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Spondylolisthesis

Injury to the recurrent laryngeal nerve is the most common and serious complication after thyroid surgery. Many different techniques have been described in the literature and interest in intraoperative neuromonitoring (IONM) has increased in an effort to prevent adverse events. IONM implicated for identification of the nerve and evaluation of its function during the operation. Continuous IONM was recently introduced and looks promising for early recognition and safe operation in the end. This paper describes the role of IONM, and its current and future issues.
Recurrent Laryngeal Nerve ; Thyroid Gland* ; Thyroidectomy

PURPOSE: The use of sealing devices such as Harmonic scalpel and Ligasure is increasing steadily in thyroid surgery. The Harmonic Focus (HF) is an ultrasonic device that enables simultaneous vessel sealing and tissue coagulation, designed for open surgery such as thyroidectomy. The aim of this study is to assess the efficiency and safety of HF use in thyroid surgery compared to Conventional Tying (CT). METHODS: A prospective study was conducted to compare the efficacy of HF versus CT. We evaluated 50 patients who underwent surgery for thyroid tumor at Korea University Anam Hospital. All patients underwent total thyroidectomy with central neck dissection after being randomly allocated into two groups: HF group and CT group. The differences in surgical outcomes and postoperative complications by device use, i.e. group assignment, were statistically analyzed. RESULTS: There were no differences in number of retrieved lymph nodes (P=0.595), number of resected parathyroid glands (P=0.330), immediate postoperative iPTH (P=0.252), length of hospitalization (P=0.375) between HF group and CT group. However, operative time was shorter in HF group than CT group (106.07±20.92 min vs. 136.54±38.24 min, P=0.046). Postoperative complications of wound infection, seroma, hematoma, chyle leakage, vocal cord palsy, and hypoparathyroidism did not differ between groups. CONCLUSION: HF is a safe, effective, and time-saving technique; outcomes are comparable with CT. Both intraoperative and postoperative variables were similar between groups. Future larger studies are warranted to further investigate the effect on postoperative complications.
Chyle ; Hematoma ; Hospitalization ; Humans ; Hypoparathyroidism ; Korea ; Lymph Nodes ; Neck Dissection* ; Neck* ; Operative Time ; Parathyroid Glands ; Postoperative Complications ; Prospective Studies ; Seroma ; Thyroid Gland ; Thyroidectomy* ; Ultrasonics ; Vocal Cord Paralysis ; Wound Infection

Carcinoma, Squamous Cell ; Cell Cycle ; Classification ; Cyclin D1 ; Cyclins ; Genes, p53 ; Genes, Tumor Suppressor ; Humans ; Lymph Nodes ; Molecular Biology ; Mouth Neoplasms ; Neck ; Oncogenes ; Prognosis

PURPOSE: In secondary hyperparathyroidism (sHPT), it is unclear which criterion for intraoperative parathyroid hormone (ioPTH) decline performs best and whether ioPTH monitoring is sufficiently efficacious in predicting postoperative surgical cure by retrospective review. METHODS: In 80 parathyroidectomies for sHPT, patients with ioPTH monitoring and follow-up PTH assay were categorized into physiologically accepted and failed groups. Receiver operating characteristic (ROC) curves were used to identify the criterion with the best performance and to determine the regression equation for prediction of surgical success. RESULTS: There was a statistically significant difference in the percentage reduction of ioPTHs between the two groups (P < 0.05). With our criterion, cure was predicted with a sensitivity of 86% and specificity that could be improved to 60% using an 85% ioPTH decrease as cut-off level when this value was compared to the Miami Criterion. There was a slightly negative correlation between the natural logarithm of percentage reduction of ioPTH and percentage reduction of PTH at follow-up (R2 = 0.109, P = 0.003). CONCLUSION: ioPTH measurements are a useful tool for improvement of the cure rate of operations for sHPT. Because this study aimed at 40 minutes (ioPTH3) as an optimal process in the operation, we recommend using a criterion of more than 85% ioPTH decline at 40 minutes by use of the ROC curve, and the use of the presently calculated regression equation may enable prediction of success.
Follow-Up Studies ; Humans ; Hyperparathyroidism ; Hyperparathyroidism, Secondary ; Parathyroid Hormone ; Parathyroidectomy ; Retrospective Studies ; ROC Curve ; Sensitivity and Specificity

Transoral robotic thyroidectomy (TORT) is well consistent with the primary goal of remote-access thyroid surgery, which is to avoid a visible cervical scar. Additionally, the extent of transoral thyroidectomy dissection is less than that of other remote-access surgical procedures. Owing to these merits of the transoral approach, several institutions around the world are now performing this procedure. Since transoral thyroidectomy is performed in a confined, narrow space, and is characterized by a close distance from the ports to the working space, more benefits can be derived from multiarticulation of robotic instruments. Especially when performing left lobectomy by TORT, the surgeon can use right-handed robotic instruments over the thyroid cartilage with the merits of multiarticulation. In this study, we present our unique procedure of left lobectomy by TORT in detail.
Cicatrix ; Liability, Legal ; Thyroid Cartilage ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy

Intraoperative neuromonitoring is a well-established method used to prevent intraoperative nerve damage, and many studies have been performed in thyroid surgery. We introduced the basic concept and practical application of intraoperative neuromonitoring, as well as its standardized techniques and detailed contents. In addition, the contents of this still yet relatively unknown field, such as its application in transoral robotic thyroidectomy and its application to the external branches of the superior laryngeal nerve, were summarized by referring to many previous studies.

Intraoperative neuromonitoring is a well-established method used to prevent intraoperative nerve damage, and many studies have been performed in thyroid surgery. We introduced the basic concept and practical application of intraoperative neuromonitoring, as well as its standardized techniques and detailed contents. In addition, the contents of this still yet relatively unknown field, such as its application in transoral robotic thyroidectomy and its application to the external branches of the superior laryngeal nerve, were summarized by referring to many previous studies.

PURPOSE: We wanted to evaluate the results of medial epicondylar osteotomy for the varus knee when performing total knee arthroplasty. MATERIALS AND METHODS: We reviewed 32 cases of medial epicondylar osteotomy for treating varus deformity, and these cases underwent operation from December 2004 to December 2007. The average age of the patients was 71.0-years-old and the average follow-up period was 23.5 months. The clinical outcomes were measured, including the Knee Society score (KSS), the function score (FS) and the range of the motion (ROM). The radiological outcomes were measured by anteroposterior simple radiographs for assessing the union state of the osteotomy site, and the valgus stress radiographs and the whole extremity radiographs were used for assessing the femorotibial angle, the mechanical axis angle and the alignment. RESULTS: The KSS improved from 46.5+/-7.6 to 89.1+/-5.9 points (p<0.001) and the FS increased from 39.5+/-9.2 to 84.2+/-8.5 points (p<0.001). The range of motion increased from 101.5+/-28.2degrees to 116.0+/-10.8degrees (p=0.006). Bony union occurred in 22 knees and fibrous union occurred in 10 knees. The femorotibial angle was corrected from varus 8.2+/-5.0degrees to valgus 5.6+/-1.5degrees (p<0.001) and the mechanical axis angle was revised from varus 13.9+/-4.5degrees to varus 0.7+/-1.6degrees (p<0.001). There were 27 neutral, 4 varus and 1 valgus alignment. On the valgus stress radiographs, the difference compared with the opposite side was 1.0+/-0.6degrees and there was no significant difference between the bony union group and the fibrous union group (p=0.175). CONCLUSION: Medial epicondylar osteotomy for the varus knee when performing total knee arthroplasty could be a useful ligament balancing technique for achieving medial stability of the knee.
Arthroplasty ; Axis, Cervical Vertebra ; Congenital Abnormalities ; Extremities ; Follow-Up Studies ; Humans ; Knee ; Ligaments ; Osteotomy ; Range of Motion, Articular

Transoral approach for thyroidectomy recently gains a lot of attention among the thyroid surgeons, with the merits of cosmetic outcomes and minimal flap dissection. We've successfully introduced the robotic surgical system to the transoral approach for thyroidectomy. For transoral robotic thyroidectomy, we made 3 incisions in the gingival-buccal sulcus for three intraoral ports. An additional axilla port was inserted for counter-traction and later drain insertion. Herein, our unique procedures of transoral robotic thyroidectomy (TORT) are described in the treatment of a patient with papillary thyroid carcinoma.
Axilla ; Humans ; Neck Dissection ; Neck ; Surgeons ; Thyroid Gland ; Thyroid Neoplasms ; Thyroidectomy