Background: Thyroid disorders are common surgical pathology in our part of world. Most commonly encountered complication after thyroid surgery are hypocalcaemia, hoarseness of voice, wound infection, seroma formation and thoracic duct injuries secondary to modifi ed neck dissections. The aim of this study is to share the experience of thyroid surgery at a tertiary care hospital in Karachi, Pakistan with rest of the world. Methodology: The cross sectional descriptive study was conducted in Endocrine unit of Jinnah Postgraduate Medical Centre, Karachi, Pakistan from April 2009 till April 2019. About 2094 cases operated which includes multinodular goiter, malignant goiter, solitary thyroid nodules, recurrent goiter and goiter with retrosternal extension. Patients managed medically or not fi t for surgery or refused to surgery are not included in this study. Descriptive statistics were used to present the data. Results: Among 2094 cases 782 (37.3%) were diagnosed as MNG, 753 (35.9%) were malignant goiter, 487 (23.2%) were solitary thyroid nodules while 72 (3.43%) presented as recurrent goiter. Most common complication reported was transient hypocalcaemia which was reported in 89 (11.3%) patients who underwent thyroidectomy for MNG, 41 (5.4%) in patients with thyroidectomy for malignant goiter, 11 (2.3%) open lobectomy, 9 (12.5%) in thyroidectomy for recurrent goiter while only 1 (0.12%) reported permanent hypoparathyroidism who underwent surgery for MNG. Transient hoarseness was reported 10 (1.27%) with MNG and 14 (1.85%) in patients with malignancy proven goiter, while 2 (0.42%) in open lobectomy, 2 (13.3%) in endoscopic lobectomy and 1 (1.38%) in recurrent goiter. Permanent hoarseness was noted in only 1 (0.2%) who underwent completion thyroidectomy. Wound infection was reported in 10 (1.27%) with MNG, 18 (2.39%) with malignancy and 3 (0.63%) in open lobectomies. Seroma formation was associated with 7 (1.45%) in MNG, 13 in malignancy (1.7%), 11 (2.3%) open lobectomies, 2 (13.3%) in endoscopic lobectomies and 3 (4.1%) in recurrent goiters. Thoracic duct injury was reported in 7 (0.94%) left sided MRNDs. A total of 3 (0.14%) deaths were reported after surgery. Conclusion: Thyroid surgery is the treatment of choice for benign or malignant goiters where medical therapy is ineffective and not practical. Proper preoperative preparations, better understanding of anatomy, modifi cation of surgical techniques, use of energy devices and intraoperative nerve monitoring and careful follow-up has lead to major decline in postoperative complications and better surgical results with more detail understanding of thyroid surgery.

Background and Objective: Surgical managements for these suspicious nontoxic swellings requires open conventional method of thyroidectomy by neck  incisions that can result in prominent scars and immediate risk usually hemorrhage. However new technological innovations came into practiced that include video assisted minimal invasive endoscopy by axillo-breast approach that gives very promising results with excellent cosmesis. In this study, we compared conventional open surgery with minimal invasive endoscopic techniques and associate various complaints and complications that were encountered in surgery. Methods: Sixty patients were enrolled in this comparative study. It was conducted from period February 2018 to February 2019.The patients were randomized alternatively in two groups. Group-I patients underwent conventional lobectomy while Group-II patients were operated endoscopically, Patients having nodules less than 3cm and Thy 1 and 2 were included in this study. Patient having nodules greater than 3cm, Multinodular goiter, recurrent nodule and Thy 3-6 were excluded from the study. Results: Patients who underwent endoscopic lobectomy were much more satisfied about scar marks whereas some developed post-operative complications. It included hoarseness of voice in Three (13.62%) patients, two patients developed seroma (9.08%), three patients (13.62%) erythema, whereas no postoperative complications were seen in patients who underwent open thyroid lobectomy. No signs of hypocalcemia noted in both approaches. Conclusions: The complications with endoscopic approaches are higher but they are minor and resolved spontaneously within maximum period of six weeks. However scar mark satisfaction was much higher in endoscopic lobectomy group. doi: https://doi.org/10.12669/pjms.36.4.1604 How to cite this:Imran M, Mehmood Z, Baloch MN, Altaf S. Endoscopic thyroid lobectomy Vs Conventional open thyroid lobectomy. Pak J Med Sci. 2020;36(4):831-835. doi: https://doi.org/10.12669/pjms.36.4.1604 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background: This study compared the accuracy of intraoperative lateral fluoroscopic images versus postoperative computed tomography (CT) 3D studies in the treatment of thoracolumbar spinal fusions. Methods: In a tertiary care hospital (study duration 6 months), we compared the use of lateral fluoroscopic images with the postoperative CT scans in 64 patients with thoracic or lumbar fractures undergoing spinal fusions. Results: Out of the 64 patients, 61% were lumbar followed by 39% thoracic fractures. In the lumbar spine, the accuracy of screw placement utilizing lateral fluoroscopy versus postoperative CT 3D was 97.4%, while in thoracic spine, accuracy was reduced to 84.4%. Of the 64 patients, just 4 (6.2%) patients demonstrated lateral pedicle cortex penetration, 1 (1.5%) patient had a medial pedicle cortex breach, while none exhibited anterior vertebral body cortex penetration. Conclusion: This study documented the efficacy of lateral fluoroscopy in intraoperative thoracic and lumbar spinal fixation as confirmed by postoperative CT 3D studies. These findings support the continued use of fluoroscopy rather than CT intraoperatively to lower the risk of radiation exposure to both patients and surgeons.

Objective:  To assess the post-operative status of Facial Nerve in cerebellopontine angle (CPA) lesion via retro-sigmoid approach and also its complications and outcome. Materials & Methods:  This prospective study was conducted at the Department of Neurosurgery, JPMC Karachi from a period of 10-12-2021 to 10-06-2022.The sample size of our study was 37 patients. All the patients were operated for CPA lesions and followed for three months to assess the outcome efficacy. Results:  Our study showed that the mean age was 37 years, with a range of 27 to 65 years, in which the males were 18 (48.6%) and the females were 19 (51.4%). Out of 37 patients, 28 (75.7%) were diagnosed with vestibular schwannoma, while 6 (16.2%) were meningiomas, and 3 (8.1%) were epidermoid cysts. Gross total resection was performed in 14 (37.8%) patients, while subtotal resection (STR) in 23 (62.2%). Facial nerve function in terms of House-Brackmann at 3 months was found to be grade I in 26 (70.3%), grade II in 9 (24.3%), grade III in 1 (2.7%), and grade IV in 1 (2.7%). Conclusion:  The CPA is a small corridor through which important neurovascular structures pass. Identification of CN VII is important in large CPA tumours to preserve facial motor nerve function.  For all kinds of CPA lesions, gross total excision should be the aim of surgery.