Abstract:

Morbid obesity continues to increase in prevalence, becoming a major socioeconomic and medical problem. The success in treating morbid obesity with surgery has been well documented. The categories of surgical treatment include restrictive, malabsorptive, and combination operations. Two of the restrictive operations at the forefront of today's treatments are laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric greater curvature plication (LGCP). A literature review has been completed to compare the current technique and results for LSG and LGCP. LSG is a restrictive technique in which reduced gastric volume is achieved by partial greater curvature resection. The benefits of LSG include ease of operation, sustainable weight loss, and low complication rate. The disadvantages include risk for severe complications such as gastric leak and bleeding. LGCP is a novel restrictive technique which reduces gastric volume by plication of the greater curvature; it is still in the investigational stages for use in the United States. A gastric tube is formed with the plication, but no portion of the stomach is excised. The benefits of LGCP include low cost, low risk of complication, such as gastric perforation and bleeding, as well as adequate short term weight loss. The disadvantages include higher risk of nausea and vomiting post-op, a non-zero risk of perforation and bleeding, and likely an unsustainable weight loss. In comparison, LGCP is considered feasible and safe in the short term and especially suited for institutions requiring lower-cost procedures. However, LGCP weight loss may be unsustainable compared to LSG. While LSG complication rates are slightly higher, LGCP is an inferior restrictive procedure for weight loss. Further studies are needed to evaluate the long term outcomes for procedural comparison.

Authors:

Ryan C Broderick, MD, General Surgery Resident, Minimally Invasive Surgery Research Fellow, University of California San Diego, San Diego, California, Hans F Fuchs, MD, Postdoctoral Scholar, Minimally Invasive Surgery Research Fellow, University of California San Diego, San Diego, California, Cristina R Harnsberger, MD, General Surgery Resident, Minimally Invasive Surgery Research Fellow, University of California San Diego, San Diego, California, Bryan J Sandler, MD, Assistant Professor of Surgery, Division of Minimally Invasive Surgery, University of California San Diego, San Diego, California, Santiago Horgan, MD, Chief, Division of Minimally Invasive Surgery, University of California San Diego, San Diego, California, Garth R Jacobsen, MD, Program Director, General Surgery Residency, Assistant Professor of Surgery, Division of Minimally Invasive Surgery, University of California San Diego, San Diego, California

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Medtronic

Abstract:

Laryngeal nerve injuries are one the most critical complications during thyroid and parathyroid surgery. Iatrogenic damages to the recurrent laryngeal nerve (RLN) are relevant in terms of clinical implications, economic costs, and for malpractice litigation. In order to minimize potential neural damages, a standardized surgical technique is mandatory. Intraoperatory neuromonitoring (IONM) of the RLN is an important adjunct to the traditional approach and is a reliable tool for neural mapping and in dissection and prognostication of postoperative neural function 4. Because of this, most of the iatrogenic damages are not related to direct transection, but they are visually undetectable. Notwithstanding the increasing use of IONM at this stage, there is still the need for prospective, randomized, well-powered, and well-designed trials in order to further validate (via evidence-based data) the role of IONM in thyroid surgery. The aim of this review is to provide a critical analysis of the scientific evidences on the clinical impact of IONM in thyroid surgery showing the unsolved problems and the future challenges.

Authors:

Alberto Mangano, MD, Resident in General Surgery, Department of Surgical and Morphological Sciences, Research Center in Endocrine Surgery, 1st Division of General Surgery Ospedale di Circolo e Fondazione Macchi Insubria University, Varese, Italy, Che-Wei Wu, MD, Otolaryngologist, Department of Otolaryngology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan, Georgios D. Lianos, MD, Resident in General Surgery, Department of Surgery, Ioannina University Hospital, Ioannina, Greece, Hoon Yub Kim, MD, PhD, General Surgeon, Department of Surgery, Korea University College of Medicine, Seoul, Korea, Feng-Yu Chiang, MD, Otolaryngologist, Department of Otolaryngology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan, Ping Wang, MD, General Surgeon, Director of Endocrine Division of Surgery, Department of General Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China, Liu Xiaoli, MD, General Surgeon, Department of Thyroid and Parathyroid Surgery, China-Japan Union Hospital, Jilin University e Jilin Provincial Key Laboratory of Surgical Translational Medicine, Changchun, China,  Sun Hui, MD, General Surgeon, Department of Thyroid and Parathyroid Surgery, China-Japan Union Hospital, Jilin University e Jilin Provincial, Key Laboratory of Surgical Translational Medicine, Changchun, China, Serkan Teksöz, MD, General Surgeon, Cerrahpasa Medical Faculty Department of General Surgery,Istanbul University, Istanbul, Turkey, Yusuf Bukey, MD, Professor of General Surgery, Istanbul University Cerrahpasa Medical, Faculty Department of General Surgery, Istanbul, Turkey, Gianlorenzo Dionigi, MD, FACS, Associate Professor of General Surgery, Fellow of the American College of Surgeons, Department of Surgical and Morphological Sciences, Head of 1st Division of General Surgery, Head of Research Center in Endocrine Surgery, Ospedale di Circolo e Fondazione Macchi, Insubria Univerisity, Varese, Italy, Stefano Rausei, MD, PhD, General Surgeon, Department of Surgical and Morphological Sciences, 1st Division of General Surgery, Ospedale di Circolo e Fondazione Macchi, Insubria Univerisity, Varese, Italy

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Abstract:

Hospitalizing patients up to 72 hours after thyroidectomy is a classical approach. However, the length of hospitalization has decreased following surgical procedures with new technological devices. Seven hundred one consecutive patients who underwent sutureless total thyroidectomy (STT) between October 2011 and 2013 were included in this study. Six hundred seventy-two (95.9%) were discharged before 24 hours following surgery (short-stay = SS), and 29 were discharged later (delayed-discharge = DD). This study aims to assess short-stay STT with early postoperative complications and readmission to hospital. One hundred forty-three SS patients were male and 529 were female. Mean age was 48 ± 13 years, BMI was 28.7 ± 8.3 kg/m2. Mean hospital stay for SS was 18.13 ± 1.97 (17–23) hours. Histopathology was benign in 443 (65.92%) and malignant in 229 (34.08%) in the SS group. In three (0.4%) of the SS group drainage was required because of hematoma, and in seven (1%) wound infection was observed. One hundred seven (7.9%) [permanent = 7 (0.52%)] of 1344 recurrent laryngeal nerves (RLNs) in SS were seen paralyzed in postoperative vocal cord examination. Hypocalcemia (all transient) was observed in 52 (7.74%) of the SS group. Eight of those 52 readmitted to hospital with symptomatic hypocalcemia and were treated as outpatients. There was no mortality. Of the DD group, two stayed in the intensive care unit, two had dysphonia, two had hematoma with anti-coagulant use, one had fever, four did not tolerate diet, five refused discharge, and 13 had symptomatic hypocalcemia. Sutureless total thyroidectomy can be performed safely and effectively as short-stay surgery.

Authors:

Akif Enes Arikan, MD, Resident, Serkan Teksöz, MD, FEBES, Surgeon, Yusuf Bukey, MD, Professor, Sina Ferahman, MD, Resident, Murat Ozcan, MD, Professor, Recep Ozgultekin, MD, Professor, Ates Ozyegin, MD, Professor, Cerrahpasa Medical Faculty, Department of General Surgery, Istanbul University, Istanbul, Turkey

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Abstract:

Image-guided thyroid nodule ablation is a relatively new technique for the management of thyroid disease. Notably, if there has been the correct patient selection and if they are performed in high volume centers and via a standardized technique, image-guided thyroid nodule ablation seems to be safe and effective and it can be used to treat thyroid goiters. However, there is still paucity of level 1 evidences and recommendation comparing ablation to surgical or to other non-surgical treatment modalities. Herein, some technical notes for the thyroid nodule ablation to achieve the critical view of safety are presented. Moreover, an additional remark and appraisal from a surgical point of view is described.

Authors:

Ejona Duka, MD, Resident in Radiology, Department of Surgical Sciences and Human Morphology, Radiology Division University of Insubria (Varese-Como), Varese, Italy, Giuseppe De Marchi, MD, Resident in Radiology, Department of Surgical Sciences and Human Morphology, Radiology Division University of Insubria (Varese-Como), Varese, Italy, Roberta Giacchero, MD, Pediatric Endocrinologist, Department of Pediatrics, San Paolo Hospital, Milan, Italy, Alberto Mangano, MD, Resident in General Surgery, 1st Division of General Surgery, Ospedale di Circolo e Fondazione Macchi-Varese, Research Center for Endocrine Surgery Department of Surgical Sciences and Human Morphology, University of Insubria (Varese-Como), Varese, Italy, Eliana Piantanida, MD, Assistant Professor of Endocrinology, Department of Clinical and Experimental Medicine, Endocrine Unit, University of Insubria (Varese-Como), Ospedale di Circolo e Fondazione Macchi, Varese, Italy, Maria Laura Piera Tanda, MD, Assistant Professor of Endocrinology, Department of Clinical and Experimental Medicine, Endocrine Unit, University of Insubria (Varese-Como), Ospedale di Circolo e Fondazione Macchi, Varese, Italy, Liu Xiaoli, MD, General Surgeon, Department of Thyroid and Parathyroid Surgery, China-Japan Union Hospital, Jilin University e Jilin Provincial , Key Laboratory of Surgical Translational Medicine, Changchun, Jilin Province, China, Sun Hui, MD, General Surgeon, Department of Thyroid and Parathyroid Surgery, China-Japan Union Hospital, Jilin University e Jilin Provincial, Key Laboratory of Surgical Translational Medicine, Changchun, Jilin Province, China, Ozer Makay, MD, General Surgeon, Department of General Surgery, Division of Endocrine Surgery, Ege University Hospital, Izmir, Turkey, Gianlorenzo Dionigi, MD, FACS, Fellow of the American College of Surgeons, Head 1st Division of General Surgery Ospedale di Circolo e Fondazione Macchi, Varese Head Research Center for Endocrine Surgery, University of Insubria (Varese-Como), Ospedale di Circolo Fondazione Macchi, Varese, Italy, Gianpaolo Carrafiello, MD, Associate Professor of Radiology, Fellow of CIRSE, Chief of Interventional Radiology Unit, Director of Research Center in Interventional Radiology, University of Insubria (Varese-Como) Ospedale di Circolo Fondazione Macchi, Varese, Italy

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