Status of Alternative Approaches for Thyroidectomy: Is There Any Evidence to Substitute in Place of Conventional Surgery?

Over the past 20 years, various alternative cervical minimally invasive (partly endoscopically assisted) and extracervical endoscopic (partly robot-assisted) approaches have been developed. All of these alternative access methods aim at optimizing the cosmetic results. In principle, the indication for the use of alternative access procedures does not differ from that for conventional surgery. Nonetheless, appropriate experience in traditional thyroid surgery and suitable patient selection, taking into account thyroid volumes and the underlying pathology, are important prerequisites. General contraindications for an alternative approach are large goiter with symptoms of compression, advanced thyroid carcinoma, recurrent interventions or previous radiotherapy in the operating area. The alternative surgical approaches to the thyroid can be divided into cervical minimally invasive, extracervical endoscopic (robot-assisted) and transoral procedures. This article gives an overview of the clinically used alternative approaches in thyroid surgery. The desire for an optimal cosmetic result should not be prioritized over patient safety. Only a few alternative procedures (minimally invasive video-assisted thyroidectomy, transaxillary robot-assisted thyroidectomy) can currently be viewed as a useful addition to conventional thyroid surgery, even when in responsible, experienced hands for a selected group of patients.

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Practical aspects of treatment of kidney cancer in a modern hospital: the evolution of surgical approaches

Cancer Urology ◽

10.17650/1726-9776-2018-14-2-44--53 ◽

2018 ◽

Vol 14 (2) ◽

pp. 44-53

Author(s):

S. A. Rakul ◽

K. V. Pozdnyakov ◽

R. A. Eloev ◽

N. A. Pliskachevskiy

Keyword(s):

Minimally Invasive ◽

Locally Advanced ◽

Renal Tumors ◽

Da Vinci Surgical System ◽

Surgical Approaches ◽

City Hospital ◽

Robot Assisted ◽

Nephron Sparing ◽

Analysis Of Results ◽

Modern Hospital

Objective: analysis of results of the outcomes of surgical treatment for renal tumors in the Saint Petersburg City Hospital No. 40 over the last 5 years and determination the trends.Materials and methods. The study included 293 patients that underwent 296 surgeries for renal tumors. The majority of patients (87.84 %) were diagnosed with localized cancer, whereas locally advanced and metastatic forms were detected in 4.39 and 7.77 % of cases respectively. We performed radical nephrectomy (RNE) or nephron sparing (NS) via open or minimally invasive route (videoendoscopic or robot-assisted surgery using the da Vinci Surgical System).Results. Organ-preserving surgeries were performed in 52.36 % of patients, RNE – in 47.64 % of patients; minimally invasive and open surgeries were conducted in 95.95 and 4.05 % respectively. In individuals with stage cT1a cancer, NS and RNE were performed in 87 and 13 % of cases respectively; in patients with stage cT1b cancer, NS and RNE were performed in 50.82 and 49.18 % of cases respectively. The majority (90.2 %) of patients with renal tumors >7 cm underwent minimally invasive surgeries, primarily RNE. The incidence of severe postoperative complications after NS and RNE was comparable: 5.75–8.06 and 1.67–15.38 % respectively (р = 0.64).Conclusion. Minimally invasive NS is the method of choice for stage сT1 tumors; however, in some cases, we should also consider it for tumors >7 cm. Videoendoscopic surgery is the most preferable option for these patients, whereas robot-assisted techniques should be used for organpreserving surgeries and RNE in difficult cases.

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Surgical approaches for minimally invasive thyroid surgery: review of the literature.

Cirugía Andaluza ◽

10.37351/2020313.6 ◽

2020 ◽

Vol 31 (3) ◽

pp. 248-255

Author(s):

E Gonzales Laguado ◽

JM Francos Martínez ◽

A García Barrasa ◽

P Moreno Llorente

Keyword(s):

Minimally Invasive ◽

Thyroid Surgery ◽

Surgical Approaches ◽

Review Of The Literature ◽

Minimally Invasive Thyroid Surgery

Resumen La tiroidectomía convencional es el procedimiento estándar y más frecuente para el tratamiento quirúrgico de la glándula tiroides. Con el afán de minimizar o eliminar la cicatriz cervical han surgido diferentes abordajes que han evolucionado con el avance de la tecnología. En las últimas décadas nuevos abordajes quirúrgicos se han desarrollado rápidamente, estos abordajes tienen buenos resultados estéticos, endocrinológicos y oncológicos. El objetivo de este artículo es realizar una revisión de la literatura acerca de los diferentes abordajes y accesos remotos para cirugía tiroidea mínimamente invasiva. Realizamos una búsqueda bibliográfica en la base de datos PubMed en junio del 2020 y se recuperaron todas las publicaciones en inglés sobre tiroidectomía mínimamente invasiva desde el año 1996. Se identificaron todos los artículos originales potenciales que se centraron principalmente en la tiroidectomía mínimamente invasiva y se revisaron los textos completos. Conclusión: la cirugía de tiroides ha tenido grandes cambios desde que se describió inicialmente hace casi un siglo. Las nuevas técnicas endoscópicas y robóticas mínimamente invasivas han aportado resultados cosméticos, disminución de dolor post operatorio y una morbimortalidad comparable a la tiroidectomía abierta. A pesar de estos avances, creemos que hay que mantener una actitud crítica, cuestionando y evaluando las indicaciones y contraindicaciones actuales para mejorar, desarrollar y obtener excelentes resultados en el futuro.

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Cost comparison of laparoscopic partial nephrectomy and robot-assisted laparoscopic partial nephrectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.7_suppl.402 ◽

2011 ◽

Vol 29 (7_suppl) ◽

pp. 402-402

Author(s):

R. L. O'Malley ◽

T. Kowalik ◽

M. H. Hayn ◽

T. B. Collins ◽

H. L. Kim ◽

...

Keyword(s):

Minimally Invasive ◽

Operating Room ◽

Partial Nephrectomy ◽

Laparoscopic Partial Nephrectomy ◽

Cost Comparison ◽

Oncologic Outcomes ◽

Perioperative Outcomes ◽

Surgical Approaches ◽

Robot Assisted ◽

Renal Masses

402 Background: Although nephron-sparing surgery is the standard of care for the treatment of small renal masses, partial nephrectomy (PN) remains under-utilized. A potential reason for the discrepancy is the desire for minimally invasive surgical approaches but limitation of the advanced laparoscopic techniques needed to perform PN. Robot-assisted surgery has eased the transition to minimally invasive prostate surgery and may also do so for PN, although some believe costs may be prohibitive. The purpose of this investigation was to quantify the cost of robot-assisted PN (RAPN) compared to laparoscopic PN (LPN). Methods: An institutional renal tumor database was used to identify consecutive patients with normal renal function who underwent RAPN for a localized renal mass by a single surgeon who had performed < 25 previously. The 35 RAPN patients were compared to the last 35 similar patients who underwent LPN by a surgeon who had performed > 150 previous LPNs. Surgical outcomes were compared. Because room time, length of stay and Cxs were similar, cost was compared based only on the total operating room charges (ORC). Total ORC included surgeon and anesthesia fees, as well as labor and supply costs. The depreciation of the robot was included in the ORC as a higher per unit time charge than for LPN. Data on charges were available for the first 29 RAPN patients which were then compared to the last 29 LPN patients. Results: Dates of operation ranged from October 2008 to July 2009 for LPN and January 2010 to August 2010 for RAPN. Patient and tumor characteristics were similar between groups, except tumor size, which was larger in the RAPN group (3.6 ± 1.8 cm vs. 2.7 ± 0.9 cm, p = 0.007). Cxs, surgical and oncologic outcomes were similar. Mean ORC (IQR) for the LPN group was $28,606 (4,796) and for the RAPN group was $30,874 (20,389) representing a difference of $2,269. If you subtract an additional $858 for the average yearly inflation rate (3%), the difference is $1,411. Conclusions: RAPN is a safe option with perioperative outcomes similar to those of LPN performed by an experienced surgeon. A cost difference of $2,269 per procedure as estimated using ORC may decrease as the experience of the operating room staff and surgeon increase. No significant financial relationships to disclose.

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P28 AN OPEN TRANSTHORACIC ESOPHAGECTOMY RESULTS IN HIGHER POSTOPERATIVE C-REACTIVE PROTEIN LEVELS COMPARED TO MINIMALLY INVASIVE ESOPHAGECTOMY

Diseases of the Esophagus ◽

10.1093/dote/doz092.28 ◽

2019 ◽

Vol 32 (Supplement_2) ◽

Author(s):

B Babic ◽

der Sluis P van ◽

I Gockel ◽

F Corvinus ◽

E Tagkalos ◽

...

Keyword(s):

Postoperative Complications ◽

Minimally Invasive ◽

Surgical Approach ◽

Minimally Invasive Esophagectomy ◽

Surgical Approaches ◽

C Reactive Protein ◽

Robot Assisted ◽

Invasive Esophagectomy ◽

Open Esophagectomy ◽

Reactive Protein

Abstract Aim With the introduction of minimally invasive access in centers for esophageal surgery, complications as well as mortality rates decreased. Laboratory tests are used routinely to screen patients for postoperative complications as early as possible. Still, the course of several laboratory parameters after esophagectomy following different surgical approaches has not been described yet and thus, reference values do not exist. Nowadays, the interpretation of inflammatory markers depends on the expertise of the medical staff. The aim of this study is to evaluate the development of CRP and leukocytes after thoracoabdominal esophagectomy following four different surgical approaches. Background & Methods 217 consecutive patients receiving a thoracoabdominal esophagectomy with either open, hybrid, totally minimally invasive or robot-assisted minimally invasive technique between 2008 and 2018 have been evaluated. Daily blood tests regarding C-reactive protein (CRP) and leukocytes have been performed daily in all patients. Data was collected prospectively and analyzed depending on the postoperative course and the surgical approach. Results There is a natural increase of leukocytes and CRP with peak values on the 2nd postoperative day (POD) after thoracoabdominal esophagectomy following all surgical approaches. The increase of inflammatory parameters is significantly higher after open esophagectomy on the first three postoperative days compared to the three minimally invasive procedures. Furthermore, postoperative CRP values > 200 mg/l on the 2nd postoperative day as well as an open esohagectomy are independently associated with postoperative complications. Conclusion The development of postoperative inflammatory laboratory parameters after esophagectomy is significantly depending on the surgical approach. Open esophagectomy results in significantly higher CRP and leukocyte values compared to the hybrid esophagectomy, minimally invasive esophagectomy and robot assisted minimally invasive esophagectomy. Open esophagectomy and an increase of CRP on the 2nd postoperative day above 200 mg/l are an independent positive predictor for postoperative complications in multivariate analysis.

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Short and long-term cosmesis of cervical thyroidectomy scars

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2016.0022 ◽

2016 ◽

Vol 98 (1) ◽

pp. 11-17 ◽

Cited By ~ 13

Author(s):

M Dordea ◽

SR Aspinall

Keyword(s):

Thyroid Gland ◽

Minimally Invasive ◽

Assessment Tools ◽

Current Evidence ◽

Surgical Approaches ◽

Significant Heterogeneity ◽

Conventional Surgery ◽

Scar Assessment ◽

Current Evidence Base

Introduction Multiple surgical approaches to the thyroid gland have been described via cervical or extracervical routes. Improved cosmesis, patient satisfaction, reduced pain (procedure dependent) and early discharge have all been reported for minimally invasive approaches with similar safety profiles and long-term outcomes to conventional surgery. This review summarises the current evidence base for improved cosmesis with minimally invasive cervical approaches to the thyroid gland compared with conventional surgery. Methods A systematic review was undertaken. The MEDLINE®, Embase™ and Cochrane databases were searched for relevant articles. Results A total of 57 papers thyroid papers were identified. Of those, 20 reported some form of cosmetic outcome assessment. There were 6 randomised controlled trials with 412 patients (evidence level 2B), 7 cohort studies with 3,073 patients (level 3B) and 7 non-comparative case series with 1,575 patients (level 4). There was significant heterogeneity between studies in terms of wound closure technique, timing of scar assessment and scar assessment scales (validated and non-validated). Most studies performed early scar assessments, some using non-validated scar assessment tools. Conclusions Assessment of cosmesis is complex and requires rigorous methodology. Evidence from healing/remodelling studies suggests scar maturation is a long-term process. This calls into question the value of early scar assessment. Current evidence does not support minimally invasive surgical approaches to the thyroid gland if improved long-term cosmesis is the goal.

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