Large Benign Thyroid Nodules Research Articles

Efficacy of microwave ablation in the treatment of large benign thyroid nodules: a multi-center study.

To evaluate the efficacy, safety, and improvement of symptoms by ultrasound-guided microwave ablation (MWA) for patients with large benign thyroid nodules (BTNs). Eighty-seven patients with 87 BTNs (≥ 4cm) treated with MWA between April 2015 and March 2021 were enrolled in this retrospective multicenter study, with clinical and ultrasound examinations performed at the 1st, 3rd, 6th, and 12th months. A multivariable linear mixed effects model was employed to explore the alterations in volume and volume reduction ratio (VRR), as well as the potential factors associated with VRR. The mean age of the 87 patients was 45.69 ± 14.21years (range 18-76years), and the ratio of men to women was 1:4.8. The mean volumes were much decreased at the 12th month after ablation compared to the initial volumes (p < .001). The mean VRR was 76.09% at the 12th month. The technique efficacy (VRR > 50%) was 90.80% at the 12th month. A multivariate analysis revealed that VRR was related to the initial volume (p = .015), annular flow (p = .010), and nodule composition (p = .024). The mean symptomatic score decreased from 4.40 ± 0.28 to 0.26 ± 0.06 at the 12th month (p < .001). At the same time, the mean cosmetic score decreased from 3.22 ± 0.10 to 1.31 ± 0.08 (p < .001). MWA could serve as a safe and effective therapy for large BTNs, significantly reducing the volume of BTNs and significantly improving compressive symptoms and appearance problems. Microwave ablation could serve as a safe and effective therapy for large benign thyroid nodules, leading to significant volume reduction and satisfied symptom and cosmetic alleviation period. • This multicenter study investigated the feasibility and safety of microwave ablation for large benign thyroid nodules. • After ablation, the nodule volume was significantly reduced, and patients' symptoms and appearance problems were significantly improved. • Microwave ablation is feasible for large benign thyroid nodules and has been a supplement treatment.

Microwave ablation for large benign thyroid nodules: a proposal for a new approach: "the fluid-motion technique".

Most thyroid nodules are benign, and treatment is primarily indicated for patients with symptoms or cosmetic concerns related to nodular volume. Recently, there has been growing interest in nonsurgical and minimally invasive techniques for the treatment of symptomatic benign thyroid nodules, including microwave ablation (MWA). This study aims to evaluate the effectiveness, efficacy, and safety of ultrasound-guided uncooled MWA in the treatment of benign symptomatic thyroid nodules, using a new ablation technique called the "fluid-motion technique." From April 2021 to February 2023, a total of 150 patients with benign thyroid nodules were treated using MWA at the Endocrine Surgery Unit of Pederzoli Hospital, Peschiera del Garda (Italy), with 102 of them being followed-up for at least 6months. Before treatment, the mean major diameter was 38.4 ± 10.0mm, and the mean volume was 13.6 ± 10.5mL. At 1month, the mean volume was 6.8 ± 6.2mL, and at 3months, it was 4.6 ± 4.1mL. The mean Volume Reduction Rate (VRR) at 3months was 61.1 ± 22.0%. Of the nodules, 17 (17%), 65 (66%), and 20 (19%) had volumes ≤ 10, 10.1-20, and ≥ 20.1mL, respectively. For these nodules, the mean VRR at 3 and 6months was 55.3 ± 16%, 63.4 ± 24.8%, 72 ± 26.9% and 68.0 ± 11.2%, 73.5 ± 18.3%, and 81.6 ± 15.8%, respectively. Our study shows that ultrasound-guided MWA is an effective and safe minimally invasive treatment for benign thyroid nodules. The goal is to achieve a VRR that can reduce symptoms and improve cosmetic appearance.

Incidence of Thyroid Carcinoma in Large (≥4cm) Benign Thyroid Nodules: A Retrospective Single Center Study

Objective: The purpose of our study is to see the incidence of thyroid carcinoma in large (≥4cm) Fine Needle Aspiration Cytology (FNAC) proven benign thyroid nodules. Study Design: Retrospective cross-sectional study Place &amp; duration of Study: Department of General Surgery, Recep Tayyip Erdogan Hospital, Muzaffargarh from August 2014 to May 2021 Methodology: 238 patients with large benign thyroid nodules who underwent thyroid surgery were included in the study. The type of thyroid nodules (solitary or dominant), size of thyroid nodule (mm) and histopathology of the thyroid nodules after surgery were collected. The data was analyzed by IBM Statistical Package for Social Sciences (IBM SPSS Statistics for Windows version 20.0. Armonk, New York). Tables were constructed using Microsoft Excel 2018. Results: A total of 238 patients with large benign thyroid nodules were included in the study. 156 patients (65.9%) had thyroid nodule size in the range of 40mm to 50mm rest of the patients had nodule size above 50mm. The incidence of thyroid carcinoma was 14.3% (34/238). There was no significant effect of age, gender &amp; type of thyroid nodule on risk of thyroid carcinoma. Conclusion: The risk of thyroid carcinoma in large (≥4cm) benign thyroid nodules is significant and there is a need to change our approach in their management to diagnose and manage them timely. Therefore, large (≥4cm) thyroid nodules may be considered for surgery even if preoperative FNAC is benign.

Delayed Cancer Diagnosis in Thyroid Nodules Initially Treated as Benign With Radiofrequency Ablation: Ultrasound Characteristics and Predictors for Cancer.

Regrowth after radiofrequency ablation (RFA) of symptomatic large thyroid nodules, initially treated as benign, sometimes turns out to be malignancies. This study aimed to assess the ultrasound (US) characteristics of thyroid nodules initially treated as benign with RFA and later diagnosed as cancers, predictive factors for cancers masquerading as benign, and methods to avoid RFA in these cancers. We reviewed the medical records of 134 consecutive patients with 148 nodules who underwent RFA between February 2008 and November 2016 for the debulking of symptomatic thyroid nodules diagnosed as benign using US-guided biopsy. We investigated the pre-RFA characteristics of the thyroid nodules, changes at follow-up after RFA, and the final surgical pathology. Nodule regrowth after RFA was observed in 36 (24.3%) of the 148 benign nodules. Twenty-two of the 36 nodules were surgically removed, and malignancies were confirmed in seven (19.4% of 36). Of the 22 nodules removed surgically, pre-RFA median volume (range) was significantly larger for malignant nodules than for benign nodules: 22.4 (13.9-84.5) vs. 13.4 (7.3-16.8) mL (P = 0.04). There was no significant difference in the regrowth interval between benign and malignant nodules (P = 0.49). The median volume reduction rate (range) at 12 months was significantly lower for malignant nodules than for benign nodules (51.4% [0-57.8] vs. 83.8% [47.9-89.6]) (P = 0.01). The pre-RFA benignity of all seven malignant nodules was confirmed using two US-guided fine-needle aspirations (FNAs), except for one nodule, which was confirmed using US-guided core-needle biopsy (CNB). Regrown malignant nodules were diagnosed as suspicious follicular neoplasms by CNB. Histological examination of the malignant nodules revealed follicular thyroid carcinomas, except for one follicular variant, a papillary thyroid carcinoma. Symptomatic large benign thyroid nodules showing regrowth or suboptimal reduction after RFA may have malignant potential. The confirmation of these nodules is better with CNB than with FNA.

A novel parallel overlapping mode for complete ablation of large benign thyroid nodules in a single-session radiofrequency ablation.

BackgroundRadiofrequency ablation (RFA) has been widely applied in patients with benign thyroid nodules (BTNs), and complete ablation in a single-session treatment brings great benefits to patients. While how the ablation should be planned and performed to achieve complete ablation in a single-session treatment in large BTNs remains unknown.PurposeTo determine a more suitable ablation strategy for sufficient treatment in a single-session treatment.Materials and MethodsThis retrospective study included 108 BTNs receiving RFA treatment. These patients were divided into two groups: group A using one insertion point with a fan-shaped overlapping mode and group B using multiple insertion points with a novel parallel overlapping mode. All the treatments used a hydrodissection approach and moving-shot technique. Contrast-enhanced ultrasonography (CEUS) was used to guide the supplementary ablation. Follow-ups were performed at 1, 3, 6 and 12 months. The rates of supplementary ablation, initial ablation ratio (IAR), the rates of complete ablation (CAR), treatment effects and complications between the two groups were compared.ResultsThe group B had larger treated nodules (10.2ml vs 6.4ml, P<0.001) than group A, while group B had a lower rate of supplementary ablation (21.6% vs 75.4%, P<0.001), especially in the BTNs with craniocaudal diameters ≥30mm (22.0% vs 100%, P<0.001). With the assistance of supplementary ablation, both groups achieved similar IAR (100% vs 100%, P=0.372) and CAR (94.7% vs 94.1%, P=1.000). Two groups showed similar VRRs at 12-month follow-up (77.9% vs 77.5%, P=0.894) and similar rates of complications (3.5% vs 2.0%, P=1.000).ConclusionsNeedle placement using the multiple insertion points with a novel parallel overlapping mode would be easier to achieve complete ablation with less supplementary ablation, especially in large nodules.

Meta-analysis of the efficacy and safety of thermal ablation for treating large benign thyroid nodules.

Many large benign thyroid nodules have symptoms and cosmetic problems. This study consisted of a meta-analysis to accurately assess the effect of thermal ablation on these nodules. The PubMed, Embase, Web of Science, and Scopus databases were systematically searched for retrospective or prospective studies of thermal ablation since June 1, 2021. The weighted mean differences of the measures were analysed before and after treatment. A total of 10 eligible studies were included. By comparing the initial nodule volume with the nodular volume after thermal ablation, we found that the volume reduction rate was increased significantly after 1 month (SMD = 0.453, 95% CI: 0.323-0.583, p &lt; .001), 3 months (SMD = 0.655, 95% CI: 0.563-0.747, p &lt; .001), 6 months (SMD = 0.691, 95% CI: 0.607-0.774, p &lt; .001), and 12 months (SMD = 0.694, 95% CI: 0.583-0.803), p &lt; .001). The nodular volume was also found to decrease significantly, after 1 month (SMD = 2.381, 95% CI: 1.278-3.485, p &lt; .001), 3 months (SMD = 5.071, 95% CI: 2.386-7.756, p &lt; .001), 6 months (SMD = 5.363, 95% CI: 2.765-7.962, p &lt; .001), and 12 months (SMD = 8.194, 95% CI: 2.113-14.274), p &lt; .001). Symptom score (SMD = 4.419, 95% CI: 2.573-6.265, p &lt; .001)and cosmetic score (SMD = 4.245, 95% CI: 2.566-5.359, p &lt; .001) were reduced after thermal ablation. Thermal ablation could become an alternative to manage large benign thyroid nodules.

Ultrasound-guided laser ablation of very large benign thyroid nodules: 4-year, retrospective follow-up in 24 patients

Background Percutaneous, ultrasound-guided laser ablation is a proven management approach for the treatment of Benign Thyroid Nodules (BTN), but only sporadic cases of treatment of large-volume nodules with laser ablation have been reported. The aim of this study was to evaluate the efficacy and safety of laser ablation in the treatment of very large (> 100 mL) thyroid nodules. Methods Between 2009 and 2016, 24 patients with very large, BTN received 2–3 sessions of laser ablation over the course of 12 months. Nodule volume was measured before treatment, and at 1 and 4 years. Results Prior to treatment, median nodule volume was 138 mL (range: 102–289 mL). At 1 year, technique efficacy was achieved in 75% of patients, with median nodule volume significantly reduced to 26 mL (range: 15–31 mL, p < 0.001 vs pretreatment). Volume reduction ratio (VRR) at 1 year was 81%. At 4-year follow-up, median nodule volume was 27 mL (range: 15–33 mL, p < 0.001 vs pretreatment), with a VRR of 80%. Two patients had nodule regrowth > 50% and went to surgery – one patient after 1 year and the other after 3 years. Treatment was well tolerated; there were no major complications, although transient fever occurred in 12% (3/24) of patients and mild-to-moderate pain was experienced by 8% (2/24) of patients. Conclusions In this patient series, percutaneous, ultrasound-guided laser ablation of very large thyroid modules provided long-term benefits and the treatment was well tolerated.

Twelve-Month Volume Reduction Ratio Predicts Regrowth and Time to Regrowth in Thyroid Nodules Submitted to Laser Ablation: A 5-Year Follow-Up Retrospective Study.

ObjectiveLaser ablation is a therapeutic modality used to reduce the volume of large benign thyroid nodules. Unsatisfactory reduction and regrowth are observed in some treated nodules. The aim of the study was to evaluate the long-term outcomes of laser treatment for solid nodules during a 5-year follow-up period, the regrowth rate, and the predictive risk factors of nodule regrowth.Materials and MethodsWe retrospectively evaluated patients with benign, solid, cold thyroid nodules who underwent laser ablation and were followed-up for 5 years. According to the selection criteria, 104 patients were included (median baseline nodule volume, 12.5 mL [25.0–75.0%, 8–18 mL]; median energy delivered, 481.5 J/mL [25.0–75.0%, 370–620 J/mL]). Nodule volume, thyroid function test results, and ultrasound were evaluated at baseline and then annually after the procedure.ResultsOf 104 patients, 31 patients (29.8%) had a 12-month volume reduction ratio (VRR) < 50.0% and 39 (37.5%) experienced nodule regrowth. Of these 39 patients, 17 (43.6%) underwent surgery and 14 (35.9%) underwent a second laser treatment. The rate of nodule regrowth was inversely related to the 12-month VRR, i.e., the lower the 12-month VRR, the higher the risk of regrowth (p < 0.001). The mean time for nodule regrowth was 33.5 ± 16.6 months. The 12-month VRR was directly related to time to regrowth, i.e., the lower the 12-month VRR, the shorter the time to regrowth (p < 0.001; R2 = 0.3516). Non-spongiform composition increased the risk of regrowth with an odds ratio of 4.3 (95% confidence interval [CI] 1.8–10.2; p < 0.001); 12-month VRR < 50.0% increased the risk of regrowth with an odds ratio of 11.7 (95% CI 4.2–32.2; p < 0.001).ConclusionThe VRR of thyroid nodules subjected to similar amounts of laser energy varies widely and depends on the nodule composition; non-spongiform nodules are reduced to a lesser extent and regrow more frequently than spongiform nodules. A 12-month VRR < 50.0% is a predictive risk factor for regrowth and correlates with the time to regrowth.

Machine Learning Prediction of Radiofrequency Thermal Ablation Efficacy: A New Option to Optimize Thyroid Nodule Selection

Background: Radiofrequency (RF) is a therapeutic modality for reducing the volume of large benign thyroid nodules. If thermal therapies are interpreted as an alternative strategy to surgery, critical issues in their use are represented by the extent of nodule reduction and by the durability of nodule reduction over a long period of time. Objective: To assess the ability of machine learning to discriminate nodules with volume reduction rate (VRR) < or ≥50% at 12 months following RF treatment. Methods: A machine learning model was trained with a dataset of 402 cytologically benign thyroid nodules subjected to RF at six Italian Institutions. The model was trained with the following variables: baseline nodule volume, echostructure, macrocalcalcifications, vascularity, and 12-month VRR. Results: After training, the model could distinguish between nodules having VRR <50% from those having VRR ≥50% in 85% of cases (accuracy: 0.85; 95% confidence interval [CI]: 0.80–0.90; sensitivity: 0.70; 95% CI: 0.62–0.75; specificity: 0.99; 95% CI: 0.98–1.0; positive predictive value: 0.95; 95% CI: 0.92–0.98; negative predictive value: 0.95; 95% CI: 0.92–0.98). Conclusions: This study demonstrates that a machine learning model can reliably identify those nodules that will have VRR < or ≥50% at 12 months after one RF treatment session. Predicting which nodules will be poor or good responders represents valuable data that may help physicians and patients decide on the best treatment option between thermal ablation and surgery or in predicting if more than one session might be necessary to obtain a significant volume reduction.

Effectiveness of radiofrequency ablation of the large benign thyroid nodules

Effectiveness of radiofrequency ablation of the large benign thyroid nodules

Two sequential applications of high-intensity focused ultrasound (HIFU) ablation for large benign thyroid nodules

High-intensity focused ultrasound (HIFU) ablation is a promising treatment for benign thyroid nodules but single application is less effective in larger-sized nodules. We aimed to assess the efficacy and safety of two sequential applications in larger-sized nodules. Fifty patients underwent ablation of a large-sized nodule (baseline volume ≥ 20mL and diameter ≤ 50mm). Thirty-one (62.0%) patients underwent single application (group I) while 19 (38.0%) underwent two sequential applications (group II). Nodule shrinkage (by volume reduction ratio or VRR), pain scores during and after ablation, and rate of vocal cord palsy (VCP), skin burn, and nausea/vomiting were compared between the two groups. t test or the Mann-Whitney U test was used for continuous variables while chi-square test was used for categorical variables. To determine factors for VRR, multivariate analysis was done by logistic regression analysis. Total energy delivered and treatment time were significantly more in group II (p < 0.001 and p = 0.001, respectively). Total energy per nodule volume (kJ/mL) was also significantly greater in group II (1.01kJ/mL vs. 0.57kJ/mL, p < 0.001). The 6-month VRR was significantly greater in group II (56.74 ± 11.47% vs. 43.49 ± 12.03%, p = 0.004). Pain severity and rates of VCP, skin burn, and nausea/vomiting were comparable between the two groups (p > 0.05). Sequential application was an independent determinant of 6-month VRR (OR = 13.936, 95% CI = 1.738-197.399, p = 0.036). Sequential application led to better 6-month treatment efficacy than single application in large-sized nodules. Patients undergoing sequential application are not at greater risks of treatment-related side effects afterwards. • Sequential application produces better 6-month efficacy over single application for large-sized nodules. • Sequential HIFU application is well-tolerated and safe in patients with large-sized nodules. • Sequential application takes longer and requires larger amount of pethidine and diazepam.

Outcomes of Radiofrequency Ablation Therapy for Large Benign Thyroid Nodules: A Mayo Clinic Case Series

ObjectiveTo assess the effectiveness, tolerability, and complications of radiofrequency ablation (RFA) in patients with benign large thyroid nodules (TNs). Patients and MethodsThis is a retrospective review of 14 patients with predominantly solid TNs treated with RFA at Mayo Clinic in Rochester, Minnesota, from December 1, 2013, through October 30, 2016. All the patients declined surgery or were poor surgical candidates. The TNs were benign on fine-needle aspiration, enlarging or causing compressive symptoms, and 3 cm or larger in largest diameter. We evaluated TN volume, compressive symptoms, cosmetic concerns, and thyroid function. ResultsMedian TN volume reduction induced by RFA was 44.6% (interquartile range [IQR], 42.1%-59.3%), from 24.2 mL (IQR, 17.7-42.5 mL) to 14.4 mL (IQR, 7.1-19.2 mL) (P<.001). Median follow-up was 8.6 months (IQR, 3.9-13.9 months). Maximum results were achieved by 6 months. Radiofrequency ablation did not affect thyroid function. In 1 patient with subclinical hyperthyroidism due to toxic adenoma, thyroid function normalized 4 months after ablation of the toxic nodule. Compressive symptoms resolved in 8 of 12 patients (67%) and improved in the other 4 (33%). Cosmetic concerns improved in all 8 patients. The procedure had no sustained complications. ConclusionIn this population, RFA of benign large TNs performed similarly to the reports from Europe and Asia. It induces a substantial volume reduction of predominantly solid TNs, improves compressive symptoms and cosmetic concerns, and does not affect normal thyroid function. Radiofrequency ablation has an acceptable safety profile and should be considered as a low-risk alternative to conventional treatment of symptomatic benign TNs.

Efficacy and safety of a single radiofrequency ablation of solid benign non-functioning thyroid nodules.

The objective of our study is to evaluate the clinical outcomes and safety of radiofrequency thermal ablation (RFA) for benign thyroid nodules (BTNs) over a 1-year follow-up. This is a monocentric retrospective study. Forty-eight patients with solid, non-functioning BTNs were treated by RFA using a 17G internally cooled electrode. We categorized thyroid nodules as small (≤ 12 mL), medium (12 to 30 mL), or large (over 30 mL). BTNs volume reduction, thyroid function, cosmetic and compressive score changes and side effect evaluation at 6 and 12 months were evaluated. BTN volume decreased significantly from baseline to 6 (mean percentage decrease of BTN volume was 66.8 ± 13.6%, p < 0.001). At 12 months, the mean percentage reduction of BTN volume compared to six months was 13.7 ± 17.1% (p < 0.001). At 6-month, symptom score had improved significantly (p < 0.001) while it does not change significantly between 6 and 12 months. In particular, symptom score improved significantly in the medium (p < 0.001) and large (p < 0.01) subgroups. Cosmetic score improved significantly between baseline and 6 months (p < 0.001) and between 6 and 12 months (p < 0.01). In all the subgroups, cosmetic score improved significantly between baseline and 6 months, while between 6 and 12 months it improved significantly only in the large group (p < 0.05). RFA was well tolerated. Only one patient experienced permanent right paramedian vocal cord palsy. A single RFA treatment was effective in reducing BTNs volume, in particular small and medium nodules. Cosmetic score improved in all treated BTNs while symptom score only got better in the medium and large BTNs.

Laser ablation is more effective for spongiform than solid thyroid nodules. A 4-year retrospective follow-up study

Purpose: Laser ablation (LA) is used as therapeutic modality for reducing the volume of large benign thyroid nodules. The aim of this retrospective study was to assess the efficacy of LA therapy in patients with benign non-functioning thyroid nodules in a 4-year follow-up and evaluate whether different compactness of nodules may influence the final shrinkage.Patients and methods: Fifty-six euthyroid patients (42 females; mean age 54.7 ± 11.7 years) with benign cold thyroid solitary nodules or a dominant nodule within a multinodular goitre underwent LA between July 2009 and March 2012. Nodule volume, thyroid function test and ultrasound were monitored at baseline, and at 3, 6 and 12 months after the procedure, then annually.Results: With a mean baseline volume of 15.7 ± 11.7 mL, nodule volume decreased by 55.5% (6.5 ± 5.7 mL) 4 years after LA (p < .01). Nodules had a significant decrease at 3 and 6 months, thereafter they remained stable, with an insignificant tendency to re-growth at 48 months. Thyroid functions and antibodies were unchanged throughout the follow-up. When dividing nodules into solid and spongiform, the former decreased at 6 months, remained stable up to 24 months, but showed a non-significant tendency to increase thereafter. Spongiform nodules progressively decreased up to 48 months. The difference in nodules’ reduction between solid and spongiform nodules was significant from 3 months (p = .04) and became even more significant up to 48 months (p = .001).Conclusions: The LA technique succeeded in reducing thyroid nodules by about 50% at 4 years, but was more effective for spongiform than solid nodules.

Efficacy and safety of radiofrequency ablation performed by an endocrinologist for large benign thyroid nodules

Efficacy and safety of radiofrequency ablation performed by an endocrinologist for large benign thyroid nodules

Interstitial laser photocoagulation for benign thyroid nodules: Time to treat large nodules

Interstitial laser photocoagulation (ILP) is a new therapeutic option for the ablation of non-functioning and hyper-functioning benign thyroid nodules. Amelioration of the ablation procedure currently allows treating large nodules. Aim of this study was to evaluate the therapeutic efficacy of ILP, performed according to a modified protocol of ablation, in patients with large functioning and non-functioning thyroid nodules and to identify the best parameters for predicting successful outcome in hyperthyroid patients. Fifty-one patients with non-functioning thyroid nodules (group 1) and 26 patients with hyperfunctioning thyroid nodules (group 2) were enrolled. All patients had a nodular volume ≥40 ml. Patients were addressed to 1-3 cycles of ILP. A cycle consisted of three ILP sessions, each lasting 5-10 minutes repeated at an interval of 1 month. After each cycle of ILP patients underwent thyroid evaluation. A nodule volume reduction, expressed as percentage of the basal volume, significantly occurred in both groups (F = 190.4; P < 0.0001 for group 1 and F = 100.2; P < 0.0001 for group 2). Receiver-operator-characteristic (ROC) curves were constructed for: (i) percentage of volume reduction; (ii) difference in nodule volume; (iii) total amount of energy delivered expressed in Joule. ROC curves identified the percentage of volume reduction as the best parameter predicting a normalized serum TSH (area under the curve 0.962; P < 0.0001). Intraoperative complications consisted in: (i) mild pain occurring in five (6.5%) patients, (ii) vasovagal reaction in two (2.6%) patients, (iii) fever within 24 hours from ILP in five (6.5%) patients. No major complications including persistent pain, laringeal nerve dysfunction, hypoparathyroidism, pseudocystic transformation, and/or neck fascitis were observed. ILP represents a valid alternative to surgery also for large benign thyroid nodules, both in terms of nodule size reduction and cure of hyperthyroidism (87% of cured patients after the last ILP cycle). ILP should not be limited to patients refusing or being ineligible for surgery and/or radioiodine.

Minimally invasive video-assisted thyroidectomy: experience of 300 cases

We report on patients selected for minimally invasive video-assisted thyroidectomy (MIVAT) over a 3-year period and evaluate the feasibility and effects of this procedure. Between March 2005 and August 2008, 300 patients (36 male, 264 female; mean age = 54.6 years) underwent MIVAT using a single central incision with an average length of 2 cm (range = 1.5-3 cm), about 2 cm above the sternal notch. Small conventional retractors and dissectors, ultrasonic scalpel, 5-mm laparoscope, and a video screen were the instruments used. General anesthesia was used in 295 patients and regional block anesthesia in 5. MIVAT was performed successfully in 280 patients (93.3%). Conversion to open thyroidectomy with a 4-cm-long incision was required to achieve selective lymphadenectomy in 18 patients after frozen sections demonstrated differentiated thyroid carcinoma. Only two patients with benign thyroid nodules were converted because of large volume or massive hemorrhage from the upper pole vessels. Mean operative time was 35 min (range = 20-70 min) for unilateral lobectomy and 58 min (35-90 min) for bilateral thyroidectomy. No patients had wound infections, postoperative bleeding that required reoperation, permanent hypoparathyroidism, or bilateral recurrent laryngeal nerve palsy. However, permanent unilateral recurrent laryngeal nerve palsy appeared in five cases (1.7%), transient unilateral recurrent laryngeal nerve palsy in seven (2.3%), superior laryngeal nerve injury in five (1.7%), transient hypocalcemia in nine (3.0%), and mild skin burn from the ultrasonic scalpel in five (1.7%). Postoperative pain was minimal and better cosmetic results were obtained than conventional open thyroidectomy. Postoperative stay was shorter than with conventional open thyroidectomy. MIVAT appears to be safe and feasible in patients with benign thyroid nodules, with minimal injury and excellent cosmetic results. Furthermore, after properly lengthening the skin incision, MIVAT can be used for patients with large benign thyroid nodules or even early-stage differentiated thyroid carcinoma.

Radiofrequency Ablation for an Autonomously Functioning Thyroid Nodule

Radiofrequency Ablation for an Autonomously Functioning Thyroid Nodule