[Show abstract][Hide abstract] ABSTRACT: Nowadays, the conventional thyroidectomy may appear an overly aggressive treatment in patients undergoing intervention for small suspicious lesions harboring in low volume glands. In these cases a minimally invasive approach may be a safe and appropriate option. This work aims to evaluate the effectiveness of minimally invasive thyroidectomy in patients indicated to surgery for small lesions with preoperative suspicion of malignancy.
71 patients, undergoing minimally invasive total thyroidectomy as a single procedure between May 2005 and April 2009, were enrolled in this study. They were indicated to surgery for small suspicious or malignant lesions (up to 20 mm lenght by US; cT1 according to UICC 2002) and satisfied the inclusion criteria of minimally invasive thyroidectomy, with gland volume up to 25 ml, no evidence of locally advanced disease and no previous neck surgery. The outcomes were considered in terms of complication rate, postoperative pain, hospitalisation stay, cosmetic results and completeness of surgical resection in malignancies.
A low complication rate was registered. The surgical completeness, with mean serum thyroglobulin of 4.41 +/- 4.03 ng/ml and radioiodine uptake of 2.91 +/- 2.46%, was considered acceptable if compared with other experiences reported in literature. Excellent results with respect to patient comfort, postoperative pain and cosmetic outcome were obtained.
This study confirms, where a correct selection of patients is made, the safety and the effectiveness of minimally invasive approach in the treatment of small suspicious and malignant nodules, which seem to represent its best indication.
European review for medical and pharmacological sciences 04/2012; 16(4):519-24. · 0.99 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To retrospectively evaluate the surgical completeness of minimally invasive total thyroidectomy for small (<20 mm) differentiated thyroid carcinoma (DTC).
The subjects of this study were 30 patients who underwent minimally invasive total thyroidectomy as a single procedure. We registered the following postoperative measurements in the LT4 withdrawal period: serum thyroglobulin level, 6-h radioiodine uptake diagnostic test results, and neck ultrasound (US) findings.
The mean serum thyroglobulin level was 4.99 +/- 4.67 ng/ml, the mean radioiodine uptake diagnostic test after 6 h was 3.11% +/- 2.90%, and US showed no thyroid remnant.
The short-term outcome measures showed adequate resection of thyroid tissue, comparable with that reported after conventional surgery. Our findings suggest that small nodules with suspicious or malignant cytology are one of the best indications for minimally invasive surgery.
Surgery Today 05/2010; 40(5):418-22. · 1.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Serum thyroglobulin levels measurement after injection of recombinant human thyrotropin (rh-TSH) represents the most important advance in the follow-up of patients with differentiated thyroid cancer, obtaining TSH elevation without L-thyroxine withdrawal, avoiding marked hypothyroidism symptoms. During a 4-yr period (2004-2008), 66 consecutive patients with DTC (59 papillary and 7 follicular carcinomas) were examined after rh-TSH Tg test and neck ultrasonography. In all patients basal Tg was <0.25 ng/ml. In twelve (18.5%) examined patients rh-TSH Tg was >0.25 ng/ml, and in seven (58.3%) of these was demonstrated persistent or recurrent disease. These data indicate that rhTSH-Tg>0.25 ng/ml should be considered diagnostic for persistent or recurrent disease and suggests further exams (neck ultrasonography, whole body scan or cytology) to localize the disease. Furthermore, neck ultrasonography has demonstrated high accuracy in detecting lymph nodal metastases and should be always combined with rh-TSH test.
[Show abstract][Hide abstract] ABSTRACT: Medullary thyroid carcinoma (MTC) is a rare tumor and accounts for 5-10% of thyroid cancers. Tuberous sclerosis (TS) is a complex autosomal dominant neurocutaneous syndrome. In literature, a few endocrine neoplasias have been reported in association with TS, but never a case of TS associated with sporadic MTC. We describe a unique case, which has never been reported previously, of MTC associated with TS. The MTC up to today has been associated with other endocrine neoplasia, and TS increases risk of neoplasia in various organs. The case reported shows one more circumstance and suggests thyroid screening in patients with diagnosis of TS.
[Show abstract][Hide abstract] ABSTRACT: Actually, thyroid volume >25 ml, obtained by preoperative ultrasound evaluation, is a very important exclusion criteria for minimally invasive thyroidectomy. So far, among different imaging techniques, two-dimensional ultrasonography has become the more accepted method for the assessment of thyroid volume (US-TV). The aims of this study were: (1) to estimate the preoperative thyroid volume in patients undergoing minimally invasive total thyroidectomy using a mathematical formula and (2) to verify its validity by comparing it with the postsurgical TV (PS-TV).
In 53 patients who underwent minimally invasive total thyroidectomy (from January 2003 to December 2007), US-TV, obtained by ellipsoid volume formula, was compared to PS-TV determined by the Archimedes' principle. A mathematical formula able to predict the TV from the US-TV was applied in 34 cases in the last 2 years.
Mean US-TV (14.4 +/- 5.9 ml) was significantly lower than mean PS-TV (21.7 +/- 10.3 ml). This underestimation was related to gland multinodularity and/or nodular involvement of the isthmus. A mathematical formula to reduce US-TV underestimation and predict the real TV was developed using a linear model. Mean predicted TV (16.8 +/- 3.7 ml) perfectly matched mean PS-TV, underestimating PS-TV in 19% of cases. We verified the accuracy of this mathematical model in patients' eligibility for minimally invasive total thyroidectomy, and we demonstrated that a predicted TV <25 ml was confirmed post-surgery in 94% of cases.
We demonstrated that using a linear model, it is possible to predict from US the PS-TV with high accuracy. In fact, the mean predicted TV perfectly matched the mean PS-TV in all cases. In particular, the percentage of cases in which the predicted TV perfectly matched the PS-TV increases from 23%, estimated by US, to 43%. Moreover, the percentage of TV underestimation was reduced from 77% to 19%, as well as the range of the disagreement from up to 200% to 80%. This study shows that two-dimensional US can provide the accurate estimation of thyroid volume but that it can be improved by a mathematical model. This may contribute to a more appropriate surgical management of thyroid diseases.
Langenbeck s Archives of Surgery 09/2008; 393(5):721-4. · 1.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The determination of thyroid volume (TV) is required for the management of thyroid diseases. Since two-dimensional ultrasonography (2D-US) has become the accepted method for the assessment of TV (2D-US-TV), we verified whether it accurately assesses postsurgical measured TV (PS-TV).
In 92 patients who underwent total thyroidectomy by conventional cervicotomy, 2D-US-TV obtained by the ellipsoid volume formula was compared to PS-TV, determined by the Archimedes' principle.
Mean 2D-US-TV (23.9 +/- 14.8 mL) was significantly lower than mean PS-TV (33.4 +/- 20.1 mL). Underestimation was observed in 77% of cases, and it was related to gland multinodularity and/or nodular involvement of the isthmus, while 2D-US-TV matched the PS-TV in the remaining 21 cases (23%). A mathematical formula, to estimate PS-TV from US-TV, was derived using a linear model (Calculated-TV = [1.24 x 2D-US-TV]+ 3.66). Calculated-TV (mean value 33.4 +/- 18.3 mL) significantly (p < 0.01) increased from 21 (23%) to 31 (34%) of the cases that matched PS-TV. In addition, it significantly (p < 0.01) decreased from 77% to 27% the percentage of cases where PS-TV was underestimated as well as the range of the disagreement from 245% to 92%.
This study shows that 2D-US does not provide an accurate estimation of TV and suggests that it can be improved by a mathematical model different from the ellipsoid model. If confirmed in prospective studies, this may contribute to a more appropriate management of thyroid diseases.
[Show abstract][Hide abstract] ABSTRACT: The targets of minimally invasive thyroidectomy could be summarised by: achievement of the same results as those obtained with traditional surgery, better postoperative course and improved cosmetic
In minimally invasive surgical approach the skin incision should not exceed 30 mm in length. In our experience this limit may be extended of 5 mm for thyroid between 25 and 50 mL in volume. This way allows more patients, excluded before, to take the advantages of minimally invasive approach. The aim of this work has been to demonstrate that the central neck minimally invasive approach is safe, less painful, better for cosmetic results and easily reproducible in surgical practice.
From January 2003 to June 2007, 75 patients have been selected for minimally invasive thyroidectomy. The procedure was carried out through a central skin incision performed ''high'' between the cricoid and jugular notch. Our ''modified Miccoli-procedure'' consists in five-easily repeatable steps. In the postoperative stay, all patients were asked to evaluate the pain that feel and the cosmetic result by means of a numeric scale.
The skin incision performed was from 25 to 30 mm (mean 27.39 +/- 2.6 mm). We obtained in all cases excellent results about patients cure rate and comfort, few postoperative pain and attractive cosmetic
In this study we demonstrate that the central neck minimally invasive approach is safe, less painful, better for cosmetic results, with less paresthetic consequences and easily reproducible in surgical practice. In our opinion a longer incision (up to 35 mm), does not affect negatively the advantages of minimally invasive procedure. This way allows more patients to take the advantages of minimally invasive approach.
[Show abstract][Hide abstract] ABSTRACT: After first endoscopic parathyroidectomy, performed and described by Gagner in 1996, several surgeons reported their experiences with minimally invasive and video-assisted (MIVA) surgery of the neck. The patients were considered eligible for MIVA hemithyroidectomy and thyroidectomy on the basis of some criteria.
Completely gasless procedure, is carried out through a 15-30 mm central incision above the sternal notch. Dissection is performed mainly under endoscopic vision using conventional endoscopic instruments. Video assisted group in our experience included 5 patients. All patients were women with mean age of 56 years.
We performed in three cases a total thyroidectomy and in two an hemithyroidectomy. Operative mean time was 189 minutes. No complications are happened. No conversion have been necessary.
Traditionally, open thyroidectomy require a 6 to 8 cm, or bigger, transverse wound on the lower neck. The minimally invasive approach wound is very small in length (1.5 cm for small nodules, maximum 2-3 cm for the biggest, in respect of the exclusion criteria) upon the suprasternal notch. Wound pain following the MIVA surgery is much less when compared with the conventional thyroidectomy, because there is less dissection and destruction of tissues. The treated pathologies are prevalently nodular goiter; the only kind of thyroid cancer what it may be attacked with endoscopic surgery is a small papillary carcinoma without lymph node involvement. The complications, there are the same complications of the traditional thyroidectomy. Conversion to the traditional approach sometimes may it be required.
At the present this kind of surgery, in selected patients, clearly demonstrate excellent results regarding patient cure rate and comfort, with short hospital stay, few postoperative pain and attractive cosmetic results.
European review for medical and pharmacological sciences 7(4):91-6. · 0.99 Impact Factor