Transient Hoarseness Research Articles

Next-Generation Exoscopic Surgery Featuring a Head-Mounted 3-Dimensional Display for Carotid Endarterectomy: 2-Dimensional Operative Video.

Recent advancements in medical equipment have led to the use of exoscopes in neurosurgery, thereby replacing conventional operating microscopes.1,2 These devices enable surgeons to work comfortably, even in situations requiring a tilted visual axis, and their effectiveness in carotid endarterectomy (CEA) for carotid artery stenosis has been reported.3,4 However, the placement of 3-dimensional (3D) monitoring devices is challenging.3,4 To address this issue, we present a case in which CEA was performed using ORBEYE with a 3D head-mounted display. This device allows continuous 3D observation of the surgical field on the preocular screen. Case: A 79-year-old man who had undergone chemoradiotherapy for left maxillary cancer 5 years earlier was referred to our department to undergo treatment for left internal carotid artery stenosis. Computed tomography angiography revealed severe left internal carotid artery stenosis with hypoechoic vulnerable plaques on carotid ultrasound. Carotid artery stenting was considered to be a better option than CEA. However, CEA yields better outcomes, especially in patients with vulnerable soft plaques.5 Left CEA was performed using ORBEYE with a 3D head-mounted display (HOGY Medical Co., Ltd.). The procedure was successfully performed under the observation of the head-mounted display, from skin incision to closure. Postoperatively, the patient had no neurological deficits but experienced transient hoarseness. Using an exoscope under the guidance of a head-mounted display represents a next-generation surgical technique that overcomes the limitations of traditional exoscopic surgery. The patient consented to the procedure, and the participants and any identifiable individuals consented to publication of his/her image. Our institutional review board approved this publication (#B230184).

Radiofrequency Ablation of Parathyroid Adenoma: Results of a Retrospective Analysis of 60 Patients.

To present the effectiveness and safety of radiofrequency ablation (RFA) in parathyroid adenoma (PTA). In this retrospective study, 60 patients with a single PTA were evaluated for changes in biochemical and ultrasonographic features up to 6months after RFA of the lesion. Adenomas were ablated with an alternative technique so called "Nik jet dissection" which incorporates full hydrodissection and polar artery coagulation. Complications as well as the variations in biochemical data and nodule volumes were analyzed between baseline measurements and at each follow-up interval data (first day, 1, 3, and 6months after ablation) were analyzed. A significant reduction in serum intact parathyroid hormone and calcium levels was observed 6 months after ablation, with a mean difference of - 83.4 ± 104.1pg/mL, p < 0.001, and - 0.29 ± 0.22mmol/L, p < 0.001, respectively. Serum phosphorus levels increased significantly with a mean difference of 0.09 ± 0.19mmol/L, p = 0.040 at the end of the follow up. We observed a significant volume reduction rate of parathyroid adenomas with 89 ± 20.8 percent, p < 0.001. Also, 51% of adenomas disappeared at the end of the follow up. In this study, two cases of hematoma and one case of transient hoarseness (grade 1 of the CIRSE classification) were encountered. Our study showed that RFA with the alternative technique, called "Nik jet dissection" is a safe and effective modality in management of PTA. Therefore, we suggest expanding the indications for RFA in PTA management, especially when surgery is not feasible. Level 3, Local non-random sample.

Quantitative comparison of three thyroidectomy approaches on neck muscles, voice, and swallowing functions

ObjectiveThis study compares endoscopic thyroidectomy by gasless unilateral axillary approach (ETGUA) and sternocleidomastoid leading-edge approach (SLEA) with conventional open thyroidectomy (COT) in hemithyroidectomy. The main focus is on the protection of neck muscles (sternocleidomastoid, omohyoid, sternothyroid) and the postoperative function of voice and swallowing yielded through these common approaches. MethodsA total of 302 patients who underwent hemithyroidectomy were enrolled and divided into three groups: ETGUA (n = 101), SLEA (n = 100), and COT (n = 101). Ultrasound was used to measure the thickness of bilateral neck muscles, including the sternocleidomastoid, omohyoid, and sternothyroid. The changes in thickness on the surgical side compared to the non-surgical side. Analyzed factors included muscle thickness changes, Swallowing Impairment Score (SIS), Voice Handicap Index (VHI), Scar Cosmesis Assessment and Rating (SCAR), Neck Incision Index (NII), surgery duration, drainage volume, hospitalization, and number of lymph nodes. ResultsThe clinical characteristics among the three groups were consistent except for differences in sex, age, and BMI. Metrics such as sternocleidomastoid muscle, NII, hypocalcemia, postoperative PTH, transient hoarseness, and number of lymph nodes showed no significant differences among the three groups. However, significant differences were found in the duration of surgery, drainage volume, hospitalization period omohyoid muscle, Sternohyoid muscle, VHI, SIS, and SCAR (all p < 0.001). ConclusionIn comparison to COT, ETGUA and SLEA demonstrate superiority in protecting neck muscles and preserving voice and swallowing function without compromising surgical safety or radicality.

Efficacy and Safety of Thermal Ablation for Solitary Low-Risk T2N0M0 Papillary Thyroid Carcinoma.

To evaluate the efficacy and safety of thermal ablation in treating solitary low-risk T2N0M0 papillary thyroid cancer (PTC) and compare the outcomes of microwave ablation (MWA) and radiofrequency ablation (RFA). This retrospective, single center study involved 34 patients (age: 40.0 ± 13.9 years; 28 female) who had low-risk T2N0M0 PTC with a maximum diameter >2 cm and ≤4 cm and underwent MWA (n = 15) or RFA (n = 19) from November 2016 to April 2023. The primary outcomes were the cumulative rate of disease progression and delayed surgery rates. In contrast, the secondary outcomes included changes in tumor size, cumulative rate of complete tumor disappearance, and complication rates. The median follow-up period was 18.0 months (interquartile range [IQR]: 9.0-40.0 months). At 12 months, the median volume reduction rate of the ablation zone was 74.2% (IQR: 53.7%-86.0%). Disease progression was noted in two patients within 1 year, including one patient with local tumor progression post-RFA and one with a new tumor post-MWA, resulting in a constant cumulative disease progression rate of 8.8% (95% confidence interval [CI]: 0%-19.8%) throughout the remaining follow-up period. Both patients were subsequently treated with additional ablation and did not require surgery. The cumulative rates of complete tumor disappearance at 1, 3, and 5 years were 4.0% (95% CI: 0%-11.4%), 26.8% (95% CI: 2.7%-44.9%), and 51.2% (95% CI: 0%-79.1%), respectively. No significant differences were observed in the disease progression (P = 0.829) or complete tumor disappearance (P = 0.633) rates between the MWA and RFA groups. Complications occurred in 14.7% (5/34) of patients presenting with transient hoarseness. RFA had a higher but not statistically significant complication rate than MWA did (21.1% [4/19] vs. 6.7% [1/15]; P = 0.355). Both MWA and RFA demonstrated promising short-term outcomes in terms of efficacy and safety in treating solitary low-risk T2N0M0 PTC, with no significant differences.

Minimally Invasive Open Bilateral Total Thyroidectomy Using Unilateral Neck Incision in Thyroid Cancer: Preliminary Surgical and Quality of Life Outcomes.

Thyroid cancer incidence has increased in recent decades, and thyroid surgery is continuously evolving in response to demands for postoperative comfort and cosmesis. This study aimed to introduce a new surgical method for minimally invasive open bilateral total thyroidectomy (MI-BTT) using a unilateral 2.5-3.0 cm neck incision. Furthermore, we reported the surgical outcomes and postoperative quality of life (QoL) using a validated Korean translated Dermatology Life Quality Index (DLQI) questionnaire. We retrospectively evaluated 41 Asian patients who underwent MI-BTT for low-risk papillary thyroid cancer by a single surgeon from March 2019 to December 2021. A total of 4 male and 37 female patients were included. The mean age and body mass index were 46.2±10.1 years and 23.3±3.3 kg/m², respectively. The average tumor size was 1.1±0.6 cm, and 36 patients (87.8%) had bilateral cancer. Twenty-three (56.1%) patients had occult central lymph node (CLN) metastasis in the final pathologic report, with the mean number of dissected CLNs being 7.2±6.5. Gross capsular extension was found in 6 patients (14.6%). Moreover, 28 patients (68.3%) received additional treatment after surgery with low or high doses of radioactive iodine. The average serum-stimulated thyroglobulin value identified during treatment was 1.57±2.30 ng/mL. The mean operation time was 78.0±13.9 minutes, and postoperative complications included transient hypocalcemia (36.6%), transient hoarseness (24.4%), and seroma (2.4%). The mean total DLQI score was 2.73±0.78, indicating a small effect on QoL. MI-BTT is a novel, safe, and feasible technique to improve patient satisfaction for surgical scars and QoL.

Effectiveness and Safety of Percutaneous Treatment in Lesions Suggestive of Thyroid Cancer (Bethesda V and VI-T1aN0M0) Compared to Surgical Treatment: Systematic Review and Meta-Analysis.

Thyroid nodules are common entities, with 5% malignancy. Differentiated thyroid cancer represents 90% of thyroid malignancies, with papillary carcinoma being the most common. Management is generally surgical; among its complications are injury to the recurrent laryngeal and superior laryngeal nerve, causing hoarseness, postsurgical hypoparathyroidism, hypothyroidism, and pain. Other noninvasive percutaneous interventions of thermal ablation such as microwave, radiofrequency, or laser incur lower costs and could be an option for treatment. To determine the effectiveness and safety of thermal ablation in lesions suspected of thyroid cancer (Bethesda V and VI/T1aN0M0) compared to surgical treatment. Systematic review/meta-analysis of observational studies and clinical trials. Database search includes MEDLINE/PUBMED, Embase, Scopus, Scielo, and BVS/LILACS. Studies on patients over 18 years of age with lesions suspicious of thyroid cancer were included. A total of 10 studies were obtained, with 2939 patients: 1468 subjected to thermal ablation and 1471 to surgery. Regarding effectiveness, no differences were found in local recurrence [relative risk (RR) 1.17 (95% CI 0.69-1.99)] and cervical lymph node metastasis [RR 0.76 (95% CI 0.43-1.36)]. Regarding safety, infection [RR 0.29 (95% CI 0.05-1.74)], hematoma [RR 0.57 (95% CI 0.17-1.94)], and transient hoarseness [RR 0.77 (95% CI 0.39-1.51)] were evaluated, without difference. However, permanent hoarseness had significant differences in favor of thermal ablation [RR 0.29 (95% CI 0.11-0.75)]. Thermal ablation for the treatment of T1aN0M0 papillary thyroid carcinoma is equally effective when compared to surgical techniques and offers a better safety profile, particularly in permanent hoarseness.

Initial Clinical Application of Enhanced Recovery After Transoral Robotic Thyroidectomy.

Background: The enhanced recovery after surgery (ERAS) protocol has been widely adopted across various surgical subspecialties. Transoral robotic thyroidectomy (TORT) has grown in popularity in the past decade. Therefore, this study aimed to discuss the initial application of ERAS in TORT. Methods: We retrospectively analyzed the clinical data of 95 patients who had undergone TORT in our department from April 2020 to March 2022. All patients were treated using the ERAS protocol. Results: TORT was successfully performed in all 95 patients. Postoperative histopathological examination revealed papillary carcinoma. The average operative time, hemorrhage volume, length of postoperative stay, and pain score (24 hours after surgery) were 227.32 ± 44.37 minutes, 35.81 ± 23.45 mL, 1.37 ± 0.62 days, and 2.11 ± 0.54, respectively. Sixty patients received an analgesia pump, with no significant difference in pain scores between the patients with and without the pump (P > .05). Eight patients experienced transient mandibular numbness, and two experienced transient hoarseness postoperatively. Of the 24 cases of total thyroidectomy/bilateral subtotal thyroidectomy (ST) or lobectomy with isthmusectomy plus contralateral ST patients, 8 developed transient hypoparathyroidism. No common complications, such as incision infection, hematoma/effusion formation, coughing while drinking, or permanent hoarseness/hypocalcemia, were reported. Conclusion: Our initial outcomes demonstrate that implementing an ERAS protocol in TORT is safe and feasible.

US-guided percutaneous radiofrequency ablation of secondary hyperparathyroidism as a bridge to renal transplantation

Purpose Secondary hyperparathyroidism (SHPT) is a frequently encountered problem in patients with end-stage renal disease (ESRD) prior to renal transplantation (RTP), and the successful management of SPHP currently is challenging. In this study, we aimed to investigate the effectiveness of radiofrequency ablation (RFA) for SHPT as a bridge to RTP and to evaluate post-transplantation outcomes. Methods Patients with SHPT receiving RFA treatment were retrospectively reviewed, and those underwent RTP after ablation were enrolled. Serum parathyroid hormone (PTH), calcium, and phosphate levels were collected before ablation and at follow-up periods. The primary endpoints are PTH values at time of transplantation and at the final follow-up. The secondary endpoints were RFA-related complications, serum calcium and phosphate concentrations, and allograft function. Results Eleven patients with 43 enlarged parathyroid glands were treated with 16 RFA sessions and enrolled in the study. Complete ablation was achieved in all glands with transient hoarseness and hypocalcemia occurring in two and five of the treatments, respectively. At time of transplantation, serum PTH levels (246.7 ± 182.6 pg/mL) were significantly lower than that before RFA (1666.55 ± 874.48 pg/mL, p < 0.001) and were all within guideline-oriented range. The median follow-up period was 57.2 months. At last visit, all patients were alive, with normal PTH values and functioning grafts. Conclusions Ultrasound-guided RFA is effective for destroying hyperplastic parathyroid tissues in SHPT patients, whose PTH values fall within the guideline-oriented range both pre-and post-transplantation. Percutaneous RFA acts as an effective bridge to RTP and might provide a new management paradigm designed to improve post-transplant outcomes.

The learning curve for gasless transaxillary posterior endoscopic thyroidectomy for thyroid cancer: a cumulative sum analysis.

Gasless transaxillary posterior endoscopic thyroidectomy (GTPET) is a new approach for thyroid cancer. It allows en bloc resection of the thyroid and central lymph nodes. Few studies have reported on the learning curve for GTPET.We examined the learning curve of GTPET for thyroid cancer by cumulative sum (CUSUM) analysis by retrospectively analyzing patients who underwent hemithyroidectomy with ipsilateral central neck dissection between December 2020 and September 2021 at a tertiary medical center, including the first patient. Moving average analysis and sequential time-block analysis were used for validation. Data on the clinical factors between the two periods were compared. In the overall cohort, the average time for GTPET for thyroid cancer was 113.25min to harvest an average of 6.4 central lymph nodes. The CUSUM curve of the operative time indicated an inflection point after 38 patients. Moving average analysis and sequential time-block analysis validated the number of procedures needed for GTPET proficiency. (124.05min vs. 107.63min for the unproficient period vs. proficient period, respectively; P < 0.001) The number of retrieved lymph nodes was not associated with a certain level of proficiency per the learning curve. The main complication during the surgeon's unproficient period was transient hoarseness (3/38), which was similar to that in their proficient period (2/73, p = 0.336). Proficiency in GTPET is associated with performing more than 38 procedures. Standard course training and instruction on careful management are required prior to introducing the procedure.

Randomized controlled trial of intravenous sedation vs general anesthesia for esophageal dilation with percutaneous endoscopic gastrostomy in esophageal cancer patients.

Esophageal squamous cell cancer (ESCC) is mostly diagnosed in its later stages, when patients present with dysphagia and weight loss. Esophageal dilation with percutaneous endoscopic gastrostomy (PEG) is a common surgical procedure in patients with locally advanced ESCC because of tumor obstruction and enteral nutrition support during neoadjuvant or definitive concurrent chemoradiotherapy (CCRT). Esophageal dilation with PEG is widely performed under general anesthesia (GA) with endotracheal intubation. To determine the overall success rate of completing this procedure using intravenous (IV) sedation with dexmedetomidine (DEX) relative to GA and to compare its perioperative conditions, including procedure times, pain scores (visual analog scale), adverse events, and costs. SongklanagarindHospital, Faculty of Medicine, Prince of Songkla University, Thailand. Prospective randomized controlled trial (RCT) of locally advanced ESCC patients who had dysphagia and needed esophageal dilation with PEG between January 2020 and December 2021. Esophageal dilation (using a Savary-Gilliard dilator) and PEG were performed using the pull technique. Seventy patients were randomly assigned to either the DEX group (n = 34) or the GA group (n = 36). All patients in both groups underwent successful surgery. The DEX group had a significantly shorter procedure time, lower procedure cost, and lower total hospital cost than the GA group. However, there were no significant between-group differences in pain scores or length of hospital stay. There were no serious adverse events in either group; however, the GA group had some incidences of sore throat, transient hoarseness, and atelectasis. This study found that IV sedation with DEX during esophageal dilation with PEG was as effective and safe as using GA.

Permanent complications after thyroid surgery and effect of surgeon volume

Introduction: Thyroidectomy is a surgical method for the management of benign and malignant thyroid disease. Thyroidectomy may cause significant complications including hypocalcemia and recurrent laryngeal nerve injury. Permanent complications after thyroid surgery pose significant costs for healthcare system, as patients require lifelong alternative treatments and healthcare facilities. Objectives: The purpose of this study was to evaluate the incidence and risk factors for permanent complications following thyroidectomy. Patients and Methods: A total of 204 consecutive patients who underwent thyroid surgery between 2017 and 2018 were included in this prospective study. The patients were followed for 12 months after surgery and clinical and biochemical data were recorded. Results: The incidence of transient and permanent hypocalcemia was 46.8% and 6.38%, respectively. Transient hoarseness affected 30.3% of patients and 2.1% had recurrent laryngeal nerve paralysis as detected by video laryngoscopy 12 months after surgery. Surgeons volume was significantly related to the presence of permanent hypocalcemia (P=0.003). In comparison to high-volume-surgeons, intermediate-volume-surgeons had an odds ratio of 5.25 (P=0.042) for permanent complications. Conclusion: Hypocalcaemia remained the most common long-term complication of thyroid surgery. High volume surgeons had lower complication rates and better outcomes. In this regard, methods for improving surgical performance are worthy of investigation.

Total areola approach for endoscopic thyroidectomy: Six years of experience with the same surgeon.

Scarless endoscopic thyroidectomy (ET) is increasingly accepted by the growing amount of surgeons. The target of this study is to assess the efficacy and summarise the experiences of total areola approach for ET (TAAET). TAAET was performed on 529 patients between January 2016 and October 2021. All operated patients were divided into two groups according to the chronological order. Demographic data, perioperative data and post-operative complications were collected to assess the effectiveness of TAAET. Five hundred and twenty-eight patients were successfully treated with TAAET, while 1 case was converted to open surgery due to bleeding. The surgical approach consists of lobectomy or total thyroidectomy with or without central lymph node dissection. The post-operative pathology of 433 (81.9%) patients was diagnosed with T1 ~2N0M0. The average number of unilateral lymph node dissection was 7.72 ± 2.44 while the bilateral lymph node was 10.70 ± 3.72. In terms of complications, 38 cases had transient hoarseness, 28 cases had tetany and numbness, 3 cases had post-operative bleeding, 1 case had infection and 33 cases had subcutaneous fluid. There were statistically significant differences between the two groups with respect to transient hoarseness (P < 0.001), tetany and numbness (P = 0.005), intraoperative blood loss (P = 0.003) and operation time for malignant tumour (P < 0.001) because of the accumulation of surgical experience and the maturation of technology. TAAET which conforms to the anatomical pathway of open thyroidectomy is a safe, effective and feasible technique and is highly suitable for novices.

Multidisciplinary management of carotid body tumors: a single-institution case series of 22 patients.

Carotid body tumors (CBTs) are rare, slow-growing neoplasms derived from the parasympathetic paraganglia of the carotid bodies. Although inherently vascular lesions, the role of preoperative embolization prior to resection remains controversial. In this report, the authors describe an institutional series of patients with CBT successfully treated via resection following preoperative embolization and compare the results in this series to previously reported outcomes in the treatment of CBT. All CBTs resected between 2013 and 2019 at a single institution were retrospectively identified. All patients had undergone preoperative embolization performed by interventional neuroradiologists, and all had been operated on by a combined team of cerebrovascular neurosurgeons and otolaryngology-head and neck surgeons. The clinical, radiographic, endovascular, and perioperative data were collected. All procedural complications were recorded. Among 22 patients with CBT, 63.6% were female and the median age was 55.5 years at the time of surgery. The most common presenting symptoms included a palpable neck mass (59.1%) and voice changes (22.7%). The average tumor volume was 15.01 ± 14.41 cm3. Most of the CBTs were Shamblin group 2 (95.5%). Blood was predominantly supplied from branches of the ascending pharyngeal artery, with an average of 2 vascular pedicles (range 1-4). Fifty percent of the tumors were embolized with more than one material: polyvinyl alcohol, 95.5%; Onyx, 50.0%; and N-butyl cyanoacrylate glue, 9.1%. The average reduction in tumor blush following embolization was 83% (range 40%-95%). No embolization procedural complications occurred. All resections were performed within 30 hours of embolization. The average operative time was 173.9 minutes, average estimated blood loss was 151.8 ml, and median length of hospital stay was 4 days. The rate of permanent postoperative complications was 0%; 2 patients experienced transient hoarseness, and 1 patient had medical complications related to alcohol withdrawal. This series reveals that endovascular embolization of CBT is a safe and effective technique for tumor devascularization, making preoperative angiography and embolization an important consideration in the management of CBT. Moreover, the successful management of CBT at the authors' institution rests on a multidisciplinary approach whereby endovascular surgeons, neurosurgeons, and ear, nose, and throat-head and neck surgeons work together to optimally manage each patient with CBT.

Clinical characteristics and prognostic analyses of cervical neuroblastoma

Objective: To determine the characteristics of cervical neuroblastoma and the effect of resection extent on survival and outcomes. Methods: We performed a retrospective review of 32 children with cervical neuroblastoma treated at Beijing Children's Hospital between April 2013 and August 2020. Data were collected from the medical record. The individualized therapy was designed based on staging and risk group. Based on the extent of resection, patients were divided into incomplete and complete resection groups. Event free and overall survival rates were compared between two groups using the Kaplan-Meier method. Results: The ages of patients ranged from 1 month to 81 months, with a median age of 11 months, including 7 males and 15 females. Twenty-nine patients (90.6%) presented with cervical painless mass. The average diameter of the primary tumors was (5.12±1.43) cm. Tumors were located in the parapharyngeal space in 25 cases (78.1%) and in the root of the neck in 7 cases (21.9%). None had MYCN amplification. According to International Neuroblastoma Staging System (INSS), 15 patients (46.9%) were identified as stage 1, 11 patients (34.3%) as stage 2B, 3 patients (9.4%) as stage 3 and 3 patients (9.4%) as stage 4. There were 12 patients (37.5%) at low risk, 17 patients (53.1%) at intermediate risk and 3 patients at high risk according to Children's Oncology Group (COG) risk classification system. All patients underwent tumor resection. Postoperatively Horner's syndrome occurred in 13 patients (40.6%), pneumonia in 9 patients (28.1%), pharyngeal dysfunction in 8 patients (25.0%) and transient hoarseness in 4 patients (12.5%). At a median follow-up of 36.5 months, the overall survival rate was 96.4%, with no significant difference between incomplete and complete resection groups (100.0% vs. 96.3%, χ2=0.19, P=0.667); the event free survival rate was 78.1%, with a significant difference between the two groups (40.0% vs. 85.2%, χ²=6.71, P=0.010). Conclusions: Primary cervical neuroblastoma has a young onset age, mostly in low and medium risk groups, and represents favorable lesions with good outcomes after multidisciplinary therapy. Less aggressive surgery with preservation of important structures is recommended. Complete resection should not be attempted if it would compromise vital structures.

Frequency of Hypocalcemia after Thyroid Surgery

Objective: The purpose of this study is to determine the prevalence of hypocalcemia among patients after thyroid surgery. Study Design: Descriptive study/ Cross-sectional Place and Duration: The study was conducted at the surgical department of Mayo Hospital, Lahore for the duration of eighteen months from July 2020 to December 2021. Methods: Fifty-five male and female subjects participated in this research. Patients ranged in age from 17 to 62 years. After obtaining written permission from the patient, demographic information such as age, sex, BMI, and tumors type was collected. Contralateral lobe cancer was also shown to be a problem. Before surgery and on the first post-operative day, the blood calcium levels of the patients were measured. Patients who received a full thyroidectomy were evaluated for signs of hypocalcemia. Analysis was performed using SPSS 22.0. Results: Among 55 patients, majority of the cases were females 30 (54.5%) were females and the rest were males 25 (45.5%). The patients mean age was 37.16±14.52 years and had mean BMI 24.45±6.62 kg/m2. Papillary cancer was the most common tumor found in 42 (76.4%) cases, followed by follicular cancer in 9 (16.4%) case and 4 (7.3%) cases had hurthle cell carcinoma. We found frequency of hypocalcemia in 14 (25.5%) cases. Among 14 patients of hypocalcemia 10 (71.4%) were females and 4 (38.6%) were males. Retrosternal of goiter found in 5 (35.7%) cases and no retrosternal extension found in 9 (64.3%) case. Post-operative other complications among all cases were seroma, transient hoarseness of voice and neck hematoma. Conclusion: In this study we found higher frequency of hypocalcemia in 25.5% cases after thyroid surgery. Majority of the cases were females and had no retrosternal extension. Except hypocalcemia other complications among all cases were seroma, transient hoarseness of voice and neck hematoma. Keywords: Thyroid Surgery, Tumors, Complications, Hypocalcemia

Successful Applications of Food-Assisted and -Simulated Training Model of Thyroid Radiofrequency Ablation.

BackgroundRadiofrequency ablation (RFA) for benign thyroid nodules is one kind of scarless treatment for symptomatic or cosmetic benign thyroid nodules. However, how to train RFA-naive physicians to become qualified operators for thyroid RFA is an important issue. Our study aimed to introduce a successful training model of thyroid RFA.Materials and MethodsWe used a food-assisted and -simulated training model of thyroid RFA. Chicken hearts were simulated into thyroid nodules, three-layer pork meats were simulated into peri-thyroid structure, and gel bottles were simulated into trachea, respectively. Successful training ablations were defined as chicken hearts that were fully cooked. After repeating training ablations of chicken hearts at least 100 times with the nearly 100% success rates for three young trainees, they served as the first assistant for the real procedures of thyroid RFA and then were qualified to perform thyroid RFA on real patients under the supervision of one experienced interventional radiologist.Results23 real patients who received RFA and follow-up at least 6 months after treatment were included in Linkou Chang Gung Memorial Hospital from January 1, 2020 to October 1, 2021. Three young endocrinologists performed thyroid RFA independently. The outcomes were volume reduction rate (VRR), major complications and minor complications. The median VRR at 12 months was 82.00%, two major complications were transient hoarseness, and three minor complications were wound pain. All complications were completely recovered within three days.ConclusionsFor young and RFA-native physicians without any basic skills of echo-guided intervention, this food-assisted and -simulated training model of thyroid RFA was useful for medical training and education.

Experience performing partial fistulectomy through a single incision to treat pyriform sinus fistula in children

Background and objectivesThe surgical treatment of pyriform sinus fistula (PSF) is improving. The aim of this study was to investigate the effect of partial fistula excision in children with PSF assisted by using methylene blue. MethodsAccording to the method used to treat PSF infection, the patients were divided into a conservative treatment group, a single incision group (the children drained the abscess through the incision at the dermatoglyph of the cricothyroid joint), and a non single incision group (the children drained the abscess through the incision in the most obvious area of the abscess or ulceration). The data were retrieved from the electronic medical records (EMRs) and hospital information system （HIS）. The patient and observer scar assessment scale (POSAS) scores at 6 months after fistula resection were compared. ResultsA total of 239 patients diagnosed with PSF underwent partial resection of the fistula through cervical approach with methylene blue. The success rate of the operation was 100%. The average operation time was 32 ± 13.2 min. The average hospital stay was 1 ± 0.2 days. There were 2 cases of transient hoarseness and 6 cases of wound infection. There were 17 patients in the conservative treatment group, 81 patients in the single incision group and 145 patients in the nonsingle incision group. The average POSAS scores of the three groups were 2.56 ± 0.6, 3.12 ± 0.84 and 4.56 ± 1.56, respectively, with significant differences among the three groups (P < 0.05). ConclusionsPartial fistulectomy assisted by using methylene blue through a single incision in the neck for the treatment of PSF in children yields a high success rate, fewer postoperative complications and greater comfort than traditional surgery. This alternative surgery can be used to treat PSF in children.

Thyroidectomy for thyroid cancer via transareola single-site endoscopic approach: results of a case-match study with large-scale population.

Due to technical challenges, single-site endoscopic thyroidectomy (SSET) is seldom reported and has been attempted in only limited cases. This large-scale study aimed to compare the clinical outcomes of standardized transareola SSET (TASSET) with those of conventional open thyroidectomy (COT) for thyroid cancer. The data were prospectively collected, and case-match study was performed at a ratio of 1:1 according to age, sex, body mass index, lesion size, number of lesion foci, lesion side, recurrent laryngeal nerve (RLN) exploration and pathology. Two hundred eligible patients underwent TASSET, and the same number of patients was selected for propensity score matching from 2256 patients who underwent COT. Perioperative data, including surgical profile, oncological and traumatic burdens, and cosmetic satisfaction, were analyzed. No significant differences were observed in blood loss or drainage between TASSET and COT groups. There were no differences in operation time between TASSET and COT (106.39 ± 28.44 vs 102.55 ± 23.10min, p = 0.154). A total of 3.63 ± 1.82 lymph nodes (LNs) were retrieved from CND with 0.96 ± 1.42 positive in TASSET. In COT, the total and positive LN yields were 3.77 ± 1.91 and 0.99 ± 1.40 (p = 0.445, p = 0.802). Cancer recurrence was not observed in either group. There were no differences in the occurrence of permanent and transient hoarseness or RLN injuries. Postoperative flap seroma or hematoma occurred in 12 TASSET patients and 58 COT patients (p < 0.001). The pain score, CRP level and ESR in TASSET group were lower than those in COT group. TASSET yielded significantly better incision recovery and cosmetic scores than did COT at both the proliferation and stabilization stages. TASSET is technically feasible and yields enhanced recovery with minimally invasive and cosmetic advantages without compromising the level of safety or cancer eradication.

Ductal closure with radiofrequency energy; outcomes of the first series

Using radiofrequency energy for closure of the patent ductus arteriosus (PDA) has been reported by us previously. In this article we report the early and late outcome of the first group in whom patent ductus arteriosus has been occluded with radiofrequency. Six children with PDA were enrolled. The procedure was successful in five cases and transient hoarseness was observed in 2 cases as the only complication.

Minimally invasive video-assisted thyroidectomy in Asian patients: experience from Singapore.

Minimally invasive video-assisted thyroidectomy (MIVAT) although well established in Europe has not yet gained widespread acceptance in Asia. We describe our learning experience in the first reported series of 105 cases from Singapore. A retrospective analysis of outcomes in 105 patients who underwent MIVAT from April 2011 to 2018 was performed. The inclusion criteria were - symptomatic benign thyroid pathologies and follicular lesions or neoplasms needing a hemi-thyroidectomy. A thyroid lobe volume less than 35 mL was used as cut-off. Patients underwent surgeon-performed thyroid ultrasound with biopsy of solid nodules. All cases were operated by one surgeon using standard Miccoli technique with energy device used in all cases. From a total of 424 patients with nodular goitres undergoing thyroidectomy, 105 (24%) symptomatic eligible patients underwent the MIVAT procedure (M:F - 23:82). The mean incision lengths at start and completion were 1.7 cm (range 1.5-2 cm) and 2.4 cm (range 2-2.7 cm), respectively. Mean operating time was 97 min (range 59-160 min). There were four conversions (3.8%) in the first 25 cases and four patients (3.8%) experienced transient hoarseness with full recovery. Visual analogue pain scores at 6 and 24 h post-operatively were 2.7 and 1.1, respectively. Scar satisfaction was reported as excellent (75%), satisfactory (23%) and poor (2%). Although technically more demanding, MIVAT is a safe and useful operation in a thyroid surgeon's armamentarium. The limitation of goitre size, however, allows only a small percentage of symptomatic patients to undergo this procedure.