With increasing interest in humanitarian surgical efforts, numerous opportunities for specialized mission trips have developed. Extreme short-term surgical “blitzes” of specialist teams have offered much-needed surgical care but lack efforts for patient continuity and local sustainability. We sought to define characteristics that aid in the long-term success of short-term international surgical missions to better apply this insight toward future dedicated humanitarian endocrine surgical efforts.

A broad search engine review identified 1,954 reports of medical and surgical missions. One hundred and sixty-six of these abstracts involved surgical missions from 2009 to 2014 with 24 articles including details of specific mission trips. We identified factors deemed essential for improving patient care and affecting local infrastructure for longterm sustainability and included our prospective experience with an endocrine surgery-specific mission trip for comparison.

Of the 24 articles reviewed, missions went to Africa (9), North America (8), South America (5), and Asia (5). Factors for mission sustainability and success included the following: (a) ability to educate local physicians and trainees, (b) multiple return trips to the same location, and (c) formal pre-mission planning and site visits. Emerging interest is on optimizing patient outcomes and cost-effectiveness.

Short-term surgical missions require a local infrastructure for optimal patient outcomes. Sustainability hinges on education and involvement of local physicians and surgical trainees, pre-mission planning, and return trips to the same location. For endocrine surgical missions, preoperative evaluation and postoperative follow-up by the operating surgeon is important for optimizing performance and outcomes.

Long KL, Cohen M, Perrier N. Pay It forward: Strategies for Successful Implementation of Short-term Endocrine Surgical Mission. World J Endoc Surg 2016;8(2):137-140.

Thyroidectomy is the commonest endocrine surgical procedure undertaken throughout the world. Redo thyroidectomies are challenging procedures with a higher morbidity rate. Lateral approach to thyroid (LATT) is a good alternative to the standard midline exploration. The key to the technique is the development of the natural tissue plane between the strap muscle and the ipsilateral sternocleidomastoid muscle to explore the thyroid bed. A study was carried out to assess the efficacy, safety, and complication of LATT.

Data on patients undergoing LATT in professorial surgical unit, Ragama from 2008 to 2015, were collected prospectively and analyzed. All procedures were done by a single surgeon.

A total of 36 LATTs were done. Data from 32 people were collected, as 4 patients lost follow-up; 29 (90.6%) were females and 3 (9.4%) were males. Their age ranges between 28 and 61 (median 43.37). Three (9.4%) LATTs for parathyroid explorations and out of it one (3.1%) for redo parathyroid explorations were done. Nine (28.1%) cases were redo thyroidectomies and 18 (56.2%) were done with mini incision with lateral approach. Hemithyroidectomies were performed on 28 (87.5%) patients. Bilateral explorations were done on three (9.4%) patients and four (12.5%) lateral approaches were done for completion thyroidectomies for follicular malignant lesions. Transient clinical hypocalcemia was noticed in four (12.5%) patients and one (3.1%) developed hoarseness of voice, which was temporary; and none of them had complications like hematoma and postsurgical stridor.

Lateral approach to thyroid is a safe alternative to the standard approach for reexplorative thyroid surgery.

Dissanayake DDMC, Fernando RF, Dissanayake IJ. Lateral approach to Thyroid: A Good Technique for Reoperative Thyroid Surgery. World J Endoc Surg 2016;8(2):141-142.

Gupta Y, Bist SS, Agrawal V, Mishra S. Study of Validity and Reliability of Fine Needle Aspiration Cytology and Tc99m Scintigraphy in Thyroid Swelling. World J Endoc Surg 2016;8(2):143-146.

Miyauchi A. The History of the Asian Association of Endocrine Surgeons. World J Endoc Surg 2016;8(2):147-155.

Tan S, Yuan NK, Lim DGZ, Parameswaran R. Calciphylaxis in Renal Hyperparathyroidism: A Case-based Review. World J Endoc Surg 2016;8(2):156-159.

Matta R, Sahoo K, Jagtap S. Carotid Body Paraganglioma: Report of Two Cases and Review of Literature. World J Endoc Surg 2016;8(2):160-163.

Radiological imaging is routinely used in patients with primary hyperparathyroidism to localize the abnormal adenoma and to plan surgical approach. We report an unusual cause of false-positive localization on parathyroid sestamibi scan, i.e., not previously described in the literature.

A 66-year-old man with primary hyperparathyroidism showed a discrete persistent focus in the left infraclavicular area during localization using sestamibi scan. Ultrasound of the neck was negative showing only small bilateral thyroid nodules. Single-photon emission and four-dimensional computed tomography (CT) scans showed an intense focus of the tracer uptake and a 1-cm lesion near the left subclavian vein (SCV), corresponding to the infraclavicular hot spot. Initial infraclavicular exploration showed the lesion to be a collapsible saccular varix of the left SCV. Bilateral neck exploration led to the discovery of the actual right parathyroid adenoma beneath an exophytic thyroid nodule. The patient made an uneventful recovery and remains normocalcemic at 1-year follow up.

Hot spot on parathyroid imaging outside the line of embryological descent should be interpreted with caution. Vascular retention of injected isotope within a saccular varix of the neck vein can give rise to falsepositive results on sestamibi scans. Bilateral neck exploration remains the “gold standard” procedure when localization scans either are negative or turn out to have false-positive findings.

Singaporewalla RM, Negi A, Seow DYB, Chinchure D. An Unusual Cause of Hot Spot on Parathyroid Imaging. World J Endoc Surg 2016;8(2):164-167.

To explore the challenges in the management of metastatic differentiated thyroid cancer.

Differentiated thyroid cancer (DTC) is the most common form of thyroid cancer. The initial diagnosis of thyroid carcinoma and the distinction between benign and neoplastic disease can be challenging. Radioiodine-refractory metastatic DTC also presents a therapeutic dilemma. Novel targeted agents for advanced radioiodine-refractory metastatic thyroid cancer, such as tyrosine kinase inhibitors (TKIs), are being increasingly used with clinical success, broadening current available therapeutic options.

We present the case of a 61-year-old woman with radioiodine-refractory metastatic follicular thyroid carcinoma, which was initially misdiagnosed as benign Hurthle cell adenoma. We focus on the challenges in both the initial diagnosis and the subsequent management of her advanced disease with skeletal dominant metastases.

The advent of targeted systemic therapies as emerging frontline and salvage therapy is a novel addition to the management of radioiodine-refractory advanced DTC. Further studies to expand the role of sequential and redifferentiation therapy for advanced disease and strategies to reduce skeletalrelated events are still required.

Lee MH, Moxey JE, McLachlan S-A, MacIsaac RJ, Sachithanandan N. Dilemmas in Metastatic Differentiated Thyroid Cancer: To irradiate, medicate, or palliate? World J Endoc Surg 2016;8(2):168-171.

Bhargav PRK. Enigma of Adenomacarcinoma Sequence in Thyroid Gland: An Interesting Case Report of Multiple Pathologies with Literature Review. World J Endoc Surg 2016;8(2):172-174.

John AR, Jain A, Vishnoi MG, Paliwal D, Sharma A, Kumar N, Dubey IP. A Rare Case of Solitary Parathyroid Adenoma presenting with Recurrent Pancreatitis detected by Dual-phase Single-isotope Imaging (Technetium Sestamibi and Technetium Thyroid Scan) with SPECT-CT. World J Endoc Surg 2016;8(2):175-178.

Chand G, Mishra SK. Transoral Endoscopic Thyroid Surgery through Vestibular Approach. World J Endoc Surg 2016;8(2):179-182.

Sekar S, Chandramohan A, Ramakant P, Abraham DT, Paul MJ. Broken Eggshell Sign: A Marker of Aggressive Thyroid Cancer. World J Endoc Surg 2016;8(2): 183-184.