World Journal of Endocrine Surgery

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2016 | September-December | Volume 8 | Issue 3

EDITORIAL

Manju Chandran MD, FACP, FACE, FAMS

Editorial

[Year:2016] [Month:September-December] [Volume:8] [Number:3] [Pages:1] [Pages No:0 - 0]

PDF  |  DOI: 10.5005/wjoes-8-3-v  |  Open Access |  How to cite  | 

RESEARCH ARTICLE

Reyaz M Singaporewalla, Anil D Rao, Arunesh Majumder

Minimally Invasive Video-assisted Thyroidectomy vs Conventional Open Hemithyroidectomy in Asian Patients

[Year:2016] [Month:September-December] [Volume:8] [Number:3] [Pages:4] [Pages No:189 - 192]

PDF  |  DOI: 10.5005/jp-journals-10002-1189  |  Open Access |  How to cite  | 

Abstract

Introduction

Although the technique of minimally invasive video assisted thyroidectomy (MIVAT) is well established in continental Europe, data on it's role in Asian patients is limited. We compared the results of MIVAT with conventional open hemithyroidectomy in Asian patients.

Materials and methods

Over a 1-year period, patients undergoing hemithyroidectomy for benign symptomatic goiters were selected. Inclusion criteria for MIVAT were benign colloid goiters, recurrent cysts or follicular lesions and neoplasms with lobe volume of less than 40 cc or nodule diameter less than 35 mm. Larger goiters underwent conventional open surgery. Patients with previous neck surgery and proven malignancy were excluded. Operative time, complications, postoperative pain score, incision length and cosmetic satisfaction at 6 months were recorded.

Results

Thirty-six patients (MIVAT-21, Conventional-15) were included. Both groups were comparable in terms of demographic profile and co-morbidities. The mean operating time for both groups showed no significant difference (MIVAT = 111.67 ± 19.4 min, Conventional = 112.40 ± 25.06 min; p = 0.925). Minimally invasive video assisted thyroidectomy patients had significantly less pain in the immediate postoperative period (mean pain score 2.38 vs 4.8, p < 0.001). Mean incision length at end of surgery was significantly smaller in the MIVAT group (2.58 vs 6.3 cm; p < 0.001). Neck scar satisfaction at 6 months was excellent in 71.4% of MIVAT cases vs 26.6% of conventional hemithyroidectomy cases. There were no complications in any of the treatment groups.

Conclusion

In selected cases, MIVAT is as safe as conventional open surgery with distinct advantages of better postoperative pain control and cosmesis.

How to cite this article

Rao AD, Singaporewalla RM, Majumder A. Minimally Invasive Video-assisted Thyroidectomy vs Conventional Open Hemithyroidectomy in Asian Patients. World J Endoc Surg 2016;8(3):189-192.

RESEARCH ARTICLE

Jamie E Anderson, Jennifer L Olson, Michael J Campbell

Parathyroidectomy in Dialysis Patients: What is the Risk?

[Year:2016] [Month:September-December] [Volume:8] [Number:3] [Pages:6] [Pages No:193 - 198]

PDF  |  DOI: 10.5005/jp-journals-10002-1190  |  Open Access |  How to cite  | 

Abstract

Aims

Patients with chronic kidney disease (CKD) on dialysis commonly develop hyperparathyroidism (HPT), but are often not referred for surgical evaluation because of the belief that the cardiopulmonary risks of a parathyroidectomy are prohibitively high. Previous studies have not adequately determined the surgical risks of parathyroidectomy in this population.

Materials and methods

We used the American College of Surgeons National Surgical Quality Improvement Program database from 2005 to 2013 to evaluate risk of complications for dialysis vs nondialysis patients undergoing parathyroidectomy using univariate and multivariate logistic regressions. We also compared outcomes between dialysis patients undergoing parathyroidectomy and arteriovenous fistula (AVF) creation to understand the relative risk between these procedures.

Results

A total of 28,438 patients underwent parathyroidectomy; 1,833 (6.5%) were on dialysis. Among patients undergoing parathyroidectomy, unadjusted mortality and complication rates were higher for patients on dialysis compared to those not on dialysis (1.4% vs 0.1%, p < 0.001; 7.9% vs 1.4%, p < 0.001). Multivariate analysis found increased odds of mortality, all complications, and cardiopulmonary complications among patients on dialysis compared to those not on dialysis [odds ratio (OR) 5.28, p = 0.004; 2.10, p < 0.001; 5.14, p < 0.001]. When compared to patients undergoing parathyroidectomy, dialysis patients undergoing AVF had no difference in odds of death (p = 0.392) or cardiopulmonary complications (p = 0.138), but did have an increased risk of any complication (OR 1.66, p = 0.035).

Conclusion

Dialysis patients undergoing parathyroidectomy have an increased risk of cardiopulmonary complications and mortality compared to patients not on dialysis; however, these risks are similar to patients undergoing AVF creation. The risks of parathyroidectomy in dialysis patients are likely similar to other commonly performed procedures for dialysis patients.

Clinical significance: The risk of mortality and complications should be discussed during informed consent with dialysis patients undergoing parathyroidectomy. These findings can also assist in preoperative risk assessments.

How to cite this article

Anderson JE, Olson JL, Campbell MJ. Parathyroidectomy in Dialysis Patients: What is the Risk? World J Endoc Surg 2016;8(3):193-198.

RESEARCH ARTICLE

Natalie Seiser, Jesse D Pasternak, Wouter Kluijfhout, Jessica E Gosnell, Wen T Shen

Ultrasound-guided Ethanol Ablation: Where does It fit in the Treatment of Recurrent Metastatic Papillary Thyroid Cancer?

[Year:2016] [Month:September-December] [Volume:8] [Number:3] [Pages:4] [Pages No:199 - 202]

PDF  |  DOI: 10.5005/jp-journals-10002-1191  |  Open Access |  How to cite  | 

Abstract

Introduction

Ethanol (ETOH) ablation of metastatic neck nodes has been described as a potentially safe and effective alternative to surgical excision. We sought to describe a subset of these patients well suited for ETOH ablation.

Materials and methods

We report ultrasound-guided ETOH ablation of metastatic papillary thyroid cancer (PTC) at a Tertiary Care Endocrine Surgery Unit over 5 years. A retrospective review of all reoperative lymph node dissections was undertaken. Ethanol injection was used as second-line treatment to operative excision and was standardized with ultrasound guidance and the use of 1 cc/cm3 of 100% ETOH solution.

Results

Five treatments of ultrasound-guided ETOH ablation were studied. All patients had been previously treated with radioactive iodine (RAI) (mean: 1.25 treatments of 174mCi), however, in three cases with pretreatment I-131 scan, no uptake of radioiodine was seen in the treated disease. In four cases with pretreatment fludeoxyglucose-positron emission tomography (FDG-PET), treated lesions were avid. Median follow-up time for treatment was 28.5 months, with no disease progression in all ablated lesions. Serum thyroglobulin (Tg) values in patients without Tg-antibody were lower after treatment. There were no complications.

Conclusion

Surgeons seeking a less-invasive approach for nodal metastases in the neck can consider ETOH ablation. Small ultrasound detectable lesions in scarred necks (irradiated and/or reoperative) which are radioiodine non-avid and FDG-PET avid may be best suited for this treatment. As demonstrated by a small set of patients in a Tertiary Care Endocrine Surgery Unit, ETOH ablation is safe and effective at controlling progression of targeted local disease.

How to cite this article

Pasternak JD, Kluijfhout W, Seiser N, Gosnell JE, Suh I, Duh Q-Y, Shen WT. Ultrasound-guided Ethanol Ablation: Where does It fit in the Treatment of Recurrent Metastatic Papillary Thyroid Cancer? World J Endoc Surg 2016;8(3):199-202.

RESEARCH ARTICLE

Thomas V Paul, Anish Cherian

Next-day Parathyroid Hormone as a Predictor of Post-thyroidectomy Hypocalcemia

[Year:2016] [Month:September-December] [Volume:8] [Number:3] [Pages:5] [Pages No:203 - 207]

PDF  |  DOI: 10.5005/jp-journals-10002-1192  |  Open Access |  How to cite  | 

Abstract

Aims

Total thyroidectomy is significantly complicated by parathyroid dysfunction and hypocalcemia. These aspects impact the decision regarding the timing of discharge and quantum of calcium supplementation required. Therefore, we aimed at evaluating the accuracy of next-day parathyroid hormone (PTH) level as a predictor of post-thyroidectomy hypocalcemia. Secondly, we aimed at establishing our institution's postoperative PTH level, which can accurately predict the development of post-thyroidectomy hypocalcemia to help us ensure the safe and early discharge of patients.

Materials and methods

A prospective observational study of 50 continuous patients undergoing thyroidectomy was conducted at a tertiary hospital in South India. Postoperative blood samples were collected for estimation of PTH, calcium, albumin, and phosphorous. The data were collated and results analyzed using Stata I/C 10.1.

Results

A total of 30% (15/50) of the patients had postoperative hypocalcemia (serum calcium <8 mg/dL). Postoperative PTH was low (<8 pg/mL) in 40% (20/50) of patients. There was a significant association between PTH < 8 pg/mL and the presence of postoperative hypocalcemia (p = 0.029). The area under the receiver operating characteristic (ROC) curve was 0.7, and a next-day PTH of <6 pg/mL showed the highest sensitivity and specificity (83 and 60% respectively) for the development of postoperative hypocalcemia, with a positive predictive value (PPV) and negative predictive value (NPV) of 83 and 60 respectively.

Conclusion

The PTH assessment performed the day after surgery is an acceptable test to predict post-thyroidectomy hypocalcemia; PTH <6 pg/mL can be used as our institution's cutoff value. Department protocols for calcium and vitamin D supplementation following total thyroidectomy may be formulated based on the appropriately timed local postoperative PTH value to assist safe and early discharge of patients.

Clinical significance

Discharge protocols for patients undergoing thyroidectomy may be formulated based on the postoperative PTH values, thus enabling safe and early discharge of patients.

How to cite this article

Cherian AJ, Ramakant P, Paul TV, Abraham DT, Paul MJ. Next-day Parathyroid Hormone as a Predictor of Post-thyroidectomy Hypocalcemia. World J Endoc Surg 2016;8(3):203-207.

RESEARCH ARTICLE

Nalini Shah, Vijaya Sarathi, M Sabaretnam

Genotype–phenotype Correlation in Children with Pheochromocytoma and Paraganglioma

[Year:2016] [Month:September-December] [Volume:8] [Number:3] [Pages:4] [Pages No:208 - 211]

PDF  |  DOI: 10.5005/jp-journals-10002-1193  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Sarathi V, Sabaretnam M, Shah N. Genotype–phenotype Correlation in Children with Pheochromocytoma and Paraganglioma. World J Endoc Surg 2016;8(3):208-211.

CASE REPORT

Indu Lata, Deepa Kapoor

A Rare Case of Functional Ectopic Hyperthyroidism: Struma Ovarii

[Year:2016] [Month:September-December] [Volume:8] [Number:3] [Pages:2] [Pages No:212 - 213]

PDF  |  DOI: 10.5005/jp-journals-10002-1194  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Lata I, Kapoor D. A Rare Case of Functional Ectopic Hyperthyroidism: Struma Ovarii. World J Endoc Surg 2016;8(3):212-213.

CASE REPORT

Daniel W Nelson, Melissa LoPinto, Charif Sidani, John I Lew

Large Substernal Thyroid Goiter Associated with Saddle Pulmonary Embolism

[Year:2016] [Month:September-December] [Volume:8] [Number:3] [Pages:3] [Pages No:214 - 216]

PDF  |  DOI: 10.5005/jp-journals-10002-1195  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Nelson DW, LoPinto M, Sidani C, Lew JI. Large Substernal Thyroid Goiter Associated with Saddle Pulmonary Embolism. World J Endoc Surg 2016;8(3):214-216.

RESEARCH ARTICLE

Chanchal Rana

Surgical Techniques for operating on Large Adherent Cervical Nodal Metastases from Thyroid Cancer causing Severe Neck Pain and Compression Effects and encasing Major Vessels

[Year:2016] [Month:September-December] [Volume:8] [Number:3] [Pages:3] [Pages No:217 - 219]

PDF  |  DOI: 10.5005/jp-journals-10002-1196  |  Open Access |  How to cite  | 

Abstract

Aim

We aim to refine and define surgical techniques for doing difficult adherent bulky cervical nodal metastases from thyroid cancer to help surgeons do dissections with better curability and lesser morbidity.

Background

Patients with thyroid cancer with large nodal metastases presenting with severe neck pain due to compression effects and encasing carotid artery and other major vessels pose a challenge to surgeons to do complete resections while preserving important structures in the neck.

Materials and methods

We define surgical planning and road map to dissect difficult bulky adherent cervical nodes encasing carotid artery and jugular vein by splaying the plane over carotid sheath by doing adventitial level dissection and dissecting medial and lateral to carotid sheath the large nodal mass adherent to adjacent structures preserving the major vessels and nerve plexus.

Conclusion

By appropriate surgical planning and meticulous dissection techniques, we can do major neck dissections with complete resections and same time preserving important structures in the neck minimizing morbidity.

Clinical significance: By doing neck dissections with complete oncological resections and saving vital structures in the neck, we aim to offer best possible chance of cure to the patient along with reduced morbidity at same time.

How to cite this article

Ramakant P, Singh KR, Rana C, Mishra AK. Surgical Techniques for operating on Large Adherent Cervical Nodal Metastases from Thyroid Cancer causing Severe Neck Pain and Compression Effects and encasing Major Vessels. World J Endoc Surg 2016;8(3):217-219.

RESEARCH ARTICLE

Bhargav PRK

Clinical Indicators of Surgical Thyroidectomy in Graves’ Disease

[Year:2016] [Month:September-December] [Volume:8] [Number:3] [Pages:1] [Pages No:220 - 220]

PDF  |  DOI: 10.5005/jp-journals-10002-1197  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Bhargav PRK. Clinical Indicators of Surgical Thyroidectomy in Graves’ Disease. World J Endoc Surg 2016;8(3):220.

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