The Year in Surgical Thyroidology: Recent Technological Developments and Future Challenges

Tufano, Ralph P.; Ali, Khalid Mohamed

doi:10.1089/thy.2021.0590

Cited by 14 publications

(15 citation statements)

References 10 publications

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“…1 Modern techniques and technologies have substantially reduced the classic complications associated with these procedures allowing surgeons to focus the attention on other aspects like pain management. 2,6 After a thyroidectomy, opioids have typically been the drug of choice for pain management. 4,5 According to Wick et al, over 90% of patients who underwent thyroid surgery received an opiate prescription for pain relief.…”

Section: Discussionmentioning

confidence: 99%

“…1 With refinement of surgical techniques and the introduction of new technologies, major complications such as postoperative bleeding, hypocalcemia, and laryngeal nerve injury have been minimized, allowing surgeons to focus the attention on improving other aspects of the procedure like pain and discomfort. 2 Postoperative pain and neck discomfort are one of the most important concerns of surgical patients after an uncomplicated thyroidectomy and although it is not considered a very painful procedure (ranks 127th among 179 surgical procedures and ranks third among the most painful head and neck surgical procedures), 3 adequate analgesia remains essential. 4,5 The major causes of postthyroidectomy pain are the neck incision, retraction of the wound edges during surgery and extensive dissection, while neck discomfort is explained by hyperextension of the neck and sore throat by orotracheal intubation.…”

Section: Introductionmentioning

confidence: 99%

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Locoregional strategies to decrease postoperative pain and neck discomfort after open thyroidectomy: A scoping review

et al. 2023

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Adequate pain control enhances patients' quality of life and allows a quick return to normal activities. Current pain management practices may contribute to the crisis of opioid addiction. We summarize the evidence that evaluates locoregional interventions to decrease pain and neck discomfort after thyroidectomy. We designed a scoping review. The search strategy was made in the Pubmed/MEDLINE and EMBASE database. We included only systematic reviews and RCTs that compared two or more strategies. Forty‐nine publications including 5045 patients fulfilled criteria. Sore throat frequency is higher for endotracheal intubation and topical administration of anesthetic before intubation decreases this. Pre‐incisional infiltration of the surgical wound decreases postoperative pain. Bilateral superficial plexus nerve block decreases analgesic requirements during and after thyroidectomy. Wound massage and neck exercises decrease postoperative discomfort. Locoregional interventions significantly impact postoperative pain and may reduce opioid use and improve patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Locoregional strategies to decrease postoperative pain and neck discomfort after open thyroidectomy: A scoping review

et al. 2023

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“…A more recent comparative study of IIONM and CIONM in patients with benign and malignant thyroid disease over a decade demonstrated that in 6029 patients, the use of CIONM independently reduced the risk of early postoperative vocal cord palsy 1.8‐fold (odds ratio (OR) 0.56) and permanent palsy 29·4‐fold (OR 0.03) compared with IIONM. While visual nerve identification and IONM were used simultaneously, the study demonstrated standardization of nerve electrophysiological measurements along with pre and post-operative laryngeal exams ( 35 , 36 ). This study provided the more robust advantage of CIONM over IONM in demonstrating higher sensitivity, specificity, positive predictive and negative predictive value.…”

Section: A Comparison Of the Technologymentioning

confidence: 99%

“…While CIONM appears to have a higher advantage over IIONM in terms of results, the percentage of surgeons employing one technology over the other has not been identified. Possible complications associated with the use of the technology have been outlined by the INMSG, with more complications associated with CIONM for reasons listed above ( 13 , 36 ).…”

Section: A Comparison Of the Technologymentioning

confidence: 99%

Intraoperative Neuromonitoring: Evaluating the Role of Continuous IONM and IONM Techniques for Emerging Surgical and Percutaneous Procedures

2022

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Continuous and intermittent intraoperative nerve monitoring (IONM) has become an important asset for endocrine surgeons over the past few decades. The ability to determine neurophysiologic integrity of the recurrent laryngeal nerve (RLN) and external branch of the superior laryngeal nerve (EBSLN) on top of identification and meticulous dissection of the nerve in the surgical field, has allowed for advances in technology and improved outcomes when it comes to prevention of vocal fold immobility. This article aims to compare in review continuous and intermittent nerve monitoring (CIONM, IIONM), as well as review the current paradigms of their use. This article will also discuss the future of intraoperative nerve monitoring technologies in scarless thyroid surgery and percutaneous approaches to thyroid pathology in form of radiofrequency ablation (RFA).

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“…Papillary thyroid carcinoma is the most common endocrine tumor worldwide ( 1 , 2 ). The transoral endoscopic thyroidectomy vestibular approach (TOETVA) provides easy access to the thyroid and central compartment and avoids skin scarring during thyroid surgery, which makes it a widely popular option in thyroidectomy ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Preoperative application of carbon nanoparticles in transoral endoscopic thyroidectomy vestibular approach for papillary thyroid cancer

Wang

Zhang²,

Huang³

et al. 2023

Front. Oncol.

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BackgroundCarbon nanoparticles (CNs) have been widely used in the protection of the parathyroid gland and act as a tracer agent in central lymph node dissection. However, the right time for CN injection has not been well illustrated in the transoral endoscopic thyroidectomy vestibular approach (TOETVA). The purpose of this study was to evaluate the safety and feasibility of the preoperative injection of CNs in TOETVA for papillary thyroid cancer.MethodsFrom October 2021 to October 2022, a total of 53 consecutive patients with PTC were retrospectively analyzed. All patients underwent unilateral thyroidectomy via the TOETVA. The patients were divided into the preoperative group (n = 28) and the intraoperative group (n = 25) according to CN injection time. In the preoperative group, 0.2 ml of CNs were injected into the thyroid lobules with malignant nodules 1 h before surgery. The numbers of total central lymph node (CLN) and metastatic central lymph node (CLNM), parathyroid autotransplantation, accidental removal of the parathyroid, and the parathyroid hormone level were recorded and analyzed.ResultsThe leakage of CNs happened more frequently in the intraoperative group than in the preoperative group (P = 0.002). The mean number of retrieved CLN and CLNM was similar in the preoperative group and the intraoperative group. In parathyroid protection, more parathyroid was discovered in the preoperative group than in the intraoperative group (1.57 ± 0.54 vs. 1.47 ± 0.50, P = 0.002), but less parathyroid autotransplantation (P = 0.004) and accidental removal of the parathyroid (P = 0.036) were discovered in the preoperative group. However, the PTH level between the two groups was similar after the first day and the first month.ConclusionThe preoperative injection of CNs is a safe and effective method to protect the parathyroid glands (PGs) in patients with PTC undergoing TOETVA. However, the value of preoperative injection of CNs in TOETVA for central lymph node dissection needs to be further studied.

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The Year in Surgical Thyroidology: Recent Technological Developments and Future Challenges

Cited by 14 publications

References 10 publications

Locoregional strategies to decrease postoperative pain and neck discomfort after open thyroidectomy: A scoping review

Locoregional strategies to decrease postoperative pain and neck discomfort after open thyroidectomy: A scoping review

Intraoperative Neuromonitoring: Evaluating the Role of Continuous IONM and IONM Techniques for Emerging Surgical and Percutaneous Procedures

Preoperative application of carbon nanoparticles in transoral endoscopic thyroidectomy vestibular approach for papillary thyroid cancer

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