Permanent Recurrent Laryngeal Nerve Palsy Research Articles

The anatomic repair of recurrent aortic arch obstruction in children and adolescents

ObjectiveSurgery for recurrent aortic arch obstruction is highly challenging and publications are rare. The aim of this retrospective, single-center study was to evaluate mortality, complications, and reintervention rate after an anatomic repair. MethodsBetween 1999 and 2022, in total 946 operations on the aortic arch were performed at the Children's Heart Center Linz. In 39 cases, the indication was a recurrent or residual aortic arch obstruction or coarctation in a patient aged 18 years or younger. This is our study cohort. The aorta was reconstructed by a direct anastomosis/autograft in 20 patients, patch in 17 patients, and interposition graft in 2 adolescents. In 32 procedures, cardiopulmonary bypass with whole body perfusion was employed, in 4, antegrade cerebral perfusion was employed, in 2, a left heart bypass was employed, and in 1 no cardiopulmonary bypass was used. ResultsMedian (Q1, Q3) age at operation was 253 days (100, 2198 days), weight 7.5 kg (4.5, 17.8 kg). Median cardiopulmonary bypass time was 177 minutes (115, 219 minutes), crossclamp time 73 minutes (49, 102 minutes). Three infants died during the hospital stay: 1 with Williams syndrome, 1 with hypoplastic left heart syndrome, and 1 with heterotaxia. There was no death due to an arch complication. The main complications were 1 neurologic injury after postoperative resuscitation (Williams syndrome) and 1 permanent recurrent laryngeal nerve paralysis. During the follow-up period of median 8.1 years (2.6, 12 years) 1 re-reintervention on the aortic arch was necessary. ConclusionsSophisticated reoperations on the aortic arch could be performed safely. In children, the growth potential of all segments of the aorta could be sustainably preserved by avoiding interposition or extra-anatomic bypass grafts.

Comparison of Robotic Versus Conventional Open Thyroidectomy for Recurrent Laryngeal Nerve Safety: A Systematic Review and Meta-Analysis.

This review aims to investigate the safety of recurrent laryngeal nerve (RLN) by comparing robotic thyroidectomy (RT) versus open thyroidectomy (OT) in Western and Asian populations. Two main outcomes of this review were (1) the safety of RLN comparing the robotic and OT assessingtransient and permanentlaryngeal nerve (PLN) palsy as a postoperative complication in each surgical procedureand (2)the safety of RLN comparing the robotic and OT assessingtransient and permanentlaryngeal nerve (PLN) palsy as a postoperative complication between studies conducted in USA/Europe andAsia.We searched relevant literature in electronic databases such as PubMed, MEDLINE, Cochrane CENTRAL, ScienceDirect, and Cumulative Index to Nursing & Allied Health(CINAHL)up to September 2022. Furtherresearch was performed duringJanuary 2024 in the Scopus database. Two primary outcomes were set:transient RLN palsyand permanent RLN palsy, comparing RT and OT. In this review, 18non-randomized studies were included. A statistically significant difference between robotic and conventional OT was not observed either in transient RLN or in permanent RLN palsy. The odds ratio (OR) for the overall comparison of transient RLN palsy was 1.18, and the 95% confidence interval (95% CI) was 0.80-1.74. The subgroup analysis for transient RLN palsy between USA/Europe studies was OR 1.28, and the95% CIwas 0.64-2.58. The subgroup analysis for transient RLN palsy between Asian studies was OR 1.14, and the 95%CIwas 0.72-1.82. The OR for the overall comparison of permanentRLN palsy was OR 0.90, and the 95% CIwas 0.38-2.15. The subgroup analysis for permanentRLN palsy between USA/Europe studies was OR0.45, and the 95% CIwas 0.07-2.97. The subgroup analysis for permanentRLN palsy between Asian studies was OR1.13, and the 95% CIwas 0.42-3.05. Heterogeneity I2was 0% in all outcomes. The Mantel-Haenszel method fixed effect was used.First, RT and open conventional thyroidectomy have comparable safety for RLN, although the analysis showed no statistically significant results. Second, no statistically significant results were found for RLN safety in either USA/Europe or Asian studies.Considering that there is not a statistically significant difference between the two approaches for RLN safety, and due to the limited number of studies from Western countries, the results should be considered with caution. Important factors such as the patient's body characteristics, the existing thyroid pathology, and the surgical approachshould be kept in mind. More comparable studies are needed on the Western population.

Complications of microwave ablation in patients with persistent/recurrent hyperparathyroidism after surgical or ablative treatment

Objective To evaluate the complications associated with microwave ablation (MWA) in treating persistent/recurrent hyperparathyroidism (HPT) post-surgical or ablative treatments. Materials and methods From January 2015 to December 2022, 87 persistent/recurrent HPT patients (primary HPT [PHPT]: secondary HPT [SHPT] = 13:74) who underwent MWA after surgical or ablative treatment were studied. Grouping was based on ablation order (initial vs. re-MWA), prior treatment (parathyroidectomy [PTX] vs. MWA), and etiology (PHPT vs. SHPT). The study focused on documenting and comparing treatment complications and analyzing major complication risk factors. Result Among the 87 patients, the overall complication rate was 17.6% (15/87), with major complications at 13.8% (12/87) and minor complications at 3.4% (3/87). Major complications included recurrent laryngeal nerve (RLN) palsy (12.6%) and Horner syndrome (1.1%), while minor complications were limited to hematoma (3.4%). Severe hypocalcemia noted in 21.6% of SHPT patients. No significant differences in major complication rates were observed between initial and re-MWA groups (10.7% vs. 13.8%, p = 0.455), PTX and MWA groups (12.5% vs. 15.4%, p = 0.770), or PHPT and SHPT groups (15.4% vs. 13.5%, p > 0.999). Risk factors for RLN palsy included ablation of superior and large parathyroid glands (>1.7 cm). All patients recovered spontaneously except for one with permanent RLN palsy in the PTX group (2.1%). Conclusion Complication rates for MWA post-surgical or ablative treatments were comparable to initial MWA rates. Most complications were transient, indicating MWA as a viable and safe treatment option for persistent/recurrent HPT patients.

An institutional experience of intraoperative neurophysiological monitoring application in robotic thyroidectomy: a retrospective case-control study.

Intraoperative neurophysiological monitoring (IONM) has been introduced in thyroid surgery to prevent injury of the recurrent laryngeal nerve (RLN). However, its effectiveness remains controversial in robotic thyroidectomy (RT). This study aimed to compare the surgical outcome of RT in patients with and without the application of IONM. This retrospective case-control study included 100 patients who underwent total thyroidectomy via robotic bilateral axillo-breast approach in a tertiary center. A study group of 50 patients who had IONM during RT was compared to a control group of 50 patients who underwent RT with nerve visualization alone. The sex ratio (4:45 vs. 7:43, P = 0.538), mean age (39.3 ± 7.1 years vs. 37.5 ± 10.4 years, P = 0.304), and body mass index (23.1 ± 2.6 kg/m2 vs. 22.2 ± 3.9 kg/m2, P = 0.215) were comparable between the IONM and control groups. Pathologic features including tumor size (0.8 cm vs. 0.9 cm, P = 0.283), extrathyroidal extension (58.0% vs. 24.0%, P = 0.316), lymph node metastasis (30% vs. 34%, P = 0.668), and number of lymph nodes (5.3 vs. 5.3, P = 0.668) showed no differences. There was no permanent RLN palsy, postoperative bleeding, and wound complications. Transient hypoparathyroidism was observed in 12 (24.0%) and 14 (28.0%), permanent hypoparathyroidism in 0 (0%) and 1 (2.0%), and transient RLN palsy was observed in 3 (6.0%) and 3 (6.0%), respectively. We did not demonstrate a clear advantage of IONM in RT. Controversies regarding the effectiveness of IONM is not closed.

Voice Changes Without Laryngeal Nerve Alterations After Thyroidectomy: The Need For Prospective Trials - A Review Study.

Thyroidectomy is a commonly performed surgical procedure that is offered for different thyroid pathologies. The most frequent complication after total thyroidectomy is transient or permanent hypoparathyroidism followed by transient or permanent recurrent laryngeal nerve palsy. Patients may experience voice impairment despite intact laryngeal nerve function. These patients are of special interest because they experience subjective symptoms which are difficult to measure and therefore to treat. The Voice Handicap Index (VHI) and VHI-10 are the most commonly used subjective questionnaires. Their results correlate with objective findings. Female sex, in particular after menopause, is a dominant factor for developing voice impairment after thyroidectomy. The extent of neck surgery and the weight and volume of the removed thyroid correlates directly with both objective and subjective voice impairment after surgery. Videolaryngostroboscopy should be considered to examine vocal cord pathologies in this patient group. Surprisingly, there are no studies showing that speech and voice therapy are beneficial for patients with voice alterations but with intact laryngeal nerves. While recurrent laryngeal nerve (RLN) paralysis can be evaluated by objective exams postoperatively, we are still left with the issue of possible partial or complete external branch of superior laryngeal nerve (EBSLN) injury. It is therefore quite difficult to segregate neural (RLN and EBSLN) and non-neural voice change populations, regardless of the method of literature evaluation. Perhaps patients' perspectives on how they experience voice functionality should play a superior role in deciding which patients should be investigated further with laryngoscopy, acoustic or perceptual analysis, and which patients should be offered treatment.

Long-term impact of prophylactic central neck dissection in non-invasive classic papillary thyroid carcinoma

BackgroundThe utilization of prophylactic central neck dissection (pCND) in cases of non-invasive clinical node-negative (cN0) papillary thyroid carcinoma (PTC) remains a topic of debate, with a dearth of long-term evidence. Materials and methodsWe retrospectively reviewed 1181 cN0 PTC patients from 1997 to 2011. Of these, 641 underwent pCND (pCND + group) and 540 did not (pCND-group). Propensity score matching (PSM) was used to identify similar patients. Event-free survival and long-term complications including permanent hyperparathyroidism and permanent recurrent laryngeal nerve (RLN) paralysis were analyzed after PSM. ResultsThe pCND + group had more aggressive characteristics. In the matched cohort after PSM, the 5-year, 10-year, and 15-year EFS rates were 98.9 %, 98.2 %, and 97.1 % for the pCND + group, and 97.7 %, 97.1 %, and 97.1 % for the pCND-group, respectively. There was no statistically significant difference in EFS rates between the two groups (Log Rank P = 0.38). There was no statistically significant difference in the incidence of permanent hyperparathyroidism (3.3 % vs. 1.5 %, P = 0.08) and permanent RLN paralysis (1.7 % vs. 0.9 %, P = 0.13) between the pCND+ and pCND– groups. ConclusionOur study, with a median follow-up duration of 107 months, indicates that pCND does not lead to a significant reduction in nodal recurrence among non-invasive cN0 PTC patients.

The impact of obesity on thyroidectomy outcomes: a case-matched study

Obesity is a well-known public health concern in Western World. Accordingly, an elevated number of obese patients undergo thyroidectomy every year. We aim to assess the impact of obesity on intraoperative and postoperative outcomes of patients who undergo thyroidectomy. 1228 patients underwent thyroidectomy at our department between January 2021 and September 2021. We divided patients into two groups according to body mass index (BMI): non-obese (BMI < 30 kg/m2) and obese (BMI ≥ 30 kg/m2). A propensity score approach was performed to create 1:1 matched pairs (matching according to age, gender, diagnosis, nodule size and type of operation). After matching, the final population included 522 patients, equally divided between each group: non-obese group (Group A; n = 261) and obese group (Group B; n = 261). The primary endpoint of the study was the overall rate of postoperative complications; secondary endpoints of the study were operative time, use of energy device and length of hospital stay. The duration of hospital stay resulted longer in Group B (p = 0.002). No statistically significant differences were documented in terms of operative time (p = 0.206), use of energy devices (p = 0.855) and surgical complications (p = 0.429). Moreover, no statistically significant differences were documented considering each specific complication: transient and permanent hypocalcemia (p = 0.336; p = 0.813, respectively), transient and permanent recurrent laryngeal nerve palsy (p = 0.483; p = 0.523, respectively), hematoma (p = 0.779), bleeding (p = 0.178), wound infection (p = 0.313) and cheloid formation (p = 0.412). Thyroidectomy can safely be performed in obese patients. Outcomes resulted comparable; nonetheless, obesity correlates to longer hospital stay.

Evaluation of Thyroidectomy Results Performed at a Tertiary Academic Center.

The aim of the study was to retrospectively analyze the patients who underwent thyroidectomy at a tertiary academic center regarding their surgical indications, histopathological diagnosis, and surgical complications. The study included a total of 739 consecutive patients who underwent lobectomy, total thyroidectomy, or completion thyroidectomy performed under intraoperative nerve monitoring (IONM) at the Department of Otorhinolaryngology-Head and Neck Surgery of Dokuz Eylül University between January 2009 and December 2019. Demographic data of the patients, preoperative clinicopathological characteristics, postoperative complications, characteristics of surgery and histopathological results were evaluated. There were 619 patients in the primary surgery and 120 patients in the revision surgery groups. Indications for surgery were suspicion of malignancy in 486, multinodular goiter in 214, and hyperthyroidism in 39 patients. Final histopathological evaluation of specimens revealed malignancy in a total of 507 (68.6%) patients. Rates of transient and permanent hypocalcemia were 7.3% (54/739) and 2.2% (16/739) in the whole group, while this was 6.6% (41/619) and 1.5% (9/619), respectively, among primary total thyroidectomy patients. There were 61 (8.3%) patients with transient recurrent laryngeal nerve (RLN) paralysis (unilateral in 60 patients, bilateral in one patient) and five (0.7%) patients with permanent unilateral RLN paralysis as postoperative complications. Rates for postoperative hematoma, seroma, wound infection and chylous fistula were 2.2%, 3.7%, 0.1%, and 0.5%, respectively. Our results support the safety of thyroid surgery performed under IONM in tertiary academic centers. Every institution should document and share its own results to properly inform its patients preoperatively.

Effectiveness of the recurrent laryngeal nerve monitoring during endoscopic thyroid surgery: systematic review and meta-analysis.

Thyroid disease is a common endocrine disorder, and thyroid surgeries and postoperative complications have increased recently. This study aimed to explore the effectiveness of intraoperative nerve monitoring (IONM) in endoscopic thyroid surgery using subgroup analysis and determine confounding factors. Two researchers individually searched for relevant studies published till November 2022 in the PubMed, Embase, Web of Science and Cochrane Library databases. Eventually, eight studies met the inclusion criteria. Heterogeneity was assessed using the Cochran's Q test, and a funnel plot was implemented to evaluate publication bias. The odds ratio or risk difference were calculated using fixed-effects models. The weighted mean difference of continuous variables was calculated. Subgroup analysis was performed according to the disease type. Eight eligible papers included 915 patients and 1242 exposed nerves. The frequencies of transient, permanent and total recurrent laryngeal nerve (RLN) palsy were 2.64, 0.19 and 2.83%, respectively, in the IONM group and 6.15, 0.75 and 6.90%, respectively, in the conventional exposure group. In addition, analysis of the secondary outcome indicators for the average total length of surgery, localisation time of the RLN, recognition rate of the superior laryngeal nerve and length of incision revealed that IONM reduced the localisation time of the RLN and increased the identification rate of the superior laryngeal nerve. Subgroup analysis showed that IONM significantly reduced the incidence of RLN palsy in patients with malignancies. The use of IONM significantly reduced the incidence of transient RLN palsy during endoscopic thyroid surgery, but it did not significantly reduce the incidence of permanent RLN palsy. However, the reduction in the total RLN palsy was statistically significant. In addition, IONM can effectively reduce the location time of the RLN and increase the recognition rate of the superior laryngeal nerve. Therefore, the application of IONM for malignant tumours is recommended.

Thyroidectomy With or Without Nerve Identification: A Personal Experience and Technique.

Careful and precise dissection of the gland, away from the typical trajectory of the recurrent and external laryngeal nerves, poses a minimal or similar risk of nerve injuries compared to directly visualizing and identifying the nerves. In a randomized controlled study involving 150 patients with various thyroid disorders who underwent different surgical procedures (total, near total, and hemi thyroidectomy), the patients were randomly assigned into two groups using a coin toss. The first group (G1) consisted of 75 patients who underwent thyroidectomy with nerve visual identification, while the second group (G2) comprised 75 patients without the requirement of nerve visualization. The aim was to determine the method with a lower risk of complications. The incidence of external laryngeal nerve palsy (ELNP) was found to be higher in G1 patients compared to G2 patients (5.3% vs2%), while no cases of permanent recurrent laryngeal nerve (RLN) palsy were observed in either group. The frequency of total nerve injury was higher in G1, with 14 patients (10.2%), compared to G2, with eight patients (5.3%). However, there was no significant association between nerve identification and the rate of nerve injury (P value = 0.452). Among the different surgical procedures, total thyroidectomy for toxic goiter was the most common operation associated with transient external laryngeal nerve (TELN) injury and permanent external laryngeal nerve (PELN) injury. By employing meticulous dissection techniques in proximity to the thyroid capsule, experienced surgeons can effectively reduce the risk of nerve injury, even in the absence of direct nerve visualization.

Transoral Thyroidectomy: Initial Results of the European TOETVA Study Group

BackgroundThe aim of this study was to evaluate a new surgical technique by the European Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) Study Group.MethodsThis study included 391 patients (47 [(12%]) male and 344 [(88%)] female) who had undergone endoscopic thyroid or parathyroid surgery via the vestibular approach between February 2016 and May 2022 at nine centers. The data were analyzed with regard to complications, surgery time and specimen retrieval.ResultsOverall, 376 (96.2%) TOETVA and 15 (3.8%) transoral endoscopic parathyroidectomy vestibular approach interventions were performed with an average surgery time of 145 (± 61.2) minutes and 509 nerves at risk. The specimens were retrieved via a transoral vestibular and retroauricular approach in 66 (16.9%) patients and via a transaxillary approach in 8 (2%). Benign histology including Grave’s disease was identified in 272 (69.6%) patients, 1 (0.3%) presented noninvasive follicular thyroid neoplasms with papillary-like nuclear features, and 103 (26.3%) showed differentiated thyroid carcinoma. Solitary parathyroid adenoma were removed in 15 (3.8%) patients. Conversion to open surgery was necessary in 13 (3.3%) and revision had to be performed in 2 (0.5%) patients. Transient recurrent laryngeal nerve palsy (RLNP) was present in 18 (4.6%) and permanent RLNP in 2 (0.5%) patients. Fifteen (3.8%) patients experienced transient hypoparathyroidism after thyroidectomy. No case of permanent hypoparathyroidism was observed. Postoperative surgical site infection occurred in 1 (0.3%) patient. Despite a higher rate of sensory and motor disorders and skin discoloration at discharge, permanent disorders were present in only 3 (0.8%) and 16 (4.1%) patients, respectively.ConclusionOur results show that transoral endoscopic surgery, performed by experienced endocrine surgeons, is a safe alternative to conventional thyroid surgery.

Endoscopic thyroidectomy via areola approach for stage T1 papillary thyroid carcinoma: feasibility, safety, and oncologic outcomes.

To evaluate the feasibility, safety, and oncologic outcomes associated with endoscopic thyroidectomy via the areolar approach (ETAA), compared with conventional open thyroidectomy (COT) for the treatment of stage T1 papillary thyroid carcinoma (PTC). Between January 2021 and June 2022, a total of 1204 patients diagnosed with PTC underwent screening, out of which 138 patients were selected for inclusion in the study population after propensity score matching (92 patients in the ETAA group and 46 patients in the COT group). The study included the collection and analysis of clinicopathologic characteristics, intraoperative outcomes, postoperative outcomes, complications, and follow-up data using R software. The operative time for the ETAA group was longer than that for the COT group (160.42 ± 32.21 min vs. 121.93 ± 29.78 min, p < 0.0001). However, there were no significant differences between the two groups in terms of intraoperative blood loss, the extent of surgical resection, the number of dissected lymph nodes, the number of metastatic lymph nodes, and the rate of parathyroid autotransplantation. Postoperative drainage and C-reactive protein levels were higher in the ETAA group than in the COT group, but there were no significant differences in 24-hour visual analogue scale scores, white blood cell counts, drainage duration, or postoperative hospital stay. Complication rates were similar between the two groups, and no permanent recurrent laryngeal nerve palsy or hypoparathyroidism was observed. Patients who underwent ETAA reported greater cosmetic satisfaction and quality of life than those who underwent COT. During the follow-up phase, only one patient in the COT group developed lateral cervical lymph node involvement requiring reoperation. ETAA is a safe and feasible surgical method for patients with stage T1 PTC, providing results similar to COT in terms of oncologic completeness, while avoiding neck scars, with excellent cosmetic effects. Chinese Clinical Trial Registry center, identifier ChiCTR2300077109.

Transoral endoscopic thyroidectomy vestibular approach (TOETVA): initial experience in Australia.

Thyroidectomy is traditionally an open procedure. The potential for and unpredictability of patients developing an unsightly anterior neck scar has led many investigators to develop various 'scarless' thyroidectomy techniques. Here we report on our initial experience, and to our knowledge, the first and largest series of this technique in Australia and New Zealand. Across two centres in Western Australia, three Endocrine surgeons utilized the Transoral Endoscopic Thyroidectomy vestibular approach (TOETVA). Key endpoints such as operating time, blood loss, pain scores, recurrent laryngeal nerve injury and hypoparathyroidism was collected. Data was analysed using R statistical program. One hundred and two TOETVAs were performed between March 2018 and May 2021. There were 66 hemithyroidectomies, 34 total thyroidectomies (four converted to open), and two isthmusectomies. We noted a trend in median operating time decreasing over the study period. There were no cases of permanent recurrent laryngeal nerve palsy, wound infection, seroma or haematoma. We had four instances of open conversion; one temporary RLN palsy, and 12 cases of temporary hypoparathyroidism. This is the first series of TOETVA reported in Australia and New Zealand. Our results demonstrate that with appropriate surgeon experience, training, collaboration, and in well selected patients, this is a feasible and safe thyroidectomy technique. We hope that our work will build confidence in Endocrine Surgical units seeking to develop this technique in Australia.

Intraoperative Neuromonitoring and Optical Magnification in the Prevention of Recurrent Laryngeal Nerve Injuries during Total Thyroidectomy.

Background and Objectives: Recurrent laryngeal nerve (RLN) paralysis is a fearful complication during thyroidectomy. Intraoperative neuromonitoring (IONM) and optical magnification (OM) facilitate RLN identification and dissection. The purpose of our study was to evaluate the influence of the two techniques on the incidence of RLN paralysis and determine correlations regarding common outcomes in thyroid surgery. Materials and Methods: Two equally sized groups of 50 patients who underwent total thyroidectomies were examined. In the first group (OM), only surgical binocular loupes (2.5×-4.5×) were used during surgery, while in the second group (IONM), the intermittent NIM was applied. Results: Both the operative time and the length of hospitalization were shorter in the OM group than in the IONM group (median 80 versus 100 min and median 2 versus 4 days, respectively) (p &lt; 0.05). The male patients were found to have a five-fold higher risk of developing transient dysphonia than the females (adjusted OR 5.19, 95% IC 0.99-27.18, p = 0.05). The OM group reported a four-fold higher risk of developing transient hypocalcemia than the IONM group (OR 3.78, adjusted OR 4.11, p = 0.01). Despite two cases of temporary bilateral RLN paralysis in the IONM group versus none in the OM group, no statistically significant difference was found (p &gt; 0.05). No permanent RLN paralysis or hypoparathyroidism have been reported. Conclusions: Despite some limitations, our study is the first to compare the use of IONM with OM alone in the prevention of RLN injuries. The risk of recurrent complications remains comparable and both techniques can be considered valid instruments, especially if applied simultaneously by surgeons.

Clinical features and prognoses of re-operated patients for persistent/recurrent papillary thyroid carcinoma

Objective: To investigate the clinicopathological characteristics and the survival of re-operated patients for persistent/recurrent papillary thyroid carcinoma (PTC) and risk factors for re-recurrence after the second operation. Method: A retrospective analysis of 69 cases underwent re-operation for persistent/recurrent PTC in Sichuan Cancer Hospital from January 2010 to December 2016 was performed. There were 21 males and 48 females, aged 14-85 (44.8) years old. According to the imaging after initial treatment, they were divided into a recurrence group (42 cases) and a persistent disease/residual group (27 cases). The positive rates of ipsilateral paratracheal lymph node metastases at re-operation were calculated and compared by chi-square test. Patients were divided into different subgroups according to potential risk factors for re-recurrence. Kaplan-Meier (K-M) method was used for survival analysis. Results: The positive rate of ipsilateral paratracheal lymph node metastasis in recurrence group (15/42, 35.7%) was significantly lower than that in the persistent disease/residual group (17/27, 63.0%) (χ2=4.91, P<0.05). The follow-up period after re-operation was 60-104 months, with a median of 66 months, and 8 patients were lost to follow-up. Permanent hypoparathyroidism occurred in 2 cases (2.9%) and permanent recurrent laryngeal nerve palsy in 1 case (1.4%). Twenty patients had structural recurrences and/or distant metastases. The 5-year disease-specific survival rate was 92.8% and the 5-year recurrence-free survival rate was 68.1%. Survival analysis was performed on risk factors such as age≥55 years old, recurrent tumor diameter ≥4 cm, number of positive lymph nodes ≥ 10, and obvious extracapsular invasion (ENE). Among them, age and diameter of recurrent tumor had significant influences on recurrence-free survival rate (χ2 was 6.36, 8.17, respectively, both P values<0.05). There was a statistically significant difference in recurrence-free survival rates between ENE(+) group and ENE(-) group (χ2=5.52, P<0.05). Conclusion: For the re-operated patients due to persistence/ recurrence PTC, attention should be paid to protecting the parathyroid gland and recurrent laryngeal nerve during re-operation. Timely and effective postoperative follow-up for patients aged ≥ 55 years, with recurrent tumor diameter ≥ 4 cm and ENE(+), can significantly improve their prognoses.

Innovative technologies in the diagnosis and safe surgical treatment of thyroid diseases

This study clarified the results of using innovative technologies in the diagnosis and surgical treatment of patients with thyroid diseases by evaluating the role of modern diagnostic methods and effectiveness of minimally invasive thyroid surgery. The results of a comprehensive examination and treatment of 332 patients with thyroid diseases, who were examined using modern diagnostic methods and underwent conventional and various minimally invasive approaches, were analyzed. The sensitivity, specificity, accuracy, and positive and negative predictive values of multiparametric neck ultrasonography, 99mTc-MIBI thyroid scintigraphy, fine-needle cytology, and molecular testing of thyroid nodules were compared. The minimally invasive procedure was performed in 70.4% of the patients. Postoperative complications were found in 4.9% of the patients who underwent surgery, functional dysphonia in 0.9%, and transitory hypoparathyroidism in 2.4%. The use of the main criteria that determine the choice of a rational minimally invasive surgery, such as the nodule size and thyroid volume, hyperfunctioning thyroid, clinical thyroiditis, substernal extension, extrathyroid extension, and necessity of implementation of central and lateral neck dissection due to lymph node metastases, avoids the conversion of access to the traditional approach, prevents damage to the recurrent laryngeal nerve with the development of transitory or permanent recurrent laryngeal nerve palsy, and minimizes injury to the parathyroid glands with the development of isolated cases of transient hypoparathyroidism. Therefore, results of the multiparametric analysis of the examination and surgical treatment outcomes of patients with thyroid diseases show the feasibility of using innovative technologies in their diagnosis and surgical treatment. Modern examination methods allow us to determine with great accuracy the morphological form of thyroid disease and choose a rational volume and surgical intervention. In this study, minimally invasive procedures are optimal and safe in the surgical treatment of this category of patients.

Surgical outcomes in survivors of childhood cancer undergoing thyroidectomy: A single-institution experience.

Childhood cancer survivors (CCS) are at increased risk for thyroid disease, and many require definitive management with thyroid surgery. Despite this, there is limited evidence on surgical outcomes among CCS. We sought to evaluate postoperative outcomes at our institution among CCS undergoing thyroid surgery compared to patients without a history of primary childhood malignancy. Medical records were reviewed for 638 patients treated at the Children's Hospital of Philadelphia Pediatric Thyroid Center between 2009 and 2020. Rates of surgical complications, including recurrent laryngeal nerve (RLN) paralysis and hypoparathyroidism, among CCS were compared to patients with sporadic/familial thyroid cancer, Graves' disease, and other benign thyroid conditions. Operative time and intraoperative parathyroid hormone levels were also evaluated. There were no significant differences in long-term surgical complication rates, such as permanent RLN paralysis and hypoparathyroidism, between CCS and patients without a history of primary childhood malignancy (all p>.05). For all surgical outcomes, there were no significant differences in complication rates when CCS were compared to those undergoing surgery for sporadic/familial thyroid cancer or Graves' disease (all p>.05). CCS with benign final pathology had significantly higher rates of transient hypoparathyroidism compared to patients with benign thyroid conditions (p<.001). Our study suggests that CCS are not at higher risk of long-term complications from thyroid surgery when treated by high-volume surgeons within a multidisciplinary team.

Postsurgical complications after robot-assisted transaxillary thyroidectomy: critical analysis of a large cohort of European patients

In the last decade, robot-assisted trans-axillary thyroidectomy has spread rapidly and has been proven to be a safe and effective procedure. However, several case series have reported new complications that have led to criticism regarding this approach. This study analyzed the incidence of complications in a large cohort of European patients. We enrolled all patients who underwent robot-assisted trans-axillary thyroidectomy from 2012 to 2020 at the University Hospital of Pisa Department of Endocrine Surgery. We analyzed complications and divided them into 2 groups. Group A included conventional complications, such as transient or permanent recurrent laryngeal nerve palsy, transient or permanent hypocalcemia, hemorrhage, and tracheal injury. Group B included unconventional complications, such as brachial plexus palsy, track seeding, seroma, great vessels injury, and skin flap perforation. There were 31 postsurgical complications (5.7%). Group A included 25 complications (4.6%): transient and permanent recurrent laryngeal nerve palsy occurred in 7 patients (1.3%) and in 1 (0.2%), respectively; transient and permanent hypocalcemia occurred in 9 patients (1.7%) and in 1 (0.2%), respectively. Postoperative bleeding occurred in 6 patients (1.1%) and tracheal injury in 1 (0.2%). Group B included 6 complications (1.1%): 1 patient with brachial plexus injury (0.2%), 1 with track seeding (0.2%), and 4 with seroma (0.7%). Robotic trans-axillary thyroidectomy is a safe approach with a risk of postoperative complications comparable to the conventional technique. Almost all complications after a novel introduction are anecdotal. With an accurate patient selection, high-volume institutions with experienced surgeons can perform this technique safely.

Clinical study of postoperative complications of thyroidectomy

Background: Thyroid surgery is one of the common surgeries performed by general surgeons, Head and neck surgeons, and endocrine surgeons today. The most common complications of thyroid surgery are bleeding, injury to recurrent laryngeal nerves, and parathyroid glands. Other complications include airway obstruction, superior laryngeal nerve injury, infections, and sometimes thyroid crisis. Patients with permanent recurrent laryngeal nerve palsy and hypocalcaemia have life-long problems with a need for continued medication, further surgeries, and rehabilitation. They have a compromised quality of life by an increase in individual's healthcare costs and requiring lifelong alternative therapies. Objectives: To evaluate the incidence of post thyroidectomy complications. It also intends to evaluate the preoperative and intra-operative factors that contribute to these complications. To assess the modalities to prevent such complications. Methods: A Prospective study was done from January 2018 to December 2019 on thyroid complications. A total of 78 patients were studied regarding the diagnosis, type of surgery, and the complications in them. The patients were followed up for 1 year. Results: The majority of patients (59%) were in the 3rd and 4th decade of life age. Female domination more than male. Multinodular goiter is the most common diagnosis. The most common complication was transient Hypocalcaemia (15.38%) and recurrent laryngeal nerve( 6.41%). Wound infections in 6.41%and seromas are 2.56%. The incidence of major bleed with respiratory obstruction and thyrotoxicosis is zero. No permanent debilitating complications of RL nerve injury or hypocalcaemia were noted. Conclusion: A thorough preoperative preparation, with adequate knowledge of Thyroid anatomy and steps of surgery is essential. A clean dissection, meticulous haemostasis and, identification and preservation of Recurrent Laryngeal and Parathyroids can relate to a low rate of complications. Extensive surgeries are associated with a higher rate of complications. Early recognition and prompt treatment of complications enable a better outcome for the patient.

Assessment of Complications following Thyroid Surgery

Background : Different diagnostic tools are available for assessment of post operative outcomes of thyroid surgery. This study was done to reach a consensus and to find out the best diagnostic tool for assessment of post operative complications of thyroid surgery.&#x0D; Materials and methods : A cross sectional study was carried out in the Medical Centre Hospital Between July 2016 to June 2017. Total 50 patients were included in the study, where post operative complications of patients were assessed, studied and enrolled. To assess the post operative outcomes of patients undergoing thyroid surgery. Data were analyzed and presented as both qualitative and quantitative data as applicable using SPSS version 20. The quantitative data were analyzed by mean, standard deviation. The qualitative data were analyzed by Mc NEMAR test (Mc NEMAR χ2 test). For all analytical test, the level of significance was set at 0.05 and p value equal or less then 0.05 was considered as significant, p value more than 0.05 was considered as not significant.&#x0D; Results : Fifty patients were selected for the study who were treated by Thyroidectomy. The mean patient's age at the time of surgery was 40.9±9.1 years ranged from 10 to 60 years. Data were collected in a prescribed data collection sheet. Then all data were compiled and analyzed. Result: 14% of the patients had complications, of them 2% had transient hypoparathyroidism, 4% had haemorrhage, 2% had temporary Recurrent Laryngeal Nerve (RLN) palsy and 2% had permanent recurrent laryngeal nerve palsy, 2% had Superior Laryngeal Nerve (SLN) palsy &amp; 2% had wound infection. Improved surgical techniques and proper management of complications reduce the postoperative morbidity and mortality of thyroid surgery.&#x0D; Conclusions: Different types of complications may occur following thyroid surgery. In spite of all measures, keen observation in postoperative period is very important to find out the complications for early intervention.&#x0D; JCMCTA 2021 ; 32 (1) : 44-47