Surgery For Thyroid Disease Research Articles

Relationship between surgeon experience and adverse events in thyroid surgery.

In scientific literature there are numerous authors that have highlighted how the outcome of patients undergoing surgical treatment, such as intraoperative or postoperative complications, surgical time, mean hospital stay, is related to the surgeon’s experience based on the number of cases treated per year for a specific disease. In our study we decided to verify if, in our clinical practice, there are significant differences in postoperative outcomes between procedures performed by a senior surgeon, a young specialist or a surgical resident, evaluating if surgical experience affects positively either on intraoperative complications such as bleeding, hypocalcemia, dysphonia, or on surgical time, mean hospital stay and postoperative complications. In this retrospective study we examined all cases of patients that underwent surgery for thyroid disease at our Operative Unit, from January 1, 2015 to December 31, 2019. The analysis of our data highlights how the surgeon’s experience affects the surgical outcome of patients undergoing lobectomy or total thyroidectomy. Our conclusion was that a high volume center, like the one we are working in, with a correct selection of the patients, allows to train a surgical resident guaranteeing both the surgical training of the doctor and the patients safety. (www.actabiomedica.it)

Remote Access Surgery for Thyroid Disease

There is continued demand for scarless or hidden-scar extracervical surgery for thyroid disease. This article reviews the most commonly embraced remote access approaches to the thyroid compartment. After initial enthusiasm, the trend towards remote access thyroid surgery has been tempered. Preference in the USA is given to techniques involving familiar cervical dissection planes. Extracervical remote access thyroid surgery is generally not considered to be minimally invasive surgery. Remote access thyroid surgery may be offered to a special subset of patients with high motivation towards absence of a visible cervical scar. The procedure should probably be done in specialized centers where adequate volumes to develop and maintain competence can be achieved by high volume surgeons to develop and maintain competence.

Transoral Robotic Thyroidectomy: the New Era of Remote-Access Surgery for Thyroid Disease

We present a comprehensive overview on the development of robotic transoral thyroidectomy, and highlight major challenges in adoption. Transoral robotic thyroidectomy (TORT) is the newest remote access approach to remove the thyroid gland and draws attention because of its cosmetic excellence. The principal advantage of TORT is that the flap dissection area is comparatively small to other remote-access methods and the lip wounds disappear over time resulting in excellent cosmesis. TORT could be done safely in the patients with appropriate selection by an experienced surgeon in robotic thyroidectomy. It serves as a potential alternative surgical approach for thyroidectomy when patients are concerned about a neck scar.

Morbidity of Redo Surgery for Thyroid Disease

Objective: Redo thyroid surgery is generally associated with more complications than firsthand surgery. The actual study reports a single center experience of redo thyroid surgery compared to primary bilateral thyroidectomy. Study Design: Mono institutional retrospective study.Materials and Methods: Institutional review of redo thyroid surgery patients (Group 2: completion thyroidectomy and Group 3: thyroidectomy for recurrent thyroid diseases) compared to Group 1: primary bilateral thyroidectomy operated on during the same time interval.Results: Demographic characteristics were not different between groups. Substernal extension and hyperthyroidism were more frequent in group 1. Weight of the resected thyroid gland was lower in groups 2 and 3. Incidence of transient hypocalcemia, permanent hypoparathyroidism, transient and permanent recurrent laryngeal palsy was not different between the groups. Hematoma occurred in 5% of cases in the 3 groups and postoperative length of stay was 1 day in 92% of cases of the 3 groups.Conclusions : Redo thyroid surgery can be performed with no excess morbidity provided strict selection criteria, having reoperation in mind while performing firsthand intervention.

Urgent surgery for thyroid diseases and complications of early postoperative period

The analysis of surgical treatment results of 27.253 patients with various diseases of thyroid cancer is performed in St. Petersburg, Endocrine Surgery and Oncology Center. A classification of urgent surgery for complications of disease (277/1.0 %) or postoperative states that required reinterventions (246/0.9 %) in period from 1973 to 2012 is developed. Altogether immediate and urgent operations are performed in 523 (1.9 %) patients. Various thyroid diseases (cervical-retrosternal goiter, anaplastic carcinoma, strumitis, thyroiditis) or the progression of inflammation of the neck and / or mediastinum became a cause of neck compression and subsequently required urgent interventions in 277 (1.0 %) cases. Complications of early postoperative period (mobility disorders of the vocal cords, postoperative bleeding, and rupture of the trachea) served as an occasion to emergency operations in 246 (0.9 %) cases. The measures of prevention, prompt diagnosis and appropriate treatment of patients with life-threatening complications in thyroid surgery are examined.

An analysis on 34 patients undergoing repeated surgery for thyroid diseases

Objective To sum up the experience of repeated surgery for thyroid diseases.Methods; The causes, prevention, indications, and procedures of repeated surgery, and protection of major tissues were analyzed in the 34 patients who had undergone repeated surgery. Results All the patients were cured. However, complications occurred in six patients including hoarseness in three,irritative cough in two, and hypothyroidism in one. Conclusions Subtotal thyroidectomy is the optimal procedure for the patients who have to undergo repeated surgery for thyroid diseases. Parathyroids and recurrent laryngeal nerve should be carefully protected during surgery. Key words: Thyroid diseases; Post-surgical recurrence; Repeated surgery

Shortening hospital stay for thyroid surgery

The number of outpatient surgical procedures performed in hospitals, increases daily. In some countries, such as Italy, outpatient operations outnumber inpatient operations. The incidence of thyroid disorders and, in particular, the cancer forms, has been increasing sharply for many years in several countries. Even if thyroid surgery is performed with low morbidity, no mortality and short operation time, some potentially lethal complications are strong arguments against shortening of hospital stay. The purpose of this review is to examine the relevant updated published results on the outcome measures that can be used to assess the quality of shortstay surgery for thyroid disease with well-controlled trials. We discuss the special ethical and legal issues that this thyroid surgery raises. Searches were last updated in May 2007.

Inadvertent parathyroid excision during thyroid surgery

Thyroidectomy is a commonly performed operation for the treatment of thyroid disease. Inadvertent removal of parathyroid glands is a recognised complication of this operation and may have consequences on the longterm regulation of calcium homeostasis post-operatively. We aimed to establish the incidence of parathyroid gland excision during surgery for thyroid disease and whether there was an effect on calcium control in patients in whom inadvertent parathyroidectomy had occurred. A retrospective review of thyroid operations at our hospital from 2001 to 2004 was carried out, reviewing pathology reports to identify specimens which included parathyroid tissue. Post-operative calcium levels were reviewed in these patients. Over three years, 126 thyroid operations were performed; 96 total thyroid lobectomies and 30 total thyroidectomies. Of these, 12 (10%) were performed for malignant disease. Parathyroid tissue was removed inadvertently in 5 of 30 thyroidectomies (16.7%) and 17 of 96 total thyroid lobectomies (17.7%) or 17.4% of all thyroid operations during this time. None of the patients in whom a parathyroid gland was removed inadvertently became hypocalcaemic post-operatively and all of these patients were normocalcaemic when followed-up at six weeks. In specialist hands there is a risk of removing a single parathyroid gland of approximately 17% during thyroid surgery. However, this does not appear to carry a risk of causing hypocalcaemia post-operatively. Careful capsular dissection will reduce the incidence of removing more than one gland

Thyroid tumors with preoperative recurrent laryngeal nerve palsy: Clinicopathologic features and treatment outcome

The aim of this present study is to define the significance of recurrent laryngeal nerve palsy (RLNP) detected before surgery for thyroid diseases with regard to the incidence of malignancy, histopathologic distribution, extrathyroidal invasion, management, and prognosis. Six hundred and twenty-two patients underwent operation for various thyroid disease and were treated by the same surgeon. The study was confined to 16 (3%) patients who suffered from a thyroid tumor with preoperative RLNP. Of these 16 patients, 1 had benign thyroid disease, while the other 15 had malignancy (94%). Among the 15 cancer patients, 14 had extrathyroidal invasion and needed more extensive surgical procedures than total thyroidectomy. The recurrent laryngeal nerve could be dissected from the thyroid neoplasm in 3 patients, 2 of whom experienced recovery of this nerve's function postoperatively. Thyroid tumor associated with RLNP is strongly suggestive of malignancy. The RLN should be preserved if it has not been invaded by the tumor, because it offers a good chance of functional recovery postoperatively. Well-differentiated thyroid cancer accounts for only half of these patients who tend to present at an older age and feature a much higher incidence of upper aerodigestive tract invasion. The operations for these patients often are complex and should be performed by experienced surgeons. Radical excision of a resectable anaplastic or squamous cell carcinoma of the thyroid gland offers the chance, albeit small, of long-term survival in this study.

Medico-legal aspects of thyroid surgery

The frequency of medico-legal issues after surgery is rising. Knowledge of the character and frequency of such problems following surgery of the thyroid gland is scant. Analysis of 21,515 cases of adverse effects after medical treatment from 1975 through 1998 identified 222 cases (1 %) of litigation following surgery for thyroid diseases. The frequency of litigation problems rose exponentially during this interval. Malpractice was confirmed in 36 cases (16 %). The litigation was directed against the surgeon in 95 % of cases, the anesthesiologist in 2 %, both of them in 3 % and the ear-nose-throat surgeon in one case. Eighty-nine percent of the 222 cases occurred after routine thyroid surgery. Typical complications such as recurrent nerve palsy (50 %), hypoparathyroidism (14 %), bleeding (3 %), and late goiter recurrence (1 %) accounted for 63 % of the presumed but for only 31 % of ascertained malpractice cases. Atypical complications such as other neurologic deficits (10 %), infections (5 %), residual nodules (4 %), scar problems (5 %) accounted for 37 % of the suspected but for 70 % of confirmed malpractice cases. Deficiencies in obtaining informed consent were present in only 11 %. Malpractice was more frequently judged to be present, if a second operation was necessary (P < 0.001), if the goal of the operation had been missed (P < 0.001), or if any kind of complication was followed by a fault in postoperative care (P < 0. 001).

Lithium stimulates the release of human parathyroid hormone in vitro.

The effect of lithium on PTH release from human parathyroid tissue was studied using a perifusion system and an immunoradiometric assay for intact human PTH. Tissue was obtained from three patients undergoing surgery for thyroid disease, three patients with secondary hyperparathyroidism due to chronic renal insufficiency, and four patients with primary hyperparathyroidism due to a parathyroid adenoma. Addition of lithium in concentrations equivalent to the therapeutic serum levels normally attained in man (1.3 mmol/L) resulted in a significant (P less than 0.05) increase in PTH release under normocalcemic (1.15 mmol/L) conditions from normal and hyperplastic tissues. The magnitude of the lithium-induced response of PTH release ranged from a 1.4- to 5.3-fold increase above basal levels (perifusion with 1.15 mmol/L calcium alone) and was comparable to the response during a low calcium (0.42 mmol/L) perifusion. Although the response to lithium was delayed compared to that of hypocalcemia, PTH returned to basal levels immediately after removal of either stimulator. In contrast, parathyroid adenomas did not respond to either lithium or hypocalcemia in a characteristic manner, but, rather, functioned in an autonomous fashion with repeated pulsatile bursts of PTH release that were not suppressible even under hypercalcemic (1.70 mmol/L) conditions. These in vitro studies suggest that lithium therapy may elevate serum PTH levels in some patients and could, thus, be responsible for hypercalcemia in them.

Surgery for Thyroid Disease

Thyroidectomy is the keystone of management in most patients with thyroid cancer, and has unique advantages in many cases of hyperthyroidism. The role of thyroidectomy in these two conditions is considered, with specific discussion of indications, extent of operation, complications, and technique.

Pathology and Surgery of Thyroid Disease

Pathology and Surgery of Thyroid Disease

Pathology and Surgery of Thyroid Disease

Pathology and Surgery of Thyroid Disease

Book ReviewPathology and Surgery of Thyroid Disease.

Book ReviewPathology and Surgery of Thyroid Disease.