Back ground: Among all types of cancer, thyroid cancer is regarded as the most prevalent endocrine cancer with a high incidence. This is due to the fact that papillary carcinomas can be largely detectable sub-clinically. Occult lymph node metastasis in PTC have a high-rate incidence. Ideal management of such a type of thyroid cancer requires a central compartment neck dissection (pCCND), despite the fact that the contribution of pCCND to manage PTC is controversial with regard to its merits as well as risks. Subject and method: In this study, we compared total thyroidectomy with or without pCCND in case of papillary thyroid cancer with a clinically negative cervical LN metastasis. The study concentrates mainly on the complication rate and the risk of disease recurrence. A prospective comparative study was conducted by collecting 40 cases of papillary thyroid cancer with clinical negative LNs operated between March 2017 and March 2019, 20 of them (group1) underwent total thyroidectomy and 20 cases (group2) underwent total thyroidectomy and pCCND. Results: The average operative time in group (1) was estimated of (122.1 ± 19.1 min), while in group (2) it was (182.2 ± 15.3 min) with a statistically significant relationship. Only one case 5% in group (2) cases suffered from hoarseness of voice. 5% of group (1) and 10% of group (2) suffered from transient hypocalcemia, one case (5%) in group (1) had recurrence and 4 cases (20%) of group (2) cases suffered from recurrence. Conclusion: Total thyroidectomy with pCCND done in cases suffering from PTC with clinically negative cervical LNs increases time of operation and post-operative hospital stay compared to total thyroidectomy with no statistical difference as regard to surgical complications and post-operative recurrence especially with the presence of post-operative radioactive ablation. Highlights

Background:The main postoperative complication of thyroidectomy is recurrent laryngeal nerve (RLN) injury. RLN is identified by its relationships with inferiorthyroid artery, tracheoesophageal groove and ligament of Berry. This method may not be always accurate due to anatomical variations. Different adjuvant methods have been used to aid in the identification of the nerve. Nerve fibre staining with methylene blue (MB) is a known method during parotid surgery. Aim of Study:This study aimed to evaluate the value of using methylene blue spray during thyroidectomy to properly identify and preserve RLN during surgery to improve outcomes following thyroidectomy. Patients and Methods:This study was a prospective study doneon sixty two patients with benign and malignant goiter disorders who were admitted at Ain Shams University Hospital and underwent total thyroidectomy in the period from January 2021 to December 2021 at endocrine surgery unit. Patients with reoperative surgery, presence of preoperative cord dysfunction were excluded from study. Patients were randomized into two groups with an equal number of candidates (n=31) using the lottery method. 31 patients underwent thyroidectomy as study group with methylene blue spray and other 31 patients were operated without methylene blue spray as control group. During the surgery, after ligation of superior pole of thyroid and the thyroid lobe could be deviated medially, One ml of 1% methylene blue solution (10mg) was sprayed over the thyroid bed and perithyroidal tissue. This area includes the parathyroid glands, inferior thyroid artery, veins and recurrent laryngeal nerve. The entire area was irrigated by normal saline solution to rinse the MB out of the surrounding tissue. After 10min, the thyroid bed was inspected for areas in which the blue color was rapidly absorbed. Comparisons between studied groups were collected.Results: Intraoperatively, recurrent laryngeal nerve was not stained and remained white in all cases while all other tissues were stained blue. RLN could be identified in all the patient, as an unstained structure in the tracheoesophageal groove. Four to seven minutes later the parathyroid glands washed out the blue stain and regain their original yellow color. It took nearly 15 minutes for the thyroid tissue to wash out the stain in all cases.

Background: Laparoscopic appendectomy is a safe and effective procedure for acute appendicitis. But several researchers found that performing laparoscopic appendectomy for complicated appendicitis may carry a risk of postoperative intraabdominal abscess development, and that's why some surgeons use the intraabdominal drain. In our study we aimed to assess the effect of the drain in laparoscopic appendectomy for complicated appendicitis. Methodology: This is a prospective comparative study which was performed at Ain Shams University Hospitals between September 2018 and September 2021. It included 80 patients who underwent laparoscopic appendectomy for complicated appendicitis. The patients were divided sequentially into two groups, Group A: drain group and Group B: no-drain group. Results: We had a non-significant difference between group A and B regarding postoperative complication (37.5% versus 32.5% respectively) and postoperative intraabdominal abscess formation (15% versus 12.5%) respectively). The no-drain group showed significantly shorter hospital stay than the drain group. We had no mortality in our study. Conclusion:In our study, we didn't find considerable benefits for using the drain over intraperitoneal irrigation and lavage without drain after laparoscopic appendectomy for complicated appendicitis with significant longer hospital stay in the drain group.

Background: Conventional trocar placement of combined operations are different, and this may cause visual and procedural difficulties. Combined laparoscopic resections improve rapid recovery, cosmoses and avoid multiple hospital admissions. Some reports on concomitant laparoscopic operations necessitates insertion of extra ports and others not.Patients and methods: This is a randomized controlled trial involved 78 obese patients with cholecystolithiasis admitted to Ain Shams University Hospitals and Family Hospitals. Computer based randomization were used for randomization into 2 groups, Group A (39 patients) we did port-sharing technique for LC and LSG. Group B (39 patients) underwent LC and LSG from the conventional Sleeve 4 ports distribution.Results: There was a statistically highly significant difference between both groups as regard mean operative time with longer mean operative time among group 2 cases. Although sleeve operative time was statistically insignificant between both groups cholecystectomy time was statistically significant. However, there was statistically significant difference between both groups as regard insertion of extra ports due to failure to achieve critical view of safety which is also statistically significant. No patients required conversion to laparotomy in both groups. There is no statistically significant difference between both groups according to other operative or post-operative data. Conclusion:Port sharing technique for both LC and LSG is easier, faster and preferred than using only sleeve ports for both procedures that may cause visual and procedural difficulties with shorter operative time for both procedures and with no need to insert extra ports.

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