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

PURPOSE: Endoscopic thyroidectomy using a cervico-axillary approach (CAA) provides optimal visualization with a smaller dissection plane. Despite the excellent cosmetic results and high patient satisfaction, the surgical and oncologic safety of CAA endoscopic surgery has not been fully established. The present study evaluated the feasibility, safety, and surgical outcomes of CAA endoscopic thyroidectomy. METHODS: From October 2009 to April 2012, 100 patients with papillary thyroid cancer underwent CAA endoscopic thyroidectomy. Patient demographics, pathologic features, and surgical outcomes including complications and recurrence were collected. RESULTS: CAA endoscopic thyroidectomy was successful in all patients, and none required conversion to open thyroidectomy. All patients underwent ipsilateral thyroid lobectomy with or without central compartment neck dissection. The mean tumor size was 1.0±0.6 cm (range, 0.5~1.6), and 35.0% of tumors showed extrathyroidal extension. The mean number of harvested lymph nodes was 4.1±4.4, and metastasis was found in 12.0% of patients. The mean surgical time was 175.2±50.4 min, mean intraoperative blood loss was 42.5±69.2 ml, and the mean hospital stay was 3.3±0.6 days. There were five cases of postoperative transient hypocalcemia and eight cases of vocal cord palsy. No permanent complication or postoperative bleeding was observed. Patients continued to be seen for a median period of 63.7 months, and no recurrence of thyroid cancer was seen. CONCLUSION: CAA endoscopic thyroidectomy is a feasible and safe procedure for low-risk thyroid cancer, with excellent cosmesis. It can be recommended as an alternative option for selected patients with low-risk thyroid cancer.
Demography ; Hemorrhage ; Humans ; Hypocalcemia ; Length of Stay ; Lymph Nodes ; Neck Dissection ; Neoplasm Metastasis ; Operative Time ; Patient Satisfaction ; Recurrence ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy* ; Vocal Cord Paralysis

No abstract available.
Humans ; Surgeons* ; Thyroid Gland* ; Thyroid Neoplasms*

PURPOSE: Adrenal schwannomas are very rare and are usually incidentally found on autopsy and imaging. The aim of this study was to describe our experience of adrenal schwannoma and review the literature regarding this rare tumor. METHODS: To identify patients with adrenal schwannoma, the MEDLINE database was searched via the major electronic database PubMed using the medical subject heading terms “adrenal” and “schwannoma”. Thirty-nine adrenal schwannoma cases, including two from our institution were included. RESULTS: The mean age at diagnosis was 47.95 years (range, 11~89 years). The female:male ratio was 21:17. Sixteen patients had tumors on the right side, 19 on the left, while one patient had bilateral tumors. The mean tumor size was 6.12 cm (range, 0.6~14.5 cm), and the mean tumor weight was 161.3 g (range, 31.5~600.0 g). Sixteen tumors were solid, four cystic, one solid and cystic, and 18 were not described. Histologically, 14 cases were Antoni A, two were Antoni B, and 12 had concomitant Antoni A and B. CONCLUSION: Adrenal schwannoma is usually an incidental finding, and the clinician must have a high index of suspicion to recognize it when imaging reveals suggestive features.
Adrenal Glands ; Autopsy ; Diagnosis ; Humans ; Incidental Findings ; Medical Subject Headings ; Neurilemmoma* ; Tumor Burden

PURPOSE: Although minimally invasive follicular thyroid carcinoma (MIFTC) is considered a thyroid tumor with low malignant potential, some MIFTC can spread, metastasize, and eventually lead to death. This study investigates the risk factors for distant metastasis in MIFTC patients. METHODS: Between 1981 and 2014, the records of 365 consecutive patients who underwent thyroidectomy for MIFTC at Seoul National University Hospital were reviewed. Univariate and multivariate analyses were performed to identify risk factors associated with distant metastasis. RESULTS: Of 351 patients, 10 (2.9%) presented with distant metastasis. Of these, two (0.6%) were found at the time of thyroidectomy, while eight (2.3%) were detected at later exams, over a median of 7.3 years (range, 0.2~30.8). In univariate analysis, lymph node metastasis (P<0.001) was significantly associated with distant metastasis. In multivariate analysis, lymph node metastasis (P<0.001) and locoregional recurrence (P=0.008) were significantly associated with distant metastasis. CONCLUSION: Distant metastasis in MIFTC patients were associated with high-risk clinicopathologic features and more aggressive clinical courses. Further study will be needed to ascertain these results with long-term surveillance.
Adenocarcinoma, Follicular ; Humans ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis* ; Recurrence ; Risk Factors ; Seoul ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

PURPOSE: Postoperative adhesion after thyroidectomy results in neck discomfort and swallowing difficulty. However, risk factors for adhesive symptom after thyroidectomy have not been well studied. This study evaluated symptoms related to postoperative adhesion after thyroidectomy. METHODS: The Glasgow-Edinburgh Throat Scale (GETS) questionnaire was used to evaluate postoperative adhesion. Patients who completed the GETS questionnaire either pre- or post-operatively were enrolled. Patient clinical and pathological details including age, gender, body weight, body mass index (BMI), tumor size, thyroid volume, extent of thyroidectomy, postoperative months, and neck thickness on ultrasonography and computed tomography (CT) were abstracted. RESULTS: Twenty-eight preoperative (22 females, six males) and 101 postoperative (83 females, 18 males) patients were enrolled. The mean age of the pre-operative enrollees was 52.1±11.7, and of post-operative enrollees 51.8±12.4 years. Patients who were within one month post-surgery had higher GETS scores than preoperative patients (27.4±20.1 vs. 6.5±11.1, P<0.001). Two months after surgery, GETS scores of postoperative patients did not differ significantly from the scores of the preoperative patients. There were no significant associations between clinical and pathologic features (age, tumor size, BMI, neck thickness on ultrasonography and CT) and GETS scores. CONCLUSION: Postoperative adhesive symptoms were most severe at one month after surgery, while questionnaire scores two months after surgery were comparable with preoperative patients. Further studies will be required for better understanding of the natural course of postoperative adhesion after thyroidectomy.
Adhesives ; Body Mass Index ; Body Weight ; Deglutition ; Female ; Humans ; Neck ; Pharynx ; Risk Factors ; Thyroid Gland* ; Thyroidectomy ; Ultrasonography

PURPOSE: This study analyzes the clinical characteristics of thyroid cancer patients over 70 years of age following thyroidectomy. We identified the differences among previous studies and investigated the significance of thyroidectomy for elderly thyroid cancer patients. METHODS: Information was abstracted from the charts of fifty-six patients treated during the period of Jan. 1995 to Dec. 2015. The abstraction included gender, age, surgical method, location with size of the main lesion, extent of lymph node metastasis, pathological features, gene mutation, complication, stage and most recent visit. RESULTS: Our study showed a frequent occurrence (96.4% of the study group) of papillary thyroid cancers in elderly patients. There were three cases of postoperative complications. None had recurrence, and there was only one death due to complications of pneumonia. There were 11 advanced cases of cancer stage IV. CONCLUSION: Previous studies show that postoperative prognosis of elderly thyroid cancer patients is favorable. Average life expectancy is rising in South Korea, and therefore, the number of elderly thyroid cancer patients is increasing. Our study is meaningful in that it confirms the results of previous studies by surveying elderly patients over a 20 year period. It is deemed necessary that thyroidectomy be performed on elderly patients.
Aged* ; Humans ; Korea ; Life Expectancy ; Lymph Nodes ; Methods ; Neoplasm Metastasis ; Pneumonia ; Postoperative Complications ; Prognosis ; Recurrence ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy

Thyroid core needle biopsy (CNB) is commonly used in diagnosis of thyroid neoplasia, and despite its low complication rate, the complications can be fatal. Here, we report on the surgical management of thyroid artery bleeding after core needle biopsy of a thyroid nodule. A 58-year-old woman who underwent core needle biopsy presented with neck bulging and pain that developed two hours after biopsy. A large hematoma surrounding her right superior thyroid artery was detected.
Arteries* ; Biopsy ; Biopsy, Large-Core Needle* ; Diagnosis ; Female ; Hematoma ; Hemorrhage* ; Humans ; Middle Aged ; Neck ; Thyroid Gland* ; Thyroid Nodule

PURPOSE: The early surgical outcomes of endoscopic thyroidectomy in papillary thyroid cancer (PTC) are comparable to those of conventional open thyroidectomy; however, there is little evidence about long-term outcomes. The aim of this study was to compare the 5-year surgical outcomes of endoscopic versus open thyroidectomy. METHODS: We reviewed 804 patients with PTC who underwent thyroidectomy between October 2008 and October 2010. Of these, 703 patients received conventional open thyroidectomy (OT group) and 101patients underwent endoscopic thyroidectomy (ET group). The clinicopathologic characteristics and surgical outcomes were compared between those treatments. RESULTS: ET was applied significantly more often in young patients and females. The lobectomy and unilateral CCND were performed more frequently in ET, and the mean tumor size was smaller. The prevalence of extrathyroidal extension, multiplicity, and lymphatic invasion was more frequent in OT. The T and TNM stage were more advanced in OT, whereas the N status was similar between treatments. The mean surgical time was significantly longer for ET, while the number of retrieved lymph nodes was greater in OT. However, the stimulated thyroglobulin levels at first RAI ablation, total amount of RAI administration and 5-year recurrence rate did not significantly differ between groups. The incidence of transient hypocalcemia was significantly higher in OT, but the incidence of permanent hypocalcemia and transient/permanent recurrent laryngeal nerve injury were similar in both groups. CONCLUSION: Endoscopic thyroidectomy might be a safe and effective procedure in well-selected PTC patients
Female ; Humans ; Hypocalcemia ; Incidence ; Lymph Nodes ; Operative Time ; Prevalence ; Recurrence ; Recurrent Laryngeal Nerve Injuries ; Thyroglobulin ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroidectomy*

PURPOSE: This study evaluates the BRAF(V600E) test with fine-needle aspiration cytology (FNAC) for lateral lymph node (LN) metastasis in papillary thyroid carcinoma (PTC). METHODS: Ninety-one patients, including 95 lateral LNs with possible PTC metastasis, were consecutively entered into the study. We analyzed the accuracy of results for the BRAF(V600E) test and FNAC for lateral LN metastasis in PTC. RESULTS: Modified radical neck dissection was performed for 34 cases due to lateral LN metastasis. The sensitivity of FNAC was 88.2% , and the LN-BRAF(V600E) test 64.7%. The specificity and positive predictive value (PPV) were 100% for both tests. The negative predictive values (NPV) were FNAC, 93.8%, and LN-BRAF(V600E), 83.6%. For samples positive with either the BRAF(V600E) test or FNAC, the sensitivity was 94.1%, specificity 100%, PPV value 100%, and NPV 96.8%. CONCLUSION: This study suggests that the complementary LN-BRAF(V600E) test with FNAC is a supportive diagnostic method for PTC patients with indeterminate or non-diagnostic suspicious lateral LNs.
Biopsy, Fine-Needle ; Humans ; Lymph Nodes* ; Methods ; Neck Dissection ; Neoplasm Metastasis ; Sensitivity and Specificity ; Thyroid Gland* ; Thyroid Neoplasms*