A Comparison of Harmonic Scalpel and Conventional Techniques for Thyroidectomy.

Thyroidectomy is one of the most frequently performed surgeries. Conventional techniques using electrocautery carry the risk of tissue injury. Recently, there has been increased use of harmonic scalpels in thyroid surgery. The harmonic scalpel utilizes ultrasonic shears for cutting and coagulation, thus minimizing thermal injury. The objective of our study was to determine differences in operative duration, hypocalcemia, and RLN palsy. This single-center retrospective comparative study included consecutive patients undergoing hemithyroidectomies using the harmonic scalpel and conventional technique in the past one year (n = 64, harmonic group = 28 and conventional group = 36). The mean operative duration for the harmonic scalpel group was 70.4 min, vs. 81.31 min for the conventional technique group, and the difference in mean duration was found to be 10.84 min (p = 0.027). There was no statistically significant difference in the rates of hypocalcemia (p = 0.751) or RLN palsy (p = 0.121). None of the patients in either group developed permanent hypocalcemia or RLN palsy. The use of a harmonic scalpel during thyroidectomy is safe. The overall surgical duration was reduced when the harmonic scalpel was used, and the complication rates were comparable to those of the conventional technique, making it a non-inferior technique for surgical intervention in thyroidectomy and warranting harmonic scalpel consideration as a valuable addition to the armamentarium of thyroid surgeons.

Observational Learning in Surgical Skill Development.

Observation plays a key role in the development of surgical skills, as it allows trainees to learn from experts and improve their performance through trial-and-error practice. This process, known as motor learning, involves the creation of new neural pathways that enable precise control of surgical instruments through hand movements. In recent years, there has been a shift towards minimally invasive surgery, which requires surgeons to continually learn new motor skills to control specialized instrumentation. Motor learning can be enhanced through repetition and the observation of expert performances. Observational learning is particularly useful when it is used in combination with physical practice, as it can provide hints and clues about important aspects of the task that may not be immediately apparent through verbal instruction alone. The role of mirror neurons, which are activated both when an action is performed and when it is observed, is also important in the process of observational learning. By understanding the mechanisms behind observational learning and the factors that influence its effectiveness, trainers can optimize the use of this method in surgical training.

Molecular Insights into Oral Malignancy.

Squamous cell carcinoma constitutes around 95% of malignancies in the oral cavity. The 5-year overall survival has not substantially improved for oral cancers over the last few decades, despite several advances in diagnosis, imaging, and treatment modalities. With progressive improvement in knowledge of the molecular pathways, cancer therapy can now be individualized. Understanding the genetic processes and natural history of cancer has the scope to enhance the clinical outcomes. There has been a significant improvement in our understanding of oncogenesis, advances in molecular detection methods, and novel biomarkers for oral cancers in the past decade. Indicators of genomic instability, the existence of expression regulators such as miRNA, and several genes and protein markers can predict which premalignant lesions are likely to turn into cancer. The molecular biomarkers in oncology are fast evolving. Still, integrating novel molecular tests into clinical practice will require a better understanding of the genetic pathways that lead to malignancy. Our article investigates the most recent concepts and knowledge on oral carcinogenesis, malignant transformation, and molecular markers for oral cancers.

Correction to: Molecular Insights into Oral Malignancy.

[This corrects the article DOI: 10.1007/s13193-021-01431-4.].

Revision Thyroid Surgery.

The incidence of recurrence in well-differentiated thyroid malignancies range from 10 to 30%. It is estimated that about 31-46% of patients with differentiated thyroid cancer will have the persistent disease and 1.2-6.8% will have structural recurrences during post-operative monitoring, depending on the initial therapy and prognostic variables. It is challenging to decide on treatment versus active monitoring following repeated or persistent tumour detection. The biological factors of the tumour and the patient guide us in the overall decision-making. Revision thyroid surgery is technically challenging. The morbidity encountered during the revision surgery is related to the anatomy of the region undergoing dissection, the degree of fibrosis and scarring from prior surgery and the operating surgeon's experience. Successful comprehensive management of revision thyroid surgery needs a multi-disciplinary approach. This review article highlights the definition, indications for revision surgery, identification of recurrent disease, management of parathyroid and recurrent laryngeal nerves with neuromonitoring.

Pharyngocutaneous Fistula Following Primary Total Laryngectomy: a Meta-analysis.

Pharyngocutaneous fistula (PCF) is the most common complication which significantly increases morbidity. High-level evidence is lacking that determines the PCF rates in the primary laryngectomy. The main objective of this study was to systematically identify the factors leading to the PCF formation in primary laryngectomy. Human studies reporting at least one risk factor for developing PCF in patients undergoing primary total laryngectomy for laryngeal cancer were included. PubMed, EMBASE, and Cochrane databases were searched for the data extraction. Risk of bias assessment tool for non-randomized trial tool was used. Cochrane's Q test and Higgin's I 2-heterogeneity was applied. The Mantel-Haenszel and DerSimonian Laird method was employed. Odds ratio was calculated for each risk factor, a P-value < 0.05 was considered as statistically significant. PROSPERO registration CRD42021248382. The meta-analysis comprised a total of 2446 patients in 14 included non-randomized studies. The among the analyzed risk factors-comorbidities (OR 2.781, R: 1.892-4.088, P < 0.001), site of tumor (OR 4.485, R: 3.003-6.699, P < 0.001), low pre-operative hemoglobin (OR 3.590, R: 2.130-6.050, P < 0.001), low pre-operative albumin (OR 2.833, R: 1.596-5.031, P < 0.001), utilization of surgical staplers (OR 0.172, R: 0.064-0.460, P < 0.001) (protective effect), positive mucosal margin (OR 4.92 R: 1.90-12.75, P = 0.001). The risk factors for PCF in patients undergoing primary TL included comorbidities, hypopharyngeal involvement, pre-operative hemoglobin and albumin, stapler usage, and positive mucosal margin. Level of Evidence - III. Supplementary Information: The online version contains supplementary material available at 10.1007/s13193-022-01581-z.