Field Of Endocrine Surgery Research Articles

Comparison of postoperative complications using Harmonic scalpel and LigaSure in thyroid surgery

Background: Thyroid surgery is the most common operation in the field of endocrine surgery. The aim of this study was to compare the use of LigaSure vessel (LS) and Harmonic scalpel (HS) in 1599 total thyroid surgeries between January 2008 and December of 2022, with regards of analysis of surgical complications, duration of hospital stay and operative surgical time.
 Methods: In this retrospective study patients have been categorized into two groups: Group A included 718 patients from January 2008 to May 2013 when LigaSure vessel was used, and the Group B included 881 patients from June 2013 to December 2022 when Harmonic scalpel was used. A summary of the total number of postoperative complications cases, surgical time and the duration of hospital stay between the two groups is presented.
 Results: There was no significant difference in the sex, age, and mean operating time between the two groups (P>0.05). Either major bleeding or wound infection occurred in 4 (0.6%) or 14 (1.9%) of the patients undergoing thyroidectomy when LS was used compared to 4 (0.5%) or 15 (1.7%) of the patients undergoing thyroid surgery when HS was used (P> 0.05 and P> 0.05, respectively). In addition, either hypoparathyroidism or temporary recurrent laryngeal nerve palsy was observed in 91 (12.7%) or 39 (5.4%) of the Group A patients compared with 98 (11.1%) or 44 (5%) of the Group B patients (P> 0.05 and P> 0.05, respectively).
 Conclusion: The current study demonstrates that thyroidectomy can be safely performed with both devices without increasing the risk of complications.

History of the Hospital Surgery Department of St. Petersburg State Pediatric Medical University (to the 80th anniversary of the Department)

The hospital surgery department of the St. Petersburg Pediatric Medical University was organized in the besieged Leningrad in 1942. The aim of the department was to train pediatricians with wide clinical background in surgery including peacetime and wartime injuries. During its existence, the department was headed by many famous surgeons: I.D. Anikin, A.A. Rusanov, A.D. Kartavova, M.S. Grigoryev, L.N. Kamardin, A.F. Romanchishen, A.V. Gostimsky.
 The article represents the history of the departments foundation and development of its main scientific and practical directions. The contribution of its leaders to the formation of educational process, training of young surgeons and improvement of treatment work at the clinical bases are considered.
 The main direction of scientific and practical activity of the Department for the last 35 years is endocrine surgery. In recent years, a new section of the Departments work has appeared: cardiovascular and X-ray endovascular surgery. Its appearance was a result of close cooperation with the staff of profile departments of the City Mariinskiy Hospital and the City Hospital 40 of the Kurortny District.
 The teaching staff of the Department, in addition to work with students, trains clinical residents, conducts postgraduate educational cycles in general, endocrine, cardiovascular and X-ray endovascular surgery. For the last 10 years the teaching staff has published more than 200 scientific works, 17 of them are monographs, devoted to various sections of surgery. During the same period the collaborators of our department have defended 4 Doctoral and 10 PhD theses.
 Further perspectives are related to clinical work in the field of endocrine surgery, as well as the development of topics on cardiovascular and endovascular, thoracic and abdominal surgery.

Comparison of postoperative bleeding using harmonic scalpel and LigaSure in thyroid surgery: a 15-year single-centre retrospective study.

Aim Thyroidectomy is the most common operation in the field of endocrine surgery. The aim of this study was to compare the use of LigaSure vessel (LS) and harmonic scalpel (HS) in 1653 total thyroidectomies between January 2008 and March of 2023, with regards to analysis of surgical bleeding complications duration the hospital stay and operative surgical time. Methods It is a retrospective analysis of a prospectively maintained database. Patients have been categorized into two groups: Group A included 718 patients from January 2008 to May 2013 when LS was used, and the Group B included 935 patients from June 2013 to March 2023 when HS was used. Results From the total of 14 postoperative bleeding cases that occurred in patients of Group A, only in 4 of them it was necessary to have a reoperation. The other 10 cases involved minor haemorrhages, while from the total of 6 postoperative bleeding cases that happened to patients of Group B, there were 4 cases that needed a reoperation (p-value >0.05) and 2 patients with minor haemorrhages. The postoperative evaluation of minor bleedings revealed statistically significant differences between the two groups (p-value < 0.05). The average hospital stay was similar in the two groups. Conclusion Both devices exhibit identical safety profiles in thyroidectomies specifically regarding major bleeding complications that require reoperation. Additionally, HS was found to be more effective at achieving haemostasis, especially in the subgroup of patients with thyroid carcinoma. The results of the present study may be useful for high-volume centres performing numerous thyroidectomies every day.

Improving Voice Outcomes after Thyroid Surgery and Ultrasound-Guided Ablation Procedures.

The field of endocrine surgery has expanded from the traditional open neck approach to include remote access techniques as well as minimally invasive approaches for benign and malignant thyroid nodules. In experienced hands and with careful patient selection, each approach is considered safe, however complications can and do exist. Post-operative dysphonia can have serious consequences to the patient by affecting quality of life and ability to function at work and in daily life. Given the significance of post-procedural dysphonia, we review the surgical and non-surgical techniques for minimizing and treating recurrent laryngeal nerve injury that can be utilized with the traditional open neck approach, remote access thyroidectomy, or minimally invasive thermal ablation.

Up-to-date evidences of transoral thyroidectomy on how to overcome the obstacles?—A review

: The progress in the field of minimally invasive surgery over the last twenty years has led to the application of natural orifice transluminal endoscopic surgery for thyroidectomy and parathyroidectomy via oral incisions. The true scarless nature of this approach had fascinated the early pioneers to prove the feasibility in the field of endocrine surgery. Through many trials and errors, the transoral thyroidectomy has now passed its experimental stage and is continually gaining momentum in obtaining worldwide popularity. However, the approach is yet to acquire status of the primary method of choice and therefore surgeons need to gain more evidence to standardize and popularize the approach. In this article we review the history, indications and contraindications, technical aspects of preserving the recurrent laryngeal nerve (RLN) and parathyroid glands, pros and cons regarding endoscopic or robotic approach, limitations and recent advancements in the field of transoral thyroidectomy

Accreditation of endocrine surgery units.

A key measure to maintain and improve the quality of healthcare is the formal accreditation of provider units. The European Society of Endocrine Surgeons (ESES) therefore proposes a system of accreditation for endocrine surgical centers in Europe to supplement existing measures that promote high standards in the practice in endocrine surgery. A working group analyzed the current healthcare situation in the field of endocrine surgery in Europe. Two surveys were distributed to ESES members to acquire information about the structure, staffing, caseload, specifications, and technology available to endocrine surgery units. Further data were sought on tracer diagnoses for quality standards, training provision, and research activity. Existing accreditation models related to endocrine surgery were included in the analysis. The analysis of existing accreditation models, available evidence, and survey results suggests that a majority of ESES members aspire to a two-level model (termed competence and reference centers), sub-divided into those providing neck endocrine surgery and those providing endocrine surgery. Criteria for minimum caseload, number and certification of staff, unit structure, on-site collaborating disciplines, research activities, and training capacity for competence center accreditation are proposed. Lastly, quality indicators for distinct tracer diagnoses are defined. Differing healthcare structures, existing accreditation models, training models, and varied case volumes across Europe are barriers to the conception and implementation of a pan-European accreditation model. However, there is consensus on accepted standards required for accrediting an ESES competence center. These will serve as a basis for first-stage accreditation of endocrine surgery units.

Contributions of Fluorescence to Endocrine Surgery

The use of fluorescence in surgery has expanded and become widespread in recent years, which has led to a real technological phenomenon with the emergence of devices adapted for use in laparoscopic and robotic approaches. Fluorescence-guided surgery in the field of endocrine surgery is also on the rise. More and more articles describe its use in surgery of the thyroid, parathyroid and adrenal glands, although the series are still modest in size and protocols have not been standardized. There are currently several developing areas for the application of fluorescence in endocrine surgery, including the use of fluorescence with indocyanine green in adrenal gland surgery, the identification and prediction of parathyroid perfusion with indocyanine green, and autofluorescence of the parathyroid glands. The objective of this article is to review the current applications of fluorescence in endocrine surgery.

Aportaciones de la fluorescencia a la cirugía endocrina

The use of fluorescence in surgery has expanded and become widespread in recent years, which has led to a real technological phenomenon with the emergence of devices adapted for use in laparoscopic and robotic approaches. Fluorescence-guided surgery in the field of endocrine surgery is also on the rise. More and more articles describe its use in surgery of the thyroid, parathyroid and adrenal glands, although the series are still modest in size and protocols have not been standardized. There are currently several developing areas for the application of fluorescence in endocrine surgery, including the use of fluorescence with indocyanine green in adrenal gland surgery, the identification and prediction of parathyroid perfusion with indocyanine green, and autofluorescence of the parathyroid glands. The objective of this article is to review the current applications of fluorescence in endocrine surgery.

Early Predictors of Post – Thyroidectomy Hypoparathyroidism

The prospective study included 142 consecutive patients undergoing total thyroidectomy for benign goiter from January 1st 2014 to December 31st 2015. Serum intact parathyroid hormone (iPTH), total calcium (Ca), phosphate (P), and magnesium (Mg) levels have been measured preoperatively and at 1, 6, 24, and 48 h postoperatively. Clinical symptoms of hypoparathyroidism developed in 25 (17.6%) of 142 patients. The best diagnostic accuracy for hypoparathyroidism based on ROC curves was obtained for iPTH at 6h (AUC 0.942; 95% CI: 0.866-1.000, p<0.001) and its percentage change from baseline ΔiPTH at 6h (AUC 0.930; 95% CI: 0.858-1.000, p<0.001). In an multivariate analysis, the preoperative Ca level higher by 0.1 mmol/l, and iPTH level higher by 0.1 pmol/l were associated with a lower risk of hypoparathyroidism, by 68% (p=0.012) and 61% (p=0.007), respectively. A 1% decline in iPTH from baseline increased the risk of hypoparathyroidism by 15% (p<0.001). The most reliable markers indicating a high risk of postoperative hypoparathyroidism are the decline in ΔiPTH at 6h by > 65% or iPTH level at 6h <1.57 pmol /l. A postoperative decline in iPTH levels is an independent risk factor for the development of hypoparathyroidism. Preoperative higher concentrations of Ca and iPTH are protective factors for the development of this disorder.

Turkish endocrine surgery publications in international scientific journals.

In recent years, major progress has been made in the field of endocrine surgery in Turkey, similar to that in the rest of the world. Parallel to these developments, there has been a significant increase in the number of publications in the related field. Our study aimed to evaluate Turkey's publications related to endocrine surgery in the international arena. Members of the general surgery departments from academic centers in Turkey were determined. Using these member names, a PubMed search was performed for English papers related to "endocrine surgery." For searching papers from non-academic centers, the same engine was used. To reach manuscripts possibly missed by the PubMed search, 3 national calls were made through the website of the Turkish Society of Endocrine Surgery. The obtained papers were divided into "thyroid," "parathyroid," "adrenal," and "neuroendocrine tumors" and were listed according to the publication year. In addition, all manuscripts were listed according to the publishing journal and the 2012 impact factor of that journal. This study did not require ethical approval, because it did not involve evaluation of experimental or patient data. A search of Turkish general surgery clinics revealed 497 international publications, between 1976 and 2012. When listed according to the year of publication, most publications were found to be in the year 2009. Papers appeared mostly in "Surgery Today." The mean impact factor of the journals where the papers have been published was 1.9 (0.1-13.8). The rates of thyroid, parathyroid, adrenal tissue and neuroendocrine tumors related publications were 69%, 10%, 15% and 6%, respectively. Since this study is not an experimental study or a study related to patient data, we did not apply for ethical approval. The contribution of Turkish general surgeons' to world science is apparent when evaluated in terms of publications related to endocrine surgery until recently. Particularly, since 2002, with the increase in the number of publications in the field of endocrine surgery, there has been an increase in Turkey's importance on the international platform.

A view on endocrine surgery as the new specialty

In this article matured necessity of decision management challenges in the field of endocrine surgery is discussed. There are epidemiological data, which improved their social magnification. The most impotent problem in this sphere are absence of modern guidelines, lack of epidemiology data and national registers, difficulties of education new specialists, delay of scientific development. The authors insist to separation of endocrine surgery as self depending specialty, it could be first step in resolving of available challenges.

European endocrine surgery in the 150-year history of Langenbeck’s Archives of Surgery

Founded in 1861 as a German language scientific forum of exchange for European surgeons, Langenbeck's Archives of Surgery quickly advanced to become the premier journal of thyroid surgery before World War I, serving as a point of crystallization for the emerging discipline of endocrine surgery. During the interwar period and, in particular, in the first decades after World War II, Langenbeck's Archives of Surgery lost its dominant position as an international and European medium of publication of top quality articles in the area of endocrine surgery. Nevertheless, the journal remained the chief publication organ of German language articles in the field of endocrine surgery. After a series of key events, Langenbeck's Archives of Surgery managed to reclaim its former position as the leading European journal of endocrine surgery: (1) the formation of endocrine surgery in the early 1980s as a subdiscipline of general and visceral surgery; (2) the change of the language of publication from German to English in 1998; and (3) the journal's appointment in 2004 as the official organ of publication of the European Society of Endocrine Surgeons. All in all, the 150-year publication record of Langenbeck's Archives of Surgery closely reflects the history of European Endocrine Surgery. Following the path of seminal articles from Billroth, Kocher, and many other surgical luminaries published in the journal more than 100 years ago, Langenbeck's Archives of Surgery today stands out as the principal European journal in the field of endocrine surgery.

New trends in the treatment of undifferentiated carcinomas of the thyroid

Malignant tumours of the thyroid are generally classified as either well-differentiated thyroid carcinoma, which is composed of papillary and follicular carcinoma, or undifferentiated/anaplastic thyroid carcinoma (ATC). ATC is not only the most lethal disease in the field of endocrine surgery but also one of the most aggressive tumours characterized by an almost invariable fatal outcome, which only very rarely exceeds a 1-year course. The impact of surgical resection in association with external beam radiation on ATC outcome has been extensively investigated also in studies based on multicentric database, and there is a general agreement on the significance of a complete resection of the tumour. It has been difficult up to now to collect data regarding chemotherapy adjuvant treatment. In spite of the lack of an extensive review about the results of this kind of treatment by itself or as part of a multimodal approach, it seems that among the several chemotherapy agents experienced, none proved to influence significantly ATC prognosis. Neither doxorubicin (the most commonly used) nor other drugs, such as cisplatin, bleomycin, fluorouracil or cyclophosphamide, showed any real efficacy in controlling the disease. The most recent development in this field seems to be represented by the possibility offered by PPARg agonists; even more promising might be the use of adenovirus-mediated p53 tumour suppressor gene therapy or BMP-7. All these new therapies need further confirmation coming from ongoing clinical trials such as those involving the use of vascular and growth factor-targeted agents.

What's new in general surgery: endocrine.

There have been many advances in the field of endocrine surgery over the past year. We continue to gain a better understanding of the pathophysiology of endocrine dis- ease through the use of intraoperative hormone mea- surement. Standard surgical procedures have been mod- ified to allow a less invasive approach to surgically cure several endocrine problems. Videoscopic technology has also improved to allow safe operative resection of adre- nal, pancreatic, thyroid, and parathyroid pathology. These procedures have shortened hospital stays, time off work, and improved patient comfort after the proce- dure. A summary of some of these advances, resulting from thoughtful investigation by endocrine surgeons throughout the world, is presented below. solved in only 6% of patients 1 month after undergoing RAI ablation. Hyperthyroidism eventually resolved in 84% of RAI patients with a mean RAI treatment dose of 28 mCi and only 10 (6%) required a second treatment dose. More than half of the patients studied had local symptoms of compression, and size reduction of the goi- ter was seen in only 55 patients (38%) treated with RAI. Thyroidectomy resulted in no postoperative mortality and recurrent nerve paresis and hypoparathyroidism each occurred in three patients (2%). Surgical treatment of toxic multinodular goiter results in rapid and reliable correction of hyperthyroidism with low morbidity. RAI ablation is also safe and effective, usually with a single dose, but resolution of hyperthyroidism is delayed and thyroid goiter persists in many patients. Fine needle aspiration biopsy (FNAB) continues to play an important role in the characterization and treat- ment of thyroid nodules, but distinguishing benign from malignant follicular nodules remains difficult if not impossible. The accuracy of FNAB in detecting thy- roid malignancy is well known in both the academic and community healthcare environments. 2 Thyroid nodules containing follicular cytopathologic features, often de- scribed as follicular neoplasms, are almost always treated with thyroidectomy and are associated with a 20% to 30% malignancy rate. 3 Goldstein and colleagues 4 fur- ther characterized follicular thyroid nodules based on the presence or absence of cytologic atypia. Thyroid ma- lignancy was found by histopathologic examination in only 6.8% of patients without atypia in their FNAB sample, and all of these tumors were a follicular variant of papillary carcinoma. In contrast, 44% of patients with atypia in their FNAB samples harbored thyroid carci- noma, including two invasive follicular carcinomas. This observation may allow for a more conservative ap- proach for carefully selected patients with follicular thy- roid nodules without atypia. The thyroid malignancy

50 Years of Breast, Endocrine, and Oncologic Surgery at the Southwestern Surgical Congress: Earlier Diagnosis and Improved Outcomes

The proceedings of the Southwestern Surgical Congress (SWSC) over the last 50 years have contained .200 presentations related to the field of breast, endocrine, and oncologic surgery. Of these, I have selected 62 for review. A review of the proceedings revealed that in most areas the papers mirrored the evolution of American surgery over the last half century. The breast presentations, beginning in the early 1960s, challenged the rationale of the Halstedian approach to breast cancer and reported comparable results with less disfiguring procedures. In the field of endocrine surgery, as surgeons began embracing newer techniques in diagnosis (fine needle aspiration [FNA], abdominal computed tomography [CT], and flow cytometry), earlier diagnoses and more information on prognosis became available. The papers related to melanoma presented a persuasive argument away from wider radical resections and amputation to operations with smaller margins, with no discernible effect on survival figures. In the area of abdominal oncologic surgery, the most striking trend seemed to be an increasingly aggressive operative approach to pancreatic cancer at the same time as operative mortality rates fell from .30% to ,5%.