Reoperative Thyroidectomy Research Articles

Long-term Quality of Life After Thyroidectomy: Transoral Endoscopic Thyroidectomy Vestibular Approach Versus Transcervical Approach.

To compare long-term health-related quality of life (HRQOL) after Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) and transcervical approach (TCA) thyroidectomy. Prospective cohort study. Tertiary referral center. A web-based survey was distributed to patients at our institution who met the criteria for TOETVA and underwent thyroidectomy by TOETVA or TCA between August 2017 and October 2021. All survey participants were at least 6 months postsurgery. Minors, non-English speakers, and patients who received concomitant neck dissection or reoperative thyroidectomy were excluded from the study. The survey assessed quality of life through 4 standardized instruments: the Dermatology Life Quality Index (DLQI), the Eating Assessment Tool (EAT-10), the Voice Handicap Index (VHI-10), and the Short Form Health Survey (SF-36). A total of 108 TOETVA and 129 TCA patients were included in the study. The median age of respondents was 44 (36, 54; 25th, 75th percentile) years and median time from surgery to survey was 35 (22, 45; 25th, 75th percentile) months. TOETVA group DLQI (0.63 vs 0.99; P = .17), VHI-10 (1.94 vs 1.67; P = .35), EAT-10 (2.14 vs 2.32; P = .29), SF-36 physical component (52.25 vs 51.00; P = .25), and SF-36 mental component (47.74 vs 47.29; P = .87) scores were all similar to those of the TCA group. Scrutinizing specific DLQI questions, individuals in the TOETVA group were less self-conscious of their skin as compared to the TCA group (Q2; 0.08 vs 0.26, P = .03). Long-term HRQOL after TOETVA is similar to TCA, with significantly lower skin-related self-consciousness.

The value of intraoperative nerve monitoring against recurrent laryngeal nerve injury in thyroid reoperations.

Reoperative thyroidectomy is challenging for surgeons because of the higher incidence of recurrent laryngeal nerve (RLN) palsy. RLN identification is the gold standard during thyroidectomy; however, it is sometimes difficult to perform thyroid reoperations. In recent years, intraoperative nerve monitoring (IONM) has gained increased acceptance, and the use of IONM can be a valuable adjunct to visual identification. The aim of this study was to evaluate the value of IONM during thyroid reoperation.A total of 109 patients who met our criteria at the Affiliated Hospital of Hangzhou Normal University from January 2010 to June 2020 were retrospectively analyzed and divided into the IONM group and the visualization-alone group (VA group) according to whether neuromonitoring was used during the operation. The patients’ characteristics, perioperative data, and intraoperative information including the RLN identification, time of RLNs confirmation, operative time, intraoperative blood loss, and the rate of RLN injury were collected.Sixty-five procedures (94 RLNs at risk) were performed in the IONM group, whereas 44 (65 RLNs at risk) were in the VA group. The rate of RLN identification was 96.8% in the IONM group and 75.4% in the VA group (P < .05). The incidence of RLN injury was 5.3% in the IONM group and 13.8% in the VA group (P > .05). The incidence of surgeon-related RLN injury rate was 0% in the IONM group compared to 7.7% in the VA group (P < .05), but the tumor-related or scar-related RLN injury rate between the 2 groups were not significantly different (4.3% vs 3.1%, 1.1% vs 3.1%, P > .05).IONM in thyroid reoperation was helpful in improving the RLN identification rate and reducing the surgeon-related RLN injury rate, but was ineffective in reducing the tumor-related and scar-related RLN injury rate. In the future, multicenter prospective studies with large sample sizes may be needed to further assess the role of IONM in thyroid reoperations.

The role of carbon nanoparticle in lymph node detection and parathyroid gland protection during thyroidectomy for non-anaplastic thyroid carcinoma- a meta-analysis.

To assess the efficiency of the carbon nanoparticles (CNs) in lymph node identification and parathyroid gland (PG) protection during thyroidectomy for non-anaplastic thyroid carcinoma (N-ATC). A systematic literature search for relevant literatures published up to December 2018 in PubMed, EMBASE, Web of Science and Cochrane Library was performed. Both English and Chinese literatures were retrieved and analyzed. Randomized controlled trials or nonrandomized controlled trials comparing the use of CNs with the use of methylene blue or a blank control in patients undergoing thyroidectomy for N-ATC were enrolled in this study. The primary outcomes included the number of lymph nodes harvested, the rate of lymph nodes involved, and the rates of accidental parathyroidectomy, hypoparathyroidism, and hypocalcemia. Weighted mean differences (WMDs), odds ratios (ORs) and risk differences (RDs) were calculated for the dichotomous outcome variables. Between study heterogeneity was tested using the Q tests and the I2 statistics. All analyses were performed using Review Manager (version 5.3.5). 25 studies comprising 3266 patients were included in this analysis. The total number of lymph nodes harvested in the CNs groups was significantly higher than that in the control groups (WMD, 2.36; 95% CI, 1.40 to 3.32; P <0.01). Administrating CNs was associated with a lower incidence of accidental PG removal (OR = 0.28, 95% CI = 0.21 to 0.37, P<0.01) and lower rates of both postoperative transient hypoparathyroidism (OR = 0.46, 95% CI = 0.33 to 0.64, P <0.01) and transient hypocalcemia (OR = 0.46, 95% CI = 0.33 to 0.65, P <0.01). No significant difference was found concerning lymph node metastatic rates between CNs group and control group. Subgroup analysis indicated that the application of CNs in reoperation thyroidectomy reduced both the rate of transient hypoparathyroidism (OR = 0.21, 95% CI = 0.06 to 0.75, P = 0.02) and the possibility of accidental PGs removal (OR = 0.21, 95% CI = 0.07 to 0.62, P = 0.004, P<0.05). The application of CNs in thyroidectomy for N-ATC results in higher number of lymph node harvested and better PG protection during both initial and reoperation thyroidectomy.

Visual and electrophysiological identification of the external branch of superior laryngeal nerve in redo thyroid surgery compared with primary thyroid surgery.

PurposeThyroid reoperations are surgically challenging because of significant anatomical variance. Visual and functional identification of the external branch of the superior laryngeal nerve (EBSLN) were studied in 2 groups of patients who underwent primary and redo thyroid surgery.MethodsThis study was conducted on 200 patients: 100 patients with redo and 100 patients with primary thyroid surgery. In addition to visual identification, nerve branches were functionally identified by intraoperative nerve monitoring (IONM). Visual, functional, and total identification rates of the EBSLN in both primary and redo surgery were determined and compared between the 2 groups.ResultsWe attempted to identify 138 and 170 EBSLNs at risk in redo and primary surgery, respectively. Visual identification rates were 65.3% and 30.4% (P < 0.001) in primary and redo surgery groups, respectively. In total, 164 (96.5%) and 97 EBSLNs (70.3%) were identified in primary and redo surgery, respectively (P < 0.001), including the use of IONM. In primary surgery group, 53 nonvisualized EBSLNs of 164 identified nerves (32.3%) were determined by IONM alone. In redo surgery group, 55 of 97 identified nerves (56.7%) were determined by IONM alone (P < 0.001).ConclusionBoth visual and total identification rates of the EBSLN are significantly decreased in reoperative thyroidectomy. IONM increases the total identification rate of the EBSLN in primary and redo thyroid surgery. Electrophysiological monitoring makes a substantial contribution to the identification of the EBSLN both in primary and especially in redo thyroid surgery.

Indications and Morbidity of Reoperative Thyroid Surgeries in a Military Hospital of Senegal.

Objectives To describe reoperative thyroid surgeries in our department. Study Design Retrospective cross-sectional and descriptive study at the Ouakam Military Hospital in Dakar (Senegal), over a period of eight and a half years. Methods The study involved all records of patients who had a reoperative thyroidectomy regardless of the indication and time of the second surgery. Parameters evaluated for first and reoperative surgery were time interval between the two surgeries, operative indications, surgical procedures, intraoperative findings, pathological examination, and morbidity. Results 30 records of patients were selected out of a total of 698 thyroidectomies (4.3%). Thyroid cancers diagnosed on first surgical specimens were the first indications of reoperations (46.67%) followed by neck hematoma (20%). Completion thyroidectomy with a prophylactic central lymph nodes dissection was the most performed surgical procedure (43.33%) followed by haemostasis (20%). During reoperation, we found active bleeding (20%), textiloma (6.67%), and fourth branchial cleft fistula (3.33%). The morbidity accounted for 10%: lymphorrhea, permanent hypocalcemia, and permanent recurrent nerve palsy, in one case, respectively. There were no statistically significant differences between the morbidity in patients reoperated on and the one for patients operated on once. Conclusion We did not find an increased risk of postoperative morbidity after reintervention.

Intraoperative Frozen Section May Reduce the Need for Reoperative Thyroid Surgery in Patients with Follicular Neoplasm

Background: Follicular neoplasm (Bethesda IV cytology) requires thyroid lobectomy for diagnosis. Approximately 15-30% of cases are ultimately malignant, requiring reoperative completion thyroidectomy. We sought to reassess whether intraoperative frozen section (FS) reduces the need for reoperative thyroidectomy in these cases. Methods: A retrospective chart review of fine needle aspiration (FNA) results showing follicular neoplasm from 2003 to 2012 was performed. Our practice is to offer thyroid lobectomy with FS for these patients; with suspicious FS, surgery proceeded to total thyroidectomy. FS suspicious for papillary thyroid carcinoma (PTC) was based on nuclear features (nuclear grooves/atypia, pseudo-nuclear inclusions) and for follicular thyroid carcinoma (FTC) was based on capsular/vascular invasion. Results: A total of 148 patients with follicular neoplasm on FNA were identified, of which 79 underwent FS. Fifteen had suspicious FS with 12 having malignancy on final pathology, for a positive predictive value of 80%. Nine showed features suspicious for PTC, of which eight had PTC. Six showed features suspicious for FTC, of which four had malignancy on final pathology. Of the 64 patients with unremarkable FS, 49 had benign final pathology, for a negative predictive value of 77%. Twelve (19%) patients required reoperation. Seven of 19 patients (37%) with malignancy avoided reoperation due to FS. Risk of malignancy with follicular neoplasm diagnosis was 34% (51/148), while risk of malignancy with follicular neoplasm and suspicious FS was 80%. Conclusions: Risk of malignancy with follicular neoplasm and suspicious FS is 80%. FS may avoid reoperative completion thyroidectomy in up to a third of patients. J Curr Surg. 2016;6(1):1-5 doi: http://dx.doi.org/10.14740/jcs286w

Fine-Needle Aspiration of the Thyroid: Correlating Suspicious Cytology Results with Histological Outcomes

Fine-needle aspiration cytology (FNAC) assists the diagnosis of thyroid malignancy. A 'suspicious for malignancy' on FNAC creates a management dilemma. The aims of this study were to investigate the malignancy rate for patients with suspicious cytology, and to describe a management approach for those with a suspicious result. A retrospective review of prospectively collected data in an endocrine surgery database was undertaken. Patients undergoing thyroidectomy with preoperative FNAC from 1992 to 2012 were analysed. Preoperative FNAC was undertaken in 2,692 patients, and the FNAC result was 'suspicious for malignancy' in 94 (3.5 %) patients. Of these, 53 (56.4 %) were malignant, with the majority 44 (83.0 %) being papillary thyroid cancer. 48 patients went straight to total thyroidectomy, 40 patients had an initial diagnostic hemithyroidectomy, and 1 patient had a diagnostic isthmusectomy. 5 patients required reoperative total thyroidectomy as an initial procedure. Of the 94 suspicious cases, 55 were reported by an unknown, presumably non-expert, thyroid cytopathologist. 38 of these cases were available for review and re-reporting by an experienced cytopathologist. On review, 28 (73.7 %) were reclassified as cytologically malignant, and all of these were confirmed as malignant on subsequent histopathology. Suspicious cytology has a high risk of malignancy. Expert thyroid cytopathology can improve diagnostic accuracy and a preoperative malignant diagnosis should be pursued to enable one-stage surgery where possible.

Reoperative Experience with Papillary Thyroid Cancer

Intense postoperative monitoring has resulted in increasing detection of patients with recurrent papillary thyroid cancer (PTC). Our goals included quantifying successful reoperation, and analyzing surgical complications and reasons for relapse. From 1999 to 2008, a total of 410 patients underwent reoperation for PTC relapse. We analyzed post-reoperative disease outcomes, reasons for relapse, and complications. Bilateral reoperative thyroidectomy was performed in 13 (3%) patients; lobectomy, 34 (8%); central neck (VI) soft tissue local recurrence excision, 47 (11.5%); bilateral VI node dissection, 107 (26%); unilateral VI dissection, 112 (27%); levels II-V dissection, 93 (23%); levels III-V, 86 (21%); lateral single- or two-compartment dissection, 51 (12%); and node picking, 20 (5%) of level VI and 53 (13%) lateral neck. Complications occurred in 6%; including hypoparathyroidism, 3%; unintentional recurrent laryngeal nerve (RLN) paralysis, 3%; phrenic nerve injury, 0.5%; spinal accessory nerve injury, 0.5%; and chyle leak in 1.6%. Of 380 (93%) patients with follow-up (mean 5.2years); 274 (72%) patients are alive with no structural evidence of disease, 38% developed disease relapse (mean 2.1years), 42 (11%) died from PTC, and 55 (14%) are alive with disease. The reason for relapse was a false negative pre-reoperative ultrasound (US) in 18 (5%), nodal recurrence in the operative field in 37 (10%), a combination of these two reasons in 10 (3%), and disease virulence (local or systemic recurrence) in 81 (21%). Although 72% of patients were rendered structurally disease free after reoperation, nearly 40% suffered additional relapse. Improved surgical technique or preoperative localization might positively affect 15-20%; at least 20% reflect the biologic aggressiveness of the disease.

Reoperative surgery for bilateral multinodular goitre in the era of total thyroidectomy

Total thyroidectomy, rather than bilateral subtotal thyroidectomy, is now accepted as the preferred management for bilateral benign multinodular goitre (BMNG) in order to reduce the need for reoperative surgery. The aim of this study was to examine whether this approach has had an impact on presentation for bilateral reoperative thyroid surgery. This was a retrospective cohort study. The study group comprised patients presenting with recurrent BMNG who underwent bilateral reoperative thyroid surgery following previous bilateral subtotal or partial thyroidectomy. They were compared with patients undergoing unilateral reoperative thyroid surgery following previous lobectomy, and those undergoing primary total thyroidectomy for BMNG. Between 1 January 1987 and 31 December 2009, 12 354 consecutive thyroid procedures were undertaken. Among those with BMNG, primary total thyroidectomy was undertaken in 3298 patients, unilateral reoperative thyroidectomy in 337 and bilateral reoperative thyroidectomy in 191. Presentations of patients with recurrent BMNG declined gradually over the study period following the change in policy from subtotal to total thyroidectomy; only five patients (representing less than 0.5 per cent of all thyroid surgery) underwent bilateral reoperative surgery for BMNG in the last year of the study. Four of these patients had their initial operation before 1987 and in another unit, whereas the remaining patient initially had surgery overseas. The introduction of a policy of initial total thyroidectomy for bilateral BMNG has essentially eliminated the need for bilateral reoperative surgery for recurrent goitre.

Reoperative thyroidectomy for benign thyroid disease

Subtotal thyroidectomy for benign thyroid disease (BTD) may lead to delayed recurrence, thus necessitating reoperative surgery. We describe our experience with reoperative thyroidectomy for BTD and recommendations for definitive primary management. Patients undergoing thyroid surgery between 2003 and 2007 by a single surgeon were prospectively assessed. Numerous clinical parameters were evaluated, including time interval between primary and reoperative surgery and complications. In all, 321 thyroidectomies were identified: 45 were reoperative and 22 were related to BTD after primary surgery done elsewhere. Median interval between the primary and reoperative procedure was 8.5 years. No recurrences followed total thyroidectomy or total thyroid lobectomy. There were no cases of permanent or transient recurrent laryngeal nerve (RLN) injury related to reoperative surgery. There was 1 case of transient hypocalcemia. Although reoperative thyroidectomy can be performed safely in the hands of experienced surgeons, a thorough initial surgical procedure should obviate the need for exposure to this additional risk.

Reoperative Thyroidectomy for Benign Thyroid Disease: The Diminishing Role of Subtotal Thyroidectomy

The LaryngoscopeVolume 119, Issue S1 p. S89-S89 Triological Society Poster Presentation South/Middle Reoperative Thyroidectomy for Benign Thyroid Disease: The Diminishing Role of Subtotal Thyroidectomy David J. Terris MD, David J. Terris MDSearch for more papers by this authorSunny A. Khichi BA, Sunny A. Khichi BASearch for more papers by this authorSusan K. Anderson DO, Susan K. Anderson DOSearch for more papers by this authorMayssoun A. El-Choufi MD, Mayssoun A. El-Choufi MDSearch for more papers by this authorMelanie W. Seybt MD, Melanie W. Seybt MDSearch for more papers by this author David J. Terris MD, David J. Terris MDSearch for more papers by this authorSunny A. Khichi BA, Sunny A. Khichi BASearch for more papers by this authorSusan K. Anderson DO, Susan K. Anderson DOSearch for more papers by this authorMayssoun A. El-Choufi MD, Mayssoun A. El-Choufi MDSearch for more papers by this authorMelanie W. Seybt MD, Melanie W. Seybt MDSearch for more papers by this author First published: 30 March 2009 https://doi.org/10.1002/lary.20374AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume119, IssueS1Supplement: Triological Society Poster Presentations from the Eastern, Western, Southern and Middle Section Meetings2009Pages S89-S89 RelatedInformation

The role of intraoperative neuromonitoring of recurrent laryngeal nerve during thyroidectomy: A comparative study on 1000 nerves at risk

The role of intraoperative neuromonitoring of recurrent laryngeal nerve (RLN) during thyroidectomy has not been well established. The present study evaluates whether RLN injury can be reduced by the application of this technique during thyroidectomy in a single center. Of 1000 RLNs that were at risk of injury in 639 consecutive patients who underwent thyroidectomy, the outcome of 501 RLNs with the use of neuromonitoring was compared with that of 499 nerves that were operated by routine identification only. The incidences of RLN paralysis were compared between the 2 groups and the assigned risk subgroups. Postoperative palsy was identified in 47 RLNs (4.7%), with complete recovery in 37 of 44 RLNs (84%) without documented injury. The overall incidence of postoperative RLN paralysis was significantly higher during thyroidectomy for malignancy (P = .025) and secondary thyroidectomy (P = .017). There was no significant difference in postoperative, transient, and permanent paralysis rates between the neuromonitoring and control groups. In subgroup analysis, the postoperative RLN palsy rate was higher during reoperative thyroidectomy (19% vs 4.6%; P = .019) in the control group but not in the neuromonitoring group (7.8% vs 3.8%; P > .05). Neuromonitoring of the RLN during thyroid surgery could not be demonstrated to reduce RLN injury significantly, compared with the adoption of routine RLN identification. However, its application can be considered for selected high-risk thyroidectomies.

Reoperative thyroidectomy in the treatment of thyroid carcinoma

The most common reason for reoperative thyroidectomy is to complete a total thyroidectomy in patients in whom a frozen-section diagnosis of benign adenoma proves to be carcinoma on permanent section. The secondary operation is frequently avoided because of the technical difficulties encountered at surgery and the fear of injury to recurrent laryngeal nerves and the development of permanent hypoparathyroidism. In a personal series of 1,182 patients operated on for thyroid carcinoma over a 40-year period, there were 140 cases with false-negative frozen section results (18.3% of frozen sections performed). There were 107 patients who underwent completion thyroidectomy. Additional foci of cancer were found in 32 patients (30%). The indications for reoperation, the operative findings, and the results of surgery are presented. The operative technique is described in detail. There was no instance of recurrent nerve injury or permanent hypoparathyroidism.