Minimal access surgery in the thyroid compartment has evolved considerably over the past 10 years and now takes many forms. This study examined the feasibility and reliability of minimally invasive thyroid surgery for the management of small benign thyroid lesions. A total of 68 patients with small thyroid nodules admitted to the Oncology Center of Mansoura University, Egypt, were enrolled in this prospective randomized trial. Patients were allotted to one of two procedures: minimally invasive video-assisted thyroidectomy (MIVAT) or minimally invasive open thyroidectomy using the Sofferman technique of strap muscle transection. Exclusion criteria were nodules > 4 cm, presence of thyroiditis, and thyroid gland volume > 20 ml. Preoperative diagnosis, operating time, blood loss, postoperative pain, complications, and cosmetic outcome were all evaluated. The MIVAT group included 35 patients, and the Sofferman group included 33 patients. The main preoperative pathology was a benign follicular lesion (70.5%), and the main postoperative final pathology was follicular adenoma (54.4%). The two groups were comparable regarding age, sex, and extent of thyroid surgery. Operating time was significantly longer in the MIVAT group (115.4 +/- 33.5 minutes) compared to the Sofferman group (65.6 +/- 23.7 minutes). The postoperative course was significantly less painful in the MIVAT group (p < 0.05). Although patients in the MIVAT group had smaller incisions (p < 0.05), the cosmetic outcome in the two groups was comparable. No long-term complication was encountered in either group. Two distinct approaches of minimally invasive thyroidectomy are now available and can be performed safely in selected patients. Despite some MIVAT advantages of less postoperative pain and slightly better cosmesis, minimally invasive open thyroidectomy offers an advantage of less operating time with comparable cosmetic results.

The surgical management of stump carcinoma includes the gold standard pelvic exenteration and more conservative approaches. This study aimed to investigate the outcome among a cohort of vaginal and cervical stump carcinomas that were treated with an intent of organ preservation. This is a prospective study of 60 patients with a biopsy confirmed stump carcinomas at a tertiary care oncology center in Egypt. The demographic, surgical, and pathological data were collected and patients underwent radical surgery with an intent of organ preservation guided by margin negativity. The pathologic data were correlated with the postoperative mortality. Correlation coefficients were calculated for simple correlation and regression analysis was used to investigate the independent predictors of survival. Pelvic exenteration was conducted in 30/60 (50%), while wide local excision with safety margins was possible in 26/60 (43%) and in two cases, resection was precluded. Mean hospital stay in days was 19 ± 9 (range 4-61). Overall operative morbidity was 83.3% (50/60). Perioperative mortality was 6.7% (4/60). Five-year diseasefree survival was 40% (24/60). Five-year overall survival was 50% (30/60). The resection margin status and the perioperative therapy were independent prognostic factors of DFS (p = 0.003 and 0.02, respectively. Only the resection margin status was significantly associated with overall survival (p = 0.009). There was no increased mortality with introduction of more conservative surgical approaches. The resection margin status is the most important determinant of recurrence free and overall survivals.

Background.The postmastectomy pain syndrome (PMPS) is chronic pain after breast cancer surgery and is reported to influence quality of life. The aim of this study was to provide long term reduction of PMPS, improve range of motion of the shoulder, and decrease the need for postoperative analgesia using ultrasound guided stellate ganglion block.Method.Sixty patients with PMPS were randomly allocated into 1 of 3 groups: bupivacaine group (group 1), bupivacaine plus ketamine group (group 2), and bupivacaine plus morphine group (group 3). Each patient received 3 blocks with an interval of one week in between. Patients were assessed for: pain visual analogue score (VAS), movement of the shoulder, skin temperature, and the need for analgesic drugs.Results.The pain VAS was significantly decreased in group 2 as compared to the other two groups. Shoulder movement improved significantly in the three studied groups with the best results observed after the third block. The need for the analgesic drugs in the form of gabapentin was more in the bupivacaine and bupivacaine plus morphine groups than in bupivacaine plus ketamine group.Conclusion.Treatment of PMPS with ultrasound guided stellate ganglion block using ketamine (0.5 mg/kg) as adjuvant to bupivacaine (0.25%) successfully decreased pain VAS and the need for analgesic drugs.

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