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Surgery 03/2013; 153(3):437. · 3.10 Impact Factor
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Endocrine Practice 07/2012; · 2.49 Impact Factor
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Otolaryngology Head and Neck Surgery 07/2012; 147(1):181. · 1.72 Impact Factor
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ABSTRACT: Hypocalcemia is one of the principal complications of total or completion thyroidectomy. A number of different protocols for managing this potential complication have been published. Our simple postoperative regimen is described and the safety and cost-effectiveness assessed.
Case series with planned data collection.
Academic medical center.
All patients undergoing total or completion thyroidectomy from January 2008 through June 2010 were evaluated. Data collected included age; gender; procedure performed; levels of ionized calcium, parathyroid hormone, and vitamin D; complications; and need for readmission. Standard descriptive statistics were used to summarize these data.
In total, 526 patients had thyroid surgery during the 30-month study period. Of these, 307 underwent completion or total thyroidectomy and were prescribed a 3-week tapering course of calcium carbonate postoperatively. Twenty-three patients (7.5%) experienced symptoms of hypocalcemia that were managed on an outpatient basis with additional doses of oral calcium. Two patients (0.7%) required readmission. The cost of a 3-week regimen of calcium carbonate is approximately $15. This is considerably less expensive than either the cost of overnight admission or published laboratory protocols that are designed to predict the risk of hypocalcemia.
Prophylactic calcium supplementation without routine laboratory assessment proved to be a safe and cost-effective method of preventing and managing postoperative hypocalcemia following total or completion thyroidectomy.
Otolaryngology Head and Neck Surgery 03/2012; 146(3):362-5. · 1.72 Impact Factor
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ABSTRACT: Two distinct remote access robotic thyroidectomy techniques were implemented in a high-volume endocrine surgery practice. Important technical and clinical differences were observed and are described.
Cross-sectional study with planned data collection.
Thyroid center.
A panel of demographic and clinical parameters was captured in a series of patients undergoing 1 of 2 robotic thyroidectomy techniques (robotic axillary thyroidectomy [RAT] or robotic facelift thyroidectomy [RFT]). Particular attention was paid to time of surgery, ease of dissection, complications, use of drains, and length of stay.
Fifteen robotic hemithyroidectomies were accomplished by either RAT (n = 5) or RFT (n = 10). The duration of surgery for RAT averaged 196 ± 38.1 minutes, with no clear downward trend observed. The mean time of surgery for RFT was 156.9 ± 16.3 minutes, with a steady trend toward shorter surgical times. All 5 RAT patients were managed with drains and as inpatients (length of stay = 1.0 days); 9 of 10 RFT patients were managed without drains and on an outpatient basis (the first patient had a drain and was observed for 1 night in the hospital; P < .001). Ease of surgery, familiarity with anatomic dissection planes, and surgeon comfort level all favored RFT.
In an early experience of a small series of patients, a more rapid learning curve reflected by shorter operative times was observed with robotic facelift thyroidectomy compared with robotic axillary thyroidectomy. Furthermore, the vast majority of patients could be managed as outpatients, which represents one of several apparent advantages.
Otolaryngology Head and Neck Surgery 02/2012; 147(1):20-5. · 1.72 Impact Factor
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ABSTRACT: A novel remote access robotic thyroidectomy technique has been described that uses as its portal a postauricular and occipital hairline (facelift) incision. Experimental investigation and clinical validation have been completed. A detailed technical description is provided.
A young woman with a thyroid nodule was referred for surgery. Because of her concerns about a visible neck scar, she opted for remote access thyroidectomy.
A left robotic facelift thyroidectomy was performed in less than 2 hours as a drainless, outpatient procedure. Videographic demonstration of the robotic resection is included.
A number of remote access thyroidectomy techniques have proliferated. We developed and described an intuitive approach that uses familiar dissection planes and avoids the need for breast incisions and crossing the clavicle.
Head & Neck 02/2012; 34(5):746-7. · 2.40 Impact Factor
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ABSTRACT: Little information is available regarding the frequency of thyroidectomy-related malpractice claims. Previous studies have not assessed claims that were settled or dropped before trial, providing only a limited view of the medical-legal environment. We sought to determine the frequency of thyroid surgery-related malpractice claims, their causes, and outcomes.
Database assessment.
Academic medical center.
The database of the Physician Insurers Association of America was reviewed. These data are estimated to represent 25% of medical malpractice claims in the United States. Claims from 1985 to 2008 with thyroid-related procedure codes were evaluated for claimant information, insured's specialty, loss description, causation, and claim outcomes.
During the 24-year period reviewed, 380 claims related to thyroid surgery were reported. 128 claims (33.7% of total claims) resulted in an indemnity payment either due to settlement or a finding against the defendant. The average indemnity payment was $185,366 (range, $363 to $2,000,000). Among cases in which a specific outcome was reported, 55 were related to laryngeal nerve injury or voice disturbance. No substantial change occurred in the incidence of claims across the study period. During this time, approximately 2,585,000 thyroidectomies were performed. Extrapolating from the Physician Insurers Association of America data, this represents an estimated 5.9 claims per 10,000 cases.
Malpractice claims related to thyroid surgery are surprisingly infrequent. While the rates of thyroid surgery have risen steadily, there has not been a corresponding increase in the rate of related malpractice claims.
Otolaryngology Head and Neck Surgery 01/2012; 146(3):358-61. · 1.72 Impact Factor
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ABSTRACT: A series of remote access thyroidectomy techniques, some using a surgical robot, have been introduced in the last decade. Most of these approaches require awkward positioning, use unfamiliar dissection planes, and have been associated with a number of significant complications. As a result, acceptance has been limited. We describe technical details and patient selection criteria of a recently described robotic facelift thyroidectomy (RFT) approach that avoids these pitfalls.
Analysis of preclinical and clinical studies.
Inanimate and cadaver dissection studies and clinical implementation were pursued. A 3-arm RFT technique with a 30-degree offset base location proved optimal. Supine positioning with arms tucked and the patient in slight Trendelenburg position facilitated the dissection of the optical pocket. Demographic and surgical data that have been obtained and considered include patient age, sex, body mass index, pathology, and complications.
A series of consecutive RFT procedures has been accomplished in a limited population of patients. All cases were completed robotically with no conversions to open surgery necessary. All but the first case was accomplished on a drainless, outpatient basis.
A RFT technique that is gasless and uses a single access port in the postauricular crease and occipital hairline location is feasible, technically less challenging than other remote access methods, and safe. Further study in an expanded patient population and in additional high-volume thyroid centers is warranted. See the videos, Supplemental Digital Content 1, http://links.lww.com/SLE/A36andSupplementalDigitalContent2, http://links.lww.com/SLE/A37.
Surgical laparoscopy, endoscopy & percutaneous techniques 08/2011; 21(4):237-42. · 1.23 Impact Factor
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ABSTRACT: A number of remote access thyroidectomy techniques have been described in the last several years. These approaches are technically challenging, can be performed on only a limited patient population, and have been associated with significant complications. We describe a novel robotic facelift approach for thyroidectomy and report our initial clinical experience.
Planned analysis of a prospectively maintained database with institutional review board approval.
Robotic facelift thyroidectomy (RFT) was performed on all patients. Demographic and surgical data were obtained and analyzed. Data collected included patient age, gender, body mass index (BMI), pathology, complications, and duration of surgery.
A total of 18 RFT procedures were undertaken in 14 patients. There were 13 females and 1 male, with a mean age of 33.7 ± 18.1 years (range: 12-70). The mean BMI was 26.9 ± 4.5. The procedures included 13 lobectomies, one bilateral thyroidectomy, and 3 completion thyroidectomies. All but the first procedure was performed on an outpatient basis without use of a drain. There were no conversions to open surgery, no permanent nerve injuries, and no cases of hypoparathyroidism. Operative times ranged from 97 to 193 minutes.
RFT is a feasible remote access thyroidectomy approach. It appears from our initial experience that it may be performed in a safe and reproducible manner without a drain and on an outpatient basis. Additional clinical experience is warranted to further validate this technique.
The Laryngoscope 04/2011; 121(8):1636-41. · 1.75 Impact Factor
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ABSTRACT: Robotic thyroidectomy was introduced in the United States despite scant preclinical data. We pursued a systematic preclinical investigation of a new remote access, robotic thyroidectomy technique via a facelift incision, and sought to define differences in extent of dissection associated with this approach and a second, popular robotic thyroidectomy technique.
Surgical simulation and morphometric analysis in fresh human cadavers.
Eleven specimens were obtained to complete four experiments designed to address two specific aims: to develop a reproducible surgical protocol for robotic removal of the thyroid through a facelift incision, and to quantify the extent of dissection required with two robotic thyroidectomy techniques.
The feasibility of the facelift approach was determined using an endoscopic technique, and two lobectomies were accomplished. Inanimate study of the optimal robotic positioning to facilitate resection was then completed. Three additional cadavers were used to develop a reproducible surgical protocol and define a stepwise algorithm of dissection. Seven specimens were used to simulate 28 robotic thyroidectomy dissection pockets. The mean area of dissection required for robotic facelift thyroidectomy was 39.2 ± 6.6 cm(2) compared with 63.5 ± 9.6 cm(2) for robotic axillary thyroidectomy, representing a difference of 38.3% (P < .0001).
We have described and refined a reproducible surgical protocol for accomplishing a new robotic facelift thyroidectomy, and then quantified the reduced dissection required when comparing it with a transaxillary technique. Cautious clinical implementation to explore safety and feasibility appears to be justified.
The Laryngoscope 04/2011; 121(8):1631-5. · 1.75 Impact Factor
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Michael C Singer
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ABSTRACT: Resident training regulations developed by the Accreditation Council for Graduate Medical Education (ACGME) in 2003 have limited resident work hours and autonomy. Proposed to improve patient safety and resident education, these regulations have not had their intended effects. They have acted to dilute otolaryngology residents' experiences, thereby weakening their training. The ACGME is currently considering tightening these regulations. By advocating for residency guidelines that are more conducive to the needs of otolaryngology education, otolaryngologists can guarantee continued superlative training for future residents.
Otolaryngology Head and Neck Surgery 03/2010; 142(3):303-5. · 1.72 Impact Factor
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The Laryngoscope 01/2010; 120 Suppl 4:S211. · 1.75 Impact Factor
