P. Nguyen-Thanh

Martin Luther University Halle-Wittenberg, Halle-on-the-Saale, Saxony-Anhalt, Germany

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Publications (11)12.39 Total impact

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    ABSTRACT: Unambiguous identification of the recurrent laryngeal nerve with detection of nerve dysfunction giving rise to postoperative vocal cord palsy (VCP) is the principal objective of intraoperative neuromonitoring (IONM) in thyroid surgery. Because intraoperative loss of the electromyographic (EMG) signal (LOS) does not result in VCP in one third of patients, controversy surrounds the issue of whether a change in strategy is needed in planned total thyroidectomy after LOS on the first side of resection. This was a retrospective institutional study of 1,049 consecutive patients (2,086 nerves at risk) with intended bilateral thyroid surgery who were operated on between April 2010 and July 2012 with the use of IONM. The rates of temporary and permanent VCP were analyzed on the basis of the IONM results of the first side of resection and the extent of contralateral resection for completion: resection without LOS (group 1); resection with LOS and contralateral thyroidectomy (group 2); resection with LOS and contralateral subtotal resection (group 3); resection with LOS without any contralateral resection (group 4). LOS on the first side of resection was noted in 27 patients (2.6 %). All VCPs were unilateral. The rates of temporary and permanent VCP were 2.5 and 0.4 %, respectively, overall; specifically: group 1: 0.5 and 0 %; group 2: 64 and 9.1 %; group 3: 100 and 50 %; group 4: 83 and 8.3 %, respectively. Because an abnormal intraoperative electromyogram carries an 80 % risk for early postoperative VCP, the initial plan of bilateral surgery needs to be critically reviewed after LOS has occurred on the first side of resection, taking into account the underlying thyroid disease of the patient and surgeon expertise. Since more than 80 % of affected nerves will fully recover after the operation, staged completion thyroidectomy is recommended.
    Der Chirurg 05/2014; DOI:10.1007/s00104-014-2751-9 · 0.52 Impact Factor
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    ABSTRACT: Hintergrund Kopf-Hals-Paragangliome („head and neck paraganglioma“, HNP) sind seltene endokrine Tumoren, bei denen die Therapieentscheidung vor allem durch die Genetik, Tumorgröße, Lokalisation, Dignität, Patientenalter und Symptomatik bestimmt wird. Die Hauptgründe für ein alternatives operatives oder strahlentherapeutisches Vorgehen der sich in enger Lagebeziehung zu wichtigen Gefäß-/Nervenstrukturen befindlichen Tumoren sind bei beiden Verfahren vergleichbare Langzeitergebnisse bei relativ hoher Morbidität der Operation. Patienten Anhand von 6 Patienten mit insgesamt 11 solitären (4 Patienten) oder multiplen (2 Patienten) HNP (8 Glomus-caroticum-Tumoren, ein vagales, ein jugulares, ein jugulotympanales Paragangliom) werden die Besonderheiten der Operationsindikationen und Verfahrenswahl bei sporadischen Succinatdehydrogenase (SDH)-negativen und hereditären SDH-positiven HNP exemplarisch dargestellt. Ergebnisse Insgesamt wurden 4 Patienten mit 6 Glomus-caroticum-Tumoren (4 sporadische, 2 hereditäre) operativ therapiert (5 Primäreingriffe, ein Rezidiveingriff). In einem Fall erfolgte 24 h präoperativ eine Tumorembolisation. Perioperativ verstarb kein Patient. Die Primäroperationen verliefen komplikationslos. Die Patientin mit den hereditären bilateralen Glomus-caroticum-Tumoren entwickelte 48 Monate nach Primäroperation ein unilaterales Tumorrezidiv. Nach Resektion des Rezidivs traten unilaterale permanente Rekurrens-, Glossopharyngeus- und Hypoglossusparesen auf. Bei einer medianen Nachbeobachtungszeit von 64 Monaten (min. 23, max. 78 Monate) lag die Rezidivfreiheit aller Patienten bei 100%. Die 5-Jahres-Überlebensraten betrugen 100%. Schlussfolgerung Unter Berücksichtigung der operativen Risiken ist ein selektives operatives Vorgehen mit geringer operativer Morbidität verbunden. Eine chirurgische Therapie ist zu favorisieren bei kleinen unilateralen Paragangliomen, malignen sowie endokrin aktiven Tumoren.
    Der Chirurg 12/2012; 83(12). DOI:10.1007/s00104-012-2326-6 · 0.52 Impact Factor
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    ABSTRACT: BACKGROUND: Head and neck paraganglioma (HNP) represent rare endocrine tumors. Therapy is decided on genetic findings, tumor characteristics (e.g. tumor size, localization and dignity), age of patient and symptoms. In terms of local control radiation therapy is as equally effective as surgery but surgical morbidity rates secondary to cranial nerve injuries remain high. PATIENTS: Based on 6 patients with 11 solitary (4 patients) and multiple (2 patients) HNP (8 carotid body tumors, 1 vagal, 1 jugular and 1 jugulotympanic paraganglioma) the specific characteristics of the need for surgery as well as correct choice of treatment in cases of sporadic succinate dehydrogenase (SDH) negative and hereditary SDH positive HNP will be exemplarily demonstrated. RESULTS: A total of 6 carotid body tumors (four sporadic, two hereditary) were resected in 4 patients, five as primary surgery and one as a revision procedure. In one case a preoperative embolization was performed 24 h before surgery. Malignancy could not be proven in any patient. The 30-day mortality was zero. In the patient with bilateral hereditary carotid body tumors, unilateral local recurrent disease occurred. After resection of the recurrent tumor permanent unilateral paralysis of the laryngeal nerve, glossopharyngeal nerve and hypoglossal nerve occurred. All patients were followed-up postoperatively for a mean of 64 months (range 23-78 months) with a local tumor control rate of 100%. The overall survival rate after 5 years was 100%. CONCLUSIONS: Given a very strict indication with awareness of surgical risks selective surgery has a key position with low postoperative morbidity in the treatment of HNPs. We prefer surgery for small unilateral paraganglioma, malignant or functioning tumors.
    Der Chirurg 07/2012; · 0.52 Impact Factor
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    ABSTRACT: Postoperative lymphatic leakage following thyroid surgery represents a management problem with considerate potential morbidity, psychological, and economical impact. Conservative and surgical management strategies for high- and low-output lymph fistulas are inconsistent. Reliable criteria to predict outcome of conservative versus surgical treatment in clinically evident lymph fistula are lacking. A retrospective single-center chart review of consecutively quality-control-documented thyroid surgeries from January 1998 to December 2009 was performed to identify reported postoperative lymph fistulas. Documentation of surgical procedures, drainage, medical, and nutritional management was analyzed to identify risk factors for occurrence and criteria for management of evident lymph fistulas. There were 29 patients identified with postoperative clinical evidence of lymph fistulas following thyroid surgery; incidence was 0.5%. Indication to surgery comprised benign nodular goiter, recurrent nodular goiter, and thyroid carcinoma or local and lymphonodal carcinoma recurrences. There were 12 (41%) primary and 17 (59%) redo surgeries performed. Surgical procedures performed included thyroidectomy, completion thyroidectomy, and primary and redo central and lateral systematic microdissection of lymphatic compartments. All patients were initially submitted to fasting diet and medical treatment, successfully in 19 (66%), whereas ten (34%) patients underwent surgical intervention for fistula closure after failure of conservative treatment. Complications were one wound infection and fistula recurrence in five (26%) patients in the conservative group and two (20%) in the surgical group. Hospital stay was exceedingly prolonged in both groups with a median of 21 and 11 versus 6 days in patients with regular postoperative course following thyroid surgery. Data of this series support definition of the two categories of high- and low-output fistulas according to drainage collection with >300 versus <200 ml/day. Fasting in low-output fistula facilitates conservative treatment with closed drainage, whereas in high-output fistulas surgical intervention should be sought. Attendant criteria for treatment stratification are equally important, like patient's compliance, nutritional, and general health status as well as evidence for wound infection. Surgical closure of lymph fistula may be demanding when identification of the secreting fistula is limited and even muscle flap fortification may fail. Ultimately, in unsuccessfully reoperated fistula recurrences, open drainage may become necessary. Lymph fistulas cause significantly prolonged hospital stay, possible critical clinical decay, and unfavorable cosmetic and oncologic outcome while the superior management remains to be defined.
    Langenbeck s Archives of Surgery 09/2010; 395(7):911-7. DOI:10.1007/s00423-010-0686-2 · 2.16 Impact Factor
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    ABSTRACT: Vaginal reconstruction has been performed for more than a century. Main complications are vaginal stenosis requiring dilatation, dyspareunia, excessive mucus secretion, and poor aesthetic and functional outcome. Here we report a new operation method modified after Baldwin for intestinal vaginoplasty in a patient with pelvic exenteration after spinal cell carcinoma of the vagina. Because of balanced liquid resorption and mucus secretion with sufficient vessel length in the terminal ileum, this intestinal segment was chosen. A J-pouch of distal ileum was constructed pedicled on the ileocolic artery and accompanying nervous plexus, transferred into the lower pelvis and sutured to the vaginal stump. One year follow-up showed a highly satisfied, sexually active patient, with adequate vaginal size, optimal lubrication and no molesting fecal odor. Terminal ileum J-pouch vaginoplasty is an optimal method for vaginal reconstruction providing a sufficient vaginal lumen and lubrication and thereby restoring patients' sexual life and increasing life quality.
    American journal of obstetrics and gynecology 05/2009; 200(6):694.e1-4. DOI:10.1016/j.ajog.2009.03.009 · 3.97 Impact Factor
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    ABSTRACT: Durch nderung der TNM-Klassifikation (2002) hat sich erneut eine intensive Diskussion ber die Leitlinien der Chirurgie der Schilddrsenkarzinome (2000), v.a. in Bezug auf die Frhformen des differenzierten Karzinoms (DTC) entwickelt. Da keine ausreichenden Literaturdaten vorliegen, die eine Definitionsnderung der bisherigen Hauptkategorien der TNM-Klassifikation begrnden knnten, die TNM-Klassifikationen von 2002 und 1997 nicht kompatibel sind und die fortgeschrittenen Tumoren (pT3/4) nur in Verbindung mit dem klinischen Befund definiert werden knnen, stellt die neue TNM-Klassifikation keine geeignete Grundlage zur Stadieneinteilung der Schilddrsenkarzinome dar. Unabhngig von der neuen TNM-Klassifikation ergibt sich nderungsbedarf bei den chirurgischen Leitlinien besonders bezglich der prophylaktischen zentralen Lymphadenektomie beim DTC, fr die sich aufgrund vorliegender Daten keine Evidenz nachweisen lsst. Beim hereditren medullren Karzinom ist bei Gentrgern ohne klinisch manifesten Tumor wegen der Genotyp-Phnotyp-Korrelation ein risikoadaptiertes Vorgehen hinsichtlich Zeitpunkt und Ausma der prophylaktischen Operation zu empfehlen. Bei resektablen, wenig differenzierten und undifferenzierten Karzinomen nimmt die Chirurgie innerhalb eines multimodalen Therapiekonzepts eine wichtige Stellung ein.Due to the recent changes of the TNM classification (2002), the discussion about the German guidelines on thyroid cancer surgery (2000), in particular with regard to the treatment of differentiated (DTC) microcarcinomas, has become very intense. Several facts argue against the new TNM classification: (1) the available literature does not support the changes of the TNM classification, (2) the new (2002) and the old TNM classifications (1997) are not compatible, and (3) according to the new classification, diagnosis of more advanced forms of thyroid cancer (pT3/4) relies on the information given by the surgeon and cannot be made by the pathologist alone. Independent from the new TNM classification, the German guidelines on thyroid cancer surgery require an update since it has become obvious that the current recommendation of prophylactic cervicocentral lymph node dissection in DTC is not evidence based. Patients with asymptomatic hereditary medullary thyroid cancer may undergo a risk-adapted surgical approach based on the genotype-phenotype correlation. Surgery plays an important role in the multimodal therapeutic approach of resectable poorly differentiated and undifferentiated thyroid carcinomas.
    Der Onkologe 12/2004; 11(1):58-69. DOI:10.1007/s00761-004-0809-x · 0.13 Impact Factor
  • K Lorenz, P Nguyen-Thanh, H Dralle
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    ABSTRACT: The currently established procedure for surgical treatment of primary hyperparathyroidism is bilateral exploration and visualization of all four glands to identify an adenoma and exclude multiglandular disease. With the development of improved preoperative localization imaging of the parathyroids using high-resolution ultrasonography and sestamibi scintigraphy, on the one hand, and perioperative control of surgical success with a rapid parathyroid hormone assay on the other, unilateral and minimally invasive techniques have become feasible. For patients with unequivocal localization in preoperative sestamibi scintigraphy and high-resolution ultrasonography of the parathyroid adenoma in probable single-gland disease, the unilateral and minimally invasive parathyroidectomy present a therapeutic option. Perioperative rapid parathyroid hormone assays, although costly, offer immediate supervision of adenoma extirpation and differentiation of single- and multiglandular disease. These methods demonstrate advantages with favorable cosmetic results and lower reported rate of postoperative hypoparathyroidism. These methods are already being practiced in some places under local anesthesia and in an ambulatory setting. This contribution provides an introduction and overview of the currently practiced unilateral and minimally invasive techniques of parathyroidectomy for primary hyperparathyroidism, discussing indications, advantages and disadvantages, and technical differences in the practiced methods.
    Langenbeck s Archives of Surgery 04/2000; 385(2):106-17. DOI:10.1007/s004230050252 · 2.16 Impact Factor
  • H Dralle, K Lorenz, P Nguyen-Thanh
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    ABSTRACT: The valid operative standard for primary hyperparathyroidism (pHPT) consists of cervicotomy and presentation of all parathyroid glands. This operative technique features the macroscopic identification of the responsible adenoma. It also has the advantage of detecting multiglandular disease. The increasing sensitivity of preoperative localization methods and the possibility of intra-operative measurement of parathyroid hormone prepared the way for minimally invasive procedures. All patients with pHPT were examined by cervical sonography and sestamibi scintigraphy of the parathyroid glands. Patients eligible for the described procedure had to comply to the following inclusion criteria: biochemical evidence of pHPT, localization of one unequivocally enlarged parathyroid gland on two corresponding imaging results; no former surgery or radiation to the neck; no multinodular goiter; no suspected carcinoma of the thyroid; and no secondary or recurrent hyperparathyroidism. We used an operative technique first described by Miccoli in 1997. Before preparation and at 2, 10 and 15 min after exstirpation of the parathyroid adenoma, peripheral blood was drawn. The operation was terminated when a 50% decrease of preoperative PTH levels was reached. During a 12-month period (1 December 1997 to 30 November 1998), 13 patients with pHPT of a total of 59 patients (22%) with hyperparathyroidism (pHPT and sHPT) were operated on employing this minimally invasive procedure. In three patients, the operative technique had to be converted to the conventional procedure due to superior adenomas in two cases and a dorsoesophageal adenoma in one case. The procedure could thus be successfully completed in ten patients. The overall failure rate was zero in all patients with regard to the underlying disease. There was one temporary, recurrent laryngeal-nerve palsy. The mean overall length of the hospital stay was 3 days. The minimally invasive video-assisted parathyroidectomy for localized single-gland adenoma is a new and attractive surgical therapy option for primary hyperparathyroidism due to improved patient comfort, shortened length of hospital stay and favorable cosmetic results. This may lead to one-day surgery and, therefore, to a reduction of overall costs.
    Langenbeck s Archives of Surgery 01/2000; 384(6):556-62. DOI:10.1007/s004230050243 · 2.16 Impact Factor
  • K. Lorenz, P. Nguyen-Thanh, H. Dralle
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    ABSTRACT: Background: Rapid development of endoscopic procedures has brought about innovation in the field of minimally invasive operative techniques. In consequence of improvement of preoperative localization diagnostics and intraoperative control measures, minimally invasive videoassisted parathyroidectomy (MIVAP) has been expanded to the field of parathyroid surgery. Methods: Patients with preoperative localization of adenoma in primary hyperparathyroidism were selected in case of primary surgical intervention of the neck in a video-endoscopically assisted technique. Preoperative localization was performed by ultrasonography and sestamibi scintigraphy. Intraoperatively, quick-PTH-levels were assessed for control of successful adenoma-exstirpation. Results: Of 62 patients with the diagnosis of PHPT, 16 patients could be selected for MIVAP. 13 out of 16 patients could be successfully completed applying the MIVAP-procedure. In 3 cases conversion to conventional parathyroidectomy became necessary. Morbidity was 6 % with 1 unilateral transient recurrent nervepalsy. There was no unsuccessful intervention in regard to the underlying disease, there was no recurrence of PHPT so far. In 2 cases additional resection of a thyroid nodule was performed videoassistedly. There was no case of postoperative hypoparathyroidism. Conclusions: The preliminary experiences and results of MIVAP encourage further clinical experience in favour of it’s good results cosmetics results and advantages of shortened hospital stay and no postoperative hypoparathyroidism. Grundlagen: Die schnelle Entwicklung endoskopischer Operationsverfahren hat eine innovative Ausdehnung der Methode auf verschiedene operative Felder bewirkt. Im Zuge der Entwicklung präoperativer Lokalisationsdiagnostiken und intraoperativer Kontrollinstrumente für die erfolgreiche Operation erfolgte die Anwendung minimal-invasiver videoendoskopischer Technik (MIVAP) auf die Nebenschilddrüsen-Operation. Methodik: Patienten mit eindeutiger präoperativer Adenomlokalisation bei PHPT wurden ausgewählt, sofern keine zervikalen Voroperationen bestanden. Präoperative Lokalisationsdiagnostik waren zervikale Sonographie und Sestamibiszintigraphie. Intraoperative quick-PTH-Bestimmung erfolgte zur Bestätigung der vollständigen Entfernung adenomatösen Nebenschilddrüsen-Gewebes. Ergebnisse: Von 62 Patienten mit der Diagnose PHPT konnten 16 Patienten für die Methode ausgewählt werden. Davon konnten 13 Patienten erfolgreich mittels MIVAP operiert werden. In 3 Fällen erfolgte eine Ausdehnung des Eingriffes zur konventionellen Parathyreoidektomie. Die Morbidität betrug 6 % mit 1 unilateralen, passageren Recurrensparese. Hinsichtlich der Beseitigung der Grunderkrankung waren alle Operationen erfolgreich. Rezidive traten bisher nicht auf. In 2 Fällen erfolgte gleichzeitig die video-assistierte Entfernung von Schilddrüsenknoten. In keinem Fall kam es zu einem postoperativen Hypoparathyreoidismus. Schlußfolgerungen: Die präliminären Ergebnisse der MIVAP-Methode ermutigen zu weiteren klinischen Anwendungen bei exzellenten kosmetischen Ergebnissen und Vorteilen hinsichtlich verkürzter Hospitalisierungszeiten und geringerer postoperativer Hypoparathyreoidismusrate.
    European Surgery 07/1999; 31(4):218-220. DOI:10.1007/BF02620167 · 0.26 Impact Factor
  • K. Lorenz, P. Nguyen-Thanh, H. Dralle