of practice

Objective: The practice of thyroidectomy has evolved over the past 10 years with the introduction of minimally invasive surgery, laryngeal nerve monitoring, and outpatient surgery. We sought to investigate corresponding trends in the disciplines performing thyroid surgery. Methods and Materials: The authors conducted a nonrandomized, case‐controlled comparison of surgical volumes and systematic analysis of publication volumes. Two surrogates for the proportion of thyroidectomies being performed by otolaryngologists–head and neck surgeons (OHNS) and general surgeons (GS) were chosen: 1) the operative case logs of graduates from American training programs in OHNS and GS from 1995 through 2004 were compared; and 2) the number of scientific articles published relating to thyroid surgery were systematically queried for two timeframes (1990–1994 and 2000–2004). Results: There was a gradual increase in the mean number of thyroidectomies performed by GS residents from 13.2 in 1995 to 18.2 in 2004. During the same timeframe, the mean number of thyroidectomies performed by OHNS residents more than doubled from 15.0 to 33.5. The number of American GS thyroid publications from 1990 to 1994 was 79, compared with 98 in the period 2000 to 2004, representing a 24% increase. During the same timeframe, the number of American OHNS articles increased from 14 to 49 (a 250% increase). The relative proportion of thyroid publications authored by American otolaryngologists more than doubled from 15.1% to 33.3% (P = .0017). Conclusions: A clear trend is emerging in the pattern of thyroid surgery in that a growing proportion of publications are being authored by otolaryngologists compared with general surgeons, and the average number of procedures performed by graduating chief residents is now 84% higher in otolaryngology compared with general surgery.     

甲状腺外科专业化的临床资料分析

目的 评价耳鼻咽喉头颈外科医师手术治疗甲状腺良性疾病的结果。方法回顾性分析北京朝阳医院耳鼻咽喉头颈外科2001年1月-2004年4月手术治疗496例甲状腺良性疾病的方式、术后并发症的发生、手术耗时、颈部切口长度、住院时间和术后复发的情况。结果甲状腺一侧腺叶加对侧腺叶部分切除314例，甲状腺一侧腺叶加峡部切除76例，甲状腺双侧腺叶次全切除29例，单纯甲状腺峡部切除3例，甲状腺全切除46例，颈部低位领式切口入路切除胸骨后结节性甲状腺肿28例。术后一侧喉返神经损伤发生率为0．2％(1／496)，无双侧喉返神经损伤。术后暂时性低钙血症发生率为1．8％(9／496)，无永久性低钙血症。术后出血发生率为0．6％(3／496)，无切口感染。手术耗时平均为66min，颈部切口长度平均为5．2cm，住院时间平均为6．3d。术后复发率0．2％(1／496)。结论受过严格头颈外科培训的耳鼻咽喉科医师行甲状腺良性疾病手术可降低喉返神经损伤的发生。     

Unintentional parathyroidectomy during thyroidectomy.

OBJECTIVES: In the United States thyroidectomy is a frequently performed surgery by both general and head and neck surgeons. Even the most experienced thyroid surgeon, however, has probably received a pathology report stating that an incidental parathyroid gland or parathyroid tissue was found in the submitted thyroidectomy specimen. The aim of this report is to explore some of the pathologic and clinical characteristics of unintentional parathyroidectomy during thyroidectomy. STUDY DESIGN: A retrospective review was performed of thyroidectomies performed at the University of California, Los Angeles, Center for the Health Sciences between 1989 and June 1998 which had pathology reports showing parathyroid tissue contained within the thyroidectomy specimen. This excluded any tissue submitted separately to be evaluated for parathyroid tissue and parathyroid tissue removed unintentionally during a thyroidectomy for a different procedure such as a laryngectomy or surgery for parathyroid disease. METHODS: The pathology slides were reviewed to determine the incidence of unintentional parathyroid tissue removal, the size of the parathyroid tissue found within the thyroid specimen, the location of the parathyroid tissue (extracapsular, intracapsular, intrathyroidal), and whether this unintentional parathyroidectomy during thyroidectomy caused clinical consequences. RESULTS: Four hundred fourteen applicable thyroidectomies were performed during this time with 45 (11%) discovered cases of unintentional parathyroidectomy during thyroidectomy. Twenty-five (56%) cases were discovered during thyroidectomy for benign disease, and 20 (44%) during thyroidectomy for malignant thyroid disease. All the parathyroid tissue was normal and was found in extracapsular (58%), intracapsular (20%), or intrathyroidal (22%) locations. Of these 45 cases, recurrent laryngeal nerve paralysis was found only in two patients who had the nerve resected intentionally during the thyroidectomy, and none of the patients developed permanent hypocalcemia. CONCLUSIONS: Incidental parathyroid gland tissue was reported in 11% of the thyroidectomies performed in our series, without the clinical consequence of hypocalcemia. The majority (78%) of this parathyroid tissue was found in the extracapsular and intracapsular locations; therefore it is possible that these parathyroid glands may be identified and preserved with more meticulous inspection of the thyroid capsule during and after thyroidectomy to decrease the incidence of unintentional parathyroidectomy during thyroidectomy in the future.     

Routine calcium measurement is not necessary after most thyroid surgeries: a prospective clinical study

Clin. Otolaryngol. 2010, 35 , 468–473 Objectives: Calcium levels are often measured to diagnose postoperative hypocalcaemia following thyroidectomy. The aims of this study were to (i) prospectively determine the incidence of symptomatic and biochemical hypocalcaemia following thyroidectomy, (ii) to identify if any associations exist between hypocalcaemia, type of surgery, histological diagnosis, specimen size/weight and the presence of histological parathyroid tissue and (iii) to evaluate the necessity of routine measurement of calcium levels following all thyroidectomies. Design: Prospective clinical study. Settings: University teaching hospital. Participants: Eighty-six patients presenting consecutively for thyroid surgery. Outcome measures: Type of surgery, indications, perioperative calcium levels, symptoms of hypocalcaemia and histology were documented. Results: Fifty-four patients underwent thyroid lobectomy and isthmusectomy, 19 underwent total and 13 completion thyroidectomy. Significantly, no patient undergoing thyroid lobectomy developed hypocalcaemia versus 26% of total thyroidectomies (P = 0.001) and 23% of completion thyroidectomies (P = 0.006). All eight patients with hypocalcaemia required treatment. Seven were initially identified clinically. Logistic regression analysis revealed that operation type was the only independent risk factor for developing hypocalcaemia (P = 0.021). Conclusions: No patient developed hypocalcaemia following thyroid lobectomy and isthmusectomy. Considering the majority (63%) of thyroid surgeries were lobectomies, most patients tested appear low risk for hypocalcaemia. Definitive prediction of hypocalcaemia postoperatively remains a challenge. However, our results suggest that analysing calcium levels routinely following thyroid lobectomy is unwarranted.     

小切口甲状腺切除术对甲状腺结节患者恢复情况及甲状腺激素水平的影响

目的探讨小切口甲状腺切除术对甲状腺结节患者恢复情况及甲状腺激素水平的影响。方法选取2017年1月至2019年12月收治的60例甲状腺结节患者进行观察,均接受小切口甲状腺切除术,观察甲状腺结节患者恢复情况,并检测观察甲状腺激素水平变化。结果60例甲状腺结节患者治疗总有效率为96.67%,并发症发生率为3.33%。术后7d患者游离三碘甲状腺原氨酸(FT3)及游离甲状腺素(FT4)等甲状腺激素水平较术前明显降低(P<0.05),总三碘甲状腺原氨酸(TT3)、总甲状腺素(TT4)较术前无明显变化(P>0.05),术后3个月甲状腺激素水平较术前无明显变化(P>0.05)。结论小切口甲状腺切除术治疗甲状腺结节手术及术后恢复效果好,术后并发症少,且不会对甲状腺激素水平造成明显影响,值得推广。     

改良Miccoli术中喉返神经的显露及损伤预防

目的：探讨甲状腺改良Miccoli术中解剖显露喉返神经的方法及预防喉返神经损伤的临床意义。方法：回顾性分析218例行甲状腺改良Miccoli术患者的资料，均在内镜直视下寻找喉返神经并进一步显露直至人喉处，行甲状腺次全切或腺叶全切除。结果：218例患者手术均获成功，无中转开放手术。术中均成功显露颈段喉返神经并保护之。术中、术后病理证实结节性甲状腺肿185例，甲状腺腺瘤8例，甲状腺乳头状微小癌25例。2例甲状腺乳头状微小癌及1例有鼻咽癌放疗史的患者，术后出现暂时性声嘶，3个月内声带活动恢复正常。结论：甲状腺改良Miccoli术中解剖显露喉返神经是该手术顺利进行的关键，是预防喉返神经损伤的有效方法。     

Transnasal endoscopic resection of lesions of the clivus: a preliminary report

OBJECTIVE: To review our experience with transnasal endoscopic resection of clival lesions. BACKGROUND: Because of the surrounding vital structures and the difficulties in achieving wide surgical exposure, the treatment of clival lesions is challenging. In an effort to overcome these obstacles, many centers use facial incisions and osteotomies to approach clival lesions. Minimally invasive endoscopic techniques have the potential to minimize morbidity while yielding similar surgical results. STUDY DESIGN: Retrospective chart analysis. MATERIALS AND METHODS: Patients with tumors involving the clivus that underwent endoscopic resection between 2000 and 2004 were identified. Charts were reviewed for clinical characteristics, previous therapies, diagnosis, tumor extent, management modalities, length of hospital stay, complications, and outcome. RESULTS: A total of six patients were identified. There were four males and two females with a mean age of 50 years, ranging from 29 to 66 years. The most common presenting symptoms were visual disturbances. Three patients had prior craniotomy with subtotal tumor resection. The pathology included three clival chordomas, and one each of meningioma, adenoid cystic carcinoma, and sinonasal undifferentiated carcinoma. All patients were managed with computer-aided transnasal endoscopic tumor resection with neurosurgical standby or involvement. None of the patients required additional craniotomies. The mean follow-up was 13 (range, 8-24) months. Intensity-modulated radiation therapy was used in three patients, and two patients are currently undergoing proton beam radiation therapy (PBRT). The average length of hospital stay was 2 (range, 2-3) days. There were no major postoperative complications. At the last follow-up, five patients were alive with two patients being free of disease. Two patients with residual disease are currently undergoing PBRT, and one patient developed distant metastasis. One patient died of unrelated causes. CONCLUSIONS: This preliminary report suggests that transnasal endoscopic management of clival lesions is a viable option to traditional open approaches with acceptable morbidity and mortality. The use of computer-aided surgery further minimizes surgical risks while maximizing tumor resection.     

内镜辅助甲状腺手术中喉上神经保护

目的　探讨内镜辅助甲状腺手术中对喉上神经保护的技巧。方法　对我院2006年10月～13年4月共650例实施内镜辅助小切口甲状腺手术的患者进行回顾性病例分 析和总结。结果　所有患者均成功完成手术,术后绝大部分患者对切口外观的满意。有8例（1.23%）患者出现暂时性喉上神经损伤,无一例永久性喉上神经损伤。结论　内镜辅助小切口甲状腺手术是一种新型的手术方式,需要术者掌握一定的手术技巧,可有效降低术后并发症,避免永久性喉上神经损伤和降低暂时性喉上神经损伤发生率。     

Role of subtotal thyroidectomy in the management of the follicular neoplasm of the thyroid

Clinically apparent thyroid nodules affect 4% to 7% of the population in North America. Malignant neoplasms of the thyroid comprise only about 1% of all cancers and are found in only 20% of patients undergoing thyroid surgery for suspected thyroid carcinoma. A follicular neoplasm of the thyroid is the most common histologic finding. During surgery, using frozen-section techniques, it is often difficult to distinguish between a benign and malignant lesion. The diagnosis may be deferred following intraoperative frozen-section examination of tissue or changed on evaluation of embedded tissue. In this series of 1224 thyroidectomies from 1976 to 1990, the pathology data from thyroidectomy surgical specimens submitted to tissue analysis were evaluated. It was found that subtotal thyroidectomy was effective in the management of the follicular neoplasm. This approach significantly reduced the morbidity and complications of patients undergoing thyroidectomy.     

内镜下甲状腺切除术(附32例报告)

目的 通过在内镜下进行甲状腺切除术,探讨其优缺点。方法 用内镜为32例甲状腺肿物的患者实施了经胸壁皮下入路甲状腺次全切除术。结果 全部病例均手术成功,平均手术时间165分钟,无喉返、喉上神经损伤和术后出血等并发症。术后恢复良好,近期随访颈部皮肤感觉接近正常。结论内镜下行甲状腺切除术对良性甲状腺病变具有无颈部疤痕,损伤小,皮肤感觉接近正常,术后恢复快等优点。     

Recurrent laryngeal nerve palsy after thyroid cancer surgery: a laryngological and surgical problem

Recurrent laryngeal nerve paralysis is one of the most frequent complications after thyroid surgery due to goiter and cancers. A higher probability of this complication occurs after secondary procedure of the thyroid and in malignant cases. The symptoms may differ and depend on many factors. Generally, patients need careful ENT and surgical care including diagnosis and treatment. Four hundred and sixty-six patients who underwent thyroid operation due to cancer were analyzed. The group was composed of 227 papillary carcinoma, 87 follicular carcinoma, 51 medullary carcinoma, and 101 anaplastic carcinoma. Two hundred and fifty-three total thyroidectomies, 82 lobectomies and subtotal second lobe operations, 91 subtotal thyroidectomies, and 40 biopsies (wedge resections) were performed. In all 426 total and subtotal thyroidectomies an attempt to identify the recurrent laryngeal nerves was carried out. For 360 patients (77%) the surgical procedure was primary and for 106 patients (23%) the operation was secondary. Preoperative and postoperative laryngoscopic examinations were performed in all patients. Every patient with palsy underwent special laryngological procedures if needed (tracheotomy, phoniatric rehabilitation, conservative treatment and surgery in lack of improvement). The rate of postoperative vocal cord paralysis was 4.7%. The permanent palsy rate was 3.5%. In 1.2% recovery was observed. Of the 4.7% palsy rate, 3.2% concerned unilateral palsy and 1.5% bilateral pathology. Using the χ² test, no significant differences between the rate of unilateral and bilateral paralysis and between temporary and permanent paralysis were found. On the basis of our material and results, identification the recurrent laryngeal nerves should be mandatory at surgery, thereby avoiding paralysis. Special laryngological procedures and surgical care from the beginning of paralysis are necessary for patients with vocal cord palsy. It allows to diagnose and treat patients with quite good results. Received: 30 May 2000 / Accepted: 21 May 2001     

The operation experience of endoscopic thyroidectomy by areola and axilla approach

To explore the feasibility of endoscopic thyroidectomy via breast areola and axilla approach. The clinical data of 36 cases that underwent endoscopic thyroidectomy via breast areola and axilla approach from February 2012 to December 2013 were reviewed. All cases were completed, the mean operation time was 136.3 min (95–183 min), intraoperative blood loss was 15.8 ml (5–60 ml). The average hospitalization time was 5 days (4–6 days). There were no conversions to open surgery, no permanent nerve injuries, and no cases of hypoparathyroidism. Three patients had postoperative subcutaneous ecchymosis who were cured spontaneously after 1 month. Endoscopic thyroidectomy is safe and feasible for patients with thyroid diseases with good cosmetic results, and is worthy of being widely applied for patients who have cosmetic demand.     

Transoral endoscopic thyroidectomy with or without central neck dissection

PurposesMinimally invasive thyroid surgeries are universally accepted. We report on one, transoral endoscopic thyroidectomy with or without central neck dissection.MethodsA case series of 103 patients were operated on between December 2018 and December 2021. We performed transoral endoscopic thyroidectomy vestibular approach (TOETVA) for 76 patients with a benign nodule, and 27 with papillary thyroid carcinoma (PTC). The patients with malignant nodules also underwent ipsilateral central neck dissection. The extent of surgery, operative time and operative complications were analyzed.ResultNo cases were converted to open surgery. Average tumor size was 3.8 ± 1.62 cm, mean operative time was 116.5 ± 41.7 min, median blood loss 40.1 ± 49 mL. There were 95 patients with lobectomy and 8 patients with total thyroidectomy. Temporary hoarseness occurred in 9 patients (8.7 %). No patients developed permanent hoarseness. Twelve patients had middle chin numbness.ConclusionThe transoral endoscopic thyroidectomy vestibular approach, with or without central neck dissection, is a safe, effective and highly aesthetic treatment.