Conventional Thyroidectomy Research Articles

Cervical scar satisfaction post conventional thyroidectomy.

Thyroidectomy is a commonly performed procedure with large centres performing thousands of thyroid surgeries per year. The traditional Kocher mid-cervical incision has been the standard approach to thyroidectomy since the late 1870s with predictable results. The introduction of minimally invasive and remote access techniques seeks to reduce the morbidity of a mid-cervical scar incision. Ninety-five [95] patients who underwent this approach over the thirty [30] months period from January 2015 to July 2017 were administered the validated Patient Scar Assessment Questionnaire and the collected data analysed. Forty-eight [48] patients, (50.5%) met inclusion criteria and provided responses with a mean time since surgery of 18.9 months. There is a high level of satisfaction with 91.7% of patients in the study having scores consistent with scar satisfaction after conventional thyroidectomy. While patients were satisfied with the appearance of their scars, a majority of patients (n=28, 58.3%) were at least slightly conscious of their incisions, with more than 10% of patients (n=5) reporting significant levels of self-consciousness. Patients of Mixed race were found to have slightly elevated scores on PSAQ compared with IndoTrinidadian and AfroTrinidadian races (P=0.002 and P=0.006). Most patients were satisfied with their scar results in the years after thyroidectomy. Despite the high level of satisfaction, a majority of patients are self-conscious about the presence of a mid-cervical incision. Further research is needed to elucidate causes and the effects of this finding.

Feasibility of using minimal incision in thyroidectomy operation

Background: The conventional technique of thyroidectomy requires long skin incision, not satisfying patient and surgeon in terms of cosmesis and endoscopic thyroid surgery requires expertise. The aim of this study was to compare the clinical outcomes of patients undergoing minimal-incision thyroidectomy with those undergoing conventional thyroidectomy for benign thyroid diseases.Methods: Prospective randomized study that was carried on 50 patients who were undergone thyroidectomy at the department of surgery-Menoufia University from June 2018 to June 2019. The patients were divided into two groups. Group A included 25 patients who were operated upon using minimal incision thyroidectomy technique and group B included 25 patients who were undergone traditional thyroidectomy incision.Results: The length of skin incision was significantly shorter in the minimal-incision thyroidectomy than that in the conventional thyroidectomy group. Operative time was shorter in minimal incision technique. The incidence of postoperative complications was higher in conventional thyroidectomy group but didn’t reach to significant level. Patients undergone minimal-incision thyroidectomy experienced significantly less postoperative pain and were more satisfied with the cosmetic result than patients who underwent conventional thyroidectomy.Conclusions: Thyroid surgery can safely be performed as a minimally invasive procedure. Minimal access thyroid surgery is therefore a feasible and safe option for selected patients with excellent cosmetic outcome, with minimal learning curve.

Association of Autofluorescence-Based Detection of the Parathyroid Glands During Total Thyroidectomy With Postoperative Hypocalcemia Risk

Because inadvertent damage of parathyroid glands can lead to postoperative hypocalcemia, their identification and preservation, which can be challenging, are pivotal during total thyroidectomy. To determine if intraoperative imaging systems using near-infrared autofluorescence (NIRAF) light to identify parathyroid glands could improve parathyroid preservation and reduce postoperative hypocalcemia. This randomized clinical trial was conducted from September 2016 to October 2018, with a 6-month follow-up at 3 referral hospitals in France. Adult patients who met eligibility criteria and underwent total thyroidectomy were randomized. The exclusion criteria were preexisting parathyroid diseases. Use of intraoperative NIRAF imaging system during total thyroidectomy. The primary outcome was the rate of postoperative hypocalcemia (a corrected calcium <8.0 mg/dL [to convert to mmol/L, multiply by 0.25] at postoperative day 1 or 2). The main secondary outcomes were the rates of parathyroid gland autotransplantation and inadvertent parathyroid gland resection. A total of 245 of 529 eligible patients underwent randomization. Overall, 241 patients were analyzed for the primary outcome (mean [SD] age, 53.6 [13.6] years; 191 women [79.3%]): 121 who underwent NIRAF-assisted thyroidectomy and 120 who underwent conventional thyroidectomy (control group). The temporary postoperative hypocalcemia rate was 9.1% (11 of 121 patients) in the NIRAF group and 21.7% (26 of 120 patients) in the control group (between-group difference, 12.6% [95% CI, 5.0%-20.1%]; P = .007). There was no significant difference in permanent hypocalcemia rates (0% in the NIRAF group and 1.6% [2 of 120 patients] in the control group). Multivariate analyses accounting for center and surgeon heterogeneity and adjusting for confounders, found that use of NIRAF reduced the risk of hypocalcemia with an odds ratio of 0.35 (95% CI, 0.15-0.83; P = .02). Analysis of secondary outcomes showed that fewer patients experienced parathyroid autotransplantation in the NIRAF group than in the control group: respectively, 4 patients (3.3% [95% CI, 0.1%-6.6%) vs 16 patients (13.3% [95% CI, 7.3%-19.4%]; P = .009). The number of inadvertently resected parathyroid glands was significantly lower in the NIRAF group than in the control group: 3 patients (2.5% [95% CI, 0.0%-5.2%]) vs 14 patients (11.7% [95% CI, 5.9%-17.4%], respectively; P = .006). The use of NIRAF for the identification of the parathyroid glands may help improve the early postoperative hypocalcemia rate significantly and increase parathyroid preservation after total thyroidectomy. ClinicalTrials.gov Identifier: NCT02892253.

Harmonic Knife New Haemostatic Procedure In Thyroid Surgery

&#x0D; Background: Thyroid operation needs very meticulous haemostasis to have minimal morbidity and mortality.&#x0D; Objectives: Assessment of harmonic knife in open thyroid surgery as anew haemostatic procedure .&#x0D; Type of the study: Cross-sectional study.&#x0D; Methods: This study had been conducted at Alkindy teaching hospital in Baghdad city from the 1st of May 2013 to the 1st of January 2017 on 229 goiterous patients who needs thyroidectomy(36 males,193 females),divided in 2 groups according to the haemostatic procedure used during their operations, Group A (15 males,85females)using the usual conventional surgery(pick, tie &amp;cut), Group B (21males,108 females) using harmonic knife as haemostatic procedure and compare the results according to time of surgery, amount of discharge in the drain during the first 24 hours post operatively ,the incidence of recurrent nerve palsy and the remote post operative hypocalcaemia (3months post operation) .&#x0D; Results: It shows that thyroid surgery (thyroidectomy) by using harmonic knife as haemostatic procedure is shorter in duration [mean67.22 minutes] with less blood loss in the&#x0D; drain [mean 64.96cc] and less incidence of hypocalcaemia in remote post operative period [3.8%] in comparison to the results of the usual conventional thyroidectomy procedures (mean duration 82.02 minutes, mean blood loss in the drain 111.13cc &amp; incidence of hypocalcaemia is 7%}.&#x0D; Conclusions: Harmonic knife is very safe &amp; beneficial haemostatic device in thyroid surgery.

Meta-analysis of the influence of prophylactic central lymph node dissection on the prognosis of patients with thyroid micropapillary carcinoma

Objective: To evaluate the efficacy and safety of prophylactic central neck dissection (pCND) in papillary thyroid microcarcinoma (PTMC). Method: The PubMed, EMbase, Web of Knowledge, CBM, Wanfang, and CNKI databases were searched, and controlled trials and cohort studies of central lymph node dissection for cervical cancer in PTMC surgery were collected. The search time was from the establishment of the library to September 2018. Meta-analysis was performed on 4 articles that met the inclusion criteria to calculate the relative risk. Result: A total of 1 169 cases were included in 4 retrospective cohort studies. In addition to conventional thyroidectomy, pCND reduced the risk of local recurrence and did not increase the recurrent laryngeal nerve (RLN) injury (temporary or permanent), the incidence of permanent hypocalcemia. Postoperative temporary hypocalcemia is more common after surgery with pCND.Conclusion: Prophylactic central lymph node dissection reduces local recurrence rates without increasing long-term complications compared with thyroid and tumor resection alone.

Scarless Neck Thyroidectomy Using Bilateral Axillo-breast Approach: Initial Impressions After Introduction in a Specialized Unit and a Review of the Literature

IntroductionThe extracervical approach for thyroidectomy remains widely unknown in our country. Its main aim is to avoid a cervical scar while maintaining the same safety profile of conventional thyroidectomy. The objective is to communicate our experience after the first 15 cases using the endoscopic bilateral axillo-breast approach (BABA) and to review critical points described in literature. MethodsBetween June 2017 and June 2018, 15 endoscopic thyroidectomies were performed using the BABA extracervical approach, locating incisions in axillary folds and areolar borders. Indications were benign goiter and suspicious nodule (Bethesda 3 and 4). ResultsAll 15 cases (12 patients) were treated using the extracervical endoscopic technique. We performed 5 total thyroidectomies, 7 hemithyroidectomies and 3 completion thyroidectomies. Mean surgical time for total thyroidectomy was 285min and 210min for hemithyroidectomy. The average hospital stay was 1.67 days. With a mean follow-up of 7.73 months, rates of transient and definitive hypoparathyroidism were 37% and 0%, and transient recurrent nerve palsy occurred in one case. Anterior chest paraesthesia rate was 80%, which were mild and resolved within the first month. The degree of cosmetic satisfaction is very high. ConclusionOur experience with endoscopic bilateral axillo-breast approach thyroidectomy is short but satisfactory. It is a reproducible procedure that requires extensive experience in endocrine and endoscopic surgery. Extracervical approaches are an alternative for selected patients who are especially concerned about cervical scarring and are not intended to displace conventional thyroidectomy, which is the current gold standard. Our Scientific Society should explore these approaches to establish coherent indications and limitations.

Tiroidectomía sin incisión cervical por abordaje endoscópico biaxilo-biareolar. Primeras impresiones tras su introducción en una unidad especializada. Revisión de la literatura

IntroductionThe extracervical approach for thyroidectomy remains widely unknown in our country. Its main aim is to avoid a cervical scar while maintaining the same safety profile of conventional thyroidectomy. The objective is to communicate our experience after the first 15 cases using the endoscopic bilateral axillo-breast approach (BABA) and to review critical points described in literature. MethodsBetween June 2017 and June 2018, 15 endoscopic thyroidectomies were performed using the BABA extracervical approach, locating incisions in axillary folds and areolar borders. Indications were benign goiter and suspicious nodule (Bethesda 3 and 4). ResultsAll 15 cases (12 patients) were treated using the extracervical endoscopic technique. We performed 5 total thyroidectomies, 7 hemithyroidectomies and 3 completion thyroidectomies. Mean surgical time for total thyroidectomy was 285minutes and 210minutes for hemithyroidectomy. The average hospital stay was 1.67days. With a mean follow-up of 7.73months, rates of transient and definitive hypoparathyroidism were 37% and 0%, and transient recurrent nerve palsy occurred in one case. Anterior chest paraesthesia rate was 80%, which were mild and resolved within the first month. The degree of cosmetic satisfaction is very high. ConclusionOur experience with endoscopic bilateral axillo-breast approach thyroidectomy is short but satisfactory. It is a reproducible procedure that requires extensive experience in endocrine and endoscopic surgery. Extracervical approaches are an alternative for selected patients who are especially concerned about cervical scarring and are not intended to displace conventional thyroidectomy, which is the current gold standard. Our Scientific Society should explore these approaches to establish coherent indications and limitations.

Can the Zuckerkandl tubercle assist in the location of the inferior laryngeal nerve during thyroidectomies?

to evaluate whether the lateral projection of the thyroid gland, called Zuckerkandl's tubercle (ZT), can assist the surgeon in identifying the inferior laryngeal nerve during conventional open thyroidectomy. we conducted a prospective study with 51 patients submitted to thyroidectomy, with a total of 100 resected thyroid lobes, and observed the presence or absence of ZT in sufficient dimensions to be identified without image magnification, its base and height, its location in the gland, and its anatomical relationship with the inferior laryngeal nerve. ZT was present in 68 of the 100 thyroid lobes analyzed (68%). The mean base was 6.7mm on the right side and 7.1mm on the left side, and the average height was 5.7mm on the right side and 6.1mm on the left side. In most of the lobes studied, the tubercle had a minimum height of 5mm (55.9%), with no significant difference between the right and left lobes of the thyroid gland. During surgery, 100% of the identified ZTs were anterior to the inferior laryngeal nerve, just below the nerve entry in the larynx. the ZT is a quite frequent entity and large enough to serve as an intraoperative anatomical reference for the inferior laryngeal nerve, next to its entry in the larynx, along with other anatomical references.

Pattern of sub-clinical dysthyroidism in a postthyroidectomy cohort: Implications for supplementary treatment

Background: Defective thyroid functioning is referred to as dysthyroidism. Despite incomplete thyroidectomy or thyroxine supplementation, post-thyroidectomy patients may still experience dysthyroidism. Many times, this may be sub - clinical. This study aimed to assess the prevalence and pattern of sub-clinical dysthyroidism following thyroid surgery. Methods: In this prospective cohort study, 40 patients were consecutively recruited following conventional thyroidectomy and followed up to 12months. All patients were euthyroid at surgery. At 12 months serum TSH, T4 and T3 levels were measured and the patients clinically assessed. The prevalence and pattern of dysthyroidism was analysed statistically against the patient demographics, clinical and peri-operative variables for significance, using stata version 13. The confidence interval was at 95% and the statistical significance at a p-value of &lt;0.05. Results: The mean age was 44.3 years (M:F= 1: 12.3). 20% of the patients had medical comorbidities. The types of surgery performed were sub-total thyroidectomy (55%), near total thyroidectomy (25%) and total thyroidectomy (20%). The prevalence of postoperative dysthyroidism was 52.5%. 22.7% of patients who underwent sub-total thyroidectomy had dysthyroidism. Most patients (90%) who were on thyroxine supplement (following total or near total thyroidectomy) still developed dysthyroidism (P= 0.017). The type of resection done had the greatest significance (P= 0.000). Other factors associated with dysthyroidism albeit non-significantly were history of pre-operative hyperthyroidism, middle age (40 - 60 years), and female gender. Conclusions: The prevalence of dysthyroidism in this cohort was high which may reflect the broader picture among post - thyroidectomy patients in this setting. Regular biochemical testing in post-thyroidectomy patients is important to identify and correct dysthyroidism early. This requires frequent follow-up and accurate dose adjustment, based on objective assessments like weight or body mass index. Keywords: post-thyroidectomy; dysthyroidism; hypothyroidism; hyperthyroidism; sub-clinical dysthyroidism; prospective; cohort

Analysis of neuromonitoring signal loss during retroauricular versus conventional thyroidectomy.

Loss of signal (LOS) during intraoperative neuromonitoring (IONM) of robotic or endoscopic thyroidectomy via a retroauricular approach (RAT) and during conventional open thyroidectomy (COT) was investigated to compare the risk of recurrent laryngeal nerve (RLN) injury between the two groups. Original article. This is a retrospective case series study performed between May 2014 and September 2016. IONM using the NIM 3.0 system (Medtronic Xomed, Inc., Jacksonville, FL) was used for this study. Pre- and postoperative vocal cord functions were assessed using a flexible laryngoscope. LOS types noted intraoperatively and their associations with postoperative vocal cord palsy (VCP) were evaluated. LOS rate and temporary and permanent VCP rates were compared between the two groups. The surgical events associated with LOS were also documented and analyzed in this study. In total, 153 patients were recruited, and 111 patients were enrolled in the RAT group; the remaining 42 patients were enrolled in the COT group. No statistically significant differences in intraoperative LOS (P = 0.812) and postoperative VCP rates (early, permanent; P = 0.259 and P = 0.577, respectively) between the two groups were observed. IONM accuracy of predicting postoperative VCP was 99.1% in our case series. On the basis of IONM findings, the risks of injury to RLN were similar between the two groups. Comparison of LOS was an objective method for verifying the novel RAT approach. We applied our IONM protocol and troubleshooting algorithm during RAT with acceptable accuracy, but the international standardized method of IONM is applicable and recommended for reducing false results using vagal nerve stimulation. 3b Laryngoscope, 129:2199-2204, 2019.

Independent predisposing factors for subcutaneous and deep wound collection after total thyroidectomy, a prospective cohort study.

BackgroundThe literature contains diverse and sometimes contradicting results about wound seroma following thyroidectomy. This is probably due to the subjective clinical estimation of seroma, or due to failure to differentiate between the occurrence of subcutaneous (SC) and deep wound collections. This work aimed at objectively investigating the factors affecting subcutaneous and deep wound seroma after thyroidectomy.MethodsThe relation between various operative and clinico-pathological factors and the collection formation was prospectively analyzed in a cohort of 100 patients after conventional thyroidectomy. Wound seroma was assessed clinically and via high-resolution ultrasonography at 24 h, 48 h and two weeks postoperatively. Sonographically detected collections were expressed as SC and/or deep wound collections according to the relation to strap muscles.ResultsOperative duration was the only independent factor significantly affecting the incidence of clinical seroma. Older patients (>40ys) showed significantly larger volumes of early SC collections. Early postoperative pain was significantly related to drain insertion, to the occurrence of clinical seroma and to the volume of SC collections.Sonographically, suction drains and shorter operative durations resulted in significantly less amount of deep collections. Suction drains did not result in less amount of SC collections or in a lower incidence of clinical seroma.ConclusionsOperative duration is the only independent factor significantly related to clinically-detected postoperative seroma with its subsequent postoperative pain. Especially in elderly patients, a flapless technique would be recommended as these patients developed larger volumes of SC collections with subsequent higher pain scores, even if seroma was not clinically detected.

Feasibility of Endoscopic Thyroidectomy via Axilla and Breast Approaches for Larger Goiters: Widening the Horizons.

Scarless (in the neck) endoscopic thyroidectomy (SET) has evolved into a cosmetically preferred alternative to conventional thyroidectomy (ConT). Recently many of our patients are demanding SET; however their goitres are larger than the recommended size of 4–6 cm. Our aim was to compare the outcomes of ET for small (<6 cm) vs large (≥6 cm) goitres and determine its feasibility in such cases. This is a retrospective analysis of prospectively maintained database of patients undergoing ET. Patients were divided into 2 groups: I, small (<6 cm) and II, large goitres (≥6 cm). Their demographic and clinicopathological profiles, operation time, conversion and complication rates, and hospital stay were compared. 99 patients (101 procedures) were included: group I, 60 patients (61 procedures), and group II, 39 patients (40 procedures). Mean tumor size (± SD) was 4.4 ± 0.9 cm and 6.7 ± 1.1 cm in groups I and II, respectively. The groups were comparable with respect to demographic and clinical profile except for mean duration of goiter [30.1 ± 32.6 months (group I) vs 60.5 ± 102.4 months (group I), p = 0.03] and gland weight [21.5 ± 15.3 grams (group I) vs 62.3 ± 51.3 grams (group II), p = 0.001]. Although there was no significant difference between mean operating times, long term perioperative outcomes, and conversion rates, temporary hypocalcaemia and length of stay were longer in group II. One patient had permanent vocal cord palsy (~1%, 1/101); none had permanent hypoparathyroidism. Our results indicate that ET can be offered to a subset of patients with larger goitres desirous of SET with no significant difference in mean operation time, conversions, and long term postoperative complications in experienced hands.

Comparing postoperative complication of LigaSure Small Jaw instrument with clamp and tie method in thyroidectomy patients: a randomized controlled trial [IRCT2014010516077N1

BackgroundLigaSure® Small Jaw (LSJ) has been recently introduced as an energy-based vessel sealing device, which has provided better intraoperative and postoperative outcomes in thyroidectomies, compared to conventional technique. In the current study, we aimed to examine the efficiency of hand-sewn and LSJ thyroidectomy, based on operation time and perioperative complications.MethodsAll patients with the diagnosis of multinodular goiter, thyroid cancers, retrosternal goiter and other indications for thyroid surgeries, enrolled. Of 550 patients, 261 patients randomly assigned to the conventional group (A) and 274 patients to LigaSure Small Jaw group (B). Study groups compared concerning operative time, recurrent laryngeal nerve (RLN) injury, hypocalcemia, and postoperative complications.ResultsThere was no significant difference regarding demographic data between groups A and B. During total thyroidectomy, intraoperative blood loss was 64.42 ± 20.72 ml and 49.64 ± 17.92 ml in groups A and B, respectively (P 0.043). Operative time was significantly lower in LSJ group compared to the conventional group in total and subtotal thyroidectomy (P 0.002; P 0.001). Three patients who underwent conventional total thyroidectomy had RLN palsy. However, there was no significant difference between techniques regarding RLN injury (P 0.134).Postoperative total and ionized serum calcium levels decreased compared to preoperative levels in both conventional and LSJ technique; however, changes in total and ionized serum calcium were more severe in patients with conventional thyroidectomy (total calcium, P < 0.0001) (ionized calcium, P 0.005).ConclusionThe LigaSure Small Jaw device decreases operative time and intraoperative bleeding compared to conventional technique. Besides, changes in total and ionized calcium levels in patients with LSJ thyroidectomy are subtle compared to HS technique.Trial registrationRegistered in Iranian Registry of Clinical Trials (www.irct.com), trial registration: IRCT2014010516077N1, Registered: 23 May 2014).

A propensity score matching study between ultrasound-guided percutaneous microwave ablation and conventional thyroidectomy for benign thyroid nodules treatment

Purpose: Our study aims to compare ultrasound (US)-guided percutaneous microwave ablation (PMWA) and conventional thyroidectomy in benign thyroid nodules (BTN) treatment.Materials and methods: From December 2015 to December 2017, a total of 280 patients with at least one benign thyroid nodule were studied retrospectively, including 156 patients treated with US-guided PMWA and 124 patients treated with conventional thyroidectomy. Propensity score matching was performed to decrease the confounding bias due to retrospective assignment and to balance the pre-operation data of the two groups. A total of 106 pairs (1:1) was created. The operation time, intraoperative blood loss, postoperative hospitalization time, serum levels of interleukin (IL-6), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α) 12 h after operation and postoperative complications incidence rate were compared between the two groups. The volume reduction ratio was calculated in the US-guided PMWA group at 1, 3, 6 and 12 months after treatment. Registration number: ChiCTR1800015531.Results: Significant differences were found between the two groups in levels of CRP, IL-6, and TNF-α after the operation； there were significant differences between the two groups in intraoperative blood loss, operation time, postoperative hospitalization time and postoperative complications rate. The volume reduction ratio at 1, 3, 6 and 12 months after treatment was 15.2%, 47.6%, 67.2% and 79.6%, respectively.Conclusions: Our study demonstrated that US-guided PMWA is characterized by a definite therapeutic success rate, good cosmetic effect, slight injury and rapid recovery. US-guided PMWA is an effective technique for benign thyroid nodules treatment．

Short Stay Thyroid Surgery: Can We Replicate the Same in Low Resource Setting?

Introduction The concept of short stay thyroidectomy has been tested and in practice in the developed world; the same has not been replicated in countries with limited resources due to lack of organized healthcare system. So, in this study, we tried to analyze if short stay thyroid surgery can be performed in a cost-effective way in developing countries and also if the endocrine surgical trainee can deliver these services safely. Methods The study was conducted prospectively from January 2013 to July 2014, at Department of Endocrine Surgery, SGPGIMS, Lucknow, India. Study group included patients undergoing short stay hemithyroidectomy whereas matched patients who qualified for inclusion criteria but did not undergo short stay surgery due to various reasons constituted control group. Outcome in both the groups was compared in terms of complication rates, cost benefit, and patient satisfaction. Subgroup analysis was also done for trainee versus consultant performed short stay thyroid surgery. Results A total of 439 patients with surgical thyroid disorders were evaluated at our institute during the study period and out of these 110 patients (58 cases and 52 controls) fulfilled the inclusion criteria. Younger patients with low socioeconomic status who were paying out of pocket were found to be more inclined to short stay thyroid surgery. There was no significant difference between the two groups in terms of postanesthetic discharge score (PADS), complication rates, and patients satisfaction; however there was significant reduction (p <0.001) in hospital cost in short stay group. In subgroup analysis, procedure time was more in trainee performed surgeries; however there was no significant difference in terms of mean PADS and complication rates. Conclusion Short stay thyroidectomy can provide a better cost-effective alternative to conventional thyroidectomy in patients undergoing thyroid surgery and can be safely performed by endocrine surgical trainees even in a low resource setting.

Endoscopic thyroidectomy-axilla breast approach: the experience of 26 cases

Background: Conventional thyroidectomy results in transverse scar formation on neck. These scars are uncomfortable and cosmetically unacceptable. Endoscopic thyroidectomy is widely accepted technique in specialized centers. The potential advantages of endoscopic technique include better cosmetic result, decreased hospital stay and better patient comfort. Author started performing endoscopic thyroidectomy at the centre to demonstrate the feasibility of operating thyroid gland endoscopically by axilla breast approach.Methods: Author performed 26 cases of endoscopic thyroidectomy by axilla breast approach from June 2014 to July 2017 in patients presenting with indication for surgical thyroid excision. Author did hemithyroidectomy in 19 patients, total thyroidectomy in 3 patients and near total thyroidectomy in 4 patients. All patients underwent endoscopic thyroidectomy by axilla breast approach by creating subplatysmal space with carbon dioxide insufflation at the pressure of 8 to 10mmHg. Results were compared with the recent studies with comparable number of patients.Results: Author did hemithyroidectomy in 19 patients, total thyroidectomy in 3 patients and near total thyroidectomy in 4 patients. Mean Operative time was 88.19 min. But last 6 cases were completed in 49.60±4.20 min. Thus, as experience increased we tend to complete procedure in progressively lesser time period. Mean blood loss in the series was 21.88ml. Mean Hospital stay was 2.88 days (range 2-5 days). Scar satisfaction on visual analogue scale after 3 months of operation was 9.11. Histopathological examination revealed adenomatous goitre in 24 cases and follicular adenoma in 2 cases.Conclusions: Endoscopic thyroidectomy via axilla breast approach is safe, feasible and minimally invasive surgical method for thyroid diseases, with good post-operative results. Surgeons having adequate training in endoscopic surgery can perform endoscopic thyroidectomy with short learning curve.

Transoral Endoscopic Thyroidectomy: A Systematic Review of the Practice So Far.

Background and Objectives:Thyroid disease largely affects young females, but the incidence is also increasing among males. In an effort to avoid the scarring of the neck that is synonymous with conventional thyroidectomy, endoscopic techniques have been developed over the years. The transoral endoscopic approach is the latest of these innovations that promises a scarless surgical outcome. This review evaluates whether this technique is safe and feasible in live patients and outlines the outcomes in published literature so far.Database:PubMed, Medline, BioMed Central, Cochrane Library, OVID and Web of Science were systematically searched by using a Medical Subject Heading (MeSH)–optimized search strategy. The selection of papers followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines after setting strict inclusion and exclusion criteria. Sixteen studies were included in the final analysis.Discussion:This systematic review presents cases of 785 patients. Surgeons in 15 of the studies used a completely vestibular approach, whereas those in the remaining 2 used the floor of the mouth for primary access. Conversion to open surgery took place in 1.3%. In total, 4.3% of patients experienced transient laryngeal nerve palsy, whereas 0.1% had permanent recurrent incidences of the condition. Transient hypocalcemia occurred in 7.4% of cases, with no recorded permanent cases. Carbon dioxide embolism occurred in 0.6% of cases, and another 0.6% had a deep-seated neck infection. The complication rates within the review were deemed acceptable and the overall technique feasible. A prospective randomized controlled trial was proposed to compare this technique with conventional thyroidectomy.

Sutureless focus harmonic thyroidectomy versus conventional clamping and knot-tying technique

Background: Thyroidectomy is the most frequent procedure in endocrine surgery. Since thyroid is the highly vascular organ, therefore, prompt and meticulous hemostasis is extremely important. Although conventional thyroidectomy is used frequently with acceptable outcomes, it is time-consuming and resulted in significant intraoperative blood loss with possible risk of injury to parathyroid glands and laryngeal nerves. The advent of ultrasonically activated focus harmonic device in thyroid surgery was encouraging for improving safety, effectiveness, and reduction of operative time. Aim of this Study: The purpose of this study was to analyze the effectiveness and surgical outcomes of using ultrasonic harmonic scalpel for thyroid surgery compared to conventional techniques (clamping and suture ligation (knots tying) and electrocautery. Patients and Methods: This is a prospective, randomized study in which 64 patients with various types of goiters presented for thyroidectomy. The patients were divided into two comparable groups. Group A (32 patients) included patients who had focus harmonic thyroidectomy and Group B (32 patients) included patients who received conventional thyroidectomy. Results: Focus harmonic thyroidectomy showed significant reduction in operative time, intraoperative blood loss, volume of postoperative fluid drainage, and postoperative pain scores compared with conventional thyroidectomy. There were no significant differences in the incidence of postoperative hypocalcemia and laryngeal nerve injury between both the groups. The total cost of focus harmonic thyroidectomy and hospital stay were also less compared with conventional techniques. Conclusions: Focus harmonic thyroidectomy was a safe, effective, faster, and beneficial alternative to conventional technique since it reduces the time of surgery, blood loss, postoperative drainage, and pain with comparable postoperative complications.

Transoral endoscopic total thyroidectomy vestibular approach: A case series and literature review.

Conventional open thyroidectomy is often associated with post-operative complications including nerve damage, voice disturbances, paraesthesias, adhesions and prominent scarring. Several endoscopic surgical techniques have been reported as alternatives to conventional thyroidectomy. Natural orifice transluminal endoscopic surgery is a promising approach which leaves no scar, produces few complications and affords faster discharge from care. Several studies have explored its utility in total thyroidectomy in patients with benign or malignant thyroid disease. Herein, we present a case series on the successful application of transoral endoscopic total thyroidectomy vestibular approach (TOETVA) in benign and malignant diseases of the thyroid. We performed TOETVA in 11 patients presenting with benign or malignant thyroid nodules in our hospital, between 1st January 2015 and 30th June 2016. The surgery was completed successfully in all patients with a pre-operative diagnosis of multinodular goitre. The surgery was performed under general anaesthesia and the mean operative time was 130 min. The mean blood loss was 2–3 cc. No incidence of recurrent laryngeal nerve injury, damage to mental nerve, parathyroid damage or peri-incisional adhesion occurred in the study participants. No visible scarring occurred in the patients following surgery. The patients had an uneventful recovery after the surgery and were discharged after 4 days. TOETVA is safe and effective in the surgical management of multinodular goitre and offers a scar-free alternative to conventional surgery.

A Meta-analysis of comparing effectiveness and safety between minimally invasive video-assisted thyroidectomy and conventional thyroidectomy in the treatment of papillary thyroid carcinoma without lymph node metastasis

Objective:To compare the effectiveness and safety between minimally invasive video-assisted thyroidectomy (MIVAT) and conventional thyroidectomy (CT) in the treatment of papillary thyroid carcinoma without lymph node metastasis, providing clinicians using video-assisted way to treat thyroid papillary carcinoma with a more reasonable basis.Method:According to the including and excluding criterion,we searched the published articles which compare the effectiveness of MIVAT and CT curing PTC in randomized controlled clinical trials. The searching time was from January 2011 to December 2016, and the data was analyzed by using revman 5.3 software.Result:Twelve articles involving 1 080 cases were included,and there were 514 cases in the MIVAT group and 566 cases in the CT group. The results of metaanalysis showed that: the operation time of MIVAT group is longer than that of CT group (MD=17.19, 95%CI12.43-21.96, P<0.05); however the VAS point of MIVAT group is less than that of CT group in twentyfour hours after surgery (MD-1.07, 95%CI-1.61--0.53, P<0.05). There is no significant difference in the incidences of transient recurrent laryngeal nerve injury(OR=2.21,95%CI0.9-5.07,P>0.05),transient hypoparathyroidism (OR=0.78, 95%CI0.48-1.28, P>0.05), serum thyroglobulin after five years followed up (MD-0.05, 95%CI -0.25-0.16, P>0.05), number of retrieved central lymph nodes (MD=-0.36, 95%CI -0.72-0.01, P>0.05) and number of retrieved central positive lymph nodes (MD=-0.15, 95%CI -0.45-0.16, P>0.05).Conclusion:Using MIVAT treating papillary thyroid carcinoma (without lymph node metastasis) is safe when its indications are strictly controlled.