Video-assisted thyroid resections in the treatment of papillary thyroid carcinoma.

UNLABELLED: One of the challenges of the minimally invasive video-assisted thyroid resections is their application for the surgical treatment of papillary thyroid carcinoma. AIM: To present our experience with the use of video-assisted thyroid resections with harmonic scalpel in the surgical treatment of patients with papillary thyroid carcinoma. MATERIAL AND METHODS: 259 patients with thyroid nodules were operated in our Clinic for a five-year period--from 2008 to 2013--via a video-assisted technique. Thyroid carcinoma was found in 53 patients (46 female patients and seven male patients, aged 18 to 52 years). The patients were selected according to the established criteria, developed and adopted in our Clinic. The resection was performed using endoscopic harmonic scalpel (Ultracision CS-14C; produced by Ethicon Endo-Surgery Care). The surgical incision length, extent of surgery, duration of operative time, type and incidence of complications (intraoperative and postoperative), period of hospital stay, and safety and radicality of the surgical procedure were examined. RESULTS: The length of the surgical incision was from 1.5 to 2.5 cm in all operated patients. The tumor size varied from 0.5 to 2.0 cm. Papillary carcinoma was found in 42 patients and follicular variant of papillary thyroid carcinoma--in eleven patients. Minimally invasive video-assisted thyroidectomy (MIVAT), using harmonic scalpel and 5 mm optics, was performed in 42 patients and video-assisted lobectomy with near-total resection of the contralateral lobe was performed in the remaining eleven patients. Lymph node micrometastases in the central cervical compartment were found in four patients. Draining of thyroid gland bed was performed in three patients. Transient hypocalcemia was found in one patient. All patients were discharged within the first 24 postoperative hours. CONCLUSION: Our results confirm that, if the criteria for selection of patients are followed, the video-assisted thyroid resections with harmonic scalpel have a place in the surgical treatment of selected patients with papillary thyroid carcinoma.

[Minimally invasive open access thyoid surgery--main point, indications and effectiveness].

UNLABELLED: Various new, minimally invasive techniques, using endoscopic, video-assisted and non-endoscopic, open access have recently appeared in the surgical treatment of nodular thyroid disease. Aim of this study is to examine the feasibility, indications and efficacy of the minimally invasive open approach (MOATS) in the thyroid surgery. PATIENTS AND METHODS: 395 patients (368 (93.2%) females and 27 (6.8%) males, age 17 to 65 years with size of the dominant thyroid nodule less than 3.5 cm have been operated on in our institution over a four years period, using minimally invasive open access thyroid surgery. Preoperative ultrasound examination of the thyroid gland was performed in all patients and FNAB--in 121 (30.6%) of the cases. Central cervical access has been used in all patients. The surgical incision size has been measured in the beginning and at the end of the procedure, on the fourth day and when the sutures have been removed. RESULTS: Partial thyroid resection of one or both thyroid lobes has been performed in 59, respectively in 17 patients; subtotal lobar resection in 106 patients; lobectomy--in 111 patients; lobectomy with partial or subtotal resection of the opposite lobe--in 34, respectively 15 patients; subtotal bilateral thyroid resection--in 25 patients and thyroidectomy in 28 patients. Pathological examination revealed nodular goiter in 168 patients (solitary variant in 99 and multinodular--in 69 patients); toxic nodular goiter--in 13 patients; follicular adenoma--in 175 patients; Hashimoto thyroiditis--in 11 and thyroid carcinoma--in 28 patients. Main peri- and postoperative parameters have been compared with those of a group of patients (well matched by sex, age, nodule size and pathological findings) in witch conventional approach has been used. Minimal collar incision and scar, possibility to apply any extent of surgery witch may be necessary, comparable operative time with the conventional method and good cosmetic results are the undoubtedly good advantages of the technique. CONCLUSIONS: Our experience demonstrates that the minimally invasive open access in the thyroid surgery is a simple, safe and effective surgical technique, with very satisfactory cosmetic results in properly selected patients with small to middle-size thyroid nodules. The technique combines the advantages of an endoscopic resection with those of the conventional, classic technique.

[Minimally invasive open thyroid resections with harmonic scalpel].

UNLABELLED: The harmonic scalpel has been widely used in the field of thyroid surgery in recent years. AIM: To present our initial results after the introduction of harmonic scalpel use during thyroid resections with minimally invasive open approach. PATIENTS AND METHODS: For the period from 01 January to 31 June 2008, 158 thyroid resections using harmonic scalpel have been done in our institution. In 73 of these procedures minimally invasive open approach has been used (69 females and 4 males, at the age of 18 to 54 years, mean age 34.3 years). Patients have been directed to the group with minimally invasive open approach on the ground of inclusion criteria and indications for minimally invasive surgery adopted in our institution. The size of the dominant nodule in multinodular goiters was less than 3.5 cm. In 38 (52%) patients with suspicious malignancy FNAB has been performed. In all procedures a central neck operative approach has been used with length of the incision between 2 and 3 cm (measured in the beginning and at the end of the procedure as well as on the 4th postoperative day). Thyroid resections have been performed using harmonic scalpel (Ethicon Inc.). The extent of thyroid resection, the amount of hemostatic instruments and ligatures, the number of drainages used during the procedures, as well as operative time and incidence of intra- and postoperative complications have been examined. RESULTS: In 8 patients subtotal unilateral thyroid resections have been performed, 42 patients underwent lobectomy, 5 patients--subtotal bilateral thyroid resection and 18 patients--thyroidectomy. The extent of surgery was: isthmusectomy with unilateral partial thyroid resection in 11 patients, isthmusectomy with bilateral partial thyroid resection in 8 patients, isthmusectomy with subtotal unilateral thyroid resection in 29 patients, lobectomy in 24 patients, subtotal bilateral thyroid resection in 17 patients and thyroidectomy in 18 patients. No hemostatic instruments for catching thyroid tissue and vessels, nor following suture ligatures have been used. Incision length reduction, absence of bleeding and shortened operative time have been observed. The reliable and steady hemostasis made the use of hemostatic instruments and stitches unnecessary. Regardless of the extent of surgery, the resections finished without draining. CONCLUSIONS: We have found the harmonic scalpel to be extremely effective device, giving possibility for widespread of minimally invasive thyroid resections with open approach.

[Sentinel lymph node biopsy in patients with papillary thyroid carcinoma].

UNLABELLED: The concept of sentinel lymph node (SLN) has been proven to be successful and accurate in surgical decision making for the treatment of some solid tumors. The AIM of this study is to investigate the feasibility and accuracy of the SLN biopsy in patients with papillary thyroid carcinoma. PATIENTS AND METHODS: Twenty eight patients underwent SLN biopsy for the period from 01 January 2003 to 30 June 2006 in our institution.Twenty three of them were females and 5 males, at the age of 21 to 57 years. All patients have had a solitary thyroid nodule, 0.8 to 3.0 cm in size. Patients with any palpable or ultrasonografically detectable cervical LNs or history for previous neck surgery and/or radiation in the same region have been excluded from the study. Blue dye (Patent blue V) injection around or inside the thyroid nodule was utilized for the SLN detection followed by SLN biopsy. RESULTS: SLN have been detected and obtained in all 22 patients with papillary thyroid carcinoma. One SLN in the central compartment was found in 19 (40,9%) patients and one in lateral compartment in 3 (13,6%) patients. In 2 (9,1%) patients one SLN was found in both, central and lateral compartments. Metastasis in SLN was found in 9 (40,9%) patients. SLN in last 13 (59,1%) patients were negative for metastases. From patients with metastasis-positive SLN, metastasis in a next regional lymph node was found in 3 (13,6%) patients. In the remaining 6 cases next lymph nodes in both compartments were metastasis-negative. Metastatic disease in regional lymph nodes was not found in anyone from the patients with metastasis-negative SLN. CONCLUSIONS: Sentinel lymph node biopsy provides reliable information about the pathomorphological lymph node status in patients with papillary thyroid carcinoma, thus making possible to avoid unnecessary neck dissections and to minimize the risk from local surgical complications and disease recurrencies. The initial results with SLN biopsy give us a reason to accept this technique as a feasible, accurate and safe option in the surgical treatment of papillary thyroid carcinoma.

[Minimally invasive non-endoscopic thyroid resections].

UNLABELLED: The interest in the application of the minimally invasive procedures in the thyroid surgery vastly increased in recent years. AIM: To present our experience with the application of minimally invasive nonendoscopic resections in the thyroid surgery. MATERIAL AND METHODS: 145 patients with various thyroid diseases were operated on with minimally invasive open approach for the period from 1 Janyary 2003 to 30 June 2004 in our institution. Nodular thyroid pathology has dominated. All patients were females, mean age 28.5 years. An preoperative ultrasonographic assessment of thyroid volume, nodular count, size and localization was performed in all cases. The mean thyroid lobe volume was 11.2 ml the size of the removed thyroid nodules was 9 to 33mm (21 +/- 12 mm). The incision length was measured at the beginning, at the end and one week after the operation. RESULTS: The extent of thyroid resection was as follows: partial thyroid resection of a lobe in 28 patients; bilateral partial thyroid resection in 16 patients; subtotal lobectomy in 35 patients; lobectomy in 50 patients; lobectomy with partial thyroid resection of the other lobe in 8 patients; subtotal thyroidectomy in 5 patients; thyroidectomy in 3 patients. The incision length at the end of operation was 3.0 +/- 0.5 cm. Mean operative time was 41.5 +/- 8.4 min. The postoperative hospital stay was 24 +/- 6 hours. Postoperative complications were not observed, except a little haematoma in one case at the beginning of the study, that did not required any additional intervention. The early and late postoperative cosmetic results we have observed, were undoubtedly better. CONCLUSION: Our experience demonstrates that miniinvasive nonendoscopic thyroid resections represent a simple, safe and feasible surgical procedure in selected patients with small to middle-size thyroid nodules.

[Argon plasma thyroid resections--main points and advantages].

UNLABELLED: Here in we present our experience with a new surgical technique of Argon Plasma Thyroid Resections which was developed in our institution to avoid the use of lots of haemostatic instruments and various size blood vessels ligations. AIM: To demonstrate the results we achieved and the advantages of APR, compared with the conventional thyroid resection. MATERIAL AND METHODS: For the period from 01. Feb. 2003 to 31. May 2004 85 patients underwent argonplasma resection (APR) of the thyroid gland in our institution. All patients were females, mean age 38, 5 years. Preoperative ultrasound examination of the thyroid has been performed in all patients for more precise determination of both thyroid lobes volume and echoic pattern of the thyroid gland. FNAB has been performed in 37 (43.5%) patients with suspicious malignancy. The distribution of patients according to the nature of the thyroid disease was as follows: 12 patients with Grave's disease, 7 patients with diffuse goiter, 20 patients with nodular goiter, 28 patients with thyroid adenoma, 14 patients with Hashimoto thyroiditis and 4 patients with thyroid cancer. The procedure has been made by means of an Argon Plasma Coagulation System (Berchtold GmbH). A power setting at 20 W has been used, with time of exposition at 15 seconds and gas-flow at 2 l/h. RESULTS: Twenty one isthmusectomies with partial resection of one lobe, thirty one isthmusectomies with subtotal resection of one lobe, nine isthmusectomies with partial resection of both lobes, six isthmusectomies with partial resection of one lobe and subtotal resection of the other lobe fourteen subtotal thyroidectomies and four thyroidectomies were performed. Lack of bleeding, smooth resection line, without need for haemostatic instruments and blood vessels ligation, minimal injury on the remaining thyroid tissue as well as shortening of the operative time have been observed. CONCLUSIONS: The experience we've gained delineates the newly developed technique of APR as a safe and promissing technique in the surgical treatment of selected patients with indications for thyroid sugery.

[Hashimoto's thyroiditis: indications for surgical treatment].

BACKGROUND: Hashimoto's thyroiditis (HT) is the prototypical example of autoimmune thyroiditis and the primary way to treat the disease is conservative. However, there are patients with HT, in which surgical treatment is mandatory. AIM: Summarizing our institutional experience, to formulate the indications for surgical treatment of Hashimoto's thyroiditis. MATERIALS AND METHODS: 132 patients (131 females and 1 man, mean age 45 years) underwent surgery for HT in the period from 1.01.1987-1.01.2004. Serum thyroid hormone levels, autoimmune and ultrasonographic findings and FNA biopsy confirmed the diagnosis of HT in 115 (87.1%) patients. In the remaining 17 (12.9%) cases, the diagnosis was based on the intraoperative findings as well as on the histological results. From 1987 to 2002 year 110 patients with HT underwent surgery and for the period 01.01.2003 to 01.01.2004 - 22 (54.6%) patients 10 (45.4%) underwent conventional thyroid resection and 12 (54.6%)--argon plasma resection (APR/introduced in our practice since 2003). The indications for surgery were: thyromegaly with compression symptoms, non-responding to L-thyroxin treatment; nodular form of HT with dominant thyroid nodul over 2 cm in size; suspicion for neoplasm or an unsightly neck appearance due to a large goiter. RESULTS: 17(12.9%) patients with diffuse form of HT were surgically treated. Isthmectomy with bilateral medial partial thyroid resection was performed (in 14 cases by conventional method and in 3 by APR). In 81 (61.4%) patients with nodular form of HT isthmectomy with bilobar or unilobar partial or near total thyroid resections were performed (74 conventional resections and 7 APRs). Seven (5.5%) patients have had pseudonodules. In 6 from these cases conventional isthmectomy was performed and in 1 isthmectomy by APR. Coexistent HT with thyroid carcinoma was diagnosed in 27 (20.4%) patients. All underwent thyroidectomy (1 by APR). CONCLUSIONS: Surgery has it's place and efficacy in the treatment of selected patients with Hashimoto's thyroiditis and compression symptoms or nodular forms with dominant nodules over 2 cm, suspicion for neoplasm or an unsightly neck appearance due to a large goiter. Argon plasma resection (APR) is a new, safe and promising technique of thyroid resection, particularly appropriate for patients with Hashimoto's thyroiditis.

[Minimally invasive open thiroydectomy--our initial experience].

UNLABELLED: A crescent number of reports concerning the use of minimally invasive approach in thyroid surgery arise in the last years. AIM: This report describes the recently developed technique of minimally invasive open thyroidectomy and represents our initial experience. PATIENTS AND METHODS: Thirty seven patients underwent a minimally invasive open thyroidectomy in the Clinic of Thoracic Surgery, Medical University of Varna between February the 1th and May the 31th, 2003. Nodular thyroid diseases were the dominant cause. All patients were females. In all cases a preoperative ultrasonography was made to evaluate the volume of each thyroid lobe, as well as the number, size and location of the thyroid nodules. RESULTS: The length of the skin incision varied from 2 to 3,5 cm. Operative time was at 45,4 +/- 10,3 min. Postoperative hospital stay was at 24 +/- 8 hours. There were not any postoperative complications. The extent of thyroid resections was as follows: partial lobe resection in 6 patients; lobectomy in 16 patients; lobectomy and partial counter lateral lobe resection in 4 patients; lobectomy with subtotal thyroidectomy of the other lobe in 2 patients and thyroidectomy in 1 patient. The cosmetic results we have observed were undoubtedly better. CONCLUSIONS: Although initial, our experience shows that minimally invasive open thyroidectomy provides surgeons with an adequate operative field, and that it has proven to be simple, safe, quick and practical for selected patients with small to middle sized thyroid nodules.

[The application of argon plasma coagulation in thoracic surgery: principles, surgical technique and clinical results]. / Prilozhenie na argon-plazmena koagulatsiia v grudnata khirurgiia--printsipi, operativna tekhnima, klinichni rezultati.

BACKGROUND: In recent years, together with the well-known high-frequency electro-coagulation, the application of plasma coagulation has been also introduced in the clinical practice. The argon plasma coagulator (APC) is one of the representatives of this surgical technique. By its nature, the APC represents a non-contact electrothermal tissue coagulation, combining the principle of the augmented surface and enhanced autogenous haemostatic mechanisms. AIM: The main objective of this study was to evaluate whether APC is an effective and safe modality in the open pulmonary surgery. MATERIALS AND METHODS: For the period from 01.01.2003 to 30.01.2004 year, in the Clinic of Thoracic Surgery, we have applied the technique of APC to 15 patients. The distribution by sex was: 10 males and 5 females. According to the nosological units, the distribution was as follows: pulmonary carcinoma in 3, pulmonary echinococcosis in 4, pleural empyema in 6, pulmonary abscessus in 1 and esophageal ahalasia in 1 patient. In our practice, we have used an argon plasma coagulator of BERCHTOLD GmbH. A power setting of 20W with exposition time 15 s and an argon gas flow setting of 1,5-2 1/h have been used in our series. Energy dose applied in our patients didn't exceed 300 J/cm2. RESULTS: The results we have obtained demonstrate the following fundamental advantages of APC: a possibility to work with long electrode--tissue distance; a possibility for large surface coagulation as well as coagulation under variable angle, limited and well controlled depth of penetration, substantial reduction of carbonization; regular distribution of the energy over the whole coagulating surface, a possibility to treat effectively larger bleeding surfaces. CONCLUSIONS: Although initial, our experience gives us the confidence to recommend the use of APC as an effective and safe procedure in the pulmonary surgery.

[The morphological characteristics of the changes in spontaneous pneumothorax. Thorascopic observation]. / Morfologichna kharakteristika na promenite pri spontanen pneumotoraks. Torakoskopsko nabliudenie.

The results obtained by thoracoscopy in 58 patients with spontaneous pneumothorax for the period 1990-1992 were discussed. The distribution of the patients by sex was: male--46 (79.31%); female--12 (20.69%). The mean age was 36.5 and the most patients was between 36-45 years (37.95%). The procedure was performed under local anesthesia with neuroleptanalgesia. Right localisation of the pneumothorax we found in 67.24% and left--in 32.76% of the cases. According to the degree of the collapse of the lung the distribution was: total pneumothorax--in 72.41% and partial pneumothorax--in 27.59% of the patients. Thoracoscopy in recidivist pneumothorax was performed in 18.5% from the followed up group of patients. The most often found causes for developing of spontaneous pneumothorax are: bullous emphysema--79.31%; pleural adhesions-in 15.52% and idiopathic pneumothorax--in 5.17%.