Bovine Pluripotent Stem Cells: Current Status and Prospects.

Pluripotent stem cells (PSCs) can differentiate into three germ layers and diverse autologous cell lines. Since cattle are the most commonly used large domesticated animals, an important food source, and bioreactors, great efforts have been made to establish bovine PSCs (bPSCs). bPSCs have great potential in bovine breeding and reproduction, modeling in vitro differentiation, imitating cancer development, and modeling diseases. Currently, bPSCs mainly include bovine embryonic stem cells (bESCs), bovine induced pluripotent stem cells (biPSCs), and bovine expanded potential stem cells (bEPSCs). Establishing stable bPSCs in vitro is a critical scientific challenge, and researchers have made numerous efforts to this end. In this review, the category of PSC pluripotency; the establishment of bESCs, biPSCs, and bEPSCs and its challenges; and the application outlook of bPSCs are discussed, aiming to provide references for future research.

A systematic review and meta-analysis of nab-paclitaxel mono-chemotherapy for metastatic breast cancer.

BACKGROUND: Although various clinical trials and real-life studies have tried to explore the value of nab-paclitaxel mono-chemotherapy for metastatic breast cancer (MBC), the safety and efficacy of nab-paclitaxel remain unclear which need to be systematically evaluated. METHODS: Electronic searches for prospective clinical trials evaluating nab-paclitaxel monotherapy for MBC were performed. Requisite data were extracted, integrated and analysed from the included studies according to the different study designs using systematic review and meta-analysis. Meta-regression and subgroup analysis were further performed to explore the potential risk factors affecting each individual outcome of interest following nab-paclitaxel monotherapy. RESULTS: Twenty-two studies with 3287 MBC patients were included. A total of 1685 MBC patients received nab-paclitaxel as first-line therapy, 640 patients as further-line therapy, and 962 patients as mixed-line therapy. A total of 1966 MBC patients (60.40%) received nab-paclitaxel weekly, 1190 patients (36.56%) received nab-paclitaxel triweekly and 99 patients (3.04%) received nab-paclitaxel biweekly. The overall incidence rates of all-grade neutropenia, leukopenia, peripheral sensory neuropathy, and fatigue were 52% (95% CI, 38-66%, I2 = 98.97%), 58% (95% CI, 43-73%, I2 = 97.72%), 58% (95% CI, 48-68%, I2 = 97.17%), and 49% (95% CI, 41-56%, I2 = 94.39%), respectively. The overall response rate (ORR) was 40% (95% CI, 35-45%, I2 = 98.97%), and the clinical benefit rate (CBR) was 66% (95% CI, 59-73%, I2 = 98.97%) following nab-paclitaxel monotherapy. The median progression-free survival (PFS) was 7.64 months (95% CI, 6.89-8.40 months, I2 = 92.3%), and the median overall survival (OS) was 24.51 months (95% CI, 21.25-27.78 months, I2 = 92.7%). Treatment line, human epidermal growth factor receptor-2(Her-2)-negative status and dosage were found to be sources of heterogeneity among the included studies. According to the meta-regression and subgroup analysis, grade 3/4 neutropenia occurred less frequently in Her-2-negative patients than in the entire population (P = 0.046). Patients who received first-line nab-paclitaxel monotherapy showed a higher ORR (P = 0.006) and longer PFS (P = 0.045). Efficacy outcomes were not affected by the administration schedule. However, within the same schedule, patients appeared to have a superior ORR (P = 0.044) and longer PFS (P = 0.03) with an increasing dosage of nab-paclitaxel administered. CONCLUSIONS: The benefits brought by nab-paclitaxel mono-chemotherapy in the treatment of MBC are considerable while the harm is generally manageable. Further study and validation are needed to figure out the roles which the dosage, schedule and other factors play actually in nab-paclitaxel chemotherapy.

The predictive factors for postoperative hypoparathyroidism and its severity on the first postoperative day after papillary thyroid carcinoma surgery.

PURPOSE: The purpose of the study was to investigate the predictive factors for hypoparathyroidism and its severity on the first postoperative day (POD1) after total thyroidectomy (TT) with or without central neck dissection (CND) in patients with papillary thyroid carcinoma (PTC). METHODS: From February 2014 to February 2019, 2550 PTC patients were admitted to our department. PTC patients who underwent TT were enrolled in this study. A parathyroid hormone (PTH) level lower than 15 pg/mL on POD1 was defined as hypoparathyroidism, and the severity of hypoparathyroidism was classified into three categories according to the level of PTH on POD1: mild hypoparathyroidism (10 pg/mL ≤ PTH < 15 pg/mL), moderate hypoparathyroidism (5 g/mL ≤ PTH < 10 pg/mL), and severe hypoparathyroidism (PTH < 5 pg/mL). Multiple clinical, pathological and surgical parameters of these two different groups were compared and analyzed to demonstrate the possible causes of hypoparathyroidism. Furthermore, patients who developed postoperative hypoparathyroidism were also included in a subgroup analysis according to the severity of their hypoparathyroidism. The underlying factors affecting different severities of hypoparathyroidism were also illustrated with univariate and multivariate analyses. RESULTS: Ultimately, 690 patients who underwent TT were enrolled in this retrospective study. Through the univariate analysis, different surgeons (P < 0.001), extent of CND (P = 0.009), prophylactic calcium supplementation (PCS) (P < 0.001), preoperative (pre-op) PTH level (P < 0.001), and pre-op phosphorus concentration (P = 0.022) were found to be significantly correlated with postoperative hypoparathyroidism. According to the multivariate analysis, PCS was the only independent high-risk factor for hypoparathyroidism. In the univariate analysis of patient subgroups with different severities of hypoparathyroidism, we demonstrated that the tumor T stage (P = 0.021) and pre-op PTH level (P < 0.001) were associated with the severity of hypoparathyroidism. Furthermore, after the multivariate analysis, hypertension (P < 0.001) and pre-op PTH (P < 0.001) were the two independent predictive factors for the severity of hypoparathyroidism after surgery. CONCLUSIONS: Postoperative PCS could increase the risk for PTC patients developing hypoparathyroidism after thyroid surgery. Patients with a history of hypertension and a relatively high pre-op PTH level may not develop severe hypoparathyroidism after TT with CND.

Inhibition of Nrf2 promotes the antitumor effect of Pinelliae rhizome in papillary thyroid cancer.

We previously reported that Xiaotan Sanjie (XTSJ) decoction can prevent the progression of gastric cancer in vitro and in vivo. Pinelliae rhizome (PR), one component of XTSJ decoction, has an inhibitory effect on the growth and proliferation of tumor cells. The present study investigated the underlying mechanisms of action of PR. Using the human papillary thyroid cancer cell lines, TPC-1 and BCPAP, we found that XTSJ decoction and PR alone decreased cell viability to a similar extent in both cell lines, whereas treatment with XTJS decoction without PR [PR (-)] had a lesser effect. PR treatment inhibited the expression of nuclear factor erythroid 2-related factor 2 (Nrf2) in a dose-dependent manner. To investigate the role of Nrf2 in the PR-mediated effects of XTSJ, knockdown of Nrf2 in the tumor cell lines using Nrf2 siRNA (siNrf2) was performed and transfected cells were treated with PR. Silencing of Nrf2 amplified the effects on autophagy, cell viability, apoptosis, and colony formation. Similar results were obtained following treatment with the autophagy inhibitor 3-methyladenine (3-MA). Furthermore, treatment with PR, siNrf2, and/or 3-MA inhibited the MAPK pathway, and analysis of the MAPK pathway components confirmed the role of this pathway in the PR-mediated cellular effects. In mice implanted with siNrf2-transfected cells, the effects of PR were amplified. Taken together, these findings indicate that PR is critical for the inhibitory effects of XTSJ decoction on tumor cell viability and that downregulation of Nrf2 promotes the antitumor effects of PR on papillary thyroid cancer cells.

Effects of Diet on Bile Acid Metabolism and Insulin Resistance in Type 2 Diabetic Rats after Roux-en-Y Gastric Bypass.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) is effective for the treatment of type 2 diabetes mellitus; however, the mechanism remains unclear. METHODS: The effects of RYGB on postprandial responses to three different diets (low carbohydrate (CH)-rich diet, high CH-rich diet, and fat-rich diet) of different nutritional composition in a Goto-Kakizaki (GK) diabetic rat model were assessed by measuring glucose tolerance, insulin resistance, incretin responses, and bile acid (BA) metabolism. RESULTS: GK-RYGB group rats lost weight and preferred low CH-rich diet, but there were no significant differences in BW among the different diets. Glucose tolerance and insulin resistance were improved in rats who underwent RYGB, together with higher levels of circulating BAs, plasma GLP-1, and PYY levels. GK-RYGB rats fed high CH-rich or fat-rich diet showed increased glucose level and insulin resistance, together with high plasma BA, GIP, and PYY levels compared to those fed a low CH-rich diet. CONCLUSION: RYGB improves glucose tolerance and insulin resistance which may be related to BA metabolism and hormone levels, and the nutrient composition of the diet affects the treatment effect of RYGB on T2DM.

Application of carbon nanoparticles accelerates the rapid recovery of parathyroid function during thyroid carcinoma surgery with central lymph node dissection: A retrospective cohort study.

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the efficacy of carbon nanoparticles in identifying lymph nodes and promoting parathyroid gland function recovery after thyroid carcinoma surgery along with central lymph node dissection. METHODS: A total of 231 patients who underwent thyroid carcinoma surgery combined with central lymph node dissection were divided into two groups: the CN group (intraoperative carbon nanoparticles injections) and the control group (no injection). Datas were collected respectively on the pre-operative, 1st, 7th and 30th postoperative days and monthly thereafter. While the pathological results (e.g. amount of incidental removed parathyroid glands and lymph nodes dissected), complications (e.g. rates of vocal cord paralysis, the neuromuscular symptoms, hypocalcemia and hypoparathyroidism), as well as follow-up outcomes of the serum Ca2+ and PTH levels were gathered and measured to be included in. RESULTS: In regard to the results of the pathological tests, the control group had a relatively higher incidence of incidental parathyroidectomy when compared to the CN group (P < 0.05). The mean number of central lymph nodes dissected was rather higher in the CN group than that of the control group (P < 0.05).With respect to the follow-up results, the CN group had an earlier and faster recovery of serum PTH levels as compared to the control group (P < 0.05). The serum PTH levels of the CN group were apparently higher than that of the control group at the first week and month postoperatively (P < 0.05). No significant differences were found in rates of long-term postoperative complications between the two groups (P > 0.05). CONCLUSION: Carbon nanoparticles play a key role in accurately identifying lymph nodes, reducing mistaken excision of parathyroid glands, accelerating rapid recovery of parathyroid function during thyroid carcinoma surgery with central lymph node dissection, without increasing the probability of postoperative complications.

A Meta-Analysis of Randomized Controlled Trials to Compare Long-Term Outcomes of Nissen and Toupet Fundoplication for Gastroesophageal Reflux Disease.

AIM: In recent years, several studies with large sample sizes and recent follow-up data have been published comparing outcomes between laparoscopic Nissen fundoplication and laparoscopic Toupet fundoplication. It is now timely to be re-evaluated and synthesized long-term efficacy and adverse events of both total and partial posterior fundoplication. MATERIALS AND METHODS: Electronic searches for RCTs comparing the outcome after laparoscopic Nissen fundoplication and laparoscopic Toupet fundoplication were performed in the databases of MEDLINE, EMBASE, and the Cochrane Center Register of Controlled Trials. The data of evaluation in positive and adverse results of laparoscopic Nissen fundoplication and laparoscopic Nissen fundoplication were extracted and compared using meta-analysis. RESULTS: 13 RCTs were ultimately identified involving 814 (52.05%) and 750 (47.95%) patients who underwent laparoscopic Nissen fundoplication and laparoscopic Toupet fundoplication, respectively. The operative time, perioperative complications, postoperative satisfaction, recurrence, and the rates of medication adoption or re-operation due to recurrence were not significantly different between two groups. The two types of fundoplication both reinforced the anti-reflux barrier and elevated the lower esophageal sphincter pressure. However, rates of adverse results involving dysphasia, gas-bloat syndrome, inability to belch and re-operation due to severe dysphasia were significantly higher after LNF. In the subgroup analysis of wrap length≤2 cm, laparoscopic Nissen fundoplication was associated with a significantly higher incidence of postoperative dysphagia. However, in the subgroup wrap length>2 cm, the difference was not statistically significant. CONCLUSION: Laparoscopic Toupet fundoplication might be the better surgery approach for gastroesophageal reflux disease with a lower rate of postoperative adverse results and equal effectiveness as Laparoscopic Nissen fundoplication.

A meta-analysis of short-term outcomes of patients with type 2 diabetes mellitus and BMI ≤ 35 kg/m2 undergoing Roux-en-Y gastric bypass.

BACKGROUND: Roux-en-Y gastric bypass (RYGB) is effective for type 2 diabetes mellitus (T2DM) patients with a body mass index (BMI) >35 kg/m(2). It is unknown whether it benefits those with a BMI ≤ 35 kg/m(2). In the last decade, the effect of bariatric procedures on metabolic outcomes in individuals who underwent surgery outside National Institutes of Health (NIH) guidelines (BMI ≤ 35 kg/m(2)) was both interesting and controversial. OBJECTIVE: We performed a systematic analysis evaluating the effect of RYGB for T2DM patients with a BMI ≤ 35 kg/m(2). METHODS: We searched databases (Embase, Ovid, PubMed, China National Knowledge Infrastructure [CNKI], and Cochrane Library) and relevant journals between January 1980 and October 2013. Keywords used in electronic searching included 'diabetes', 'gastric bypass', 'BMI', and 'body mass index'. Inclusion criteria were as follows: (1) patients who underwent RYGB; (2) sample size ≥ 15; (3) patients with a BMI ≤ 35 kg/m(2); and (4) follow-up ≥ 12 months. Exclusion criteria were as follows: (1) data extracted from a database; (2) trials for sleeve gastrectomy; (3) trials for laparoscopic banding; (4) trials for bilio-pancreatic diversion; and (5) trials for duodenojejunal bypass. Participants and intervention type 2 diabetes patients with BMI ≤ 35 kg/m(2) who underwent RYGB. Two investigators reviewed all reported studies independently. Data were extracted according to previously defined endpoints. A meta-analysis was performed for these parameters, with homogeneity among different trials. RESULTS: Nine articles fulfilled inclusion criteria. After 12 months, patients with T2DM had a significant decrease in their BMI postoperatively (p < 0.00001, weighted mean difference [WMD] -7.42, 95 % confidence interval [CI] -8.87 to -5.97), and remission of diabetes (glucose: p < 0.00001, WMD -59.87, 95 % CI -67.74 to -52.01; hemoglobin A1c p < 0.00001, WMD -2.76, 95 % CI -3.41 to -2.11). There were no deaths in all trials, and the complication rate was between 6.7 and 25.9 %. Mean length of hospital stay was 2.00 to 3.20 days, and mean operative time was from 72.8 to 112.0 min. In terms of study limitations, publication and selection bias were unavoidable. Trials with small sample sizes were excluded, which may lead to a selection bias. CONCLUSION: RYGB was effective for T2DM patients with BMI ≤ 35 kg/m(2). Further clinical studies with long-term follow-up data are necessary to clarify this issue.

Influence of laparoscopy vs. laparotomy on bacterial translocation and systemic inflammatory responses in a porcine model with peritonitis.

BACKGROUND: This study aimed to compare the effects of laparoscopy vs. laparotomy on bacterial translocation and immunologic responses in a porcine model with peritonitis caused by small bowel injuries (SBIs). METHODS: Pigs with SBIs were first established, assigned into either the laparoscopy group or the laparotomy group, and then received surgical intervention. During 72 hours (72 hr) observation period, blood, and tissues of different organs were obtained for bacterial cultures; endotoxin and peripheral leukocyte were determined; serum levels of IL-6, TNF-α, and CRP were measured. RESULTS: Blood cultures confirmed systemic bacteremia in all animals and the endotoxin level was comparable between groups at 24 hr after surgery. However, two days later, positive bacteremia was only detected in four pigs following laparoscopy and five following laparotomy. Eight and four pigs during laparoscopy (seven and six pigs during laparotomy) had translocated bacteria in mesenteric lymph nodes (MLN) and liver. The 72 hr later, bacteria in MLN, liver, lung, and kidney was found in 2, 1, 2, and 0 pig after laparoscopy, respectively (3, 2, 2, and 1 pig after laparotomy). The peripheral blood monocytes (PBMC) counts remained at a much lower level after laparoscopy than after laparotomy. Serum IL-6, TNF-α, and CRP increased notably after both procedures when compared to preoperative levels. However, significantly faster and lower regression of IL-6, TNF-α, and CRP were observed in the laparoscopy group. CONCLUSION: Compared with laparotomy, laparoscopy does not result in increased bacterial translocation, but decrease IL-6, TNF-α, and CRP release.

Dual-sided composite mesh repair of hiatal hernia: our experience and a review of the Chinese literature.

AIM: To summarize our experience in the application of Crurasoft® for antireflux surgery and hiatal hernia (HH) repair and to introduce the work of Chinese doctors on this topic. METHODS: Twenty-one patients underwent HH repair with Crurasoft® reinforcement. Gastroesophageal reflux disease (GERD) and HH-related symptoms including heartburn, regurgitation, chest pain, dysphagia, and abdominal pain were evaluated preoperatively and 6 mo postoperatively. A patient survey was conducted by phone by one of the authors. Patients were asked about "recurrent reflux or heartburn" and "dysphagia". An internet-based Chinese literature search in this field was also performed. Data extracted from each study included: number of patients treated, hernia size, hiatorrhaphy, antireflux surgery, follow-up period, recurrence rate, and complications (especially dysphagia). RESULTS: There were 8 type I, 10 type II and 3 type III HHs in this group. Mean operative time was 119.29 min (range 80-175 min). Intraoperatively, length and width of the hiatal orifice were measured, (4.33 ± 0.84 and 2.85 ± 0.85 cm, respectively). Thirteen and eight Nissen and Toupet fundoplications were performed, respectively. The intraoperative complication rate was 9.52%. Despite dysphagia, GERD-related symptoms improved significantly compared with those before surgery. The recurrence rate was 0% during the 6-mo follow-up period, and long-term follow-up disclosed a recurrence rate of 4.76% with a mean period of 16.28 mo. Eight patients developed new-onset dysphagia. The Chinese literature review identified 12 papers with 213 patients. The overall recurrence rate was 1.88%. There was no esophageal erosion and the rate of dysphagia ranged from 0% to 24%. CONCLUSION: The use of Crurasoft® mesh for HH repair results in satisfactory symptom control with a low recurrence rate. Postoperative dysphagia continues to be an issue, and requires more research to reduce its incidence.

Is laparoscopy equal to laparotomy in detecting and treating small bowel injuries in a porcine model?

AIM: To evaluate the safety and effectiveness of laparoscopy compared with laparotomy for diagnosing and treating small bowel injuries (SBIs) in a porcine model. METHODS: Twenty-eight female pigs were anesthetized and laid in the left recumbent position. The SBI model was established by shooting at the right lower quadrant of the abdomen. The pigs were then randomized into either the laparotomy group or the laparoscopy group. All pigs underwent routine exploratory laparotomy or laparoscopy to evaluate the abdominal injuries, particularly the types, sites, and numbers of SBIs. Traditional open surgery or therapeutic laparoscopy was then performed. All pigs were kept alive within the observational period (postoperative 72 h). The postoperative recovery of each pig was carefully observed. RESULTS: The vital signs of all pigs were stable within 1-2 h after shooting and none of the pigs died from gunshot wounds or SBIs immediately. The SBI model was successfully established in all pigs and definitively diagnosed with single or multiple SBIs either by exploratory laparotomy or laparoscopy. Compared with exploratory laparotomy, laparoscopy took a significantly longer time for diagnosis (41.27 ± 12.04 min vs 27.64 ± 13.32 min, P = 0.02), but the time for therapeutic laparoscopy was similar to that of open surgery. The length of incision was significantly reduced in the laparoscopy group compared with the laparotomy group (5.27 ± 1.86 cm vs 15.73 ± 1.06 cm, P < 0.01). In the final post-mortem examination 72 h after surgery, both laparotomy and laparoscopy offered a definitive diagnosis with no missed injuries. Postoperative complications occurred in four cases (three following laparotomy and one following laparoscopy, P = 0.326). The average recovery period for bowel function, vital appearance, and food re-intake after laparoscopy was 10.36 ± 4.72 h, 14.91 ± 3.14 h, and 15.00 ± 7.11 h, respectively. All of these were significantly shorter than after laparotomy (21.27 ± 10.17 h, P = 0.004; 27.82 ± 9.61 h, P < 0.001; and 24.55 ± 9.72 h, respectively, P = 0.016). CONCLUSION: Compared with laparotomy, laparoscopy offers equivalent efficacy for diagnosing and treating SBIs, and reduces postoperative complications as well as recovery period.

Routine central neck dissection in differentiated thyroid carcinoma: a systematic review and meta-analysis.

OBJECTIVE/HYPOTHESIS: The role of central neck dissection (CND) remains controversial in differentiated thyroid cancer (DTC). STUDY DESIGN: Systematic review and meta-analysis. METHODS: A systematic review and meta-analysis focusing on surgical morbidities and locoregional recurrence after total thyroidectomy (TT) with CND versus TT alone was performed. RESULTS: Sixteen trials were analyzed. There was no increased risk of recurrent laryngeal nerve (RLN) injury (temporary or permanent), permanent hypocalcemia, or locoregional recurrence when CND was performed in addition to TT. Postoperative temporary hypocalcemia was more common after TT with CND than after TT alone. CONCLUSIONS: TT alone results in less surgical morbidity in the immediate postoperative period and an identical locoregional recurrence rate compared with TT plus CND.

Laparoscope-assisted creation of a neovagina using pedicled ileum segment transfer.

BACKGROUND: To present our experience of vaginal reconstruction with the use of a pedicled ileum segment and laparoscope assistance, and to analyze its complications and long-term anatomic and functional results. METHODS: The abdominal and perineal approaches were performed simultaneously with the patient in a special position. Under the guidance of laparoscopy, the target ileal segment was harvested and transposed down to the perineum through an artificial tunnel between the bladder and the rectum. A silicon vaginal tutor was introduced into the vaginal cavity and maintained all day long for 2-3 months. The complications and the anatomical and functional results were summarized and analyzed. RESULTS: From February 2002 to June 2010, 82 patients underwent laparoscope-assisted total vaginal reconstruction with a pedicled ileum segment at our department. Complications developed in 16 of 82 patients, including rectum and/or bladder injury during operation, acute renal failure, delayed healing of the ileocutaneous anastomosis, introital stenosis, and partial or complete intestinal obstruction. The abdominal cutaneous scar was acceptable after the surgery. The vulva was not altered, which was especially significant for patients with congenital vaginal atresia. The neovagina was patent, soft, moist, and flexible. The mean width and depth of the neovagina at the latest postoperative visit measured 3.2 and 15 cm, respectively. CONCLUSIONS: The favorable long-term anatomical and functional results demonstrate that our technique is ideal for patients with congenital vaginal atresia or patients who need secondary vaginal reconstruction. For the primary male-to-female transsexuals or hermaphrodites, it can be an alternative method for vaginal construction.

New technique for retraction of the strap muscles in endoscopic thyroidectomy.

OBJECTIVE: It is extremely important to establish sufficient exposure and room for manipulation during endoscopic thyroidectomy. To solve this problem, the authors have developed a new technique for retraction of the strap muscles perfected during 500 cases of breast-approach endoscopic thyroidectomy. METHODS: The new technique encompasses the use of 3 styles of retractor: the suture retractor, the button retractor, and the adjustable button retractor. These retractors are all easy to make and are all useful in different situations. CONCLUSIONS: The new technique is a safe and cost-effective method. It reduces the operation time required to obtain good exposure without transecting the strap muscles. In addition, it is minimally invasive and confers cosmetic benefits.

Current status of endoscopic thyroid surgery in China.

The first cases of video-assisted thyroidectomy and scarless endoscopic thyroidectomy were reported in China in 2001 and 2002, respectively. Breast approach endoscopic thyroidectomy (BAET) has become the most popular procedure for treating thyroid disease in China. Chinese doctors did not pioneer this approach, but contributed toward improvement in technical details such as incision selection, creation of a working space, suture exposure, and control of intraoperative bleeding. Relatively large series confirmed that BAET is a safe procedure but has a long learning curve that can be overcome with training. Surgical stress was not significantly increased despite the larger subcutaneous dissection. BAET to treat malignancy is feasible, but larger series and longer follow-up are warranted before its widespread acceptance.

Clinical benefits of scarless endoscopic thyroidectomy: an expert's experience.

BACKGROUND: By comparison with the conventional surgical approach to thyroidectomy, scarless (in the neck) endoscopic thyroidectomy (SET) has a superior cosmetic result but a very long learning curve. The objective of the present study was to compare surgical outcomes of SET performed by an experienced surgeon with the outcomes of conventional thyroidectomy. METHOD: Enrolled in this study were 25 patients who underwent SET and 18 who underwent conventional surgery. Differences in size of tumor, length of incision, duration of operation, volume of blood loss, pathological findings, postoperative pain, complications, and cosmetic result were investigated. RESULTS: The two groups were well matched. The total length of incisions and volume of blood loss of SET were significantly lower than those of conventional surgery. In addition to the superior cosmetic result, postoperative pain was significantly less severe and rates of hypesthesia or paresthesia and discomfort while swallowing were significantly lower in the endoscopy group. CONCLUSIONS: In experienced hands, SET offers more benefits than the conventional approach, including less postoperative pain and discomfort and a better cosmetic outcome.

Evaluating the safety of the Harmonic Scalpel around the recurrent laryngeal nerve.

BACKGROUND: The Harmonic Scalpel (HS) is widely used in thyroidectomy. Determining the safety margin of using the HS near the recurrent laryngeal nerve (RLN) is helpful in preventing the injury to this nerve during thyroidectomy. METHODS: The parameters of evoked electromyography (EEMG) of vocal muscles before and after using the HS at a power level of 3 were recorded in a rabbit model. Masson staining was used to determine lateral injury caused by incisions using the HS. RESULTS: After the activated tip of the HS made contact with the RLN for ≥1 s or was placed 1 mm from the nerve for 3 or 5 s or 2 mm from the nerve for 5 s, significant changes were observed in the minimal stimulus current intensity threshold, the optimal stimulus current intensity threshold, the onset latency and the wave amplitude of EEMG. After the activated HS tip touched the RLN or was placed 1 mm to the nerve for ≥1 s or 2 mm to the nerve for 5 s, significant changes were found in peak latency. The thickness of injured lateral tissue was <1, 1-2 and >2 mm when using HS for 1, 3 and 5 s, respectively. CONCLUSION: When used near the RLN at a power level of 3, the activated HS tip should be ≥2 mm from the nerve and the duration of incision should be ≤3 s.

The minimally invasive effect of breast approach endoscopic thyroidectomy: an expert's experience.

We evaluated the invasiveness of breast approach endoscopic thyroidectomy (BAET) carried out by surgeon very experienced in this procedure. Twenty-four patients who underwent BAET and 19 patients who underwent conventional thyroidectomy were the study population. Postoperative pain was assessed by a visual analog scale (VAS). The values 2, 12, and 24 h after surgery were significantly lower in the BAET group than those in the conventional group. Serum IL-6 and CRP levels were measured by an ELISA preoperatively and at 2, 12, 24 and 48 h after operation. Their values increased significantly after both procedures when compared to preoperative levels with significant differences between the two groups detected at the 24-hour and 48-hour time points. Subjective and objective evidence supported the notion that BAET could become a minimally invasive procedure if the surgeon gained sufficient experience.

Evidence-based appraisal in laparoscopic Nissen and Toupet fundoplications for gastroesophageal reflux disease.

AIM: To demonstrate the optimal surgical procedure for gastroesophageal reflux disease. METHODS: The electronic databases of Medline, Elsevier, Springerlink and Embase over the last 16 years were searched. All clinical trials involved in the outcomes of laparoscopic Nissen fundoplication (LNF) and laparoscopic Toupet fundoplication (LTF) were identified. The data of assessment in benefits and adverse results of LNF and LTF were extracted and compared using meta-analysis. RESULTS: We ultimately identified a total of 32 references reporting nine randomized controlled trials, eight prospective cohort trials and 15 retrospective trials. These studies reported a total of 6236 patients, of whom 4252 (68.18%) underwent LNF and 1984 (31.82%) underwent LTF. There were no differences between LNF and LTF in patients' satisfaction, perioperative complications, postoperative heartburn, reflux recurrence and re-operation. Both LNF and LTF enhanced the function of lower esophageal sphincter and improved esophagitis. The postoperative dysphagia, gas-bloating syndrome, inability to belch and the need for dilatation after LNF were more common than after LTF. Subgroup analyses showed that dysphagia after LNF and LTF was similar in patients with normal esophageal peristalsis (EP), but occurred more frequently in patients with weak EP after LNF than after LTF. Furthermore, patients with normal EP after LNF still had a higher risk of developing dysphagia than did patients with abnormal EP after LTF. CONCLUSION: Compared with LNF, LTF offers equivalent symptom relief and reduces adverse results.

Progress in laparoscopic anatomy research: a review of the Chinese literature.

The development of laparoscopic surgery has generated the new field of study, laparoscopic anatomy. This article reviews the reported literature on laparoscopic anatomy and explores how it has evolved along with advances in abdominal surgery. In addition, the principal concerns in current laparoscopic anatomy research are discussed, including: (1) types of special adjacent anatomical structures; and (2) special surgical planes and anatomical landmarks. Understanding of systematic laparoscopic anatomy can provide the junior surgeons a clear procedural approach, and would benefit laparoscopic surgeons in training.