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Objective: To explore the feasibility and safety of the gasless transoral vestibular robotic thyroidectomy using skin suspension. Methods: The clinical data of 20 patients underwent gasless transoral vestibular robotic thyroidectomy in the Department of Otorhinolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University from February 2022 to May 2022 were retrospectively analyzed. Among them, 18 were females and 2 were males, aged (38.7±8.0) years old. The intraoperative blood loss, operation time, postoperative hospital stay, postoperative drainage volume, postoperative pain visual analogue scale (VAS) score, postoperative swallowing function swallowing impairment score-6 (SIS-6), postoperative aesthetic VAS score, postoperative voice handicap index-10 (VHI-10) voice quality, postoperative pathology and complications were recorded. SPSS 25.0 was used for statistical analysis of the data. Results: The operations were successfully completed without conversion to open surgery in all patients. Pathological examination showed papillary thyroid carcinoma in 18 cases, retrosternal nodular goiter in 1 case, and cystic change in goiter in 1 case. The operative time for thyroid cancer was 161.50 (152.75, 182.50) min [M (P25, P75), the same below] and the average operative time for benign thyroid diseases was 166.50 minutes. The intraoperative blood loss 25.00 (21.25, 30.00) ml. In 18 cases of thyroid cancer, the mean diameter of the tumors was (7.22±2.02) mm, and lymph nodes (6.56±2.14) were dissected in the central region, with a lymph node metastasis rate of 61.11%. The postoperative pain VAS score was 3.00 (2.25, 4.00) points at 24 hours, the mean postoperative drainage volume was (118.35±24.32) ml, the postoperative hospital stay was 3.00 (3.00, 3.75) days, the postoperative SIS-6 score was (4.90±1.58) points at 3 months, and the postoperative VHI-10 score was 7.50 (2.00, 11.00) points at 3 months. Seven patients had mild mandibular numbness, 10 patients had mild cervical numbness, and 3 patients had temporary hypothyroidism three months after surgery and 1 patient had skin flap burn, but recovered one month after surgery. All patients were satisfied with the postoperative aesthetic effects, and the postoperative aesthetic VAS score was 10.00 (10.00, 10.00). Conclusion: Gasless transoral vestibular robotic thyroidectomy using skin suspension is a safe and feasible option with good postoperative aesthetic effect, which can provide a new treatment option for some selected patients with thyroid tumors.
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Masculino , Femenino , Humanos , Adulto , Persona de Mediana Edad , Tiroidectomía/efectos adversos , Procedimientos Quirúrgicos Robotizados/efectos adversos , Estudios Retrospectivos , Pérdida de Sangre Quirúrgica , Hipoestesia/cirugía , Disección del Cuello/efectos adversos , Neoplasias de la Tiroides/cirugía , Dolor Postoperatorio/cirugía , Complicaciones Posoperatorias/etiologíaRESUMEN
Objective: To investigate the safety, efficacy, locally control and survival results of transoral Da Vinci robotic surgery for salvage treatment of locally recurrent nasopharyngeal carcinoma. Methods: This retrospective study included 33 patients with locally recurrent nasopharyngeal carcinoma (stage rT1-2, partial rT3) underwent transoral Da Vinci robotic surgery between October 2017 and January 2020. There were 20 males and 11 females, with an average age of (47.9±10.5) years. The lesions were localized in nasopharyngeal cavity in 14 cases, with extending to parapharyngeal space in 6 cases and the floor of sphenoid sinus in 13 cases. Transnasal endoscopy was used to assist surgery if necessary. SPSS 25.0 statistical software was used for statistical analysis. Results: Transoral robotic nasopharyngectomy was successfully performed in all cases without conversion to open surgery, of which 13 cases were combined with transnasal endoscopic surgery. The average operation time was (126.2±30.0) min, ranging from 90 to 180 min. The postoperative pathological margin was R0 (31 cases) and R1 (2 cases), with no tumor residue. Complications of surgery mainly included symptoms of headache, nasal dryness and velopharyngeal insufficiency without nasopharyngeal hemorrhage. Follow-up time was from 3 to 54 months. One case had tumor recurrence 11 months after operation, 1 case had ipsilateral cervical lymph node metastasis 27 months after operation, 2 cases had distant metastasis and 1 case died of nasopharyngeal hemorrhage 3 months after operation. The 1-year, 2-year and 3-year overall survival rates were 97.0%, 96.0% and 92.9%, respectively and the local recurrence free rates were 97.0%, 95.7% and 91.7%, respectively. Conclusion: Transoral robotic nasopharyngectomy is safe and feasible for local recurrent nasopharyngeal carcinoma in selected patients, with higher local control rate and quality of life.
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Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Carcinoma Nasofaríngeo/cirugía , Neoplasias Nasofaríngeas/patología , Recurrencia Local de Neoplasia/cirugía , Calidad de Vida , Estudios Retrospectivos , Procedimientos Quirúrgicos RobotizadosRESUMEN
BACKGROUND: This study investigates the conservative management of radiation-induced early nasal adhesion after radiotherapy for nasopharyngeal carcinoma (NPC). METHODS: From June 2008 to June 2010, patients with bilateral or unilateral early nasal adhesion after radiotherapy for NPC were selected. All patients received endoscopic management and then nasal irrigation daily and nasal steroids spray for at least 3 months. All of the clinical data and follow-up endoscopy were analyzed. RESULTS: There were 40 patients enrolled. The mean follow-up period was 19.6 months (range, 12-24 months) after procedure. Thirty-eight patients (95%) had patent nasal cavity during follow-up. Two patients (5%) had not received endoscopy regularly and developed severe fibrosis. For the whole group, nasal obstruction, rhinorrhea, hyposmia, and xerostomia all were improved from before management according to visual analog score (p < 0.05). CONCLUSION: Therapeutic endoscopy in combination with nasal steroid sprays and nasal irrigation provides a convenient, simple, effective, and minimally invasive therapy to treat early radiation-induced nasal adhesion patients.
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Glucocorticoides/administración & dosificación , Lavado Nasal (Proceso) , Neoplasias Nasofaríngeas/complicaciones , Enfermedades Nasales/diagnóstico , Enfermedades Nasales/terapia , Radioterapia Adyuvante/efectos adversos , Adulto , Anciano , Carcinoma , Diagnóstico Precoz , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Lavado Nasal (Proceso)/métodos , Rociadores Nasales , Carcinoma Nasofaríngeo , Neoplasias Nasofaríngeas/radioterapia , Enfermedades Nasales/etiología , Adherencias Tisulares/diagnóstico , Adherencias Tisulares/terapia , Resultado del TratamientoRESUMEN
<p><b>OBJECTIVE</b>To investigate the feasibility of the endoscope-assisted styloidectomy.</p><p><b>METHODS</b>Sixty patients with Eagle's syndrome undergoing the endoscope-assisted styloidectomy via postauricular incision, including 7 unilateral and 53 bilateral, between June 2010 and March 2013 were reviewed.</p><p><b>RESULTS</b>The styloid processes in all patients were resected successfully via this approach, with the incision length range of 2.0 to 2.5 cm. The mean operative time was (21.3 ± 4.8) min(X(-) ± s), for unilateral surgery and (48.5 ± 11.4) min for bilateral surgery. Fifty-four patients symptom showed complete remission of symptom, 3 cases with decrease in symptom and other 3 cases with no significant relief of symptom after surgery. None case recurred for follow-up of 3 to 70 months. There were 3 sides with ear numbness after surgery for 3 months, and one case had transient facial paralysis and recovered after 3 months.</p><p><b>CONCLUSIONS</b>The endoscope-assisted styloidectomy via postauricular incision is effective and feasible.</p>
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Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Endoscopios , Osificación Heterotópica , Cirugía General , Osteotomía , Métodos , Hueso Temporal , Cirugía GeneralRESUMEN
<p><b>OBJECTIVE</b>To evaluate the feasibility and safety of endoscopic thyroidectomy via anterior chest approach for early papillary thyroid cancer (T1N0M0).</p><p><b>METHODS</b>From July 2004 to December 2010, 91 patients with early papillary thyroid cancer underwent minimally invasive endoscopic thyroidectomy via anterior chest approach. The clinical and pathologic characteristics of patients, operation types, operative time, postoperative hospital stay time, and postoperative complications were analyzed retrospectively.</p><p><b>RESULTS</b>All 91 operations were successfully performed endoscopically. There was no case conversed to open surgery. The mean tumor size was (0.96 ± 0.71) cm. The operation types included unilateral lobectomy (41 cases), unilateral subtotal lobectomy (3 cases), ipsilateral lobectomy and contralateral subtotal lobectomy (42 cases), and bilateral total thyroidectomy (5 cases). Central compartment node dissection was carried out in 39 cases with the tumor diameter less than 1.0 cm and in 29 cases with the tumor diameter of 1.0 - 2.0 cm. The mean operating time was (99 ± 17) min, the mean bleeding volume was (18 ± 12) ml, and the mean post-operative hospital stay time was (3 ± 1) days. Temporary recurrent laryngeal nerve (RLN), paresis occurred in 2 cases and recovered within 1 to 2 months after the surgery. One patient showed permanent RLN paralysis. Two patients showed temporary hypoparathyroidism. No patient showed post-operative seroma and tracheal injury. There was no case with injury to the superior laryngeal nerve. No further complications, such as irritating cough, tetany, and emphysema developed after the operation. With the anterior chest wall approach, all patients had no surgical scar on the neck and thus they were satisfied with the cosmetic outcomes. All patients were disease free by follow-up of 7 to 85 (58.4 ± 17.2) months.</p><p><b>CONCLUSIONS</b>Minimally invasive endoscopic thyroid surgery through anterior chest approach is a feasible and safe method for the treatment of early papillary thyroid cancer. This technique had better cosmetic results and the long-term effect of this technique needs further evaluation.</p>
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Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Carcinoma , Cirugía General , Carcinoma Papilar , Endoscopía , Métodos , Neoplasias de la Tiroides , Cirugía General , Tiroidectomía , Métodos , Resultado del TratamientoRESUMEN
The diagnosis of postradiation nasopharyngeal skull base lesions in petients with nasopharyngeal carcinoma (NPC) is still a tough problem in clinical practice. An early and accurate diagnosis is important for subsequent management. We prospectively evaluated the diagnostic value of plasma Epstein-Barr virus(EBV) DNA in detecting postradiation nasopharyngeal skull base lesions in NPC patients. From July 2006 to September 2010, 90 patients with postradiation NPC (34 women and 56 men; median age: 42 years) met the selection criteria and were recruited in this study. All postradiation nasopharyngeal skull base lesions were found in the latest magnetic resonance imaging (MRI) examinations before endoscopic surgery, and the nasopharyngeal cavity was normal under flexible nasopharyngoscopy. Plasma EBV DNA detection was performed within 2 weeks before endoscopic surgery. A total of 90 endoscopic operations were successfully performed without any postoperative complications. Recurrences confirmed by postoperative pathology were found in 30 patients. The specificity, positive and negative predictive values of plasma EBV DNA detection were better than those of MRI. In addition, combining plasma EBV DNA detection with MRI improved the specificity and positive predictive values of MRI. Plasma EBV DNA detection followed by MRI would help to diagnose recurrence whereas MRI was unable. These results indicate that plasma EBV DNA is an effective and feasible biomarker for detecting postradiation nasopharyngeal skull base lesions in NPC patients.
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Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Carcinoma de Células Escamosas , Sangre , Radioterapia , Virología , ADN Viral , Sangre , Endoscopía , Estudios de Seguimiento , Herpesvirus Humano 4 , Genética , Imagen por Resonancia Magnética , Neoplasias Nasofaríngeas , Sangre , Radioterapia , Virología , Nasofaringe , Patología , Recurrencia Local de Neoplasia , Diagnóstico , Virología , Neoplasia Residual , Osteorradionecrosis , Diagnóstico , Cirugía General , Estudios Prospectivos , Base del Cráneo , PatologíaRESUMEN
<p><b>OBJECTIVE</b>To study on thyroid bilateral gland lobe disease with endoscopic monolateral anterior chest approach.</p><p><b>METHODS</b>Twenty patients experienced thyroid bilateral gland lobe surgery with endoscopic monolateral anterior chest approach; 24 experienced conventional surgery simultaneously and were enrolled in control group. Two groups were compared at surgical style, complications, surgical time, length of stay in hospital, incision cosmetic result and incision pain etc. Criteria of patients selected for thyroid bilateral gland lobe surgery with endoscopic monolateralanterior chest approach:with no surgical history of thyroid or other neck-related diseases and no chemotherapy; diagnosed with benign tumor according to presurgery CT result and thyroid functional examination. Diameter of tumor on both sides should be smaller than 4 cm, one side smaller than 2 cm, located at lower middle part of gland lobe and near to gland surface.</p><p><b>RESULTS</b>Patients in both groups matched in age and sex; scorings on surgical style, hospital stay, postoperative drainage, and postoperative pain were not significantly distinctive. Endoscopic group had less bleeding volumn than conventional group during surgery, better cosmetic results, but longer surgical duration and higher cost of hospitalization. Both groups occurred no permanent glottic paralysis and hypocalcemia, no recurrence. Endoscopic group had one case ecchymoma; one case temporary glottic paralysis; both recovered in one month. Complication incidence in both groups was not significantly distinctive (chi(2) = 2.514, P = 0.201).</p><p><b>CONCLUSIONS</b>Gasless endoscopic monolateral anterior chest approach can well treat selected thyroid bilateral gland lobe disease and with a better cosmetic result than conventional surgery.</p>