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thyroidectomy: Frequency and Indications in the General Surgery Department of the Hôpital National Ignace Deen/CHU de Conakry

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International Journal of Otolaryngology and Head & Neck Surgery 2024年第3期13卷 157-167页

作者： Mamadou Sakoba Barry Mamadou Mouctar Ramata Diallo Houssein Fofana Vignin Baudouin Kpossou Boubacar Barry Aboubacar Touré Aissatou Taran Diallo General Surgery Department H&#244pital National Ignace Deen/CHU de Conakry Conakry Guinea Faculté des Sciences and Techniques de la Sant&#233-Universit&#233 Gamal Abdel Nasser de Conakry Conakry Guinea ENT Department Mamou Regional Hospital Mamou Guinea

Introduction: thyroidectomy is a surgical procedure to remove all or part of the thyroid gland. The aim of this study was to report the results of thyroidectomy in the general surgery department of the Hôpital national Ignace Deen/CHU de Conakry. Methodology: This was a retrospective study, of seven (07) years (January 1, 2016 - August 31, 2023), in the General Surgery Department of the Ignace Deen National Hospital-CHU in Conakry. We included all records of patients admitted and operated on for thyroidectomy and with up-to-date medical records. The variables were epidemiological, clinical and therapeutic. Results: During the study period, we recorded 3221 cases of surgery, including 40 thyroidectomies (1.24% of cases). The average age was 42.4 years. Women were the most represented, with a sex ratio of 0.16. The reason for consultation was anterior cervical swelling in 86% (n = 25) of cases, followed by signs of cervical compression 21% (n = 6) and signs of thyrotoxicosis 31% (n = 9). Indications for thyroidectomy were dominated by homogeneous goitres in 69% (n = 20) of cases, basedow’s disease in 20.7% (n = 6) and nodular goitres in 6.9% (n = 2) of cases. The surgical procedures were lobo-isthmectomies in 72.4% (n = 21), subtotal thyroidectomies 13.8% (n = 4), total thyroidectomies 10.3% (n = 3). Postoperative follow-up was straightforward in 69% (n = 20). Complications included haemorrhage in 20.7% (n = 6) and recurrence in 6.9% (n = 2). The average hospital stay was 7 days. Conclusion: thyroidectomy is a relatively frequent surgical procedure in our department. Indications are dominated by homogeneous goitres. Morbidity is related to hemorrhage. Rigorous hemostasis could improve the quality of thyroidectomy.

关键词： thyroidectomy Indication Ignace Deen

Treatment duration of wrist-ankle acupuncture for relieving post-thyroidectomy pain:A randomized controlled trial

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Journal of Integrative Medicine 2023年第2期21卷 168-175页

作者： Xin-rui Han Wei Yue Hui-chao Chen Wei He Jiang-he Luo Shan-xia Chen Na Liu Ming Yang Department of Nursing Chengdu Integrated TCM&Western Medicine HospitalSichuan 610041Sichuan ProvinceChina School of Nursing Guangzhou University of Chinese MedicineGuangzhou 510006Guangdong ProvinceChina Department of Nursing Guangdong Provincial Hospital of Traditional Chinese MedicineGuangzhou 510120Guangdong ProvinceChina Department of General Surgery Guangdong Provincial Hospital of Traditional Chinese MedicineGuangzhou 510120Guangdong ProvinceChina Department of Gynecology and Obstetrics Guangzhou Women and Children’s Medical CenterGuangzhou 510120Guangdong ProvinceChina

Background Treatment duration of wrist-ankle acupuncture(WAA)is uncertain for post-thyroidectomy pain relief.Objective This study evaluated the effect of different WAA treatment duration on post-operative pain relief and other discomforts associated with thyroidectomy.Design,setting,participants and intervention This randomized controlled trial was conducted at a single research site in Guangzhou,China.A total of 132 patients receiving thyroidectomy were randomly divided into the control group(sham WAA,30 min)and three intervention groups(group 1:WAA,30 min;group 2:WAA,45 min;group 3:WAA,60 min),with group allocation ratio of 1:1:1:1.Acupuncture was administered within 1 hour of leaving the operating room.Outcomes and measures Primary outcome was patients’pain at the surgical site assessed by visual analogue scale(VAS)at the moment after acupuncture treatment(post-intervention).Secondary outcomes included the patients’pain VAS scores at 6,12,24,48 and 72 h after the thyroidectomy,the 40-item Quality of Recovery(QoR-40)score,the grade of post-operative nausea and vomiting(PONV),and the use of additional analgesic therapy.Results The adjusted mean difference(AMD)in VAS scores from baseline to post-intervention in group 1 was-0.89(95%confidence interval[CI],-1.02 to-0.76).The decrease in VAS score at post-intervention was statistically significant in group 1 compared to the control group(AMD,-0.43;95%CI,-0.58 to-0.28;P<0.001),and in groups 2 and 3 compared to group 1(group 2 vs group 1:AMD,-0.65;95%CI,-0.81 to-0.48;P<0.001;group 3 vs group 1:AMD,-0.66;95%CI,-0.86 to-0.47;P<0.001).The VAS scores in the four groups converged beyond 24 h after the operation.Fewer patients in group 2 and group 3 experienced PONV in the first 24 h after operation.No statistical differences were measured in QoR-40 score and the number of patients with additional analgesic therapy.Conclusion Compared with the 30 min intervention,WAA treatment with longer needle retention time(45 or 60 min)had an advantage in pain relief within 6 h after su

关键词： thyroidectomy Thyroid tumor Wrist-ankle acupuncture Post-operative pain Randomized controlled trial

Complications associated with energy-based devices during thyroidectomy from 2010–2020

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2023年第1期9卷 35-44页

作者： Esther Lee Jane Y.Tong Luke J.Pasick Daniel A.Benito Arjun Joshi Punam G.Thakkar Joseph F.Goodman Division of Otolaryngology-Head and Neck Surgery George Washington University School of Medicine&amp Health SciencesWashingtonDCUSA Western University of Health Sciences PomonaCAUSA Department of Otolaryngology-Head and Neck Surgery Drexel University College of MedicinePhiladelphiaPAUSA Department of Otolaryngology-Head and Neck Surgery University of Miami Miller School of MedicineMiamiFLUSA

Objective:Harmonic Focus(Ethicon,Johnson and Johnson,Cincinnati,OH,USA),LigaSure Small Jaw(Medtronic,Covidien Products,Minneapolis,MN,USA),and Thunderbeat Open Fine Jaw(Olympus,Japan)are electrosurgical instruments used widely in head and neck surgery.The study aims to compare device malfunctions,adverse events to patients,operative injuries,and interventions related to Harmonic,LigaSure,and Thunderbeat use during thyroidectomy.Methods:The US Food and Drug Administration's Manufacture and User Facility Device Experience(MAUDE)database was queried for adverse events associated with Harmonic,LigaSure,and Thunderbeat from January 2005 to August 2020.Data were extracted from reports pertaining to thyroidectomy.Results:Of the 620 adverse events extracted,394(63.5%)involved Harmonic,134(21.6%)LigaSure,and 92(14.8%)Thunderbeat.The reported device malfunctions most frequently associated with Harmonic was damage to the blade(110(27.9%)),LigaSure was inappropriate function(47(43.1%)),Thunderbeat was damage to the tissue or Teflon pad(27(30.7%)),respectively.Burn injury and incomplete hemostasis were the most commonly reported adverse events.The operative injury reported most frequently when using Harmonic and LigaSure was burn injury.No operator injuries were reported with Thunderbeat use.Conclusion:The most frequently reported device malfunctions were damage to the blade,inappropriate function,and damage to the tissue or Teflon pad.The most frequently reported adverse events to patients was a burn injury and incomplete hemostasis.Interventions aimed at improving physician education may help reduce adverse events attributed to improper use.

关键词： Adverse events Harmonic LigaSure Manufacture and User Facility Device Experience Patient safety Quality Thunderbeat thyroidectomy

Three-port transoral robotic thyroidectomy without axillary incision:A preliminary report of 20 cases in China

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2023年第2期9卷 138-143页

作者： Bin Zhang Bikash Rai Kuang-yu Fei Zong-hui Han Michelle Savu Key Laboratory of Carcinogenesis and Translational Research(Ministryof Education) Department of Head andNeck SurgeryPeking University Cancer Hospital and InstituteBeijingChina Department of Surgery Beijing United Family HospitalBeijingChina

Objective:Transoral scarless thyroid surgery has proven to be a popular alternative to traditional approaches.Transoral robotic thyroidectomy(TORT)has been reported using ports on the lower lip and axilla.Avoiding axillary incision can further reduce scars on the armpit.Here,we present our preliminary data from the initial 20 consecutive patients to explore the feasibility of three-port TORT without axillary incision.Methods:From September 2017 to June 2019,we performed TORT at Beijing United Family Hospital using three intraoral ports without axillary incision via the da Vinci Si system with three robotic arms.The outcomes of the procedure were retrospectively reviewed.Results:Among 20 patients(mean age 30±7 years;mean tumor size 1.64±0.96 cm),16 patients underwent unilateral thyroid lobectomy and four had total thyroidectomy with or without central neck dissection.Eighteen patients had papillary thyroid carcinomas(PTC),one had a follicular thyroid carcinoma,and one had a thyroid adenoma.The mean surgical time was 221±68 min.The mean number of retrieved central lymph nodes in the PTC patients was 5.6±5.There was no permanent vocal cord palsy or hypocalcemia postoperatively.One patient had transient vocal cord palsy,which resolved within 1 week.Paresthesia of the lower lip and the chin was observed in nine patients,and one patient had a first-degree burn of the skin flap due to the lens.Conclusion:Three-port TORT without axillary incision is feasible for selected patients and would be a potential alternative for remote-access thyroid surgery to avoid leaving scars on the neck or the armpit.

关键词： three port thyroid carcinoma thyroidectomy transoral robotic

Comparison of cosmetic outcomes between remote-access and conventional thyroidectomy:A review of the current literature

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2023年第1期9卷 1-8页

作者： Anna Kasouli Eleftherios Spartalis Alexios Giannakodimos Gerasimos Tsourouflis Dimitrios Dimitroulis Nikolaos I.Nikiteas Hellenic Minimally Invasive and Robotic Surgery(MIRS)Study Group Medical School AthensNational and Kapodistrian University of AthensAthensGreece 2nd Department of Propaedeutic Surgery Medical SchoolNational and Kapodistrian University of AthensAthensGreece

Objective:The pursuit of an esthetically pleasing scar following open thyroid surgery has led to the development of endoscopic thyroidectomy through remote incisions placed in several locations outside the neck.The objective of this study is to review the recent literature and compare the incision site appearance and patient satisfaction with the cosmetic outcome after extracervical and conventional thyroidectomy.Methods:The English literature published since 2010 was searched through the PubMed/Medline database for studies comparing the cosmetic outcomes between remote-access endoscopic and conventional thyroidectomy using a form of scar assessment scale.Results:A total of 9 relevant papers fulfilled the eligibility criteria including 1486 patients.Among them,595 patients underwent endoscopic thyroidectomy through several remote-access approaches and 891 patients were assigned to the conventional group.Only one randomized-controlled trial was identified,whereas among the rest,four were prospective and four were retrospective nonrandomized cohorts.Regarding the extracervical modifications performed in the endoscopic groups,the axillary approach was performed in three studies and the breast approach in four studies,while the retroauricular facelift technique and the transoral vestibular method were applied in one study,respectively.Conclusions:Evaluation of the wound appearance and patient satisfaction with the cosmetic outcome at various time points during the follow-up highlighted the superiority of the extracervical approaches over the conventional cervicotomy.Considering these findings,remote-access techniques could possibly be the ideal surgical method for patients with high esthetic requirements,providing an excellent appearance of the thoroughly exposed neck.

关键词： esthetic cosmesis cosmetic cosmetic results incision scar thyroidectomy

Childhood Papillary Thyroid Carcinoma: A Case Report

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Case Reports in Clinical Medicine 2024年第4期13卷 108-114页

作者： Alma Al Mansour Hayder Makki Hamadi Mahmoud Elshafey Mohamed Maryam Alkhatry Alqassemi Hospital Emirates Health Services Sharjah UAE Ibrahim Bin Hamad Obaidulla Hospital Ras Al Khaimah UAE

Background: Thyroid cancer is a rare disease yet the most common endocrine malignancy in pediatrics. Unlike adult patients, children with thyroid nodules typically don’t complain of pain, soreness, or difficulty swallowing. Additionally, using the recommended therapy for adults to treat paediatrics is not appropriate. There is an unmet need for updated unique guidelines for the management of papillary thyroid carcinoma (PTC) in paediatrics and adolescents. Case Report: A 12-year-old girl had an atypical presentation of metastatic PTC in lymph nodes. She was treated initially with hemi-thyroidectomy, followed by total thyroidectomy. A multidisciplinary team followed her up till successful results were found. Conclusion: Due to the difference in pathophysiology between thyroid tumors in children and adults, a unique approach to PTC management is to be implemented. Further trials are required for a better understanding of risk factors, the likelihood of recurrence, and the long-term side effects of the chosen management plan.

关键词： Papillary Thyroid Carcinoma Childhood thyroidectomy Case Report

Endoscopic thyroidectomy： an evidence-based research on feasibility, safety and clinical effectiveness

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Chinese Medical Journal 2008年第20期121卷 2088-2094页

作者： CHEN Xiao-dong PENG Bing GONG Ri-xiang WANG Li LIAO Bo LI Chun-lin Department of General Surgery West China Hospital Sichuan University Chengdu Sichuan 610041 China Department of Evidence-Based Medicine and Clinical Epidemiology West China Hospital Sichuan University Chengdu Sichuan 610041 China

Background The feasibility and safety of endoscopic thyroidectomy were evaluated by an approach of systematic review of published studies in the past decade.Methods A database searching was performed on MEDLINE, Cochrane Database of Systematic Reviews, American College of Physicians Journal Club, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials. Both comparative and non-comparative studies about endoscopic thyroidectomy were selected and analyzed. For the comparative studies, RevMan 4.2 was used for statistical analysis; and for the non-comparative studies, data analysis was performed by SPSS 13.0.Results Seven comparative studies involving 367 patients （video-assisted thyroidectomy （VAT）, 174 patients; conventional thyroidectomy （CT）, 193 patients） were included in VAT-CT group. Age, gender, operative types, and pathological diagnosis were similar. Compared with CT, the mean operative time for VAT was significantly longer （VAT, 80.0 minutes; CT, 61.9 minutes, P 〈0.01）, but the postoperative hospital stay was shorter （VAT, 1.7 days; CT, 2.5 days, P 〈0.01）. The complication rate for VAT was 6.9%, while that for CT was 9.3% （P=0.35）. Three studies analyzed the postoperative pain and cosmetic evaluation, and indicated that the VAT group was superior to the CT group, but there was no significant difference after a meta-analysis. Three comparative studies involving 273 patients （totally endoscopic thyroidectomy （TET）, 145 patients; CT, 128 patients） were included in TET-CT group and the results generally resembled that of VAT-CT group. There were 18 and 14 non-comparative studies reporting the results of VAT and TET, respectively. The mean operative time for VAT was 76.8 minutes compared with 135.8 minutes for TET. The postoperative hospital stay was 1.8 and 3.8 days for VAT and TET respectively. The rates of conversion to open surgery for VAT and TET were similar （VAT, 2.8%; TET, 3.9%, P=0.105）. The complication rate for VAT was 8.6%, while that for TET was 3.5% （P 〈0.01

关键词： minimally invasive surgery endoscopy video-assisted surgery thyroidectomy systematic review

Transoral endoscopic thyroidectomy with central neck dissection：experimental studies on human cadavers

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Chinese Medical Journal 2014年第6期127卷 1067-1070页

作者： Guo Peiyi Tang Zhiping Ding Zihai Chu Guoliang Yao Huosheng Pan Tao Wang Huaqiao Department of Orthopedics Sixth Affiliated Hospital Sun Yat-sen University Guangzhou Guangdong 510655 China Department of General Surgery Zhongshan Boai Hospital of Southern Medical University Zhongshan Guangdong 528400 China Department of Anatomy Southern Medical University Guangzhou Guangdong 510515 China Department of Anatomy Zhongshan School of Medicine Sun Yat-sen University Guangzhou Guangdong 510080 China

Background With the development of natural orifice trans-luminal endoscopic surgery, studies on transoral video-assistedthyroidectomy in preclinical experiments （e.g., human anatomy and animal trials） were progressing gradually. From 2009to 2011, embalmed human cadavers were dissected to define the anatomical location, surgical planes, and related neuraland vascular structures to create a safe transoral access to the front cervical spaces. Recently, experimental transoralendoscopic thvroidectomv was performed to verify the feasibility of this approach on 15 fresh specimens.

关键词： transoral endoscopic thyroidectomy central neck region video-assisted surgery

Potential protection of indocyanine green on parathyroid gland function during near-infrared laparoscopic-assisted thyroidectomy: A case report and literature review

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World Journal of Clinical Cases 2020年第21期8卷 5480-5486页

作者： Shu-Jia Peng Ping Yang Yan-Ming Dong Lin Yang Zhen-Yu Yang Xi-E Hu Guo-Qiang Bao Department of General Surgery Tangdu HospitalAir Force Military Medical UniversityXi’an 710032Shannxi ProvinceChina

BACKGROUND In recent decades,significant advances have been made in protecting the parathyroid glands and recurrent laryngeal nerves during thyroidectomy.However,reliable and convenient technical means are still lacking.In this study,the reliability,safety and feasibility of near-infrared(NIR)laparoscopyassisted thyroid lobectomy with isthmectomy and prophylactic central lymph node dissection(CLND)were reported.CASE SUMMARY A 63-year-old female patient with a free previous medical history,was admitted to our department due to multiple thyroid nodules.Ultrasonic examination suggested diffuse thyroid changes and one thyroid nodule in the right upper lobe with the largest diameter of 1.5 cm adjacent to the trachea and Breast Imaging Reporting and Data System grade 4B.Imaging examination of the neck showed no obvious enlarged lymph nodes.Fine needle aspiration biopsy suggested a papillary thyroid carcinoma.Combined with thyroid function examination,the patient was diagnosed with papillary thyroid carcinoma and Hashimoto's thyroiditis.Considering the risk of invading the capsule and the patient's extreme anxiety,a right thyroid lobectomy with isthmectomy and prophylactic CLND was planned.No significant abnormalities were found during preoperative examinations,except for an increased thyroid stimulating hormone level.The patient underwent NIR laparoscopy-assisted thyroid lobectomy with isthmectomy and prophylactic CLND.During the operation,two right parathyroid glands(PGs)adjacent to the thyroid gland capsule and the right recurrent laryngeal nerve(RLN)were examined by indocyanine green(ICG)fluorescence using a NIR fluorescence camera,and the PGs and RLN were reliably preserved.Considering the ICG-positive PG,prophylactic CLND was performed.The postoperative parathyroid hormone level was in the normal range and no significant hypocalcemia symptoms were observed.CONCLUSION During NIR laparoscopy-assisted thyroidectomy,ICG fluorescence may aid PG identification and protection.

关键词： Indocyanine green Near-infrared laparoscopy Carbon nanoparticles Hypoparathyroidism thyroidectomy Case report