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Aim: To compare early postoperative voice outcome between visual nerve identification (VNI) and selective intraoperative nerve monitoring (IONM) in high-risk thyroidectomy operations. Materials and methods: All patients undergoing high-risk thyroidectomy operations for thyroid cancer, thyrotoxicosis, and reoperative completion between January 2018 and June 2019 were retrospectively evaluated. Demographic information, type of operation (hemithyroidectomy/ reoperation/total thyroidectomy), and nature of thyroid disease were assessed. Comparisons were made between VNI and IONM groups on postoperative clinical hoarseness, endoscopically confirmed recurrent laryngeal nerve (RLN) injury, and the operating time between the VNI group and IONM group. Subgroup analyses were also carried out. Results: Fifty-eight patients with 94 nerves at risk were included in the analysis. Forty-seven patients (81.0%) underwent thyroidectomy with VNI, while 11 patients (19.0%) had IONM. Thirty-six procedures (62.1%) were total thyroidectomy and 22 (37.9%) were hemithyroidectomy. Six patients received concomitant cervical lymph node dissection (10.3%). Indications for surgery included 43 thyroid carcinoma (74.1%) and 15 thyrotoxicosis (25.9%); and of which, 22 (37.9%) were reoperations. Demographics were comparable between the assessed groups. Postoperative clinical hoarseness per nerve at risk was significantly lower in the IONM group compared to the VNI group (0 vs 19.4%, p = 0.046). Endoscopically confirmed recurrent laryngeal nerve injury in IONM group was apparently lower, without statistical significance (0 vs 10.4% p = 0.176). Conclusion:Our data demonstrated that the use of IONM in selected high-risk thyroidectomy surgery significantly reduced early postoperative clinical hoarseness compared to the routine VNI. Clinical significance: The use of IONM in selected high-risk thyroidectomy may improve early postoperative voice outcome.

Aim:The aim of the present study was to evaluate current results of endovascular and open-bypass treatment of critical limb ischaemia subsequent to advancement in endovascular instruments and the development of endovascular technique in the past decade. Patients and Methods: A total of 160 patients with 167 limbs treated at a single centre between 2008 and 2012 were followed up for at least 2 years and reviewed retrospectively. Patients were stratified into an endovascular group and an open-bypass group based on first intervention received. The two groups demonstrated comparable demographics, clinical profile classified by Rutherford Classifications and lesion characteristics evaluated according to TransAtlantic Intersociety Consensus staging standards. One-year primary patency, 2-year primary patency, secondary patency, overall survival rate and amputation-free-survival rate were compared between the endovascular group and open-bypass group. Results: The endovascular group showed superior results to the bypass group in terms of 1-year amputation-free-survival (endovascular: 78.2 per cent, open bypass: 61.3 per cent, P = 0.023) and 2-yearamputation-free-survival (endovascular: 73.1 per cent, open bypass: 56 per cent, P = 0.027). No significant difference was found between the two groups in 1-year primary patency (endovascular: 80.3 per cent, open bypass: 67.8 per cent, P = 0.103), 2-year primary patency (endovascular: 80.3 per cent, open bypass: 64.8 per cent, P = 0.056), 1-year secondary patency (endovascular: 77.8 per cent, open bypass: 66.7 per cent, P = 0.577) and two-year secondary patency (endovascular: 77.8 per cent, open bypass: 58.3 per cent, P = 0.350). Comparable results were noted in the 1-year survival rate (endovascular: 91 per cent, open bypass: 81.3 per cent, P = 0.082) and 2-year survival rate (endovascular: 84.6 per cent, open bypass: 72 per cent, P = 0.058). Lower median blood loss (endovascular: 15 mL, open bypass: 100 mL) and shorter mean operative time (endovascular: 27.2 min, open bypass: 143.1 min) were demonstrated in the endovascular group.Conclusion: Endovascular intervention has demonstrated superior results to bypass surgery in critical limb ischaemia in terms of 1-year and 2-year amputation-free-survival, with potential benefits of lower intraoperative blood loss and a shorter operative time. Primary patency, secondary patency and overall survival in 2 years are currently comparable between the two intervention modalities.

Introduction This study presents the initial results of a transfascial suture mesh fixation technique. This method was devised to reduce operative costs and foreign body‐associated risks while embracing the benefits of fixation in laparoscopic inguinal hernia repair. Materials and Surgical Technique Patients undergoing laparoscopic inguinal hernia repair with transfascial suture fixation (TRANSFIX) in our center between March 2017 and March 2018 were retrospectively reviewed. The procedure is orchestrated by a reusable fascial closure device sequentially puncturing the fascia vertically through the inferior port site and guiding a polypropylene thread through the mesh. The thread is retrieved from the extraperitoneal plane with the device, creating an extracorporeal suture loop to embed a surgical knot at the subcutaneous layer of the port site. Discussion In its first year after introduction, 16 TRANSFIX were performed. All patients were men (mean age, 62.6 years). Thirteen hernias (81.3%) were first occurrence, and three (18.8%) were recurrent. Twelve (75.0%) were direct hernias, and three (18.8%) were indirect hernias; one patient presented with concurrent direct and indirect hernia. Median operating time was 41.5 minutes for unilateral repair and 73.0 minutes for bilateral. Median blood loss was 5 mL. One patient had a seroma after unilateral indirect hernia repair. After a median follow‐up of 15.5 months (range, 9‐21 months), no patient had chronic pain, wound infection, hematoma, or recurrence. Instrumental cost reduction per operation was between $150 and $300. TRANSFIX appears to be a safe and economical mesh fixation method.