scholarly journals Single-port transaxillary robotic thyroidectomy (START): 200-cases with two-step retraction method

2021 ◽  
Author(s):  
Jin Kyong Kim ◽  
Sun Hyung Choi ◽  
Soon Min Choi ◽  
Hye Ryeon Choi ◽  
Cho Rok Lee ◽  
...  
Keyword(s):  
Single Port ◽  
Skin Flap ◽  
Robotic Thyroidectomy ◽  
Thyroid Tumor ◽  
The Novel ◽  
Robot System ◽  
Thyroid Lobectomy ◽  
The Mean ◽  
Benign Thyroid Nodules ◽  
Benign Thyroid

Abstract Background This study aims to report the results of a pioneering clinical study using the single-port transaxillary robotic thyroidectomy (START) for 200 patients with thyroid tumor and to introduce our novel two-step retraction method. Methods START was performed on consecutive 200 patients using the da Vinci Single-Port (SP) robot system from January 2019 to September 2020 at the Yonsei University Health System, Seoul, Korea. The novel two-step retraction technique, in which a 3.5 cm long incision is made along the natural skin crease, was used for the latter 164 patients. The surgical outcome and invasiveness of the SP two-step retraction method were analyzed. Results Among the 200 cases who underwent START, 198 were female and 2 were male, with a mean age of 34.7 (range: 13–58 years). Thyroid lobectomy was performed for 177 patients and total thyroidectomy was performed for 23 patients. Ten patients had benign thyroid nodules, whereas the other 190 had thyroid malignancy. The mean body mass index (BMI) was 22.2 ± 3.7 kg/m2 (range: 15.9–37.0 kg/m2). All of the operations were performed successfully without any open conversions, and patients were discharged on postoperative day 3 or 4 without significant complication. The mean operative time for thyroid lobectomy with the two-step retraction method was 116.69 ± 23.23 min, which was similar to that in the conventional robotic skin flap method (115.33 ± 17.29 min). We could minimize the extent of the robotic skin flap dissection with the two-step retraction method. Conclusions START is a practical surgical method. By employing the new two-step retraction method, we can maximize the cosmetic and functional benefits for patients and reduce the workload fatigue of surgeons by increasing robotic dependency.

scholarly journals Efficacy and safety of radiofrequency ablation for benign thyroid nodules in patients with previous thyroid lobectomy

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lin Yan ◽  
Mingbo Zhang ◽  
Fang Xie ◽  
Jun Ma ◽  
Jing Xiao ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Symptom Score ◽  
Thyroid Function ◽  
Thyroid Nodules ◽  
Efficacy And Safety ◽  
Thyroid Lobectomy ◽  
The Mean ◽  
Benign Thyroid Nodules ◽  
Benign Thyroid

Abstract Background Radiofrequency ablation (RFA) is recommended for the treatment of benign thyroid nodules. However, data on the clinical role of RFA for benign thyroid nodules in patients with history of thyroid lobectomy are insufficient. The purpose of this study was to evaluate the efficacy and safety of radiofrequency ablation (RFA) for benign thyroid nodules in patients who had previously undergoing thyroid lobectomy. Methods From May 2015 to October 2018, a total of 20 patients (19 females, 1 male, mean age 49.50 ± 14.26 years, range 22–74 years) with 20 benign thyroid nodules (mean volume 15.04 ± 21.17 ml, range 0.40–69.67 ml) who had undergone previous thyroid lobectomy were included in this retrospective study. Patients were followed up at 3, 6, 12 months after RFA and every 12 months thereafter by ultrasound, clinical evaluation and thyroid function. Volume, volume reduction rate (VRR), symptom score and cosmetic score were evaluated. Results During the mean follow-up time of 21.24 ± 16.41 months, the mean nodule volume decreased significantly from 15.04 ± 21.17 ml to 1.29 ± 1.17 ml (P = 0.018) with a mean VRR of 85.41 ± 12.17%. Therapeutic success was achieved in a single session for all thyroid nodules. The symptom score (P = 0.001) and cosmetic score (P = 0.001) were both significantly reduced at the last follow-up. The levels of free triiodothyronine (fT3), free thyroxine (fT4) and thyroid stimulating hormone were not significantly different at the last follow-up from those prior to treatment (all P > 0.05). No life-threatening complications or sequelae occurred after RFA. Conclusions As a minimally invasive modality, RFA was a safe, effective, and thyroid function-preserving option for patients with symptomatic benign thyroid nodules after a previous lobectomy.

scholarly journals Reproducibility of Ablated Volume Measurement Is Higher with Contrast-Enhanced Ultrasound than with B-Mode Ultrasound after Benign Thyroid Nodule Radiofrequency Ablation—A Preliminary Study

2020 ◽  
Vol 9 (5) ◽  
pp. 1504 ◽  
Author(s):  
Simone Schiaffino ◽  
Francesca Serpi ◽  
Duccio Rossi ◽  
Valerio Ferrara ◽  
Ciriaco Buonomenna ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Thyroid Nodules ◽  
Observer Agreement ◽  
Contrast Enhanced Ultrasound ◽  
Limits Of Agreement ◽  
Contrast Enhanced ◽  
The Mean ◽  
Preliminary Study ◽  
Benign Thyroid Nodules ◽  
Benign Thyroid

The reproducibility of contrast-enhanced ultrasound (CEUS) and standard B-mode ultrasound in the assessment of radiofrequency-ablated volume of benign thyroid nodules was compared. A preliminary study was conducted on consecutive patients who underwent radiofrequency ablation (RFA) of benign thyroid nodules between 2014 and 2016, with available CEUS and B-mode post-ablation checks. CEUS and B-mode images were retrospectively evaluated by two radiologists to assess inter- and intra-observer agreement in the assessment of ablated volume (Bland–Altman test). For CEUS, the mean inter-observer difference (95% limits of agreement) was 0.219 mL (-0.372–0.809 mL); for B-mode, the mean difference was 0.880 mL (-1.655–3.414 mL). Reproducibility was significantly higher for CEUS (85%) than for B-mode (27%). Mean intra-observer differences (95% limits of agreement) were 0.013 mL (0.803–4.097 mL) for Reader 1 and 0.031 mL (0.763–3.931 mL) for Reader 2 using CEUS, while they were 0.567 mL (-2.180–4.317 mL, Reader 1) and 0.759 mL (-2.584–4.290 mL, Reader 2) for B-mode. Intra-observer reproducibility was significantly higher for CEUS (96% and 95%, for the two readers) than for B-mode (21% and 23%). In conclusion, CEUS had higher reproducibility and inter- and intra-observer agreement compared to conventional B-mode in the assessment of radiofrequency-ablated volume of benign thyroid nodules.

scholarly journals Management of bleeding associated with radiofrequency ablation of benign thyroid nodules

2020 ◽  
Vol 48 (8) ◽  
pp. 030006052093752
Author(s):  
Kunpeng Hu ◽  
Yufan Lian ◽  
Jinfen Wang ◽  
Wenchao Li ◽  
Zhicheng Yao ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Thyroid Nodules ◽  
Effective Management ◽  
Voice Change ◽  
Life Threatening ◽  
The Mean ◽  
Benign Thyroid Nodules ◽  
Benign Thyroid ◽  
Clinical Strategy

Objective This study was performed to explore the effective management of bleeding associated with radiofrequency ablation (RFA) of benign thyroid nodules. Methods Thirty-five patients with benign thyroid nodules who were treated with ultrasound-guided RFA from July 2015 to December 2016 at the Third Affiliated Hospital of Sun Yat-sen University were retrospectively reviewed. The technique efficacy, bleeding, and other complications were assessed during the follow-up period. Results The mean technique efficacy was 55.6%±22.8% at 1 month and 24.1%±17.1% at 6 months after the procedure. One case of an intranodular haematoma and two cases of voice change (>1 month) were observed. All patients recovered with corresponding treatment. Conclusion Although the incidence of haemorrhage is low, serious haematomas are life-threatening. Therefore, having a comprehensive understanding of the potential complications, an accurate clinical strategy, and adequate technical skills may prevent or help to properly manage these complications.

SERUM THYROGLOBULIN AND ANTI THYROGLOBULIN LEVELS IN PATIENTS WITH THYROID NODULES

2020 ◽  
pp. 73-78
Author(s):  
Hung Nguyen Trung ◽  
Thuy Nguyen Hai ◽  
Quan Nguyen Phuoc Bao
Keyword(s):  
Thyroid Nodule ◽  
Thyroid Nodules ◽  
Serum Thyroglobulin ◽  
Elasticity Score ◽  
Thyroglobulin Level ◽  
The Mean ◽  
Operation Results ◽  
The Relationship ◽  
Benign Thyroid Nodules ◽  
Benign Thyroid

Objectives: To compare the levels and pathological values of serum Tg and TgAb between the patients with benign and malignant thyroid nodules and evaluate the relationship between serum Tg and TgAb levels with the rim characteristic and elasticity score of the nodule by thyroid elasto-echography. Subjects: 30 patients with thyroid nodules, Serum Tg and TgAb levels and thyroid elasto-echography are examen before operation. Results: The ratio of the positive Tg level of malignant thyroid nodules was higher than the benign thyroid nodules (16.7% vs 8.3%) but the serum Tg level was not significantly different (33.48 ± 38.67 ng/ml vs 27.32 ± 28.44 ng/ml, p > 0.05) and The ratio of positive TgAb level of malignant thyroid nodules was higher than that of benign thyroid nodules (22.2% vs 0%) but serum TgAb level was not different (64.15 ± 14.91 UI/ml vs 16.9 ± 14.48 UI/ml, p > 0.05). The combination of the ratio of positive Tg and positive TgAb level did not show any difference in the ratio of pathological value between benign and malignant thyroid nodules (5.6% vs 0%). Serum Tg levels in patients with irregular rim thyroid nodules were higher than those in patients with regular rim thyroid nodules but the serum Tg level was not different when evaluated with the elastic score. Conclusions: The mean level and ratio of the pathological value of serum Tg and TgAb did not differ between malignant and benign thyroid nodules. There is a relationship between serum Tg level and irregular rim characteristic of thyroid nodule (p < 0.05). Key words: serum thyroglobulin level, serum anti thyroglobulin level, thyroid nodule.

Endoscopic Versus Conventional Open Thyroid Lobectomy for Benign Thyroid Nodules

2002 ◽  
Vol 12 (6) ◽  
pp. 426-429 ◽  
Author(s):  
Masahide Yamamoto ◽  
Akira Sasaki ◽  
Hiroshi Asahi ◽  
Yutaka Shimada ◽  
Kazuyoshi Saito
Keyword(s):  
Thyroid Nodules ◽  
Thyroid Lobectomy ◽  
Benign Thyroid Nodules ◽  
Benign Thyroid

Diagnostic Value of Acoustic Radiation Force Impulse Quantification in the Differentiation of Benign and Malignant Thyroid Nodules

2017 ◽  
Vol 39 (5) ◽  
pp. 326-336 ◽  
Author(s):  
Niraj Nirmal Pandey ◽  
Gaurav Shanker Pradhan ◽  
Alpana Manchanda ◽  
Anju Garg
Keyword(s):  
Thyroid Nodules ◽  
Acoustic Radiation ◽  
Radiation Force ◽  
Acoustic Radiation Force ◽  
Ultrasound Elastography ◽  
Acoustic Radiation Force Impulse ◽  
Shear Wave Speed ◽  
The Mean ◽  
Benign Thyroid Nodules ◽  
Benign Thyroid

The objective of this study was to evaluate the role of ultrasound elastography using acoustic radiation force impulse (ARFI) quantification in characterizing and differentiating malignant versus benign thyroid nodules. A total of 40 thyroid nodules were evaluated with conventional sonography and ultrasound elastography using ARFI quantification. The final diagnosis was obtained from histologic findings. A total of 14 malignant and 26 benign nodules were diagnosed on the basis of histologic examination. Majority of the malignant thyroid nodules demonstrated presence of intranodular vascular flow, hypoechoic echotexture, absent halo, irregular margins and microcalcifications. However, a considerable overlap was noted in the sonographic features of malignant and benign thyroid nodules. On ARFI quantification, the mean shear wave speed (SWS) values ( M ± SD) of malignant and benign thyroid nodules were 3.131 ± 0.921 m/s and 1.691 ± 0.513 m/s, respectively. A significant difference was observed between the mean SWS values of malignant thyroid nodules and benign thyroid nodules ( p < 0.0001). Applying a cutoff value of 2.53 m/s, the sensitivity, specificity, and the area under the receiver operating characteristic curve for the differentiation were 85.71%, 96.15%, and 0.922, respectively. ARFI quantification is a promising elastography technique that provides quantitative information about tissue stiffness. It provides additional information and complements sonography as an effective diagnostic tool in characterizing and differentiating benign from malignant thyroid nodules.

scholarly journals Single-Port Access Endoscopic Thyroidectomy via Axillary Approach for the Benign Thyroid Tumor: New Aspects from Vietnam

2021 ◽  
Vol Volume 14 ◽  
pp. 1853-1864
Author(s):  
Hoang-Hiep Phan ◽  
Thai-Hoang Nguyen ◽  
Hoang-Long Vo ◽  
Ngoc-Thanh Le ◽  
Ngoc-Luong Tran
Keyword(s):  
Single Port ◽  
Endoscopic Thyroidectomy ◽  
Thyroid Tumor ◽  
Single Port Access ◽  
Axillary Approach ◽  
Port Access ◽  
Benign Thyroid

scholarly journals SUN-LB83 Outpatient Radiofrequency Ablation Is a Safe and Effective Treatment Option for Benign Thyroid Nodules in North America

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Jules Aljammal ◽  
Shahzad Ahmad ◽  
Iram Hussain
Keyword(s):  
Radiofrequency Ablation ◽  
Thyroid Nodules ◽  
Hormone Replacement ◽  
P Value ◽  
Free T4 ◽  
Thyroid Hormone Replacement ◽  
The Mean ◽  
Benign Thyroid Nodules ◽  
Benign Thyroid

Abstract Background: Radiofrequency ablation (RFA) of thyroid nodules is a non-mainstream treatment option for benign thyroid nodules. Studies in Asia and Europe (1) have demonstrated RFA to be an effective outpatient alternative to surgery, however, these results have not been reproduced in North America. Hypothesis: RFA of symptomatic benign thyroid nodules can reduce morbidity associated with thyroidectomies, without sacrificing favorable clinical outcomes. Methodology: A retrospective review of 11 patients (all female and Caucasian) with 13 thyroid nodules treated with RFA in our practice was conducted (Nov 2018 - Oct 2019). The 9 nontoxic nodules were biopsied twice, and 4 toxic adenomas were biopsied once; all had benign cytopathology results prior to RFA. RFA was done under local anesthesia/conscious sedation, with follow-up telephone call after 2 days to assess complications (pain, voice change, hematoma/swelling, skin burns). Nodule volume in mL (length x depth x width in cm x 0.525), cosmetic score (2), and thyroid function tests (TSH and free T4) were recorded pre-procedure, and 6 - 10 weeks post procedure. The volume reduction rate (VRR) was calculated as follows: [(baseline volume - final volume)/baseline volume] x 100 (%). Results: The mean age of the patients was 45 years; 7 were euthyroid (not on thyroid hormone replacement), and 4 had hyperthyroidism. The mean volume of treated thyroid nodules decreased from 12.3 cc to 5.6 cc, with a mean VRR of ~ 54%. Thyroid nodules with volumes less than 10 cc (smaller) had a VRR of ~ 75%, whereas nodules with volumes more than 10 cc (larger) had a VRR of ~ 50%. The VRR between smaller and larger nodules (p-value: 0.11), and toxic adenomas and nontoxic thyroid nodules (p-value: 0.26), was not significantly different. 3 out of 4 patients with toxic adenomas normalized their TSH levels; 1 patient normalized free T4 levels, but TSH remained suppressed. None of the patients developed hypothyroidism. The cosmetic scores (indicating visible or palpable mass) improved by 50%. All patients had complete resolution of compressive symptoms. Minimal discomfort only reported at time of procedure. No complications were reported at the 2-day, or the 6-10-week follow-up. Conclusions: Outpatient RFA is a safe and effective treatment for benign thyroid nodules and toxic adenomas. There were no complications in our study, however, this may be limited by the small sample size and relatively short follow-up duration. Advantages of RFA include avoiding lifelong thyroid hormone replacement and complications of surgery and/or general anesthesia. We propose that RFA be considered as a first-line therapy for the treatment of benign thyroid nodules for these reasons. References: (1) Feldkamp, et al. Exp Clin Endocrinol Diabetes. 2020 Jan 7. doi: 10.1055/a-1075-2025. (2) Dobnig, et al. Thyroid. 2018 Apr;28(4):472-480. doi: 10.1089/thy.2017.0547.

US-guided percutaneous radiofrequency versus microwave ablation for benign thyroid nodules: A prospective multicenter study.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e17593-e17593
Author(s):  
Zhigang Cheng
Keyword(s):  
Clinical Trial ◽  
Multicenter Study ◽  
Microwave Ablation ◽  
Thyroid Nodules ◽  
Prospective Multicenter Study ◽  
Us Guidance ◽  
The Mean ◽  
Benign Thyroid Nodules ◽  
Benign Thyroid

e17593 Background: To evaluate the clinical outcomes between radiofrequency ablation (RFA) and microwave ablation (MWA) in treating benign thyroid nodules (BTNs) with a prospective multicenter study. Methods: The prospective multicenter study achieved the registration of Chinese Clinical Trial Registry (Number: ChiCTR-ONRC-13003087). From January of 2013 to December of 2015, the total number of 1,252 patients with 1351 benign thyroid nodules (BTNs) at eight participating institutions was enrolled in the multicenter study. The ablation devices were applied in the study including RFA system of VIVA RF generator (VIVA RF generator, STARmed, Goyang, Korea) and MWA system of KY-2000 2450MHz microwave system (KY-2000, Kangyou Medical, Nanjing, China). All the procedures of RFA or MWA were performed under ultrasound (US) guidance in each center. Results: The number of target nodules treated by RFA and MWA were 687 in 649 cases and 664 in 603 cases, respectively. For the estimation of efficacy, the mean maximal diameter reduction ratios (MDRRs) of RFA vs. MWA groups at the 3rd, 6th, 12th month and last follow-up were 36.4±17.3% vs. 36.0±23.0% (p = 0.765), 54.1±22.7% vs. 49.3±28.0% (p = 0.005), 64.5±22.1% vs. 57.9±40.1% (p = 0.008) and 65.5±26.0% vs. 58.2±33.5% (p = 0.028), respectively. The mean volume reduction ratios (VRRs) of RFA vs. MWA groups at the 3rd, 6th, 12th month and last follow-up were 67.6±20.3% vs. 64.4±43.5% (p = 0.143), 84.1±13.5% vs. 78.4±48.2% (p = 0.016), 89.6±20.0% vs. 82.5±49.7% (p = 0.035) and 91.3±12.6% vs. 81.1±70.4% (p = 0.045), respectively. For the estimation of safety, for all the complications and side effects encountered at the peri-ablation and follow-up period in two groups, the major, minor complication and side effect rates of RFA vs. MWA group were all no statistical significances with 4.78% vs. 6.63% (p = 0.156), 2.00% vs. 2.49% (p = 0.562) and 4.93% and 4.64% (p = 0.812), respectively. Conclusions: As a conclusion of the prospective multicenter study, both RFA and MWA under US guidance percutaneously are safe and effective techniques for selected patients with BTNs. Larger MDRR and VRR can be achieved in RFA group than the ones in MWA group at 6-month and later follow-up. Clinical trial information: ChiCTR-ONRC-13003087.

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