A Clinical Analysis of Endoscopic Thyroid Lobectomy and Comparison with Conventional Thyroid Lobectomy

PURPOSE: A conventional thyroidectomy requires a wide transverse incision on the anterior neck, which can cause significant scaring. We developed an endoscopic thyroid lobectomy using the breast approach and a low carbon dioxide pressure in order to produce better cosmetic results. We reports the clinical analysis of endoscopic thyroid lobectomy and compare the result with those from a conventional thyroid lobectomy. METHOD: From July 2003 and December 2004, 55 consecutive patients with benign thyroid nodules, who underwent endoscopic thyroid lobectomy, and 51 consecutive patients with benign thyroid nodules, who underwent a conventional thyroid lobectomy, were retrospectively reviewed. The preoperative diagnosis of the thyroid nodules was performed using high-resolution ultrasonography and fine- needle aspiration cytology. The clinical results of endoscopic thyroid lobectomy were analyzed and compared with those from a conventional thyroid lobectomy. RESULTS: There were no significant differences between the two groups in terms of the patients' gender, size of tumor, preoperative diagnosis (follicular tumor/adenomatous nodule), postoperative diagnosis (cancer/benign), level of postoperative discomfort, length of hospital stay. The patients who underwent endoscopic thyroidectomy were significantly younger than those underwent conventional thryoidectomy (37.4+/-10.3 years vs. 48.8+/-13.0 years; P<0.001). The operation time for the endoscopic group was significantly longer than that for the conventional group (171.9+/-35.6 min vs. 92.5+/-26.5 min; P<0.001). The length of closed drainage in the endoscopic group was longer than that in the conventional group (2.8+/-0.8 days vs. 1.4+/-1.3 days; P<0.001). However, these factors did not affect the length of the hospital stay, and the number of intraoperative complications. CONCLUSION: Endoscopic thyroid lobectomy using the breast approach and a low carbon dioxide pressure has cosmetic benefits and is a feasible and safe procedure.

Analysis of the Possibility of Operative Treatment in Pediatric Intussusception and its Scoring

PURPOSE: Owing to the trend of a nuclear family the concern and protection are still more increasing than before. The patients admitted to hospital for intussusception, as well as their parents, seem to be under great stress when non- operative treatments fail. In order to identify those patients likely to fail an attempted non-operative treatment, and to administer prompt treatment, the patients that came to our hospital for pediatric intussusception were analyzed. METHODS: 285 cases, between 2000 and 2003 were reviewed. They were divided into two groups from their medical records, and retrospectively compared. Group I included 243 pneumoreduction cases and group II 42 operation cases. To find the probability of non-operative treatment failure, an attempt was made to analyze and score the risk factors that increase the possibility of operative treatment. RESULTS: The factors contributing to an increased possibility of operative treatment were fever, leukocyte count, plain abdominal X-ray findings and duration of symptoms. CONCLUSION: This study revealed that fever, leukocyte count, plain abdominal X-ray findings and duration of symptoms contributed to an increased possibility of operative treatment. An increase in the sum of the scores of each factor increased the possibility of operative treatment. This simple scoring system could eliminate excessive and repeated pneumoreduction, thus indicating its potential value as a useful aid in surgical decision making for high failure rate cases of pneumoreduction in intussusception.

Risk Factors of Bowel Resection on Intussusception

PURPOSE: Intussusception is one of the most common causes of childhood intestinal obstructions. Early diagnosis is essential to avoid treatment delays, which can increase morbidity and mortality. In this study, authors have tried to analyze the risk factors associated with intussusception in infants and children to establish an early diagnosis to prevent unwanted outcomes. METHODS: We reviewed 44 cases involving operations for childhood intussusception from 1997 to 2001. These were divided into two groups and compared retrospectively using medical records. Group I included 34 cases of manual reduction (77.3%), and group II consisted of 10 cases of bowel resection (22.7%). RESULTS: There were no significant differences in age, sex, and clinical symptoms between the 2 groups. The anatomic location of the intussusceptum, and fever seemed to vary, but this was of no statistical significance. Factors significantly contributing to increase in the rate of bowel resection were the duration of the symptoms (more than 48 hours), and the leukocyte count (more than 15,000/mm3). CONCLUSION: This study revealed that only the duration of symptom and the leukocyte count contributed to an increase in the rate of bowel resection. Further prospective studies would be needed to reveal more risk factors to accurately predict the prognosis of the disease.