scholarly journals Endoscopic thyroidectomy versus conventional open thyroidectomy for early differentiated thyroid cancer

2020 ◽  
Vol 10 (4) ◽  
Author(s):  
Hoang Hiep Phan ◽  
Keyword(s):  
Thyroid Cancer ◽  
Recurrent Laryngeal Nerve ◽  
Nerve Injury ◽  
Open Surgery ◽  
Differentiated Thyroid Cancer ◽  
Endoscopic Thyroidectomy ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Laryngeal Nerve Injury ◽  
Open Lobectomy

Introduction: Endoscopic thyroidectomy has been applied prudently for malignant thyroid tumors. The aim of our study was to compare the outcomes of endoscopic lobectomy and conventional open lobectomy for early differentiated thyroid cancer. Materials and Methods: From October 2018 to October 2019, 485 patients with early differentiated thyroid cancer underwent thyroid lobectomy in National hospital of Endocrinology enrolled. Of them, 235 patients underwent endoscopic lobectomy (EL) and 250 patients underwent conventional open lobectomy (OL). Results: The mean age of the patients was lower in the EL group (22,3 ± 3,6 years) than in the OL group (31,0 ± 5,8 years, P = 0,013). The ratio female/male was higher in the EL group than in the OL group (12/1 vs 7/1, P = 0,002). The operation time in the EL group was longer than in the OL group (58,4 ± 12,9 vs 42,3 ± 9 minutes, P = 0,014). However, there was no significant differences between EL group and OL group in tumor size (1,2 ± 0,2 vs 1,1 ± 0,6, P = 0,123), blood loss (12,5 ± 0,9 vs 13,6 ± 1,6ml, P = 0,457), postoperative hospital day (4,35 ± 1,4 vs 4,1 ± 1,1 days, P = 0,061), transient hypoparathyroidism (0,85% vs 0,8%, P = 0,431) or transient recurrent laryngeal nerve injury (1,27% vs 1,2%, P = 0,311). The drainage volume in the EL group was higher than in the OL group (75,5 ± 11,4 vs 54,1 ± 10,1ml, P = 0,046). Postoperative bleeding was similar in two groups (0,42% vs 0,4%, P = 0,457). There was no postoperative complications such as permanent recurrent laryngeal nerve injury, tracheal perforation, conversion to open surgery, chyle leak, surgical site infection. Patients in the EL group experienced with less pain than those in the OL group at 1 and 2 days after operation according to a visual analog scale (VAS) (P = 0,047). Wound site numbness is significantly less pronounced in the OL group (p = 0,032). Cosmetically, patients in the EL group were more satisfied than in OL group according to the questionnaire we used (P = 0,021). Conclusions: Endoscopic thyroidectomy for patients with early differentiated thyroid cancer is a safe and effective procedure with excellent cosmetic outcome. Postoperative hospital length stays and complications were similar to conventional open surgery.

scholarly journals Learning Curve for Using Intraoperative Neural Monitoring Technology of Thyroid Cancer

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Ning Zhao ◽  
Zhigang Bai ◽  
Changsheng Teng ◽  
Zhongtao Zhang
Keyword(s):  
Thyroid Cancer ◽  
Learning Curve ◽  
Recurrent Laryngeal Nerve ◽  
Nerve Injury ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Cancer Surgery ◽  
Monitoring Technology ◽  
Laryngeal Nerve Injury ◽  
Neural Monitoring

We investigated the learning curve for using intraoperative neural monitoring technology in thyroid cancer, with a view to reducing recurrent laryngeal nerve injury complications. Radical or combined radical surgery for thyroid cancer was performed in 82 patients with thyroid cancer and 147 recurrent laryngeal nerves were dissected. Intraoperative neural monitoring technology was applied and the “four-step method” used to monitor recurrent laryngeal nerve function. When the intraoperative signal was attenuated by more than 50%, recurrent laryngeal nerve injury was diagnosed, and the point and causes of injury were determined. The time required to identify the recurrent laryngeal nerve was 0.5–2 min and the injury rate was 2.7%; injuries were diagnosed intraoperatively. Injury most commonly occurred at or close to the point of entry of the nerve into the larynx and was caused by stretching, tumor adhesion, heat, and clamping. The groups are divided in chronological order; a learning curve for using intraoperative neural monitoring technology in thyroid cancer surgery was generated based on the time to identify the recurrent laryngeal nerve and the number of cases with nerve injury. The time to identify the recurrent laryngeal nerve and the number of injury cases decreased markedly with increasing patient numbers. There is a clear learning curve in applying intraoperative neural monitoring technology to thyroid cancer surgery; appropriate use of such technology aids in the protection of the recurrent laryngeal nerve.

scholarly journals Transoral Endoscopic Thyroidectomy via Vestibular Approach With 4 Trocars: A New Technique

2020 ◽  
pp. 014556132094335
Author(s):  
Duy Quoc Ngo ◽  
Toan Duc Tran ◽  
Quy Xuan Ngo ◽  
Quang Van Le
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Nerve Injury ◽  
Endoscopic Thyroidectomy ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Mental Nerve ◽  
Feasible Method ◽  
Laryngeal Nerve Injury ◽  
A New Technique ◽  
Vestibular Approach

Objectives: The objective of this study was to report the feasibility and safety of a novel 4-trocar approach for transoral endoscopic thyroidectomy via the vestibular. Methods: In this study, we first used 4 trocars via vestibular area to perform transoral endoscopic thyroidectomy. We reported the safety and surgical feasibility of transoral endoscopic thyroidectomy using a 4-trocar technique in our institute from February 1, 2020, to May 10, 2020. Results: Transoral endoscopic thyroidectomy via the vestibular approach using 4 trocars was carried out in 5 patients. No complications such as bleeding, mental nerve injury, recurrent laryngeal nerve injury, or hypoparathyroidism were reported. All patients were completely satisfied with the cosmetic results. Conclusions: Transoral endoscopic thyroidectomy with 4 trocars via vestibular approach is an effective and feasible method. Markedly, this technique can assist surgeons to expose and preserve both parathyroid glands and recurrent laryngeal nerve easily when performing transoral endoscopic thyroidectomy.

scholarly journals Endoscopic surgery for early differentiated thyroid cancer in Vietnam

2020 ◽  
Vol 10 (2) ◽  
Author(s):  
Hoàng Hiệp Phan ◽  
Keyword(s):  
Thyroid Cancer ◽  
Lymph Node ◽  
Recurrent Laryngeal Nerve ◽  
Total Thyroidectomy ◽  
Lymph Node Dissection ◽  
Differentiated Thyroid Cancer ◽  
Endoscopic Thyroidectomy ◽  
Recurrent Laryngeal Nerve Injury ◽  
Node Dissection ◽  
Laryngeal Nerve Injury

Tóm tắt Đặt vấn đề: Phẫu thuật nội soi (PTNS) điều trị bướu nhân tuyến giáp được chứng minh an toàn và hiệu quả. Tuy nhiên với ung thư tuyến giáp (UTTG) còn những tranh luận về kỹ thuật và kết quả ung thư học. Phương pháp nghiên cứu: Nghiên cứu tiến cứu 95 người bệnh (NB) ung thư tuyến giáp thể biệt hóa giai đoạn sớm, được phẫu thuật bằng phương pháp nội soi đường ngực - nách 2 bên, tạo khoang làm việc bằng bơm khí CO2, tại Bệnh viện Nội tiết Trung ương từ 01/2013 đến 9/2016. Kết quả: 95 NB ung thư tuyến giáp, 2 NB (2,1%) cắt 1 thùy tuyến giáp, 42 NB (44,2%) cắt toàn bộ tuyến giáp không nạo vét hạch, đây là những NB không có hạch khi thăm khám lâm sàng và cận lâm sàng. 51 NB (53,7%) đã có di căn ra hạch. Việc nạo vét hạch theo phương pháp chọn lọc các khoang được thực hiện lần lượt sau khi cắt thùy tuyến giáp mỗi bên. Thời gian mổ trung bình của cắt 1 thùy tuyến giáp là 47,5 phút, cắt toàn bộ tuyến giáp là 60 phút, thời gian mổ cắt toàn bộ tuyến giáp + nạo vét hạch 1 khoang, 2 khoang và 3 khoang lần lượt là 75/94/100 phút. Tính trung bình thời gian mổ cho cả 95 NB là 84,9 phút. Lượng máu mất trung bình là 16ml. Suy tuyến cận giáp tạm thời sau cắt toàn bộ tuyến giáp là 2,4% và sau cắt toàn bộ tuyến giáp kết hợp vét hạch cổ là 7,1%, tính chung suy tuyến cận giáp tạm thời là 5,3%. Không có suy tuyến cận giáp vĩnh viễn. Tổn thương thần kinh (TK) quặt ngược tạm thời sau cắt toàn bộ tuyến giáp là (4,8%), cắt toàn bộ tuyến giáp kết hợp vét hạch cổ là (5,6%), tính chung tổn thương liệt thần kinh quặt ngược tạm thời (5,3%). Có 1 trường hợp (TH) liệt dây thần kinh thanh quản (TKTQ) vĩnh viễn. Biến chứng bỏng da (1,1%), thủng khí quản (1,1%), chảy máu sau mổ có tỉ lệ thấp (2,1%). Không có trường hợp nào phải chuyển mổ mở, không có dò dưỡng chấp và nhiễm trùng sau mổ. Kết luận: Kỹ thuật nội soi có thể cắt tuyến giáp và nạo vét được hạch điều trị UTTG thể biệt hóa theo chỉ định. Kết quả phẫu thuật an toàn, ít biến chứng, đảm bảo được về mặt ung thư học. Abstract Introduction: Endoscopic surgery for benign thyroid nodule is a safe and effective procedure. However, there are many controversies in thyroid cancer about technique and oncologic outcome. Materials and Methods: Prospective research for all patients with early differentiated thyroid cancer who underwent endoscopic thyroidectomy using axilla-breast approach with CO2 insufflation at National hospital of Endocrinology from January, 2013 to September, 2016. Results: There were 95 patients included: 2 patients (2,1%) underwent thyroid lobectomy, 42 patients (44,2%) underwent total thyroidectomy without lymph node dissection because they had no detected lymph node in both clinical and para-clinical examinations, 51 patients underwent total thyroidectomy with lymph node dissection. Lymph node dissection was performed in selective compartments after one by one lateral thyroidectomy. Mean operative time for thyroid lobectomy was 47,5 minutes, for total thyroidectomy was 60 minutes, for total thyroidectomy with one , two and three compartments was 75, 94 and 100 minutes, respectively. Mean operative time for 95 patients was 84,9 minutes. Mean blood loss was 16ml. Transient hypoparathyroidism rate was 2,4% for total thyroidectomy and 7,1% for total thyroidectomy with lymph node dissection. Total temporary hypoparathyroidism was in 5,3%. There was no permanent hypoparathyroidism. Transient recurrent laryngeal nerve injury was 4,8% for total thyroidectomy and 5,6% for total thyroidectomy with lymph node dissection, total recurrent laryngeal nerve injury was 5,3%. 1 patient with permanent recurrent laryngeal nerve injury. 1 Complication of skin burn (1,1%), tracheal perforation (1,1%), low postoperative bleeding rate (2,1%). There was no conversion to open surgery, neither chyle leak, or postoperative infection. Conclusion: For properly selected patients with differentiated thyroid cancer, endoscopic thyroidectomy with or without lymph node dissection is a safe and effective procedure with low complication rate and oncologic adequacy. Keywords: Endoscopic thyroidectomy, Early differentiated thyroid cancer.

scholarly journals Thyroid surgery in 103 children in a single institution from 2000-2014

2020 ◽  
Vol 40 (4) ◽  
pp. 316-320
Author(s):  
Osama Ibrahim Almosallam ◽  
Ali Aseeri ◽  
Ahmed Alhumaid ◽  
Ali S. AlZahrani ◽  
Saif Alsobhi ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Recurrent Laryngeal Nerve ◽  
Nerve Injury ◽  
Thyroid Surgery ◽  
Radioactive Iodine ◽  
Pediatric Population ◽  
Recurrent Laryngeal Nerve Injury ◽  
Outcome Data ◽  
Laryngeal Nerve ◽  
Laryngeal Nerve Injury

ABSTRACT BACKGROUND: Data on thyroid surgery in children are scarce. OBJECTIVE: Analyze outcome data on thyroid surgery in a pediatric population. DESIGN: Medical record review. SETTING: Tertiary health care institution. PATIENTS AND METHODS: We collected demographic and clinical data on patients 18 years or younger who had thyroid surgery in the period 2000 to 2014. Descriptive data are presented. MAIN OUTCOME MEASURES: Indications for thyroidectomy, thyroid pathology, complications, length of stay, and radioactive iodine treatment and recurrences. SAMPLE SIZE: 103. RESULTS: Of 103 patients who underwent 112 thyroidectomy procedures, 80 (78%) were females and the mean age at operation was 13.2 years. and 17 (16%) were associated with multiple endocrine neoplasia type 2. There was no history of radiation exposure. Eighty-one patients (78%) had fine needle aspiration (FNA) which correlated with the final histopathology in 94% of cases. Sixty-six patients (64%) had malignant cancer (61 papillary), 44 (74.6%) of 59 patients who had neck dissection had lymph node metastasis and 7 (11%) had distant metastases to the lung. Procedures included total thyroidectomy (50%), hemithyroidectomy (17%), completion (31%), and subtotal thyroidectomy (2%). Twenty-three patients (22%) developed hypocalcemia (3 permanent) and 6 (5.8%) had unilateral recurrent laryngeal nerve injury (3 permanent). Patients were followed up for a mean duration of 71.7 months (median 60 months). Of 66 patients with thyroid cancer, 43 (65%) received radioactive iodine, and 10 (15%) had recurrence. CONCLUSION: Malignancy is the commonest indication for thyroid surgery in children and FNA is highly diagnostic. Hypocalcemia and recurrent laryngeal nerve injury are significant complications. The recurrence rate in thyroid cancer is 15%. LIMITATIONS: Retrospective. CONFLICT OF INTEREST: None.

scholarly journals Recurrent laryngeal nerve injury in thyroid surgery: a review

2012 ◽  
Vol 83 (1-2) ◽  
pp. 15-21 ◽  
Author(s):  
Nathan James Hayward ◽  
Simon Grodski ◽  
Meei Yeung ◽  
William R. Johnson ◽  
Jonathan Serpell
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Nerve Injury ◽  
Thyroid Surgery ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Laryngeal Nerve Injury

Observations of recurrent laryngeal nerve injury and recovery using a rat model

2009 ◽  
Vol 119 (8) ◽  
pp. 1644-1651 ◽  
Author(s):  
Belachew Tessema ◽  
Rick M. Roark ◽  
Michael J. Pitman ◽  
Philip Weissbrod ◽  
Sansar Sharma ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Nerve Injury ◽  
Rat Model ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Laryngeal Nerve Injury

scholarly journals A current view on recurrent laryngeal nerve injury in total thyroidectomy

2021 ◽  
Vol 28 (1) ◽  
pp. 7-12
Author(s):  
Lucian ALECU ◽  
◽  
Iulian SLAVU ◽  
Adrian TULIN ◽  
Vlad BRAGA ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Total Thyroidectomy ◽  
Nerve Injury ◽  
Unintentional Injury ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Current View ◽  
Pubmed Database ◽  
Laryngeal Nerve Injury ◽  
The Moment

Introduction: Recurrent laryngeal nerve damage during total thyroidectomy was, is, and probably will be in the near future the Achilles’ heel of total thyroidectomy. Material and method: To perform the research we used the PubMed database. The questions were conceived to respect the PICOS guidelines. The PRISMA checklist was used to filter the results. The search was structured following the words: „recurrent laryngeal nerve injury” AND „total thyroidectomy”. Results: A total of 60 papers were identified. We excluded 12 papers as they were duplicates. From the 48 papers left, another 4 could not be obtained. Another 3 papers from the 44 left were excluded due to the fact they were not written in English. One paper was excluded as the subject did not follow our research purpose. 40 papers were left for analysis and discussion. Conclusion: To prevent recurrent laryngeal nerve lesions, at the moment in the literature there is no consensus. Unintentional injury to the recurrent laryngeal nerve is predictable but not an avertible situation thus bilateral lesions still represent a dramatic situation across the world for the patients and the operating surgeon.

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