Conventional Dissection Research Articles

A Comparative Study Between Coblation-Assisted Tonsillectomy and Conventional Dissection and Snare Tonsillectomy.

Background Tonsillitis is a vastly prevalent disease, accounting for the majority of outpatient visits. The dissection and snare method has been the predominant approach for tonsillectomy for centuries. Coblation-assisted tonsillectomy offers advantages such as faster healing, shorter surgery duration, minimal blood loss, and fewer postoperative complications. Therefore, a study was conducted to evaluate the distinctions and compare the efficacy of traditional dissection and coblation-assisted tonsillectomy. Materials and methods Patients were divided into two groups: Group I was operated on using the conventional method, and Group II was operated on using the coblation method. Both groups were then assessed for intraoperative time, intraoperative bleeding, postoperative pain, and postoperative complications. Results Coblation-assisted tonsillectomy patients had a significantly shorter mean duration for the procedure and significantly lower blood loss in comparison to the conventional method. There were no statistically significant variations in the incidence of postoperative complications. Coblation-assisted tonsillectomy patients experienced considerably higher pain scores on various postoperative days. Conclusion Coblation-assisted tonsillectomy had the added advantage of reduced intraoperative blood loss, shorter surgical time, and faster recovery postoperatively. Coblation-assisted tonsillectomy can be considered an effective alternative to conventional methods. However, it's important to consider factors such as cost-effectiveness and surgeon experience. Further research involving larger sample sizes and longer follow-up periods could yield more insightful knowledge of the outcomes of these two tonsillectomy techniques.

Feasibility and Safety of Uniportal Thoracoscopic Segmentectomy Using a Unidirectional Dissection Approach without Dissecting a Fissure.

Background: Few original articles describe the perioperative outcomes of uniportal thoracoscopic segmentectomy using a unidirectional dissection approach. In this retrospective study, we evaluated the feasibility and safety of this procedure. Methods: This study included 119 patients who underwent uniportal thoracoscopic segmentectomy in our department between February 2019 and December 2022. The patients were divided into unidirectional (group U, n = 28) and conventional (group C, n = 91) dissection approach groups. While the dominant pulmonary vessels and bronchi were transected at the hilum without dissecting a fissure in the unidirectional (U) group, the dominant pulmonary artery was exposed and divided at a fissure in the conventional (C) group. Patient characteristics and perioperative outcomes were compared between groups U and C. Results: The proportions of simple and complex segmentectomies were statistically similar between the groups. The operating time was shorter (group U: 110 [interqurtile range: 90-140] min, group C: 135 [interqurtile range: 105-166] min, p = 0.012) and there was less blood loss (group U: 0 [interqurtile range: 0-0] g, group C: 0 [interqurtile range: 0-50] g, p = 0.003) in group U than in group C. However, there were no significant intergroup differences in other perioperative outcomes. Conclusions: The unidirectional dissection approach in uniportal thoracoscopic pulmonary segmentectomy is safe and feasible and enables a smoother operation.

The impact of methylene blue in colon cancer: a retrospective multicentric study

IntroductionDiscussions about the optimal lymph node (LN) count and its therapeutic consequences have persisted over time. The final LN count in colorectal tissues is affected by a variety of variables (patient, tumor, operation, pathologist, immune response). Methylene blue (MB) intra-arterial injection is a simple and inexpensive procedure that can be used to enhance lymph node count.AimAnalyze whether there is a statistically significant difference between intra-arterial methylene blue injection and conventional dissection for the quantification of lymph nodes and determine if there is a variation in the quality of lymph node acquisition.Methods and resultsBetween 2015 and 2022, we conducted a retrospective analysis of colon cancer specimens. Data on the tumor’s features, the number of lymph nodes, the number of lymph nodes that were positive, and other factors had been collected. The number of identified lymph nodes was highly significantly improved in the study group (P < 0.05). There is not a significant statistical difference between groups regarding the metastatic lymph node harvest. The group with injection of intra-arterial methylene blue shows a significantly decreased (P < 0.05) of the of cases with less than 12 lymph nodes recovered comparing with the control group.ConclusionColon cancer specimens can be easily evaluated concerning lymph nodes using the methylene blue method. Therefore, we strongly advise this approach as a standard procedure in the histological evaluation of colon cancer specimens in order to maximize the identification of lymph nodes. However, the detection of metastatic lymph nodes was unaffected significantly.

Plastic Clamp Versus Conventional Surgical Dissection Technique in Pediatric Circumcision: A Systematic Review and Meta-Analysis.

Phimosis is a common condition of the urinary system in children and often requires surgical treatment. However, the optimal method of circumcision for children has not been determined. We conducted a systematic review and meta-analysis to compare the safety and effectiveness of plastic clamp with conventional surgical circumcision in pediatric circumcision. A literature search was carried out to compare the plastic clamp and conventional dissection technique in the pediatric population. The following search terms were used: "circumcision", "plastic clamp", "conventional", "plastibell", "children" and etc. Meta-analysis was used to pool and evaluate variables such as operative time, blood loss, wound infection, bleeding, edema, and total postoperative complications. The plastic clamp technique (PCT) was used in 10,412 of the 17,325 participants in the nine studies, while the conventional surgical dissection technique (CST) was used on 6913 patients. When compared to the CST approach, the PCT approach resulted in shorter operative times (mean difference (MD) -17.48, 95% CI -22 to -12.96; P < 0.001), less blood loss (MD -4.25, 95% CI -7.75 to -0.77; P = 0.02), and a higher incidence of postoperative edema (OR 2.33, 95% CI 1.34 to 4.08; P = 0.003). However, no significant difference was found in the incidence of postoperative complications, including wound infection and bleeding between PCT and CST. PCT is a safe and time-saving option in the pediatric population. However, this method appeared to have a significant greater rate of postoperative edema.

Cavitron ultrasonic surgical aspirator (CUSA) compared with conventional pancreatic transection in distal pancreatectomy: study protocol for the randomised controlled CUSA-1 pilot trial

BackgroundPostoperative pancreatic fistula (POPF) remains the most common and serious complication after distal pancreatectomy. Many attempts at lowering fistula rates have led to unrewarding insignificant results as still up to...

Wound Healing and Cosmetic Outcomes in Neonatal Circumcision Using Three Different Techniques.

Circumcision of a male child is an integral part of some African cultures. An ideal technique of neonatal circumcision should be simple, safe and heal satisfactorily with good cosmetic appeal. The aim was to compare conventional dissection (CD), Plastibell (PB) and Gomco (GM) techniques of circumcision in neonates in terms of wound healing, wound healing complications, cosmetic outcome and parental satisfaction. A total of 144 male neonates were randomised into three study groups: CD, GM and PB groups. All procedures were performed under local anaesthesia as day case. Superficial wound healing was assessed on the 7 th post-operative day. The cosmetic outcome of the three techniques was assessed by a plastic surgeon and the parents using a 4-point Likert scale on the 4 th post-operative week. The three groups were comparable in terms of age ( P = 0.207) and weight ( P = 0.098) at circumcision. There was satisfactory wound healing in 48 (100%) patients in the GM group, compared to 47 (97.8%) in the CD group and 45 (93.8%) in the PB group ( P = 0.324). Wound healing complications were recorded in seven patients, 1 (2.1%) in the CD group with wound infection, 5 (10.4%) in the PB group with moderate pain despite the use of analgesia and 1 (2.1%) patient with skin bridge in the CD group. The plastic surgeon and the parents rated the cosmetic outcome of CD higher than the other two techniques. There is no significant difference in superficial wound healing amongst the three circumcision techniques. The cosmetic outcome of CD was significantly better than that of GM and PB circumcisions.

Robot-assisted gastric endoscopic submucosal dissection significantly improves procedure time at challenging dissection locations.

Endoscopic submucosal dissection (ESD) is the standard treatment for early malignant stomach lesions. However, this procedure is technically demanding and carries a high complication risk. The level of difficulty in performing ESD is influenced by the location of the lesion. In our study, we aimed to investigate and analyze the effectiveness of robot-assisted ESD for lesions situated in challenging locations within the stomach. We developed a gastric simulator that could be used to implement various gastric ESD locations. An EndoGel (Sunarrow, Tokyo, Japan) was attached to the simulator for the dissection procedures. Robot-assisted or conventional ESD was performed at challenging or easy locations by two ESD-trainee endoscopists. The procedure time was remarkably shorter for robotic ESD than conventional dissection at challenging locations (6.2 vs. 10.2min, P < 0.05), mainly due to faster dissection (220.3 vs. 101.9mm2/min, P < 0.05). The blind dissection rate was significantly lower with robotic ESD than with the conventional method (17.6 vs. 35.2%, P < 0.05) at challenging locations. The procedure time was significantly shortened when robot-assisted gastric ESD procedures were performed at challenging locations. Therefore, our robotic device provides simple, effective, and safe multidirectional traction for endoscopic submucosal dissection at challenging locations, thereby reducing difficulty of the procedure.

Comparison of monopolar radiofrequency thermal ablation and conventional dissection tonsillectomy: a randomized control trial

Aim: To compare monopolar radiofrequency thermal ablation with the conventional dissection tonsillectomy in terms of postoperative healing process and any possible complications. Methods: 56 patients of 14 years of age and above were randomly divided into two groups. Group 1 underwent Conventional dissection tonsillectomy and group 2 underwent Monopolar radiofrequency tonsillectomy. Intraoperative duration, bleeding, postoperative pain and healing were compared between the two groups. Intraoperative duration was measured and bleeding was analysed by visual estimation. Visual Analogue Scale was used to analyse the postoperative pain and a grading system was used to analyse healing. Objective: To compare monopolar radiofrequency thermal ablation with the conventional dissection tonsillectomy in terms of duration of surgery, perioperative blood loss and postoperative intensity of pain. Results: Intraoperative duration was found to be longer in RFA group with increased blood loss and p-value was found to be statistically significant of &lt;0.001. Postoperative pain was found to be significantly low during postoperative day 0 and 1 with RFA group when compared to CD group with p-value &lt;0.001. No statistically significant difference was noticed regarding the time taken for wound healing in both the groups. Conclusion: Conventional dissection tonsillectomy is better than monopolar radiofrequency ablation in terms of short operative duration and intraoperative bleeding even though monopolar radiofrequency ablation seems to be better than conventional dissection tonsillectomy in view of postoperative pain.

Endoscopic Anatomy of the Equine Guttural Pouch: An Anatomic Observational Study.

Guttural pouch endoscopy allows for both the visualization and treatment of many clinical problems in the equine retropharyngeal region. This area is extremely complex, and its description remains a real challenge for veterinary anatomists and practitioners. Six clinically normal equine cadavers were employed. Conventional dissections of guttural pouches without penetrating the guttural pouch membrane were first performed, and each adjacent structure was identified. Then, a guttural pouch endoscopic exam of the dissected heads was performed in order to correctly map each visible underlying anatomic structure identified in the previous dissection. This allowed us to: 1-identify each structure visible on endoscopic examination of the guttural pouch; 2-create a representative map of all the structures accurately identified via endoscopy; and 3-describe a systematic guttural pouch endoscopic examination with practical keys to help identification of the underlying vital structures. Our investigation provides new practical information on guttural pouch endoscopic anatomy and has allowed us to identify structures that were not previously described. We believe that this information may help with an accurate diagnosis in some cases and also potentially reduce iatrogenic trauma to important structures.

Comparison of Postoperative Secondary Haemorrhage Rates and Pain Threshold between Conventional Cold Dissection, Bipolar, Monopolar Electrocautery and Laser Tonsillectomy, Meta Analysis Study

Abstract Background Tonsil surgery is one of the most common surgical procedures performed in otorhinolaryngology. The earliest known removal of tonsils was performed by Celsius in the first century A.D. Aim of the Work To compare the postoperative secondary haemorrhage rates and pain threshold between conventional cold dissection, bipolar, monopolar electrocautery and laser tonsillectomy. Patients and Methods This review was done using standard methodology outlined in the Cochrane Handbook and reported the findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement guidelines. An initial search will be carried out using the PubMed, Cochrane library Ovid, Scopus &amp; Google scholar using the following keywords: Dissection, Diathermy, Laser electrocautery, Tonsillectomy. Results Highly significant decrease in mean 7-day post-operative pain score, in conventional dissection group compared to diathermy group (p &amp;lt; 0.01). Significant decrease in mean 7-day post-operative pain score, in conventional dissection group compared to laser electrocautery group (p = 0.024). Nonsignificant difference in mean 7-day post-operative pain score, in diathermy group compared to laser electrocautery group (p &amp;gt; 0.05). Non-significant difference in revision or re-operation rate, in conventional dissection group compared to diathermy group (p &amp;gt; 0.05). Non-significant difference in secondary haemorrhage rate, in conventional dissection group compared to diathermy group (p &amp;gt; 0.05). Non-significant difference in secondary haemorrhage rate, in conventional dissection group compared to laser electrocautery group (p &amp;gt; 0.05). Conclusion Based on the findings of the present study, all the methods used in the study are safe but there was significant decrease in mean 7-day post-operative pain score using conventional dissection method compared to diathermy and laser electrocautery methods with no difference found in secondary haemorrhage rates between different methods used.

Description of the neuroanatomy of the brachial plexus in South American lizards. Phylogenetic implications.

Few studies considered the anatomy of the nerve plexuses and musculature associated with them in ectothermic sauropsids. Based on differentiated Sudan Black B staining and conventional dissections, we describe the neuroanatomy of the brachial plexus, its main associated nerves, and muscles. For that, representatives of the genera Diplolaemus, Liolaemus, Phymaturus, and Tropidurus were selected. Based on this, potentially useful characters for phylogenetic analysis were described. Our results show that the brachial plexus can be formed by four, five, or six nerve branches. The brachial flexor trunk, circumflex, interosseous, median, radial, subscapulocoracoid, supracoracoid, and ulnar nerves were identified. Regarding the muscles innervated by the main nerves, the following muscles were identified: biceps brachii, deltoideus scapularis, latissimus dorsi, levator scapulae, pectoralis, serratus thoracis, trapezius, triceps longus caudalis, and triceps longus lateralis. Phylogenetic analyzes revealed 31 potential synapomorphies. There exists evidence that neuroanatomy studies in a phylogenetic context could provide useful information helping to elucidate the relationships between taxonomic groups.

Imaging the levator ani and the puborectalis muscle: implications in understanding regional anatomy, physiology and pathology

Purpose: To review the findings of recent dynamic imaging of the levator ani muscle in order to explain its function during defecation. Historical anatomical studies have suggested that the levator ani initiates defecation by lifting the anal canal, with conventional dissections and static radiologic imagery having been equated with manometry and electromyography. Materials and methods: An analysis of the literature was made concerning the chronological development of imaging modalities specifically designed to assess pelvic floor dynamics. Comparisons are made between imaging and electromyographic data at rest and during provocative manoeuvres including squeeze and strain. Results: The puborectalis muscle is shown distinctly separate from the levator ani and the deep external anal sphincter. In contrast to conventional teaching that the levator ani initiates defecation by lifting the anus, dynamic illustration defecography (DID) has confirmed that the abdominal musculature and the diaphragm instigate defecation with the transverse and vertical component portions of the levator ani resulting in descent of the anus. Current imaging has shown a tendinous peripheral structure to the termination of the conjoint longitudinal muscle, clarifying the anatomy of the perianal spaces. Planar oXy defecography has established patterns of movement of the anorectal junction that separate controls from those presenting with descending perineum syndrome or with anismus (paradoxical puborectalis spasm). Conclusions: Dynamic imaging of the pelvic floor (now mostly with MR proctography) has clarified the integral role of the levator ani during defecation. Rather than lifting the rectum, the muscle ensures descent of the anal canal.

Blood-saving dissection with monopolar tungsten needle electrodes and Teflon-coated spatula electrodes in tumor orthopedics

IntroductionResection of musculoskeletal tumors and reconstruction with tumor endoprostheses often results in blood loss requiring transfusion of blood products. We assessed the blood-saving potential of using monopolar tungsten needle electrodes and polytetrafluoroethylene (PTFE)-coated spatula electrodes (intervention) compared with conventional dissection with sharp instruments and coagulation with uncoated steel electrodes (control).MethodsWe retrospectively analyzed data of 132 patients (79 interventions, 53 controls) undergoing surgery by one single experienced surgeon in our tertiary referral center between 2012 and 2021.ResultsIntraoperative blood loss in the intervention group was reduced by 29% [median (IQR): 700 (400–1200) vs 500 (200–700) ml; p = 0.0043]. Postoperative wound drainage decreased by 41% [median (IQR): 1230 (668–2041) vs 730 (450–1354) ml; p = 0.0080]. Additionally, patients in need of PRBCs during surgery declined from 43% to 15% (23/53 vs 12/79; p = 0.0005), while the transfusion rate after surgery did not change notably. The number of patients in need of revision surgery due to wound healing disorders was low in both groups (control group: 4/53 vs intervention group: 4/79). Only one patient in the control group and two patients in the intervention group underwent revision surgery due to hemorrhage. Baseline characteristics were similar between groups (sex, Charlson Comorbidity score, tumor entity).ConclusionDissection with tungsten needle electrodes and PTFE-coated spatula electrodes appears an effective surgical blood-saving measure without increased risk of wound healing disorders.Level of evidenceIII, retrospective comparative study.Clinical trial registration. The study was registered at ClinicalTrials.gov. Identifier: NCT05164809.

Anatomical knowledge of zygomatico-buccal plexus in a cadaveric study.

The details of the facial nerve pattern were clearly explained in the parotid gland (PG), lateral area of the face, and periorbital areas to prevent the unexpected outcome of medical intervention. However, it remains unclear whether information about the zygomatico-buccal plexus (ZBP) in the masseteric and buccal regions. Therefore, this study aimed to help clinicians avoid this ZBP injury by predicting their common location. This study was conducted in forty-two hemifaces of twenty-nine embalmed cadavers by conventional dissection. The characteristics of the buccal branch (BB) and the ZBP were investigated in the mid-face region. The results presented that the BB gave 2-5 branches to emerge from the PG. According to the masseteric and buccal regions, the BB were arranged into ZBP in three patterns including an incomplete loop (11.9%), a single-loop (31.0%), and a multi-loop (57.1%). The mean distance and diameter of the medial line of the ZBP at the corner of the mouth level were 31.6 (6.7) and 1.5 (0.6) mm respectively, while at the alar base level were 22.5 (4.3) and 1.1 (0.6) mm respectively. Moreover, the angular nerve arose from the superior portion of the ZBP at the alar base level. The BB formed a multiloop mostly and showed a constant medial line of ZBP in an area approximately 30 mm lateral to the corner of the mouth, and 20 mm lateral to the alar base. Therefore, it is recommended that physicians should be very careful when performing facial rejuvenation in the mid-face region.

Anatomical study of the red flour beetle using synchrotron radiation X-ray phase-contrast micro-tomography.

Synchrotron X-ray phase-contrast microtomography (SR-PhC micro-CT) is well established, fast and non-destructive imaging technique for data acquisition that is currently being used to obtain new insights into insect anatomy and function in physiological, morphological and phylogenetic studies. In this study, we described in situ the internal organs of the red flour beetle Tribolium castaneum Herbst 1797, a widespread pest of cereals and stored food causing serious damage to the human economy. Two-dimensional virtual sections and volumetric reconstructions of the nervous, alimentary and reproductive systems were carried out in both sexes. The results provided a comprehensive overview of the morphological characteristics of this species, such as the different maturation stages of ovarioles and the realistic location, size and shape of internal organs. Given the great interest in this model species in experimental biology and forensic entomology, complete knowledge of the general anatomy is required for future functional applications in pest control and experimental studies. In addition, this study confirms SR-PhC micro-CT as a powerful and innovative tool in entomology, particularly suitable for small species and chitinized structures that are difficult to analyse using conventional dissection and histological methods.

Is Laser Better than Cold Steel (Dissection and Snare) for Tonsillectomy?

To analyse the surgical outcome of CO2 laser assisted tonsillectomy with the cold steel (conventional dissection and snare) tonsillectomy. This prospective, non-randomised, single blind study was conducted in 25 cases suffering with recurrent tonsillitis. The left tonsillectomy was performed with CO2 laser while the right tonsil was excised using cold steel method (conventional dissection and snare method). The surgical time, blood loss and post-operative pain for each method was recorded and analysed. CO2 laser tonsillectomy had highly significant less intra-operative blood loss (41.8ml vs. 78.8ml with p = 0.001) and postoperative pain levels on postoperative day 1,3, and 5 ( p value of 0.013, 0.006 and 0.000 respectively) as compared to cold steel method. However; there was no statistically significant difference in operative time between the two techniques (p > 0.05). CO2 laser tonsillectomy appeared to be better technique than cold steel in terms of intra-operative haemorrhage and pain.

Microscopic Assistance in Cold Dissection Tonsillectomy – Does it Improve Surgical Outcome?

Background: Tonsillectomy is one of the commonest surgical procedure carried out by ENT surgeon. In the post-operative period, rate of life-threatening post-operative bleeding varies between 0 and 20 % of the patients. The use of magnifying devices like microscopes or magnifying glasses is still in the focus of clinical investigation as it is hypothesized that precise vision of vessels during surgery allows precise coagulation and therefore reduces post-operative bleeding. Furthermore, precise coagulation should reduce post-operative pain too. The study aims to compare the surgical outcome between microscopic assisted tonsillectomy and traditional cold dissection tonsillectomy. Methods: This prospective study was conducted on 32 patients who had undergone tonsillectomy from March 2020 to December 2021. The patients included in the study underwent cold dissection tonsillectomy where one tonsil was removed with Microscopic assistance and other with traditional cold dissection method with unsupported vision. Intraoperative blood loss was calculated. Post-operative pain score was measured with Wong- Baker FACES® Pain rating scale till 7th post-operative day. Post-operative complications if present were noted. Results: Total of 32 patients were enrolled in the study with age ranging from 16-42 years. There were total 18 male (56.3%) and 14 females (43.8%) in the study. Intraoperative time for Microscopic assisted cold dissection (16.44 ± 3.46 minutes) was longer than Conventional dissection technique (13.94 ± 2.86 minutes) (p=0.04). Amount of blood loss during MCD technique was 16.47 ± 4.58 ml whereas in CD group it was 18.22 ± 4.54 ml (p=0.02). Pain score in both methods were higher during early post-operative period and gradually decreased with time. During rest, there was no statistically significant difference in pain between the two methods during first three post-operative days, after which pain was significantly reduced in MCD through day 4-7 (p &lt;0.05). None of the patient had post- operative hemorrhage requiring intervention in operation room. Conclusions: Microscopic assisted cold dissection showed statistically significant results for reduced intraoperative blood loss and post-operative pain score than Conventional dissection method.

PSAT383 Tension-free Thyroidectomy in the Treatment of Thyroid Cancer and Follicular Neoplasia: Experience of the First 100 Cases

Abstract Background and aims. The safety of thyroid surgery in terms of recurrent laryngeal nerve palsy and hypoparathyroidism was increasing in the last decade. In this study, we present a new method of tension-free thyroidectomy (TFT), which could be used to further decrease the complication rate after thyroidectomy. Patients and Methods The procedure is based on the medial approach to the recurrent laryngeal nerve and the parathyroid glands after the division of isthmus and successive total dissection of Barry ligament. One hundred consecutive patients (128 nerves at risk) underwent "tension-free thyroidectomy" (TFT) from August to November 2021 performed by one surgeon. There were 80 females and 20 male patients (ratio 4: 1) with a mean age of ninety-two 46,4 (range from 17 to 75). Lobectomy was carried out in 74 (74%) patients, total thyroidectomy in 26 (26%). In 42 cases patients additionally underwent central or/and lateral neck dissection. Indications for surgery were papillary carcinoma (N=52), medullary cancer (N=2), follicular neoplasia - Bethesda IV group after fine-needle biopsy (N=46). Mean thyroid nodule size was 25,3 mm (ranged 7 - 120 mm). Intraoperative transient neuromonitoring was used in all the cases (5 mA), in 20 cases permanent neuromonitoring was also used. Translaryngeal untrasound or direct laryngoscopy were routinely used prior and after surgery to evaluate vocal cords mobility. Calcium and parathormone level were measured in patients after thyroidectomy on the first, 14th and 30th postoperative days. Results The mean operating time of lobectomy was 80±39 (range: 25-120), for total thyroidectomy 80 ±36 (range: 55-130). There was no conversion to the conventional lateral-to-medial approach. No fluctuation of electric activity of laryngeal nerves during surgery was revealed. Intraoperative loss of signal (LOS) due to thermal effect of electrocautery and subsequent transient unilateral laryngeal nerve palsy occurred in 3 cases (2,3% from the total number of nerves at risk). In all these patients normal vocal fold function was confirmed on the 30th day after surgery. No permanent nerve palsy cases revealed. Three patients (out of 26 in the total thyroidectomy group – 11,5%) exhibited a decrease of parathyroid hormone level on the postoperative day 1 which was resolved in two weeks under the substitution therapy with calcium and alfacalcidol. No cases of permanent hypoparathyroidism occurred. Conclusion TFT (tension-free thyroidectomy) can be considered a safe and feasible operation in patients with thyroid cancer and follicular neoplasia. Larger and comparative (randomized) studies with conventional dissection technique should be performed to investigate the hypothesis that this approach can provide a lower complication rate. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

351. SUPERIOR MEDIASTINAL DISSECTION DURING MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER—A MULTICENTER PROPENSITY SCORE MATCHED (PSM) ANALYSIS

Abstract Minimally invasive esophagectomy (MIE) is currently the preferred approach of surgery for esophageal cancer. Systematic superior mediastinal lymphadendectomy along bilateral recurrent laryngeal nerve is enhanced by the magnified view in thoracoscopy, and is increasingly performed to achieve complete nodal dissection. Both participating centers began MIE with systematic superior mediastinal dissection in recent 5 years. In the current study, we aim to compare the short- and medium-term outcomes of MIE with or without superior mediastinal dissection. Consecutive patients who received MIE for esophageal cancers from 2004 to 2021 were recruited, data were collected from a prospectively maintained database. Patients were divided into ‘systematic superior mediastinal dissection’ and ‘control’ groups, and propensity score matching was performed with age, tumor location, tumor stage and neoadjuvant therapy. Total 157 patients were recruited, 67 (42.7%) in the extended superior mediastinal dissection group. After PSM, 48 patients were identified in each group. Short term surgical outcomes as well as medium term survival results were compared. Operative time was significantly longer with extended superior mediastinal dissection. Higher number of lymph nodes were yielded in total and from the superior mediastinum. Recurrent laryngeal nerve palsy developed in 52.1% and 43.8% of the MIE with or without extended dissection respectively, but significantly fewer palsies required intervention in the extended dissection group. Higher rate of anastomotic leakage was observed in the extended dissection group, but there was no difference in the overall severe adverse event (&amp;gt; = Grade III: 31.3% vs 35.4%). There was no statistical difference in the survival, but a trend towards improved 2 year disease-free survival was observed. Minimally invasive esophagectomy with systematic superior mediastinal dissection achieved a higher lymph node yield and a trend towards improved disease free survival. The overall adverse event rate was similar with conventional dissection. While better cancer staging could be achieved with extended dissection, further research is required to confirm the oncological benefit of extended dissection.

Lower Nose Arterial Plexus and Implications for Safe Filler Injections.

The lower nose has abundant blood supply; however, nasal tip necrosis still occurs following filler injections. This study revealed the complicated pattern of the arterial supply of the lower nose. The arterial pattern of the lower nose was studied in 40 cadavers using conventional dissections and translucent modified Sihler staining. Two arterial rings were connected in a figure of eight. The upper ring (nasal arterial circle) consisted of the lateral nasal and the subalar arteries encircling the nasal tip and alae. The lower ring (arterial plexus of the upper lip) was more important because of the contribution of the facial and superior labial arteries. This specific feature had not been mentioned elsewhere. Understanding this specific feature of the blood supply of the lower nose is essential for aesthetic physicians to perform the appropriate techniques during filler injection procedures in the nasal and perioral regions.