ObjectiveTo compare postoperatively clinical effect of endoscopic total thyroidectomy via breast approach versus traditional total thyroidectomy via neck in treatment of thyroid papillary carcinoma on postoperative function of parathyroid gland. MethodsRetrospective study performed on 124 thyroid papillary carcinoma patients who were hospitalized between June 2014 and December 2015 in Department of General Surgery of The First Affiliated Hospital of General Hospital of PLA. All patients underwent total thyroidectomy plus central Ⅵ lymphadenectomy. Endoscopic total thyroidectomy via breast were applied on 48 patients and traditional total thyroidectomy via neck were applied on 76 patients. Serum intact parathyroid hormone (iPTH) and calcium on postoperative day 1 were monitored for all patients. Then comparison of the serum iPTH and calcium between the 2 groups was performed. ResultsSerum iPTH and calcium for all 124 patients were within the normal range before surgery, and there was no significant difference between the endoscopic total thyroidectomy via breast group and traditional total thyroidectomy via neck group in the serum iPTH and calcium (P > 0.05). On 1 day after surgery, the level of iPTH in endoscopic total thyroidectomy via breast group was lower than that of traditional total thyroidectomy via neck group[(20.8±5.7) pg/mL vs. (28.3±4.9) pg/mL], and ratio of lower iPTH than normal of endoscopic total thyroidectomy via breast group was higher[43.8% (21/48) vs. 22.4% (17/76)], P < 0.05; but there was no significant difference in serum calcium between 2 groups[(2.1±0.3) mmol/L vs. (2.0±0.5) mmol/L], P > 0.05. In addition, the incidence of perioral, chiral and pedal numbness was higher in endoscopic total thyroidectomy via breast group than that of traditional total thyroidectomy via neck group[47.9% (23/48) vs. 27.6% (21/76)], P < 0.05. ConclusionsComparably, endoscopic total thyroidectomy via breast approach is more prone to lowly postoperative serum iPTH and calcium. Patients are more prone to exhibit clinical symptom such as perioral numbness, chiral and pedal numbness.
Objective To evaluate the impact of total thyroidectomy on health-related quality of life （HRQOL） in patients with nodular goiter. Methods The patients who underwent total thyroidectomy from Jan. 2009 to Dec. 2011 in our hospital were retrospectively analyzed with regard to the quality of life （total thyroidectomy group）. The patients with similar demographic features who underwent hemithyroidectomy during the same period were matched as control （hemi-thyroidectomy group）. The validated HRQOL instrument， which was the Euro quality of life-5D （EQ-5D）， was applied to measure the HRQOL. Comparison of HRQOL in patients of 2 groups was performed， meanwhile， the data of total thyroidectomy group was compared with data of normal population who were obtained from The Forth National Health Survey. Results There were 26 and 28 valid questionnaires returned for the total thyroidectomy group and hemithyroi-dectomy group respectively. The demographic features of patients in 2 groups were comparable. No significant variancecould be found between the 2 groups that there were no significant differences on the mobility， self-care， usual activities，pain/discomfort， anxiety/depression， and visual analogous scales （P＞0.05）. Furthermore， no significant differences in HRQOL were found in EQ-5D questionnaire compared with normal population derived from The Forth National Health Survey （P＞0.05）， except that there were more patients complained of moderate and severe pain/discomfort in the total thyroidectomy group 〔30.8% （8/26） vs.9.2% （16 330/177 501）， P＜0.01〕. Conclusion Total thyroidectomy appears to have little impact on the quality of life in the patients with nodular goiter.
Objective To compare the mean operative time and complications between the LigaSure device and Harmonic Scalpel during video-assisted endoscopic approaches thyroidectomy. Methods The clinical data of 684 cases performed Miccoli thyroidectomy by the same operation team from January 2007 to December 2011 in the department of general surgery，Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University were analyzed. Three hundred and forty-nine patients were used Harmonic Scalpel，335 patients were used LigaSure device. The mean operative time and complications （such as hematoma，transient hoarseness，permanent recurrent laryngeal nerve injury，and hypocalcemia） were compared between two groups. Results A total of 684 patients were included in the study，of whom 263 underwent total thyroidectomy and 421 underwent lobectomy. There were not significant differences of the operative time and the complications in both thyroidectomy and lobectomy between the LigaSure device and Harmonic Scalpel（P＞0.05）. Conclusions The uses of the LigaSure device and Harmonic Scalpel in thyroid surgery are safe and reliable，surgeons may choose surgical instruments by habits and medical equipments.
ObjectiveTo investigate the effectiveness of probe-based near infrared autofluorescence (AF) technology in the identification and functional protection of parathyroid gland (PG) during endoscopic total thyroidectomy. MethodsWe retrospectively collected the clinical data of 160 patients who underwent total thyroidectomy with bilateral central compartment lymph node dissection due to papillary thyroid carcinoma in Chongqing General Hospital from 1 July 2023 to 31 January 2024. Among them, 80 patients who used probe-based near infrared AF technology to identify the PGs were categorized as the AF group, 80 patients who used naked eye (NE) to identify the PGs were categorized as the NE group. The number of PGs identified, inadvertently removed, preserved in situ and autotransplanted, the incidence of postoperative hypoparathyroidism, and operative time were compared between the two groups. ResultsThe incidence of transient hypoparathyroidism was significantly lower in the AF group than that of the NE group [21.25% (17/80) vs. 43.75% (35/80), χ2=9.231, P=0.002], with no cases of permanent hypoparathyroidism in either group. The AF group had significantly more PGs identified and preserved in situ than the NE group (P<0.05) , but had significantly fewer PGs inadvertently removed and autotransplanted than the NE group (P<0.05). The AF group identified the first PG earlier than the NE group (4 min vs. 5 min, P<0.001). But there was no statistically difference in the operative time between the two groups (90 min vs. 94 min, P=0.052). ConclusionThe probe-based near infrared AF technology can help surgeons better identify and protect PGs during surgery, reducing the incidence of postoperative transient hypoparathyroidism.
ObjectiveTo summarize the risk factors of the change of voice quality after thyroidectomy without recurrent laryngeal nerve injury and to provide reference for the prevention and treatment of postoperative voice quality damages.MethodThe research progress of the change of voice quality after thyroidectomy without recurrent laryngeal nerve injury was reviewed by reading the related literatures at home and abroad.ResultsEven if there was no obvious recurrent laryngeal nerve injury during the operation, the voice quality may change after the operation for the patients undergoing thyroidectomy. The change of voice quality after thyroidectomy without recurrent laryngeal nerve injury was associated with various risk factors such as dysfunction of superior laryngeal nerve, injury of anterior laryngeal band muscles, endotracheal intubation, surgical methods, age, gender and special occupations.ConclusionsThe change of voice quality is a common complication after thyroidectomy, which seriously affects the quality of life of patients. In the absence of significant recurrent laryngeal nerve injury, many patients will still experience problems with voice quality. Understanding the related risk factors of voice quality change after thyroidectomy is helpful to optimize postoperative voice function, to prevent possible secondary injuries, and to improve the quality of life of patients.
ObjectiveTo systematically evaluate the effectiveness and safety of prophylactic central neck dissection (PCND) for stage cN0 papillary thyroid carcinoma. MethodsDatabases including PubMed, EMbase, The Cochrane Library (Issue 1, 2015), WanFang Data, CBM and CNKI were searched to collect the studies about total thyroidectomy (TT)+PCND versus TT alone for stage cN0 papillary thyroid carcinoma from inception to March 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.1 software. ResultsA total of 10 studies involving 3 661 patients were included. The results of meta-analysis showed that, compared with TT alone, TT+PCND had higher transient hypocalcemia (OR=2.50, 95%CI 2.05 to 3.03, P<0.000 01), higher permanent hypocalcemia (OR=3.11, 95%CI 1.82 to 5.30, P<0.000 1), and lower recurrence (OR=0.66, 95%CI 0.47 to 0.93, P=0.02). But there were no significant differences between two groups in transient laryngeal nerve palsy or permanent laryngeal nerve palsy. ConclusionTT+PCND is safe and feasible for treating stage cN0 papillary thyroid carcinoma when its indications are strictly controlled. However, due to limited quantity and quality of the included studies, more high-quality randomized controlled trials are needed to verify the abovementioned conclusion.
Thirty patients with heperthyroidism were investigated for triiodothyronine (T3), thyroxine (T4), thyroid stimulating hormone (TSH), thyromicrosome antibody (TMA), thyroglobulin antibody (TGA) and hydrocortisone before and after operation. The levels of serum T3, T4, TGA, TMA were markedly decreased after operation, and the level of hydrocortisone farther decreased from the preoperative low level. But only a little decrease in TSH level was found as compared with that before operation. The assay of these hormones and antibodies has very important clinical significance for judgement of the effect of operation and prevention of crisis of hyperthyroidism.
Objective To explore the accuracy and efficiency of indocyanine green fluorescence (ICGF) imaging in evaluating blood perfusion of parathyroid gland (PG) during total thyroidectomy. Methods Seventy patients who underwent total thyroidectomy and bilateral central lymph node dissection for papillary thyroid carcinoma (PTC) from March 2021 to December 2021 were enrolled and randomly divided into experimental group (ICGF imaging, n=35) and control group (normal treatment, n=35). Blood perfusion of PGs was evaluated by ICGF imaging and naked eye in each group respectively. The perfusion of PGs, incidence of hypoparathyroidism, and number of autotransplanted PGs were analyzed between the two groups. Results There was no difference between two groups in the incidence of transient hypoparathyroidism (P=0.339), and no one occurred permanent hypoparathyroidism. More PGs were autotransplanted in the experimental group compared to the control group (P＜0.001). At least one PG with good perfusion in the experimental group predicted an extremely high rate of normal parathyroid hormone levels of the patients postoperatively than the control group (P=0.003). Conclusion ICGF imaging can evaluate the blood perfusion of PGs accurately and guide their autotransplantation.
Objective To explore the protection of the structure and function around the upper pole of the thyroid gland by endoscopic thyroidectomy combined with nerve detection through the gasless unilateral axillary approach. Methods From January 2019 to June 2020, 48 thyroid patients who underwent the gasless unilateral axillary approach combined with the endoscopy and nerve detection technology in the Department of Head and Neck Surgery of Zhejiang Provincial People’s Hospital were reviewed as the endoscopic group, and 53 thyroid patients underwent open surgery combined with the endoscopy and nerve detection technology as the open group. The protection of the functional structure of the suprathyroid pole were compared. Results In terms of operation time, the endoscopic group was longer than that of the open group (67.5 min vs. 54.1 min, P=0.001). There was no statistical difference between the two groups in terms of postoperative hospital stay and blood loss (P>0.05). Forty-seven patients with the endoscopic thyroid surgery through the gasless unilateral axillary approach effectively detected the superior laryngeal nerve (47/48, 97.9%), which was higher than that of the open group (40/53, 75.5%), P=0.003, and the exposure rate of hypoglossal nerve descending branch in the endoscopic group was also higher [31.3% (15/48) vs. 3.8% (2/53), P=0.001]. In the endoscopic group, the superior parathyroid gland was kept in situ during the operation, and there was no change of voice and cough after the operation. In the open group, there were 2 cases of autologous transplantation of the upper pole parathyroid gland, 2 patients had voice changes, and 1 case had partial upper pole banded muscle incision. There was no significant difference in the incidence of nerve injury complications, the rate of autologous transplantation of the upper pole parathyroid gland and the rate of anterior cervical banded muscle injury between the two groups (P>0.05). In addition, there was no significant difference in the levels of parathyroid hormone, blood calcium, blood magnesium and blood phosphorus between the two groups before/after operation (P>0.05). Conclusion During the endoscopic thyroidectomy through the gasless unilateral axillary approach, the nerve monitoring technology is combined with the exploration and protection of the superior laryngeal nerve on the surface of the medial cricothyroid muscle of the upper pole of the thyroid, and the fine capsule anatomy technology is used to protect the superior parathyroid gland in situ, which can more effectively expose the external branch of the superior laryngeal nerve. It is conducive to the protection of the structures around the upper pole.
ObjectiveTo discuss clinical significance of total endoscopic thyroidectomy (TET) via chest-breast approach. MethodsThe clinical data of 890 patients with thyroid diseases from September 2008 to September 2015 in this hospital were analyzed retrospectively. These patients were divided into TET group (received TET, n=420) and traditional group (received traditional thyroidectomy, n=470). The data of operation and postoperative recovery were compared between these two groups. ResultsThere was no significant difference between the TET group and the traditional group in the operation time [(73.571 4±28.533 9) min versus (70.212 8±27.199 8) min, t=1.80, P=0.072 7], bleeding volume [(30.714 3±14.225 1) mL versus (29.106 4±13.559 1) mL, t=1.73, P=0.084 8], postoperative drainage [(60.000 0±27.287 9) mL versus (56.595 7±27.803 5) mL, t=1.84, P=0.066 2], postoperative hospitalization time [(5.333 3±1.085 1) d versus (5.446 8± 1.089 0) d, t=1.55, P=0.120 4], postoperative 24 h pain score [(5.333 3±2.308 7) points versus (5.404 3±2.182 1) points, t=0.47, P=0.637 8] and postoperative injury rate of recurrent laryngeal nerve [0.714 2% (3/420) versus 0.851 1% (4/470), x2=0.053 2, P=0.817 6] and hypoparathyroidism rate [0.476 2% (2/420) versus 0.851 1% (4/470), x2=0.465 5, P=0.495 1]. The score of aesthetic effect of incision on day 7 after operation in the TET group was significantly higher than that in the traditional group [(7.809 5±1.296 9) points versus (3.361 7±1.391 8) points, t=49.14, P < 0.000 1]. ConclusionTET is safe and effective, and could improve cosmetic effect for patients with thyroid diseases.