Thyroidectomy

Thyroidectomy requires meticulous dissection and the technique has changed over time. We discuss the gold standard and evolving new methods of performing a thyroidectomy and the common complications and difficulties associated with these. Retrosternal goitres present slightly different challenges. The preoperative assessment and characterization of these retrosternal goitres and the associated increased complication rates are discussed. New techniques to minimize these complications such as nerve monitoring are now more routinely being utilized and are described in this article.     

Conventional Versus Computer-Assisted Technique for Total Knee Arthroplasty: A Minimum of 5-Year Follow-up of 200 Patients in a Prospective Randomized Comparative Trial

In the literature, studies of computer-assisted total knee arthroplasty (TKA) after mid-term period are not conclusive and long-term data are rare. In a prospective, randomized, comparative study 100 conventional TKAs (group REG) were compared with 100 computer-assisted TKAs (group NAV). Minimum follow-up was 5 years. No difference in implant failure was found with 1.1% in group NAV versus 4.6% in group REG (P = 0.368). Group NAV showed a significantly less mean deviation of mechanical limb axis (P = 0.015), more TKAs (90% versus 81% in group REG) were within 3° varus/valgus and a higher tibial slope and lateral distal femoral angle (LDFA) accuracy was found (P ≤ 0.034). Clinical investigational parameters showed no differences (P ≥ 0.058). Insall and HSS score total were also higher in group NAV (P ≤ 0.016).     

悬吊法在48例内镜甲状腺手术中的运用体会

目的 探讨悬吊法在内镜甲状腺切除术中运用的方法 及可行性.方法 对该院2005年9月-2008年3月收治的甲状腺疾病中,行经胸乳径路及颈前小切口径路的内镜甲状腺手术中运用悬吊法的48例临床资料进行回顾性分析.其中甲状腺瘤18例,结节性甲状腺肿28例,原发性甲状腺功能亢进2倒.行甲状腺瘤摘除术16例,单侧部分甲状腺切除10例,单侧甲状腺次全切除20例,双侧甲状腺次全切除2例.结果 手术过程顺利,平均手术时间(74±18.6)min,平均术中出血(20±16.8)mL,无中转开放手术,无声嘶或甲状旁腺损伤等并发症,平均住院时间(6±3.5)d,术后随访3-18个月,无复发病例.结论 悬吊法运用在内镜甲状腺切除术中,安全可行,并具有良好的建腔效果.     

Evaluation of the Optimal Visceral Branch Configuration in Open Thoracoabdominal Aortic Repair by Computed Tomography

Background: In thoracoabdominal aneurysm (TAAA) repair, our technical modification of visceral reconstruction using longer cut pre-sewn side branches has provided good surgical outcomes. Here, we assessed the long-term durability and patency of revascularized branches using computed tomography (CT) to confirm the validity of our approach.Methods: Early and late CT evaluations were performed in 11 TAAA patients (males: 5; mean age: 60.6 years) using the Coselli graft to evaluate the position of main graft and the diverging pattern and patency of side branches. Seven of 11 were sutured in an extra-anatomical fashion using longer cut side branches.Results: In Anatomical (n = 4) and Extra-anatomical (n = 7) groups, the early patency of side branches was not significantly different. Although the late patency of right renal artery (RA) was 100% in both groups, the one of left RA was 60% in Extra-anatomical, while 100% in Anatomical. Furthermore, the main graft in Extra-anatomical was significantly posterior and leftward to the spine with left RA side branch diverging at an acute angle.Conclusions: When a pre-sewn branched graft designed for TAAA is used, the graft should be sutured in a fashion similar to normal patient anatomy to minimize the possibility of kinking of RA side branch for the patency.