Application of meticulous anatomy skills with straight bipolar electric coagulation forceps in thyroid surgery / 中华耳鼻咽喉头颈外科杂志

To compare the efficacies of the two techniques of "micro-hemostasis and micro-cutting" with straight bipolar electrocoagulation forceps and traditional clamp-ligation for hemostasia in thyroid surgery. A total of 228 patients who underwent surgical treatment for thyroid neoplasms in our hospital between January 2015 and December 2018 were retrospectively analyzed, including 50 males and 178 females, aged 23-68 years old. Of those, 150 cases as electric knife group received traditional thyroid surgery between January 2015 and December 2018 and 78 cases as bipolar electrocoagulation group received thyroid surgery by using the technique of bipolar electrocoagulation with meticulous anatomy between January 2018 and December 2018. The total operation time, single operation time, intraoperative hemorrhage, postoperative drainage volume on the first day, postoperative hoarseness and hypocalcemia were compared between the two groups. SPSS 16.0 was used to analyze the data. The total operation time and intraoperative hemorrhage in the bipolar electrocoagulation group were significantly lower than those in the electric knife group ((59.33±18.29)min (77.21±25.39)min, (14.83±9.22)ml (36.86±11.80)ml, all 0.01). The single operation time of the bipolar electrocoagulation group was shorter than that of the electric knife group((10.25±6.16) min (20.34±7.24)min, (16.25±7.15)min (35.68±8.25)min, (12.12±5.25)min (20.68±7.26)min, value was 3.948,16.262,8.238, all 0.01).There was no significant difference between the two groups in postoperative drainage volume on the first day (0.05) and the incidence of postoperative hoarseness (0.05), while the incidence of hypocalcemia in the bipolar electrocoagulation group(10.26%) was lower than that in the electric knife group(21.33%,χ(2)=4.353, 0.05). The fine dissection for thyroid operation can be achieved by using straight bipolar electrocoagulation tweezers. The use of "micro-hemostasis" and "micro-cutting" technique with bipolar electrocoagulation tweezers can greatly reduce intraoperative bleeding, operation time and postoperative complication.

Application of meticulous anatomy skills with straight bipolar electric coagulation forceps in thyroid surgery / 中华耳鼻咽喉头颈外科杂志

Objective@#To compare the efficacies of the two techniques of "micro-hemostasis and micro-cutting" with straight bipolar electrocoagulation forceps and traditional clamp-ligation for hemostasia in thyroid surgery.@*Methods@#A total of 228 patients who underwent surgical treatment for thyroid neoplasms in our hospital between January 2015 and December 2018 were retrospectively analyzed, including 50 males and 178 females, aged 23-68 years old. Of those, 150 cases as electric knife group received traditional thyroid surgery between January 2015 and December 2018 and 78 cases as bipolar electrocoagulation group received thyroid surgery by using the technique of bipolar electrocoagulation with meticulous anatomy between January 2018 and December 2018. The total operation time, single operation time, intraoperative hemorrhage, postoperative drainage volume on the first day, postoperative hoarseness and hypocalcemia were compared between the two groups. SPSS 16.0 was used to analyze the data.@*Results@#The total operation time and intraoperative hemorrhage in the bipolar electrocoagulation group were significantly lower than those in the electric knife group ((59.33±18.29)min vs (77.21±25.39)min, (14.83±9.22)ml vs (36.86±11.80)ml, all P<0.01). The single operation time of the bipolar electrocoagulation group was shorter than that of the electric knife group((10.25±6.16) min vs (20.34±7.24)min, (16.25±7.15)min vs (35.68±8.25)min, (12.12±5.25)min vs (20.68±7.26)min, t value was 3.948,16.262,8.238, all P<0.01).There was no significant difference between the two groups in postoperative drainage volume on the first day (P>0.05) and the incidence of postoperative hoarseness (P>0.05), while the incidence of hypocalcemia in the bipolar electrocoagulation group(10.26%) was lower than that in the electric knife group(21.33%,χ2=4.353, P<0.05).@*Conclusions@#The fine dissection for thyroid operation can be achieved by using straight bipolar electrocoagulation tweezers. The use of "micro-hemostasis" and "micro-cutting" technique with bipolar electrocoagulation tweezers can greatly reduce intraoperative bleeding, operation time and postoperative complication.

Protection of recurrent laryngeal nerve in thyroidectomy / 国际外科学杂志

Recurrent laryngeal nerve damage is one of the common complications in thyroidectomy.With the wide application of ultrasonic scalpel,intraoperative nuromonitoring,endoscopic thyroidectomy,meticulous dissection technique,the surgery methods has changed obviously,in the same time,new problems to protect recurrent laryngeal nerve in thyroidectomy has appeared.To be familiar with the anatomical characteristics of recurrent laryngeal nerve and to be skilled in using the new technique and new device are the keys to protect recurrent laryngeal nerve under new technologies and advanced conceptions.

Protection of recurrent laryngeal nerve in thyroidectomy / 国际外科学杂志

Recurrent laryngeal nerve damage is one of the common complications in thyroidectomy.With the wide application of ultrasonic scalpel,intraoperative nuromonitoring,endoscopic thyroidectomy,meticulous dissection technique,the surgery methods has changed obviously,in the same time,new problems to protect recurrent laryngeal nerve in thyroidectomy has appeared.To be familiar with the anatomical characteristics of recurrent laryngeal nerve and to be skilled in using the new technique and new device are the keys to protect recurrent laryngeal nerve under new technologies and advanced conceptions.

Application of Meticulous Capsular Dissection Technique in the Prevention of Recurrent Laryngeal Nerve and Parathyroid Injuries in Thyroid Operations / 中国微创外科杂志

Objective To assess the application and effects of meticulous capsular dissection technique in the prevention of recurrent laryngeal nerve and parathyroid injuries in thyroid operations . Methods A retrospective analysis of clinical data of 195 cases which received meticulous capsular dissection technique in thyroid operations from June 2007 to June 2012 was carried out .All the cases were supermicro-dissected in the loose clearance between real and false thyroid capsules , leaving the blood vessel dissected close to the real thyroid capsule . Results The operation was successfully performed in all the 195 patients, with recurrent laryngeal nerve clearly exposed in the operation in 9 patients.There were 4 cases of transient recurrent laryngeal nerve paralysis (2.1%) and 1 case of permanent paralysis (0.5%).No permanent recurrent laryngeal nerve and superior laryngeal nerve injuries and permanent hypoparathyroidism happened in the remaining cases . Conclusion The use of meticulous capsular dissection technique not only can effectively avoid the superior laryngeal nerve and recurrent laryngeal nerve injuries , but also can preserve in situ parathyroid glands and their nutrient vessels .

Morphology and dissection technique of the kidney of the grey snapper lutjanus griseus (teleostei: lutjanidae) / Morfología y técnica de disección del riñón del pargo gris lutjanus griseus (teleostei: lutjanidae)

In order to describe the morphology of the kidney and implement its dissection technique, specimens of the grey snapper Lutjanus griseus were analyzed. The morphology of the kidney fits with the structural pattern of the higher teleosts, consisting of a large fusion of the right kidney with the left, with the exception of the anterior renal lobes. Both anterior renal lobes are separated by the retractores dorsales muscles and by the anchorage of the gas bladder to the vertebrae. Some cranial and spinal nerves, as well as ribs, blood vessels, the Baudelot's ligament, the sinus venosus of the heart, the precaudal vertebrae, and the gas bladder mark the surface of the kidney. The archinephric ducts are connected with the urinary bladder, from which the common urinary and urogenital leaves.

Con el objeto de describir la morfología del riñón y de implementar su técnica de disección, se analizaron ejemplares del pargo gris Lutjanus griseus. La morfología del riñón corresponde al patrón estructural de los teleósteos superiores, consistiendo en una amplia fusión del riñón derecho con el izquierdo, con excepción de los lóbulos renales anteriores. Ambos lóbulos renales anteriores están separados por los músculos retractores dorsales y por el anclaje de la vejiga gaseosa a las vértebras. Algunas estructuras marcan la superficie del riñón, como algunos de los nervios craneales y espinales, las costillas, vasos sanguíneos, el ligamento de Baudelot, el seno venoso del corazón, las vértebras precaudales y la vejiga gaseosa. Los conductos arquinéfricos se conectan a la vesícula urinaria, desde la cual sale el conducto urinario común.

Microsurgery therapy with Toth water dissection technique for patients with hypertensive intracerebral hemorrhage via lateral fissure approach / 中华神经医学杂志

Objective To investigate the feasibility of microsurgery therapy with Toth water dissection technique for patients with hypertensive intracerebral hemorrhage via lateral fissure approach.Methods Forty-eight patients with hypertension basal ganglia cerebral hemorrhage,admitted to our hospital from January 2009 to January 2012,were selected in our study; they were divided into two groups according to different treatment methods:the observation group (n=24) chose Toth water dissection technique via lateral fissure approach and the control group (n=24) adopted surgery via lateral fissure approach.The operation time,postoperative coma time,hematoma clear rate,postoperative bleeding and activity of daily living (ADL) were compared between the two groups.Results Better results of operating time,postoperative coma time and hematoma clear rate in the observation group were noted as compared with those in the control group with significant differences (P＜0.05).All patients were followed up for 3 months; significant difference on ADL grading was noted between the observation group and the control group (Z=-1.998,P=0.046).The mean rank in the observation group (20.67) was obviously smaller than that in the control group (28.33),indicating that the prognosis in the observation group was better than that in the control group.No death was noted in the observation group while two in the control group.Conclusion Toth water dissection technique has better effect,enjoying smaller trauma,simpler operation,less time consuming and better protective effects on frontal and temporal lobes,in patients with hypertensive intracerebral hemorrhage as compared with traditional lateral fissure technology.

Application of harmonic scalpel combined with meticulous capsular dissection technique in thyroidectomy / 中国医师进修杂志

Objective To introduce the clinical experience and investigate the significance and safety of harmonic scalpel combined with meticulous capsular dissection technique in thyroidectomy.Methods A retrospective analysis was performed on 275 patients who underwent thyroidectomy among which 135 patients were treated by capsular dissection technique and harmonic scalpel (harmonic scalpel group),the other 140 patients were treated by electric knife and traditional ligation (traditional group).The thyroidectomy operative time,intraoperative bleeding volume,postoperative drainage volume and surgical complications were compared between two groups.Results In harmonic scalpel group,the thyroidectomy operative time of total thyroidectomy and subtotal thyroidectomy was significantly shorter than that in traditional group [(50.0±6.9) min vs.(82.0± 14.4) min,(39.9±6.6) min vs.(73.1 ± 14.5) min](P＜0.01).The intraoperative bleeding volume of total thyroidectomy and subtotal thyroidectomy in harmonic scalpel group was significantly lower than that in traditional group [(18.7 ± 10.9) ml vs.(41.9 ± 15.6) ml,(17.7 ± 9.3) ml vs.(42.2 ± 14.6) ml] (P ＜ 0.01).The postoperative drainage volume of total thyroidectomy and subtotal thyroidectomy in harmonic scalpel group was significantly lower than that in traditional group [(40.7 ± 11.7) ml vs.(53.9 ± 17.5) ml,(42.7 ± 14.5) ml vs.(61.8 ±22.9) ml](P＜0.01).The rate of temporary hypoparathyroidism and temporary recurrent laryngeal nerve palsy had no significant difference between two groups (P ＞ 0.05).Conclusions Application of harmonic scalpel combined with meticulous capsular dissection technique in thyroidectomy can significantly reduce thyroidectomy operative time,intraoperative bleeding volume,postoperative drainage volume and surgical complications.Harmonic scalpel combined with meticulous capsular dissection technique in thyroidectomy should be widely used.

Explortation of the clinical application of total thyroidectomy / 中国现代普通外科进展

Objective:To discuss the method of surgery treatment for nodular goiter,Graves disease,Hashimoto thyroiditis and differentiated thyroid carcinoma. Methods:A retrospective analysis of the clinical records of 76 patients undergoing total thyroidectomy was analyzed for the method of surgery treatment for thyroid diseases from resection extent,operative techniques,intraoperative and postoperative complications. Results:Five patients(78.4%)of all the patients accepted total thyroidectomy in first operation had transient or short-term completely recovered hypocalcemia postoperatively,and there were no cases with injury of recurrent laryngeal nerve. 4 patients(33.3%) had one-sided recurrent laryngeal nerve injury and temporary hypoparathyroidism in recurrent patient,and one of the cases had permanent hypoparathyroidism. Conclusion:Total thyroidectomy could be served as the routine operative method for multinodular goiter,Graves disease,Hashimoto thyroiditis and differentiated thyroid carcinoma.

Dissection technique for the study of the cerebral sulci, gyri and ventricles / Técnica de dissecação para o estudo dos sulcos, giros e ventriculos cerebrais

Neuroanatomy in addition to neurophysiology, are the basic areas for the proper formation from health students to specialized professionals in neuroscience. A step by step guide for practical studies of neuroanatomy is required for this kind of knowledge to become more acceptable among medical students, neurosurgeons, neurologists, neuropediatricians and psychiatric physicians. Based on the well known courses of sulci, gyri and ventricles offered by Beneficência Portuguesa Hospital in São Paulo, Brazil, two times a year, since 1994, totalizing more than 20 complete courses, and answering the request of many neuroscience students and professionals whose asked for a practical guide to the neuroanatomy study, the authors suggest a protocol for the study of superficial and deep brain structures showing how to approach the more structures as possible with minimum damage to the anatomic piece and with the smaller number of brains.

Neuroanatomia e a neurofisiologia são as áreas básicas para a adequada formação desde estudantes na área da saúde a profissionais especializados em neurociências. Um guia prático, passo a passo, para o estudo de neuroanatomia é necessário para tornar esse conhecimento mais acessível entre estudantes de medicina, neurologistas, neurofisiologistas, neurocirurgiões, neuropediatras e psiquiatras. Baseados em cursos reconhecidos nacional e internacionalmente a respeito dos sulcos, giros e ventrículos cerebrais elaborados e realizados pelo Instituto de Ciências Neurológicas (ICNE) no Hospital de Beneficência Portuguesa de São Paulo, Brasil, duas vezes ao ano, totalizando mais de 20 cursos já realizados, os autores apresentam um protocolo de dissecação para o estudo das estruturas superficiais e profundas do encéfalo, mostrando como expor o máximo de estruturas com um mínimo de manipulação e dano à peça anatômica e utilizando o menor número de encéfalos possíveis.

Cerebellar Cortical Artery Dissection Technique for the Preservation of Operative Fields during Microvascular Decompression for Hemifacial Spasm: Technical Note

It is important to obtain a good exposure of the root exit zone(REZ) of the facial nerve during microvascular decompression(MVD) for hemifacial spasm(HFS). For this purpose, authors dissected cerebellar cortical artery in addition to exposing the proximal portion of lower cranial nerves. During MVD for HFS, surgeons frequently meet a cerebellar cortical artery along the inferolateral aspect of cerebellar hemisphere. It is usually hemispheric branch of anterior inferior cerebellar artery(AICA) or posterior inferior cerebellar artery(PICA). It is reason that authors have dissected the outside arachnoid membrane attached pia mater of cerebellar cortical artery with a arachnoid knife or microscissor but preserve the inside arachnoid membrane attached dura mater. Microsurgical retractor is placed inferolaterally between cerebellar cortical artery and cerebellar hemisphere and elevated from the floor of the posterior fossa. The subarachnoid cisterns over the lower cranial nerves are opened with sharp dissector and wide operative fields and good exposure of REZ of facial nerve is obtained.