Step-by-step illustrated guide to central neck dissection

Background The incidence of thyroid carcinoma has been increasing worldwide and surgery is the primary treatment. Central compartment dissection of the neck is a very delicate procedure given the risks of recurrent laryngeal nerve injury and hypoparathyroidism. Methods This paper gives a detailed description of this surgical technique in a patient affected by papillary carcinoma of the thyroid gland, supported by highly representative iconographic materials from a tertiary department. Results A stepwise description is provided, along with high-quality pictures and specific tips and tricks. Although neck dissection is a well-codified procedure, the fine details of this surgical technique are not currently available and are still the prerogative of the expert surgeon. Conclusion The central neck compartment contains several vulnerable structures; damage to these structures would affect patients’ lives, possibly permanently. Anatomical knowledge and standardisation are needed for all surgeons, particularly new surgeons (such as residents) who cannot rely simply on experience.

Contemporary outcomes of aortic arch hypoplasia and coarctation repair in a tertiary paediatric cardiac surgery centre

Objectives: There are several studies reporting the outcomes of hypoplastic aortic arch and aortic coarctation repair with combination of techniques. However, only few studies reported of aortic arch and coarctation repair using a homograft patch through sternotomy and circulatory arrest with retrograde cerebral perfusion. We report our experience and outcomes of this cohort of neonates and infants. Methods: We performed retrospective data collection for all neonates and infants who underwent aortic arch reconstruction between 2015 and 2020 at our institute. Data are presented as median and inter-quartile range (IQR). Results: The cohort included 76 patients: 49 were males (64.5%). Median age at operation was 16 days (IQR 9–43.25 days). Median weight was 3.5 kg (IQR 3.10–4 kg). There was no 30 days mortality. Three patients died in hospital after 30 days (3.95%), neurological adverse events occurred in only one patient (1.32%) and recurrent laryngeal nerve injury was noted in four patients (5.26%). Only three patients required the support of extracorporeal membrane oxygenation (ECMO) with a median ECMO run of 4 days. Median follow-up was 35 months (IQR 18.9–46.4 months); 5 years survival was 93.42% (n = 71). The rate of re-intervention on the aortic arch was 9.21% (n = 7). Conclusion: Our experience shows excellent outcomes in repairing aortic arch hypoplasia with homograft patch under moderate to deep hypothermia with low in-hospital and 5 years mortality rates.

Edge Segmentation Algorithm‐Based Prevention of Recurrent Laryngeal Nerve Injury in Treatment of Thyroid Nodules Using Ultrasound Images

The study was aimed to explore the segmentation effects of different algorithms on thyroid nodule ultrasound images, so as to better protect the recurrent laryngeal nerve during thyroid surgery. Specifically, 186 patients with thyroid nodules were selected as the research objects. The segmentation performances of the gradient vector flow (GVF) Snake, Watershed, and Snake algorithms were compared from 6 aspects of image segmentation effects, pixel accuracy (PA), Intersection over Union (IOU) value, algorithm running time, postoperative recurrent laryngeal nerve injury, intraoperative bleeding volume, and postoperative drainage volume. It was found that the average PA value (0.954) and the IOU value (0.866) of the GVF Snake algorithm were obviously higher than those of the other two algorithms. The total incidence of recurrent laryngeal nerve injury based on the GVF Snake algorithm (4.69%) was obviously lower than that of the Snake algorithm (19.35%) and the watershed algorithm (16.13%). The bleeding volume and postoperative drainage volume based on the GVF Snake algorithm were less versus the other two algorithms ( P < 0.05 ). In conclusion, the GVF Snake algorithm demonstrates ideal segmentation effects, which is suggested in the treatment of thyroid nodules to better protect the recurrent laryngeal nerve.

Identification of recurrent laryngeal nerve: a dilemma in thyroid surgery

<p class="abstract"><strong>Background: </strong>Surgery of the thyroid gland is one of the most common surgical procedures performed. Recurrent laryngeal nerve injury is the most dreaded complication of thyroid surgery. Hence reducing intraoperative injury is of utmost importance. Routine dissection and identification of the recurrent nerve remain controversial.</p><p class="abstract"><strong>Methods:</strong> This study consists of 70 patients who underwent thyroid surgery. This study was conducted at our institute during the period of 2 years (2018-2020). Patients were evaluated and operated. Patients with thyroid diseases and normal vocal cords were allocated to two groups randomly; in group A the nerve was identified and in group B the nerve was not identified.</p><p class="abstract">Results: Most of the patients participating in the study were in the age group of 33-42 years. Male to female disease ratio was 0.13:1. In our study out of 70 patients who underwent thyroid surgery, 18 (25.71%) patients suffered from recurrent laryngeal nerve palsy. Amongst those 18 patients, 2 palsies (5.71%) were in Group A and 16 palsies (45.71%) were in Group B. Recurrent laryngeal nerve most commonly lied posterior to the inferior thyroid artery on both right (65.38%) as well as left side (45.45%). Most commonly injured recurrent laryngeal nerve was the right sided recurrent laryngeal nerve (77.77%).</p><p class="abstract"><strong>Conclusions:</strong> Careful dissection of nerve during thyroid surgery eliminates the risk of recurrent laryngeal nerve injury. A thorough knowledge of thyroid gland, recurrent laryngeal nerve and its anatomical relations and variations is of utmost importance in preserving the recurrent laryngeal nerve in thyroid surgery.</p>

Thyroid surgery during the COVID-19 pandemic: results from a systematic review

Purpose During the COVID-19 pandemic, elective thyroid surgery is experiencing delays. The problem is that the COVID-19 pandemic is ongoing. The research purposes were to systematically collect the literature data on the characteristics of those thyroid operations performed and to assess the safety/risks associated with thyroid surgery during the COVID-19 pandemic. Methods We used all the procedures consistent with the PRISMA guidelines. A comprehensive literature in MEDLINE (PubMed) and Scopus was made using ‘‘Thyroid’’ and “coronavirus” as search terms. Results Of a total of 293 articles identified, 9 studies met the inclusion criteria. The total number of patients undergoing thyroid surgery was 2217. The indication for surgery was malignancy in 1347 cases (60.8%). Screening protocols varied depending on hospital protocol and maximum levels of personal protection equipment were adopted. The hospital length of stay was 2–3 days. Total thyroidectomy was chosen for 1557 patients (1557/1868, 83.4%), of which 596 procedures (596/1558, 38.3%) were combined with lymph node dissections. Cross-infections were registered in 14 cases (14/721, 1.9%), of which three (3/721, 0.4%) with severe pulmonary complications of COVID-19. 377 patients (377/1868, 20.2%) had complications after surgery, of which 285 (285/377, 75.6%) hypoparathyroidism and 71 (71/377, 18.8%) recurrent laryngeal nerve injury. Conclusion The risk of SARS-CoV-2 transmission after thyroid surgery is relatively low. Our study could promote the restart of planned thyroid surgery due to COVID-19. Future studies are warranted to obtain more solid data about the risk of complications after thyroid surgery during the COVID-19 era.

Thyroidectomy for Graves’ Disease Predicts Postoperative Neck Hematoma and Hypocalcemia: A North American cohort study

Objective: Examine the association of Graves’ disease with the development of postoperative neck hematoma. Design: A cohort of patients participating in the Thyroid Procedure-Targeted Database of the National Surgical Quality Improvement Program from January 1, 2016 to December 31, 2018. Setting: A North American surgical cohort study. Methods: 17 906 patients who underwent thyroidectomy were included. Propensity score matching was performed to adjust for differences in baseline covariates. Multivariate logistic regression was used to ascertain the association between thyroidectomy for Graves’ disease and risk of postoperative adverse events within 30 days of surgery. The primary outcome was postoperative hematoma. Secondary outcomes were postoperative hypocalcemia and recurrent laryngeal nerve injury. Results: One-to-three propensity score matching yielded 1207 patients with mean age (SD) of 42.6 (14.9) years and 1017 (84.3%) female in the group with Graves’ disease and 3621 patients with mean age (SD) of 46.7 (15.0%) years and 2998 (82.8%) female in the group with indications other than Graves’ disease for thyroidectomy. The cumulative 30-day incidence of postoperative hematoma was 3.1% (38/1207) in the Graves’ disease group and 1.9% (70/3621) in other patients. The matched cohort showed that Graves’ disease was associated with higher odds of postoperative hematoma (OR 1.65, 95% CI 1.10-2.46) and hypocalcemia (OR 2.04, 95% CI 1.66-2.50) compared with other indications for thyroid surgery. There was no difference in recurrent laryngeal nerve injury among the 2 groups. Conclusions: Patients with Graves’ disease undergoing thyroidectomy are more likely to suffer from postoperative hematoma and hypocalcemia compared to patients undergoing surgery for other indications.