No abstract available.
Thyroidectomy*

This is our first experience in providing general anaesthesia for robotic-assisted thyroidectomy (RAT). It is rather a new experience for our anaesthetic team and few issues should be addressed. The conduct of RAT must be fully understood and familiarized as it may present with few challenges for the anaesthesiologists. The key point of success during this learning curve period is the importance of teamwork between the anaesthesiologists and the operating surgeons. The specific anaesthetic challenges include limited access to the patient post-docking of the robot, the need of extra precautions of the anaesthetic circuit and IV line connections, a vigilant anaesthesiologists and options for postoperative pain relief.
Thyroidectomy

Thyroidectomy

Objective: Micropapillary thyroid carcinoma (micro-PTC) has a good prognosis but a number of cases will present with aggressive behavior. This study aims to determine the clinical outcomes with surgical management and histopathologic characteristics of Filipino patients with micro-PTC at University of Santo Tomas Hospital. Methodology: 139 patients were diagnosed with micro-PTC from the year 2004-2011. Seventy five patients had complete data and were included in this retrospective study. Chi square test with Yates correction, T-test for tumor diameter, statistical means and percentages were used in data analysis. Results: A total of 1,689 thyroid surgeries were done between 2004 and 2011. There were 1,054 patients (62.4%) diagnosed with benign thyroid tumor(s) and 635 patients (37.6%) with well-differentiated thyroid carcinoma. Of these, 139 (22%) patients have micro-PTC. The prevalence rate of micro-PTC was 22%, with a female predominance (86.6%). The patients’ ages ranged from 24-80 years old with a mean age of 47 years. Comparison of groups showed that having either incidental or non-incidental micro-PTC is independent of the clinical variables of the patient. Two (2.6%) patients initially presented with cranial and supraclavicular metastasis. This study had a low recurrence rate (5.3%) and a mortality rate of 1.3%. Conclusion Male gender is the only significant variable for lymph node and distant metastasis. The patient’s age, family history of cancer, number of foci, size and histological type of tumor have no prognostic value.
Thyroidectomy

Objective: To determine the risk of malignancy of Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) indeterminate Thyroid Nodules (Bethesda III, IV and V) by combining cytologic (TSBRTC) and Thyroid Imaging Reporting and Data Systems (TI-RADS) ultrasonographic features based on final histopathology. Methods: Design: Retrospective review of records. Setting: Tertiary Private Training Hospital. Participants: 551 records. Results: Among 81 eligible participants, 59 out of 84 nodules (70.24%) wer malignant on histopathology. The malignancy risk of Bethesda classification was 60.87% (28 out of 46) for Bethesda III, 57.14% (8 out of 14) for Bethesda IV and 95.83% for Bethesda V. The malignancy risk for TI-RADS categories was 0 % (0/1) for TI-RADS 2, 50% (10 out of 20) for TI-RADS 3, 71.05 % for TI-RADS 4 and 91.67 % for TI-RADS 5. The highest risk of malignancy (100%) was associated with [Bethesda IV/TI-RADS 1, 2, and 3], [Bethesda V/TI-RADS 1, 2 and 3 [Bethesda IV and V/TI-RADS 1, 2 and 3] and [Bethesda IV/TI-RADS 5]. The lowest risk of malignancy (33.33%) was associated with [Bethesda III/TI-RADS1, 2 and 3]. A high Bethesda classification (Bethesda V) was almost 5x more likely to have a malignant anatomorphology compared with Bethesda III (p = .05) while a TI-RADS 4 or 5 category was almost 5x more likely to have a malignant anatomorphology compared to TI-RADS 1, 2 or 3 (p = .026). Conclusion This study showed that TI-RADS scoring is a sensitive diagnostic classification in recognizing patients with thyroid cancer and combining Bethesda classification and TI-RADS scoring increases the sensitivity in the diagnosis of malignant thyroid nodules. A higher likelihood of malignancy is associated with higher Bethesda classification and TI-RADS scoring.
Thyroidectomy

Objective: To present the perioperative data of patients with solitary or multinodular goiter and/ or papillary thyroid carcinoma who underwent Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) in a single tertiary medical center. Methods: Design: Case series. Setting: Tertiary Government Hospital. Participants: Records of 10 patients who underwent TOETVA from June 2018 to July 2019 (9 thyroid lobectomies, 1 total thyroidectomy) were reviewed. Outcomes and measures included conversion to open surgery, operative time, intraoperative blood loss, size of the thyroid gland, postoperative hospital stay, visual analogue pain scores (VAS), and postoperative complications. Results: None of the 10 patients were converted to an open procedure. The average preoperative thyroid size was 4.73 cm in widest diameter using thyroid ultrasound (±1.88 cm, range 3.6 to 6.5 cm). Mean operative time for thyroid lobectomy and total thyroidectomy was 4 hours and 29 minutes and 4 hours and 15 minutes, respectively. Mean intraoperative blood loss was 140 ml (±47.96 ml, range 80 to 200 ml) for thyroid lobectomy and 100 ml for total thyroidectomy. The average intraoperative size of the thyroid gland measured in widest diameter (larger lobe for total thyroidectomy) was 4.48 cm (±0.919 cm, range 3 to 5.5 cm). Median postoperative hospital stay was 2 days (±1.55 days, range 2 to 12 days). Mean VAS pain scores for postoperative days 1, 2, 3, and 7 were 5, 3, 2, and 0, respectively. Transient recurrent laryngeal nerve injury (of 3 months duration) occurred in 1 patient. Two cases had surgical site infection, 2 had wound dehiscence, 1 had seroma and 1 had skin burn as a complication. None had hypocalcemia or mental nerve injury in the series. Conclusions TOETVA was replicated in the local setting and a presentation of the perioperative data of all the patients who underwent this novel technique, the indications, as well as surgical and patient outcomes, were described.
Thyroidectomy ; Endoscopy

BACKGROUND: One way to make rapid increase in alveolar anesthetic concentration includes using high fresh gas flow rates. Fresh gas flow rates should be increased to compensate the amount of uptake either. This study was performed to elucidate optimal fresh gas flow rates for rapid induction by comparison of changes of ratio of expired to inspired concentration. METHODS: The study population was composed of 107 patients undergoing thyroidectomy. Patients were randomly allocated to one of three groups who received desflurane or sevoflurane or isoflurane. Each group was randomly subdivided into three groups who received one of the fresh gas flow rate: 2, 5 or 10 L/min. Inspired anesthetic concentration (Fi) and expiratory anesthetic concentration (Fe), delivered concentration (FD) were recorded. RESULTS: With same fresh gas flow rates, there were significant differences between Fe/Fi of desflurane, sevoflurane, isoflurane. With same anesthetics, Fe/Fi of desflurane and sevoflurane were not influenced by fresh gas flow rates. But Fe/Fi of isoflurane at 2 L/min was significantly lower than 5 L/min and 10 L/min. Fi/FD of desflurane at 10 L/min did not differ from sevoflurane. At 2 L/min and 5 L/min, Fi/FD of desflurane was highest and then sevofluane, isoflurane in that order. CONCLUSIONS: Because rates of Fe/Fi of desflurane and sevoflurane were not influenced by fresh gas flow rates, 2 L/min of fresh gas flow rates could be selected. However, considering the wash-in time in circuit, optimal choice of fresh gas flow rate for desflurane and sevoflurane could be 5 L/min, that of isoflurane be 10 L/min.
Anesthetics ; Humans ; Isoflurane ; Thyroidectomy

Conventional thyroidectomy requires a transverse cervical incision and a cutting of myocutaneos flaps to gain access to the thyroid. This approach leaves an undesirable scar on the anterior surface of the neck especially for young patients. Endoscopic thyroidectomy is a new minimally invasive technique that permits thyroid excision results of conventional thyroidectomy. From May 2003 to January 2005, the authors have performed 200 cases of endoscopic thyroidectomy at Surgical Department of national Hospital of Endocrinology. The indication for operation included thyroid nodule multinodules located in 1 lobe. The average of nodule size is 2.6cm (1.0-5.6cm). To access the thyroid, the authors use 2 approach: breast approach (100 cases) and auxiliary approach (100 cases) - There are 122 cases of lobectomy (61%), 78 of subtotal lobectomy (39.0%). - The mean operative time was 98.6 minutes (40-180), the mean blood loss was 8.6ml(0-100). - There is no mortality, the life-threaten complication as well as the hypocalcimia and there is not the conversion to open surgery. There is only one patient of the transient hoarseness. Conclusion: Endoscopic lobectomy of thyroid is feasible and safe for single nodule or multinodules located in the same lobe. There may be 2 approaches: anterior breast wall and auxiliary approach.
Thyroidectomy ; Endoscopy ; Breast

From May 2003 to 30 June 2004, 173 patients including 163 females and 10 males suffering from thyroidectomy was performed safely, successfully. Surgeon must prosess good skill on open surgery as well as on endoscopic surgery. The indication of this method was a routine only in nodule goiter in one lobe, but in multinoduli goiter in two lobes and in basedow the operationc success was still limited, especially for basedow disease, it must be prepare well pior to operation. It can made the incision from the anterior wall of the chest or from armpit with more cosmetic benefits
Thyroidectomy ; endoscopy ; methods

Deep cervical plexus block for thyroidectomy (n=150) with dose of lidocain from 4-5 mg/kg at the location for analgesia: Intersection between line via upper of hyoid bone and the posterior site of sternocleidomastioid muscle. Results: good effect 95.3%; relative good 4.7%. Onset time 6.9  1.18 minutes and the duration is 80  6.85 minutes. The operation was not influenced by change of blood pressure’s pulse and oxygen saturation. The method is cost-effective, less complications, compared with other anesthesia methods; in addition, the monitoring and taking care post operation was simple and comfortable.
Thyroidectomy ; Cervical Plexus