[Impact of medical TV series on surgical hospital patient's perception of reality]. / Einfluss von Arzt- und Krankenhausserien auf das Wirklichkeitsempfinden chirurgischer Krankenhauspatienten.

BACKGROUND: Medical TV series are very popular. Media research emphasizes that watching TV has an influence on patient's expectations and estimations concerning upcoming surgery. We analyzed these associations in our own patients. We suspected that reality as presented in the media and the actual reality of hospitals are not always conceived as two different worlds. METHODS: Over a 15-month period a standardized questionnaire was used to interview 162 in-house patients who had been admitted for an elective standard operation. They were interviewed 1-2 days prior to surgery and shortly before discharge from hospital. The questions aimed at their social situation and their TV viewing habits with special consideration of medical TV series. RESULTS: The knowledge of medical TV series is highly associated with a realistic assessment of these programs (p < 0.05). Furthermore, the knowledge of these programs is correlated with patient's unrealistic estimations of upcoming surgery. CONCLUSION: Medical TV series have a significant influence on surgical in-house patients. Patients with knowledge of many medical TV series believe that the medical setting in these shows is realistic. This can result in false estimations concerning real surgery.

Hybrid techniques and patients' safety in implementing transoral sublingual thyroidectomy.

PURPOSE: Cosmetic advantages and minimally invasive aspects become more and more important for patients undergoing thyroidectomy. We report on our personal experience and conceptual design in dealing with approaches to the thyroid gland, which we were the first to describe. We report on ideas and experiences concerning its implementation. METHODS: Our own experiences and considerations in the process of finding an endoscopic minimally invasive access in thyroidectomy are compared in a systematic review with the available literature on minimally invasive or endoscopic thyroid surgery. We describe our failures and risk assessment. RESULTS: Our analysis of the literature on minimally invasive thyroidectomy and our own experiences lead us to the conclusion that using different hybrid technologies during the implementation of endoscopic procedures in thyroid surgery can be helpful and could improve patients' safety. A combination of transoral endoscopic and non-transoral techniques might be a useful safer, but more traumatizing alternative for implementation. Several studies show the feasibility of the transoral access in thyroid surgery. We believe that the implementation of these new procedures as routine surgery in specialized centers must be carefully considered and discussed. CONCLUSIONS: The transoral access seems to be less invasive than other extracollar endoscopic accesses in thyroid surgery. For a sublingual single-access routine surgery, better instruments are needed. The vestibular access is possible with standard instruments. Using hybrid technologies for implementation should not be considered as a failure. The transoral thyroidectomy can be a safe method in the hand of experienced surgeons. We expect this hybrid technique to play a major part in further spreading endoscopic transoral thyroid surgery.

Minimally invasive endoscopic thyroid surgery using a collar access: experience in 246 cases with the CEViTS technique.

BACKGROUND: The arguments for applying minimally invasive techniques are, besides cosmetic results, reduced access trauma and less postoperative pain. In thyroid surgery, cosmetic aspects are gaining importance. Whether minimally invasive endoscopic thyroid surgery is less painful has not been shown yet. METHOD: In this study, we analyse the outcome of 246 patients who underwent cervical endoscopic video-assisted thyroid surgery (CEViTS) regarding the surgery itself, their postoperative pain and satisfaction with the procedure. RESULTS: CEViTS is routinely performed in our hospital. In this study, no postoperative bleedings that would have made a reoperation necessary occurred. All lobectomies could be completed endoscopically. In two cases, conversions (enlargement of the 5-mm incision to 25 mm) were necessary. Transient nerve palsy was registered in three patients (1.22%). One patient (0.41%) had a permanent palsy of the recurrent laryngeal nerve. In comparison to open surgery (n = 173 patients), the 246 CEViTS patients had a significantly lower pain level (p = 0.047). CONCLUSIONS: Cervical endoscopic video-assisted thyroid surgery (CEViTS) can be considered a safe, less traumatizing and useful minimally invasive procedure in endoscopic thyroid surgery.

Impact of Medical TV Shows on Preprocedural Fear of Surgical In-House Patients.

Background and Hypotheses: The growing number of medical television series and the increasing amount of time people spend watching TV will have an influence on what they expect from their treatment in a hospital. We suspect that reality as presented in the media and the actual reality of hospitals are not always conceived of as two different worlds. Many medical TV shows present dramatic, life-threatening operations much more often than they occur in reality. Patients who frequently watch such shows might be induced to believe that even routine operations are often dangerous, which could result in higher levels of fear before such an operation. We suspect then that there is a significant relation between preoperative levels of fear and TV viewing habits. METHODS: A standardized questionnaire was used to interview 162 in-house patients who had come to the hospital for an elective standard operation in a German hospital. They were interviewed 1-2 days prior to operation and shortly before discharge from hospital. The questions aimed at their social situation, their TV viewing habits with special consideration of medical TV shows, and the patients' preprocedural fear. RESULTS: The links between levels of education, age, and gender on the one hand, and viewing habits on the other, which have been shown in cultivation research, are supported by our findings. Approximately 50% reported a relevant anxiety level above 4 (on a scale of 0-10). There is a significant association between levels of fear and TV viewing habits. Thirteen subjects (8%) indicated that they suffered the highest imaginable degree of fear, all of them frequent watchers of medical TV shows. Frequent viewers of medical TV shows were definitely more scared than all other patients (p = 0.039). The preoperative level of fear was highest in the age group of under 40 years and significantly lower (p = 0.0042) in the age group of over 70 years. CONCLUSION: The assumed effects of cultivation with in-house patients caused by watching TV series could be shown to be statistically significant. Watching medical TV shows increases the patients' preoperative fear.

Endoscopic thyroidectomy: the transoral approach.

Transoral endoscopic thyroid surgery seems to be the logical consequence in the evolution of thyroid surgery. Animal and cadaver studies have shown that different endoscopic techniques can be performed in a safe and successful way. Presently, the minimally invasive aspect and cosmetic advantage seem to be the most important factor for the patients. However, even if these procedures are feasible in patients, the transoral access must still be considered as experimental. In this study then we aim at comparing the available literature on transoral thyroid surgery with our own experience in this field. The access itself needs to be further refined, and even more suitable and better adapted instruments need to be developed so that optimal and safe results that meet all requirements on endocrine surgery can be achieved and all requirements for endocrine surgery are met. The transoral thyroidectomy should only be performed in highly specialized centres for endocrine and endoscopic surgery. As an alternative, a combination with endoscopic non-transoral techniques-so called hybrid techniques-might be useful for our patients.