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Yeo Kyu Youn - One of the best experts on this subject based on the ideXlab platform.
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endoscopic Thyroidectomy via bilateral axillo breast approach baba review of 512 cases in a single institute
Surgical Endoscopy and Other Interventional Techniques, 2012Co-Authors: June Young Choi, Yoo Seung Chung, Jun Ho Choe, Seok Won Kim, Ki Wook Chung, Kyu Eun Lee, Do Hoon Koo, Su Jin Kim, Jeong Hun Lee, Yeo Kyu YounAbstract:Various techniques for endoscopic Thyroidectomy have been introduced in the past decade, and the cosmetic superiority of these techniques has been universally acknowledged. We developed the endoscopic Thyroidectomy via bilateral axillo-breast approach (BABA) and have performed more than 500 operations. The aims of this study are to analyze the surgical outcomes and to evaluate the effectiveness and safety of BABA endoscopic Thyroidectomy. Between February 2004 and March 2008, 512 patients with thyroid diseases underwent BABA endoscopic Thyroidectomy. The criteria analyzed were clinicopathologic characteristics, types of operation, operation time, tumor–node–metastasis (TNM) stage on the basis of the 7th edition of the American Joint Committee on Cancer (AJCC), results after radioactive ablation therapy, and recurrence of disease in these patients. Of 512 patients, 397 had a malignant tumor and 115 had benign thyroid disease. Eight patients were diagnosed with Graves’ disease, and nine patients underwent completion Thyroidectomy. Three cases were subjected to open Thyroidectomy due to uncontrolled bleeding. Mean operation time was 151.2 ± 38.1 min for total and near-total Thyroidectomy, and 141.7 ± 50.1 min for subtotal Thyroidectomy and lobectomy. Regarding postoperative complications, transient hypocalcemia occurred in 31.1% of patients and permanent hypoparathyroidism occurred in 4.2% of patients. Transient hoarseness occurred in 20.3% of patients, and permanent vocal cord palsy occurred in 1.7%. Mean hospital stay after operation was 3.34 ± 0.8 days (range 3–7 days), and mean follow-up period was 57.1 ± 17.6 months (range 38.5–71.7 months). There were eight cases of recurrent thyroid carcinoma, and no mortality has occurred up to the present time. Endoscopic Thyroidectomy via bilateral axillo-breast approach is a safe and effective method that gives good surgical completeness, a low rate of postoperative complications and recurrence, and an excellent cosmetic result. Therefore, this method is a good choice for patients with surgical thyroid diseases.
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endoscopic Thyroidectomy for thyroid malignancies comparison with conventional open Thyroidectomy
World Journal of Surgery, 2007Co-Authors: Yoo Seung Chung, Jun Ho Choe, Kyung Ho Kang, Seok Won Kim, Ki Wook Chung, Kyoung Sik Park, Wonshik Han, Dongyoung Noh, Yeo Kyu YounAbstract:Endoscopic techniques have recently been applied to thyroid surgery. We developed the bilateral axillo-breast (BAB) approach for total Thyroidectomy. The aims of this study were to evaluate the completeness of this approach for total Thyroidectomy and to compare complications between endoscopic Thyroidectomy and conventional open Thyroidectomy. We analyzed 198 patients who underwent open Thyroidectomy and 103 patients who underwent endoscopic Thyroidectomy for papillary thyroid microcarcinoma between January 2003 and June 2006 at Seoul National University Hospital. The postoperative thyroglobulin (TG) level was used to assess the completeness of the two methods. Complications such as hypocalcemia or vocal cord palsy were also evaluated. The mean hospitalization period was 3.18 days following open Thyroidectomy and 3.04 days after endoscopic Thyroidectomy. The 3-month postoperative TG levels were <1.0 ng/ml in 90.4% of patients after open total Thyroidectomy and in 88.9% following endoscopic total Thyroidectomy. Transient hypocalcemia occurred in 17.7% and 25.2% of patients, respectively. Permanent hypocalcemia occurred in 4.5% and 1.0% of patients, respectively. Permanent vocal cord palsy frequencies were 0.5% and 0%, respectively. There were no significant differences in postoperative TG levels, hypocalcemia, or permanent vocal cord palsy. Transient vocal cord palsy occurred in 2.5% of patients after open Thyroidectomy and in 25.2% after endoscopic Thyroidectomy (p < 0.0001), but it disappeared within 3 months. Cosmetic results were excellent after endoscopic Thyroidectomy. The bilateral axillo-breast (BAB) approach for endoscopic Thyroidectomy shows insignificant postoperative complications, except transient vocal cord palsy, as well as good cosmetic results. It is also a feasible method for total Thyroidectomy. Therefore, the BAB approach for endoscopic total Thyroidectomy can be the surgical treatment of choice for selected cases of thyroid cancer.
Larry Shemen - One of the best experts on this subject based on the ideXlab platform.
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Thyroidectomy using the harmonic scalpel analysis of 105 consecutive cases
Otolaryngology-Head and Neck Surgery, 2002Co-Authors: Larry ShemenAbstract:OBJECTIVE: The purpose of this report was to evaluate the technical benefits, if any, of Thyroidectomy using the harmonic scalpel versus conventional Thyroidectomy. STUDY DESIGN: One hundred five consecutive patients underwent Thyroidectomy over 1 year with use of the harmonic scalpel. They were compared with a group of 20 patients who underwent Thyroidectomy 1 year earlier using conventional techniques. RESULTS: The incision length for those undergoing Thyroidectomy with the harmonic knife averaged 4.5 cm compared with 5.5 cm for the conventional Thyroidectomy group. The operating time for a hemiThyroidectomy averaged 50 minutes for the harmonic scalpel group versus 80 minutes for the conventional technique. The operating time for a total Thyroidectomy averaged 80 minutes for the harmonic scalpel group versus 120 minutes for the conventional Thyroidectomy group. CONCLUSION: The use of the harmonic scalpel in thyroid surgery offers several advantages over the conventional technique. The incision length is shorter and the operating time is reduced. Bleeding is negligible and complications are few. SIGNIFICANCE: The harmonic scalpel, whose use was pioneered in laparoscopic surgery, offers the thyroid surgeon the ability to safely and expeditiously control the feeding vessels through a limited field.
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Thyroidectomy using the harmonic scalpel analysis of 105 consecutive cases
Otolaryngology-Head and Neck Surgery, 2002Co-Authors: Larry ShemenAbstract:Objective: The purpose of this report was to evaluate the technical benefits, if any, of Thyroidectomy using the harmonic scalpel versus conventional Thyroidectomy. Study Design: One hundred five consecutive patients underwent Thyroidectomy over 1 year with use of the harmonic scalpel. They were compared with a group of 20 patients who underwent Thyroidectomy 1 year earlier using conventional techniques. Results: The incision length for those undergoing Thyroidectomy with the harmonic knife averaged 4.5 cm compared with 5.5 cm for the conventional Thyroidectomy group. The operating time for a hemiThyroidectomy averaged 50 minutes for the harmonic scalpel group versus 80 minutes for the conventional technique. The operating time for a total Thyroidectomy averaged 80 minutes for the harmonic scalpel group versus 120 minutes for the conventional Thyroidectomy group. Conclusion: The use of the harmonic scalpel in thyroid surgery offers several advantages over the conventional technique. The incision length is shorter and the operating time is reduced. Bleeding is negligible and complications are few. Significance: The harmonic scalpel, whose use was pioneered in laparoscopic surgery, offers the thyroid surgeon the ability to safely and expeditiously control the feeding vessels through a limited field. (Otolaryngol Head Neck Surg 2002;127:284-8.)
Ralph P Tufano - One of the best experts on this subject based on the ideXlab platform.
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comparative analysis of 2 robotic Thyroidectomy procedures transoral versus bilateral axillo breast approach
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2018Co-Authors: Young Jun Chai, Gianlorenzo Dionigi, Angkoon Anuwong, Jeremy D Richmon, Ralph P TufanoAbstract:BACKGROUND:The surgical outcomes of a single surgeon's initial cases of transoral robotic Thyroidectomy (TORT) were compared with the surgeon's initial cases of a bilateral axillo-breast approach (BABA) robotic Thyroidectomy. METHODS:The medical reports were retrospectively reviewed. The BABA robotic thyroidectomies were performed between 2008 and 2009, and TORTs were performed between 2012 and 2016. RESULTS:Each group comprised 50 patients. Operative time for total Thyroidectomy was shorter, the pain scores were lower, and hospital stays were shorter in the TORT group than in the BABA robotic Thyroidectomy group. There were no significant differences between groups in either vocal cord palsy or hypoparathyroidism rates. There were 9 cases of mental nerve injury in the first 12 cases of TORT, but none subsequently. CONCLUSION:The TORT procedure could be performed safely and showed comparable outcomes with BABA robotic Thyroidectomy in selected patients. Therefore, TORT may be an alternative approach for patients who prefer a scar-free Thyroidectomy.
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robotic total Thyroidectomy with modified radical neck dissection via unilateral retroauricular approach
Annals of Surgical Oncology, 2014Co-Authors: Hyung Kwon Byeon, Ralph P Tufano, Christopher F Holsinger, Hyo Jin Chung, Won Shik Kim, Yoon Woo Koh, Eun Chang ChoiAbstract:Background Traditionally, total Thyroidectomy was performed through an open transcervical incision; in cases where there was evident nodal metastasis, the conventional surgical approach was to extend the incision into a large single transverse incision to complete the required neck dissection. However, recent innovation in the surgical technique of Thyroidectomy has offered the opportunity to reduce the patient’s burden from these prominent surgical scars in the neck. Minimally invasive surgical techniques have been developed and applied by many institutions worldwide, and more recently, various techniques of remote access surgery have been suggested and actively applied.1, 2, 3, 4, 5, 6 Since the advent of robotic surgical systems, some have adopted the concept of remote access surgery into developing various robotic Thyroidectomy techniques. The more former and widely acknowledged robotic Thyroidectomy technique uses a transaxillary (TA) approach, which has been developed by Chung et al. in Korea.7,8 This particular technique has some limitations in the sense that accessing the lymph nodes of the central compartment is troublesome. Terris et al. realized some shortcomings of robotic TA Thyroidectomy, especially in their patients in the United States, and developed and reported the feasibility of robotic facelift Thyroidectomy.9, 10, 11, 12, 13 In cases of thyroid carcinomas with lateral neck node metastases, most abandoned the concept of minimally invasive or remote access surgery and safely adopted conventional open surgical methods to remove the tumor burden. However, Chung et al. have attempted to perform concomitant modified radical neck dissection (MRND) after robotic Thyroidectomy through the same TA port.14 This type of robot-assisted neck dissection (RAND) had some inherent limitations, due to fact that lymph nodes of the upper neck were difficult to remove. Over the past few years, we have developed a RAND via modified facelift (MFL) or retroauricular (RA) approach and reported the feasibility and safety of this technique.15, 16 Since then, we have actively applied such RAND techniques in various head and neck cancers. In our country, almost all cases of robotic total Thyroidectomy utilize the TA approach. According to the reports made by Terris et al., robotic facelift Thyroidectomy technique has been solely applied for ipsilateral hemiThyroidectomy. For total Thyroidectomy, Terris et al. performed the robotic surgery with bilateral RA incisions. Here, we intend to introduce our novel surgical method after successfully attempting simultaneous robotic total Thyroidectomy and RAND via a single RA approach without an axillary incision. To our knowledge, this is the first to report in the medical literature.
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safety of robotic Thyroidectomy approaches meta analysis and systematic review
Head and Neck-journal for The Sciences and Specialties of The Head and Neck, 2014Co-Authors: Nicole R Jackson, Ralph P Tufano, Lu Yao, Emad KandilAbstract:Background. This study compared the efficacy of robotic Thyroidectomy via a gasless, axillary approach with conventional cervical and endoscopic techniques by meta-analysis. Methods. Articles were identified from the following keyword searches: robotic/robot-assisted Thyroidectomy/thyroid surgery. Outcomes included operative time, hospital stay, complications, and cosmetic satisfaction after surgery. Between-group outcome differences were calculated using random-effects models. Results. In all, 87 publications were identified and 9 studies met inclusion criteria, totaling 2881 patients, 1122 of whom underwent robotic Thyroidectomy. Those who underwent robotic surgery reported greater cosmetic satisfaction, with a pooled net mean difference of � 1.35 (95% confidence interval (CI): � 1.69, � 1.09). Robotic approach operative time was longer than that of the conventional approach (95% CI: 29.23, 54.87), with a trend to be shorter than the endoscopic approaches. Robotic surgery had similar risks to open and endoscopic approaches. Conclusions. Our meta-analysis suggests that robotic Thyroidectomy is as safe, feasible, and efficacious as conventional cervical and endoscopic Thyroidectomy, showing superior cosmetic satisfaction than that of conventional Thyroidectomy. V C 2013 Wiley Periodicals, Inc. Head Neck 36: 137-143, 2014
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postoperative hypocalcemia after Thyroidectomy for graves disease
Thyroid, 2010Co-Authors: Catherine E Pesce, Zita Shiue, Hua Ling Tsai, Christopher B Umbricht, Ralph P Tufano, Alan P B Dackiw, Jeanne Kowalski, Martha A ZeigerAbstract:Background: It is believed that patients who undergo Thyroidectomy for Graves' disease are more likely to experience postoperative hypocalcemia than patients undergoing total Thyroidectomy for other indications. However, no study has directly compared these two groups of patients. The aim of this study was to determine whether there was an increased incidence or severity of postoperative hypocalcemia in patients who underwent Thyroidectomy for Graves' disease. Methods: An institutional review board-approved database was created of all patients who underwent Thyroidectomy from 1998 to 2009 at the Johns Hopkins Hospital. There were a total of 68 patients with Graves' disease who underwent surgery. Fifty-five patients who underwent total Thyroidectomy were randomly selected and served as control subjects. An analysis was conducted that examined potential covariates for postoperative hypocalcemia, including age, gender, ethnicity, preoperative alkaline phosphatase level, size of goiter, whether parathyroid ti...
Yong Wang - One of the best experts on this subject based on the ideXlab platform.
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comparison of transoral endoscopic Thyroidectomy vestibular approach total endoscopic Thyroidectomy via areola approach and conventional open Thyroidectomy a retrospective analysis of safety trauma and feasibility of central neck dissection in the treatment of papillary thyroid carcinoma
Surgical Endoscopy and Other Interventional Techniques, 2020Co-Authors: Haiqing Sun, Haitao Zheng, Xiaojie Wang, Qingdong Zeng, Ping Wang, Yong WangAbstract:Background Transoral endoscopic Thyroidectomy vestibular approach (TOETVA) and total endoscopic Thyroidectomy via areola approach (ETA) are commonly used endoscopic Thyroidectomy approaches. This study compares the effectiveness of these approaches with conventional open Thyroidectomy (COT) in terms of safety, associated trauma, and feasibility of central neck dissection in the treatment of papillary thyroid carcinoma (PTC).
Yoo Seung Chung - One of the best experts on this subject based on the ideXlab platform.
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endoscopic Thyroidectomy via bilateral axillo breast approach baba review of 512 cases in a single institute
Surgical Endoscopy and Other Interventional Techniques, 2012Co-Authors: June Young Choi, Yoo Seung Chung, Jun Ho Choe, Seok Won Kim, Ki Wook Chung, Kyu Eun Lee, Do Hoon Koo, Su Jin Kim, Jeong Hun Lee, Yeo Kyu YounAbstract:Various techniques for endoscopic Thyroidectomy have been introduced in the past decade, and the cosmetic superiority of these techniques has been universally acknowledged. We developed the endoscopic Thyroidectomy via bilateral axillo-breast approach (BABA) and have performed more than 500 operations. The aims of this study are to analyze the surgical outcomes and to evaluate the effectiveness and safety of BABA endoscopic Thyroidectomy. Between February 2004 and March 2008, 512 patients with thyroid diseases underwent BABA endoscopic Thyroidectomy. The criteria analyzed were clinicopathologic characteristics, types of operation, operation time, tumor–node–metastasis (TNM) stage on the basis of the 7th edition of the American Joint Committee on Cancer (AJCC), results after radioactive ablation therapy, and recurrence of disease in these patients. Of 512 patients, 397 had a malignant tumor and 115 had benign thyroid disease. Eight patients were diagnosed with Graves’ disease, and nine patients underwent completion Thyroidectomy. Three cases were subjected to open Thyroidectomy due to uncontrolled bleeding. Mean operation time was 151.2 ± 38.1 min for total and near-total Thyroidectomy, and 141.7 ± 50.1 min for subtotal Thyroidectomy and lobectomy. Regarding postoperative complications, transient hypocalcemia occurred in 31.1% of patients and permanent hypoparathyroidism occurred in 4.2% of patients. Transient hoarseness occurred in 20.3% of patients, and permanent vocal cord palsy occurred in 1.7%. Mean hospital stay after operation was 3.34 ± 0.8 days (range 3–7 days), and mean follow-up period was 57.1 ± 17.6 months (range 38.5–71.7 months). There were eight cases of recurrent thyroid carcinoma, and no mortality has occurred up to the present time. Endoscopic Thyroidectomy via bilateral axillo-breast approach is a safe and effective method that gives good surgical completeness, a low rate of postoperative complications and recurrence, and an excellent cosmetic result. Therefore, this method is a good choice for patients with surgical thyroid diseases.
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endoscopic Thyroidectomy for thyroid malignancies comparison with conventional open Thyroidectomy
World Journal of Surgery, 2007Co-Authors: Yoo Seung Chung, Jun Ho Choe, Kyung Ho Kang, Seok Won Kim, Ki Wook Chung, Kyoung Sik Park, Wonshik Han, Dongyoung Noh, Yeo Kyu YounAbstract:Endoscopic techniques have recently been applied to thyroid surgery. We developed the bilateral axillo-breast (BAB) approach for total Thyroidectomy. The aims of this study were to evaluate the completeness of this approach for total Thyroidectomy and to compare complications between endoscopic Thyroidectomy and conventional open Thyroidectomy. We analyzed 198 patients who underwent open Thyroidectomy and 103 patients who underwent endoscopic Thyroidectomy for papillary thyroid microcarcinoma between January 2003 and June 2006 at Seoul National University Hospital. The postoperative thyroglobulin (TG) level was used to assess the completeness of the two methods. Complications such as hypocalcemia or vocal cord palsy were also evaluated. The mean hospitalization period was 3.18 days following open Thyroidectomy and 3.04 days after endoscopic Thyroidectomy. The 3-month postoperative TG levels were <1.0 ng/ml in 90.4% of patients after open total Thyroidectomy and in 88.9% following endoscopic total Thyroidectomy. Transient hypocalcemia occurred in 17.7% and 25.2% of patients, respectively. Permanent hypocalcemia occurred in 4.5% and 1.0% of patients, respectively. Permanent vocal cord palsy frequencies were 0.5% and 0%, respectively. There were no significant differences in postoperative TG levels, hypocalcemia, or permanent vocal cord palsy. Transient vocal cord palsy occurred in 2.5% of patients after open Thyroidectomy and in 25.2% after endoscopic Thyroidectomy (p < 0.0001), but it disappeared within 3 months. Cosmetic results were excellent after endoscopic Thyroidectomy. The bilateral axillo-breast (BAB) approach for endoscopic Thyroidectomy shows insignificant postoperative complications, except transient vocal cord palsy, as well as good cosmetic results. It is also a feasible method for total Thyroidectomy. Therefore, the BAB approach for endoscopic total Thyroidectomy can be the surgical treatment of choice for selected cases of thyroid cancer.
