[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.