A Preliminary Study for Randomized, Controlled Trial of On-Q® PainBuster® Pain Pump vs. Intravenous Patient-controlled Analgesia after Gasless Transaxillary Endoscopic Thyroidectomy / 대한내분비외과학회지

PURPOSE: Gasless transaxillary approach to endoscopic thyroidectomy is a widely performed procedure for benign or malignant thyroid neoplasms. However, it requires wide dissection for approaching the target area. The intravenous patient-controlled analgesia (IV PCA) is an effective method for postoperative pain control and patients can use it according to their requirement. However, patients suffer from nausea, vomiting, sleep disturbance, etc. due to opioids. Pain pump ON-Q® PainBuster® (pain buster) has been used widely in various surgeries for control of postoperative localizing and wide area pain without side effects of opioid analgesia because it consists of Ropivacaine. METHODS: From Aug. 2008 to Jan. 2013, Gasless transaxillary endoscopic thyroidectomy was performed in 90 patients in a single institution, who were divided into three groups, including the IV PCA, pain buster, and null groups. We compared postoperative outcomes, pain severity between groups. We recorded scores immediately, 6, 12, 24, and 48 hours after surgery following visual analog pain score (VAS), and investigated hospital stay and occurrence of events of nausea, vomiting, and complications. RESULTS: In the IV PCA group, it was discontinued due to nausea in 36.7% of patients. No significant difference in pain severity following VAS score was observed among the three groups. However, smaller numbers of analgesia injections were required in the Pain buster group than in the other groups, and fewer patients suffered from constipation, compared with the PCA group. CONCLUSION: Pain buster showed even effects compared to IV PCA, with few side effects and less discomfort of patients, compared with the other groups. Therefore, pain buster was thought to be the proper method for pain control after dissection of the anterior chest wall, cervical area in order to secure an operative view for transaxillary endoscopic thyroidectomy.

Clinical and radiologic preoperative predicting factors for GB cholesterol polyp / 대한외과학회지

PURPOSE: To use the clinical and radiological data to differentiate non-cholesterol versus cholesterol gall bladder (GB) polyps, which can be useful in deciding the treatment of the patient. METHODS: One hundred and eighty-seven patients underwent cholecystectomy for GB polyps of around 10 mm for 10 years, and were divided into two groups, cholesterol polyps (146 patients) and non-cholesterol polyps (41 patients) based on the postoperative pathological findings. Gender, age, body weight, height, body mass index (BMI), symptoms, laboratory findings, size, number of polyps, presence of GB stone and maximum diameter measured by preoperative ultrasonography (USG), computed tomography (CT), and pathological diameter were subjected to comparative analysis. RESULTS: Patients diagnosed with cholesterol polyps were younger in age and had higher BMI, and the total cholesterol levels and white blood cell levels were higher, but were not statistically significant. It was notable to see that 28.6% of the cholesterol polyps were not found in the preoperative CT yet the percentage of the undetectable rate was significantly lower (8%) in the non-cholesterol polyp group. There was a discrepancy in maximum diameters between the two radiological methods in both groups but the discrepancy was significantly larger in the cholesterol polyp group. CONCLUSION: The clinical signs that can be helpful to diagnose whether it is a cholesterol polyp or not are younger patients who have high BMI, polyps which are detectable only on the USG and large maximum diameters between the USG and CT. And if the discrepancy of the maximum diameter is lesser than 1mm the polyp may be considered as a non-cholesterol polyp.

Gasless Endoscopic Thyroidectomy using the Trans-axillary Approach: Surgical Outcomes of 634 Patients / 대한내분비외과학회지

PURPOSE: Various techniques of minimally invasive thyroid surgery have been introduced during the past decade, including the endoscopic technique. We have developed a novel method of gasless endoscopic thyroidectomy via an axillary approach. The present report describes the technique of this method and the analysis of the surgical outcomes. METHODS: Between Dec. 2001 and Feb. 2008 (the actual operation period was 55 months), 634 patients with thyroid tumors underwent gasless endoscopic thyroidectomy via an axillary approach. The clinical and pathologic characteristics of the patients, the type of operation, the operative time, the post operative hospital stay and the post operative complications were retrospectively analyzed. RESULTS: Among the 634 patients, 176 patients had benign tumor and 458 patients had malignant tumor. The type of operationwas classified according to the extent of surgery. Lymphadenectomy (CCND, SND, MRND) was respectively performed for treating the patients with malignant tumor, depending on the indications. The mean operating time and the mean length of the post-operative hospital stay were 129.4±51.3 minutes, 3.3±1.7 days for benign tumor and 135.5±47 minutes, 3.4±0.9 days for malignancy, respectively. The mean tumor size was 2.7±1.2 (0.4~6.0) cm for benign tumor and 0.78±0.5 (0.1~4.0) cm for malignancy. Central compartment lymph node metastasis was found in 117 (25.6%) patients and lateral neck lymph node metastasis was found in 14 (3.0%) patients. There was no conversion to open thyroidectomy. As for the post-operative complications, transient hypocalcemia occurred in 19 patients, transient hoarseness was noted in 13 patients and permanent vocal cord palsy occurred in 2 patients. For the TNM stage, 406 (88.6%) patients were stage I, 51 (11.2%) patients were stage III and 1 (0.2%) patient was stage IVA. CONCLUSION: According to our experience, gasless endoscopic thyroidectomy using a trans-axillary approach is a feasible and safe method. Endoscopic thyroid surgery has become a new treatment modality for selected patients with benign tumors and it can be an effective treatment for selected patients who suffer with thyroid cancer.

Papillary Thyroid Carcinoma with Nodular Fasciitis-like Stroma

The morphologic spectrum of papillary thyroid carcinoma (PTC) is wide, and many different variants have been recognized. Papillary thyroid carcinoma with nodular fasciitis-like stroma (PTC-NFS) is one of the rare variants of a papillary thyroid carcinoma. Because of the rarity of PTC-NFS, the pathogenesis and clinicopathological significance are still unknown. We recently experienced a case of papillary thyroid carcinoma with extensive nodular fasciitis-like stroma. A 45-year-old female was admitted due to thyroid incidentaloma. An sonographic examination revealed well-demarcated nodules in the right lobe of the thyroid. Fine-needle aspiration cytology showed a finding suspicious for PTC, but was not diagnostic. The patient underwent a right hemithyroidectomy with central compartment node dissection. On gross examination, a well-demarcated white solid ovoid mass measuring 1.0 x 1.0 cm was seen at the upper pole of the right thyroid gland. An intraoperative frozen section also was unable to differentiate between a benign and malignant lesion. An histopathological test showed prominent stromal cell proliferation, exuberant myofibroblastic proliferation associated with deposition of dense bands of collagen, and an area of papillary carcinoma merging with the desmoplastic stroma. Finally, the patent was diagnosed as having a papillary thyroid carcinoma with nodular fasciitis-like stroma.