ORCID Profile
0000-0001-8479-5901
Current Organisations
The Hashemite University Faculty of Medicine
,
University of Western Australia
,
University Hospital of Pisa
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Publications
Less is more: time to expand the indications for minimally invasive video-assisted parathyroidectomy.
Publisher: Springer Science and Business Media LLC
Date: 03-04-2017
DOI: 10.1007/S40618-017-0658-2
Abstract: Minimally invasive video-assisted parathyroidectomy (MIVAP) is one of the most widespread targeted parathyroid surgeries for primary hyperparathyroidism (PHP). The aim of this study was to assess its limits and propose an expansion of its indications in the management of parathyroid pathology. A retrospective analysis of 77 consecutive patients who underwent MIVAP for PHP between Jan and Oct 2016 was conducted. The adequacy of the procedure and/or the need to convert to a standard cervicotomy was the main outcome of interest. Secondary outcomes of interest included: operative time, postoperative morbidity, postoperative pain assessed by the visual analogue scale (VAS) score, and the length of the surgical incision. There were 64 females and 13 males with a mean age of 51 years. In one patient a concomitant en bloc thyroid lobectomy was required due to features suspicious of parathyroid carcinoma while exploration was required in two other patients. None of these three cases required conversion to standard cervicotomy. The mean operative time, length of incision and VAS score was 31 min, 17 mm and 1.6, respectively. Biochemical cure was achieved in all patients, and no postoperative morbidities were reported. MIVAP offers the ability to perform a neck exploration and/or an en bloc thyroid lobectomy without the need to convert to a standard cervicotomy. Therefore, it not only serves as a targeted parathyroid procedure but also a potential alternative to full neck exploration.
Postoperatively determined high-risk histopathologic features in papillary thyroid carcinoma initially eligible for thyroid lobectomy: a game changer
Publisher: Springer Science and Business Media LLC
Date: 10-06-2021
Minimally Invasive Video-Assisted Thyroidectomy (MIVAT) in the Era of Minimal Access Thyroid Surgery
Publisher: Briefland
Date: 28-02-2017
Impact of the COVID-19 pandemic on the management of chronic limb-threatening ischemia in Northern Jordan: Case series and literature review
Publisher: Elsevier BV
Date: 03-2021
Implications of a background of Hashimoto’s thyroiditis on the current conservative surgical trend towards papillary thyroid carcinoma
Publisher: Springer Science and Business Media LLC
Date: 20-05-2021
Early surgery: a favorable prognosticator in amiodarone-induced thyrotoxicosis—a single-center experience with 53 cases
Publisher: Springer Science and Business Media LLC
Date: 25-05-2022
DOI: 10.1007/S13304-022-01297-3
Abstract: Fewer than 100 cases of amiodarone-induced thyrotoxicosis (AIT) managed surgically have been reported worldwide. This study aims to assess the outcome of thyroidectomy under general anesthesia in a relatively large case series. A retrospective analysis of the clinical records of 53 patients who underwent thyroidectomy for AIT between 1995 and 2019 was conducted. There were 48 (90%) males and 5 females with an average age of 63.7 years. Type 1 and 2 AIT were present in 35 (66%) and 18 (34%) of patients, respectively. The mean preoperative ejection fraction (EF) was 45 ± 13%. Salvage surgery was performed in 6 (11%) patients due to decompensating heart failure and/or malignant arrhythmias. 35 (66%) patients underwent urgent surgery due to a predicted late response to medical therapy and/or the need to discontinue it. Elective surgery was performed in the remainder. A considerable improvement in mean EF occurred 12 months post-surgery (44% vs. 49% p < 0.001). The overall survival rate following thyroidectomy was 96% at 12 months, and 83% at 5 years. No survival differences were observed based on systolic function. Cardiac-specific mortality was 11%, and these patients demonstrated a considerably shorter survival post-surgery compared to those who died of a non-cardiac cause (27 ± 18 vs. 77.5 ± 54 months p < 0.05). Total thyroidectomy can be safely performed under general anesthesia despite severe cardiac disease. It considerably improves cardiac function and confers a survival advantage. Therefore, it should be considered early in the treatment plan of select cases.
Prevention and management of bleeding in thyroid surgery
Publisher: AME Publishing Company
Date: 10-2017
Impact of COVID-19 on thyroid cancer surgery and adjunct therapy
Publisher: Springer Science and Business Media LLC
Date: 14-06-2020
BRAFV600E mutation: a potential predictor of more than a Sistrunk’s procedure in patients with thyroglossal duct cyst carcinoma and a normal thyroid gland
Publisher: Springer Science and Business Media LLC
Date: 04-10-2019
DOI: 10.1007/S13304-019-00684-7
Abstract: To assess the utility of mutational markers in determining the most appropriate initial surgery for patients with thyroglossal duct cyst carcinoma (TGDCCa) and a normal thyroid gland. Our s le comprised 15 patients with a diagnosis of TGDCCa and a thyroid gland histologically negative for any malignant involvement, who underwent surgery between the years 1994 and 2017. Clinical records were reviewed and tissue specimens were genetically tested for the presence of the most commonly encountered mutational markers in differentiated thyroid cancer: BRAF, N-RAS, and H-RAS. The primary outcome of interest was the correlation between mutational marker positivity and the T-stage of the primary tumor and its potential implication on therapeutic decision making. All 15 cases were papillary carcinomas with a mean tumor size of 17 mm (2-40 mm). According to the 7th edition of the American Joint Committee on Cancer TNM staging system, these represented: T
Transoral thyroidectomy: a viable surgical option with unprecedented complications—a case series
Publisher: Springer Science and Business Media LLC
Date: 14-12-2018
DOI: 10.1007/S40618-017-0808-6
Abstract: To report the clinical implications of an initial experience with transoral endoscopic thyroidectomy vestibular approach (TOETVA). From March to November 2017, five cases of TOETVA were performed. Data reported include patient demographics, indication for surgery, extent of surgery, operative time, the need to convert to cervicotomy, the length of hospital stay and post-operative pain and morbidity. Unconventional complications regarded as specific for TOETVA were reported. The burden of surgery on the patient's quality of life was evaluated using the 36-item short form (SF-36) health survey 1 month after surgery. All patients were females with a mean age of 36 years. They all underwent a right-sided hemithyroidectomy for a solitary thyroid nodule measuring on average 3.5 cm in size. The nodule was reported as Bethesda category II (n = 3), III (n = 1), and IV (n = 1) on fine needle aspiration cytology. The mean operative time was 122 min. Conversion to a transverse cervicotomy was required in one case. None of the patients developed post-operative bleeding, and none experienced vocal fold or mental nerve palsy. Surgical site infection did not occur. All patients developed subcutaneous emphysema that resolved within 12-48 h. All patients reported a long-standing bothersome pulling sensation along the surgical track that resulted in a poor outcome in some scales of the SF-36 survey. Flap perforation occurred in one case. The median VAS score was 3. Patients strongly motivated to undergo a novel surgical procedure tailored to their needs and desires should be properly counselled particularly regarding unconventional procedure-related complications.
Surgical management of papillary thyroid carcinoma: an overview
Publisher: Springer Science and Business Media LLC
Date: 12-04-2017
DOI: 10.1007/S13304-017-0449-5
Abstract: The surgical management of papillary thyroid carcinoma remains contentious and the optimal surgical strategy has not been yet established. The extent of thyroid resection has been the nub of this debate. Literature lacks prospective randomized controlled trials that could help put this debate to rest, and these have been labeled as being impractical. Consequently, large retrospective studies and expert opinion have constituted the basis of clinical practice guidelines. Recent American Thyroid Association and National Comprehensive Cancer Network guidelines consider a conservative approach in the form of a thyroid lobectomy sufficient for low-risk disease and that total thyroidectomy remains the standard of care in the presence of high-risk features. Nevertheless, many authorities still advocate more aggressive therapy for low-risk disease. The challenge in standardizing the surgical strategy to papillary thyroid carcinoma is mainly related to a major tumor characteristic: the high frequency of occult cancerous foci whether within the thyroid gland itself or within loco-regional lymph nodes as this tumor characteristic has been incriminated for a higher risk of recurrent disease and its adverse sequelae. The purpose of this article is to provide an overview of the surgical management of papillary thyroid carcinoma and the main arguments surrounding this hotly debated topic. All evidences for this review article were drawn from PubMed articles in English language mostly cross-referenced with international guideline statements.
A Point in the History of Contemporary Thyroid Surgery
Publisher: Symbiosis Group
Date: 22-09-2016
Minimally Invasive Video-Assisted Parathyroidectomy; A Detailed Illustration and Highlighting an Additional Potential Advantage Over Other Targeted Parathyroid Surgeries
Publisher: OMICS Publishing Group
Date: 2016
<p>Lesion Type Analysis of Hemodialysis Patients Who Underwent Endovascular Management for Symptomatic Central Venous Disease</p>
Publisher: Informa UK Limited
Date: 10-2020
DOI: 10.2147/VHRM.S273450
MicroRNAs in Papillary Thyroid Cancer: What Is New in Diagnosis and Treatment
Publisher: Frontiers Media SA
Date: 03-02-2022
Abstract: Papillary thyroid cancer (PTC) accounts for up to 80% of thyroid malignancies. New diagnostic and therapeutic options are suggested including innovative molecular methods. MicroRNAs (miRNAs) are nonprotein coding single-stranded RNAs that regulate many cell processes. The aim of the present study is to review the deregulated miRNAs associated with PTCs. A bibliographic research was conducted, resulting in 272 articles referred to miRNAs and PTC. Regarding our exclusion criteria, 183 articles were finally included in our review. A remarkably large number of miRNAs have been found to be deregulated during PTC manifestation in the literature. The deregulated miRNAs are detected in tissue s les, serum lasma, and FNA s les of patients with PTC. These miRNAs are related to several molecular pathways, involving genes and proteins responsible for important biological processes. MiRNA deregulation is associated with tumor aggressiveness, including larger tumor size, multifocality, extrathyroidal extension, lymphovascular invasion, lymph node and distant metastasis, and advanced tumor node metastasis stage. MiRNAs are proposed as new diagnostic and therapeutic tools regarding PTC. They could be essential biomarkers for PTC diagnosis applied in serum and FNA s les, while their contribution to prognosis is of great importance.
Track Recurrence after Robotic Transaxillary Thyroidectomy: A Case Report Highlighting the Importance of Controlled Surgical Indications and Addressing Unprecedented Complications
Publisher: Mary Ann Liebert Inc
Date: 04-2016
Abstract: Robot-assisted transaxillary thyroid surgery (RATS), widely accepted and used in Asian countries, can be an appealing treatment option both for patients with major concerns regarding a cervical scar and for their surgeons. Patients benefit from scarless neck surgery, while their surgeons benefit from improved dexterity and ergonomics compared with remote-access endoscopic thyroid surgery. However, validating any novel surgical procedure for thyroid pathology should be based on evidence regarding its feasibility, radicality, and safety compared to the time-honored, safe and effective, conventional open thyroidectomy. It should also be evaluated for potential risks that are not present with conventional approaches. This study reports a patient with surgical track and cervical nodal recurrence, and distant metastasis following a two-stage robot-assisted surgery, and radioactive iodine ablation therapy for a papillary thyroid carcinoma that was initially regarded a single indeterminate nodule. This case emphasizes the importance of thoroughly evaluating the oncological safety of RATS, and points out the possibility of "malignant seeding along the surgical access" being an untraditional potential complication associated with the procedure. While tailoring the surgical strategy to the patients' concerns and desires is important, adhering to fundamental onco-surgical principles is a priority. Furthermore, unconventional complications associated with novel surgical procedures should be properly evaluated and addressed.
BRAFK601E Mutation in a Follicular Thyroid Adenoma: A Case Report
Publisher: SAGE Publications
Date: 23-01-2017
Abstract: BRAF mutations represent the most common genetic alteration in papillary thyroid carcinoma (PTC). The p.V600E mutation is specific for the classic and tall-cell variants of PTC and has been associated with a more aggressive biologic behavior. On the other hand, the p.K601E mutation is peculiar to the follicular variant of PTC, and seems to be a favorable prognostic indicator. A 12-year-old boy presented with a 10-mm left-sided thyroid nodule. Fine-needle aspiration cytology reported the lesion as suspicious for a follicular neoplasm (Bethesda category IV). The patient underwent lobectomy, and histopathology revealed a follicular adenoma with normal surrounding tissue. The cytological smear was found to be positive for BRAF p.K601E mutation, and this was later confirmed on the corresponding paraffin block. This case was independently revised by 4 expert pathologists, all of whom confirmed the benign nature of the thyroid lesion. This article describes the presence of a BRAF mutation in a benign thyroid lesion. To the authors’ knowledge, this is the fourth case of follicular adenoma carrying BRAF K601E reported in literature to date. BRAF K601E mutation can occur in benign thyroid lesions. This finding, in the context of the current literature and the recently proposed reclassification of the noninvasive encapsulated follicular variant of papillary thyroid carcinoma into a benign lesion, confirms the importance of preoperative BRAF p.K601E testing in offering patients a tailored treatment plan and avoiding overtreatment.
Energy-based devices in thyroid surgery-an overview.
Publisher: AME Publishing Company
Date: 2020
Major lower extremity amputation: A contemporary analysis from an academic tertiary referral centre in a developing community
Publisher: Springer Science and Business Media LLC
Date: 13-11-2019
DOI: 10.1186/S12893-019-0637-Y
Abstract: We aimed to explore the surgical outcomes of major lower extremity utation (MLEA) and influencing factors at an academic tertiary referral centre in north Jordan, optimistically providing a platform for future health care policies and initiatives to improve the outcomes of MLEA in Jordan. Clinical records of patients who had undergone MLEA between January 2012 and December 2017 were identified and retrospectively reviewed. International Classification of Diseases codes were used to identify the study cohort from a prospectively maintained computerised database. We included adult patients of both genders who underwent utations for ischemic lower limb (acute and chronic) and diabetic foot syndrome (DFS). We excluded patients for whom MLEA surgery was performed for other indications (trauma and tumors). Outcomes of interest included patient demographics and comorbidities, type of utation and indications, length of hospital stay (LOS), the need for revision surgery (ipsilateral conversion to a higher level of utation), and cumulative mortality rate at 1 year. The impact of the operating surgeon’s specialty (vascular vs. non-vascular surgeon) on outcomes was evaluated. The study cohort comprised 140 patients who underwent MLEA (110 below-knee utations [BKA] and 30 above-knee utations [AKA] ratio: 3:1 86 men 54 women mean age, 62.9 ± 1.1 years). Comorbidities included diabetes, hypertension, dyslipidaemia, ischaemic heart disease, congestive heart failure, chronic kidney disease, stroke, and Buerger disease. The only associated comorbidity was chronic kidney disease, which was more prevalent among BKA patients ( p = 0.047). Indications for MLEA included DFS, and lower limb ischaemia. Acute limb ischaemia was more likely to be an indication for AKA ( p = 0.006). LOS was considerably longer for AKA ( p = 0.035). The cumulative mortality rate at 1 year was 30.7%. Revision surgery rates and LOS improved significantly with increased rate of vascular surgeon-led MLEA. In developing countries, the adverse impact of MLEA is increased because of limited resources and increased prevalence of diabetes-related foot complications. Vascular surgeon-led MLEA is associated with decreased revision rates, LOS and possibly improved outcomes, particularly when it is performed for vascular insufficiency. It is important to formulate national health care policies to improve patient outcomes in these countries.
Underestimated risk of cancer in solitary thyroid nodules ≥3 cm reported as benign
Publisher: Springer Science and Business Media LLC
Date: 08-07-2017
DOI: 10.1007/S00423-017-1600-Y
Abstract: The study aims to assess the risk of cancer in solitary thyroid nodules ≥30 mm in size reported as Bethesda II, and its implications. The clinical records of 202 patients, who underwent thyroid lobectomy for solitary nodules measuring ≥30 mm, reported as Bethesda II on preoperative FNAC between Jan 2015 and Apr 2016 were reviewed. Data collected included nodule size and consistency, and final histopathology results. The risk of cancer and the recommended management according to ATA guidelines were the outcomes of interest. Comparisons were then made between two size categories: (30-40 mm n = 72 C1) and (>40 mm n = 130 C2), and two nodule consistencies. Mean nodule size was 43.2 mm (range 30-92). Ninety-five percent were solid and 5% were predominantly cystic. The risk of cancer was 22.8% (46/202) with no size threshold, or graded increase in risk observed. Based on biologic behavior, 50% of cancers were considered clinically significant. Accordingly, the risk of cancer for which surgery is recommended was 11.4% (23/202). The risk of cancer requiring total thyroidectomy was 9.4% and was influenced by nodule size (19 vs. 60% in C1 and C2, respectively p = 0.01). Predominantly cystic nodules had a greater risk of malignancy compared to predominantly solid nodules even after adjusting for size (40 vs. 9.9% p = 0.01 and 40 vs. 12.5% p = 0.02, respectively). The risk of malignancy in Bethesda II solitary nodules ≥30 mm is considerable implying a need for changing the way these are approached and refining cytopathology reporting.
Less is more: an outcome assessment of patients operated for gallstone ileus without fistula treatment
Publisher: Elsevier BV
Date: 2017
Xanthogranulomatous Cholecystitis in the Laparoscopic Era Is Still a Challenging Disease
Publisher: Springer Science and Business Media LLC
Date: 21-04-2015
DOI: 10.1007/S11605-015-2818-Z
Abstract: Xanthogranulomatous cholecystitis is an unusual inflammatory process of the gallbladder which is difficult to diagnose and manage and may be confused with gallbladder cancer. Many surgeons and pathologists are not familiar with this condition. We aim to highlight this condition and to review the role of laparoscopy in its management. We reviewed the records of 4406 patients who underwent cholecystectomy in 8 years at two teaching hospitals in North Jordan. Forty-two cases of Xanthogranulomatous cholecystitis were identified. The details of these patients were analyzed. The findings were compared with results of a previous study in all cholecystectomy patients conducted in the same centers. The incidence of Xanthogranulomatous cholecystitis was 0.95 %. Twenty-five patients (59.5 %) presented as acute emergencies. Nine patients (21.4 %) had jaundice. Ultrasound showed marked gallbladder wall thickening in 36 patients (85.7 %). Compared with all cholecystectomy patients, xanthogranulomatous cholecystitis patients showed higher conversion rate from laparoscopic to open cholecystectomy (31.4 vs. 3.2 %, p < 0.001) and higher morbidity (33.3 vs. 6.4 % p < 0.001). Xanthogranulomatous cholecystitis is rare. Acute presentation, associated jaundice, and gallbladder wall thickening should raise the suspicion of the condition. Laparoscopic cholecystectomy is associated with high conversion rate.
Tailored surgery according to molecular analysis in differentiated thyroid carcinomas
Publisher: AME Publishing Company
Date: 08-2018
Bouveret's Syndrome: An Overlooked Diagnosis. A Case Report and Review of Literature.
Publisher: International College of Surgeons
Date: 11-2014
DOI: 10.9738/INTSURG-D-14-00087.1
Abstract: Bouveret's syndrome is a rare cause of gastric outlet obstruction. Its diagnosis is often delayed or overlooked. It is characterized by the passage of a large gall bladder stone through a bilio-duodenal fistula, which becomes lodged in the duodenum causing duodenal obstruction. We report the case of a 70-year-old male with a history suggestive of gall bladder disease over a 1-year period. The diagnosis was confirmed by ultrasound, which showed a single large gall bladder stone and the patient was planned for elective laparoscopic cholecystectomy. One week prior to the elective surgery he presented with upper gastrointestinal bleeding for which he was admitted, diagnosed by a gastroenterologist as bleeding duodenal ulcer and treated by local epinephrine injection and blood transfusion. One week later he presented with a picture of acute gastric outlet obstruction, which proved by endoscopy to be due to a large stone impacted in the duodenum. Endoscopic management failed and the stone was managed by open surgery. The patient made a good postoperative recovery and for the last year he has remained free of symptoms.
Minimally invasive video-assisted thyroidectomy (MIVAT) from A to Z
Publisher: Springer Science and Business Media LLC
Date: 31-08-2016
DOI: 10.1007/S00595-015-1241-0
Abstract: A minimal access procedure does not necessarily mean that it is minimally invasive. However, as its name implies, MIVAT is a truly minimally invasive treatment modality. The advantages it offers over its conventional counterpart are indeed related to its minimally invasive nature. Furthermore, this nature has not compromised its ability to accomplish its purpose both safely and effectively. Ever since its introduction in the late 1990s, MIVAT has been progressively evolving. The indications for this procedure, which was initially surrounded by skepticism, have been expanding. Benign thyroid pathology is now considered only one of its indications among others. This article provides a detailed description of this minimally invasive, maximally effective and patient satisfying procedure so that it may be adopted by more surgeons around the globe for better patient care and to also encourage the development of further future advancements.
The Current Practice of Metabolic Surgery for the Treatment of Type 2 Diabetes Mellitus
Publisher: Briefland
Date: 31-05-2017
The effect of intraoperative autofluorescence monitoring on unintentional parathyroid gland excision rates and postoperative PTH concentrations—a single-blind randomized-controlled trial
Publisher: Springer Science and Business Media LLC
Date: 11-01-2021
Indocyanine green fluorescence: an additional tool for endoscopic adrenalectomy
Publisher: Wiley
Date: 09-2021
DOI: 10.1111/ANS.16725
Introducing a new scrotal orchiopexy technique: The fat anchor orchiopexy
Publisher: Elsevier BV
Date: 03-2021
Resuming elective paediatric surgical procedures in the era of COVID-19
Publisher: Medknow
Date: 2021
Surgical management of papillary thyroid carcinoma in childhood and adolescence: an Italian multicenter study on 250 patients
Publisher: Springer Science and Business Media LLC
Date: 29-04-2016
DOI: 10.1007/S40618-016-0474-0
Abstract: The extent of surgery for pediatric papillary thyroid carcinoma is debatable. The aim of this study was to evaluate the feasibility of offering pediatric patients a tailored surgical approach based on certain clinical features. A national multicenter retrospective review of 250 pediatric patients treated for papillary thyroid carcinoma in a 14-year period was performed. Outcomes of interest included tumor-related features, type of surgery, surgical morbidity, disease-free and overall survival rates. Recurrence was thoroughly analyzed with particular focus on how it correlated with certain patient- and tumor-related features. The majority of patients (58.8 %) had tumors >2 cm in size. Nodal involvement occurred in 115/250 (46 %) patients and distant metastasis in 4 % (10/250). Total thyroidectomy and lobectomy were performed in 90.4 % (226/250) and 9.6 % (24/250) of patients, respectively. The overall rate of surgical complications was 20.8 % (52/250). These included transient and permanent hypoparathyroidism (13.6 and 4.4 %, respectively), and vocal fold palsy (2.8 %). All surgical complications occurred exclusively in the total thyroidectomy group. The rate of recurrent disease was 12 % (30/250) with the vast majority of recurrences (96.6 %) occurring in the total thyroidectomy group. The risk of recurrence correlated significantly with certain tumor-related features (size > 2 cm, multifocality, extrathyroidal invasion, nodal positivity, and distant metastasis). However, it did not correlate with the patient's age or sex. Overall survival was 100 %. Pediatric patients are likely to benefit from a tailored surgical strategy. Uniformly offering patients total thyroidectomy seems to be an overly radical approach.
Minimally invasive video-assisted thyroidectomy (MIVAT)
Publisher: AME Publishing Company
Date: 2020
First report of benign track seeding after robot-assisted transaxillary thyroid surgery
Publisher: Elsevier BV
Date: 2021
SimLife model: introducing a new teaching device in endocrine surgery simulation
Publisher: Springer Science and Business Media LLC
Date: 02-09-2020
Posterior Retroperitonoscopic Adrenalectomy; How to Do it – Pearls and Secrets
Publisher: Briefland
Date: 19-10-2016
Comparing LigasureTM Exact dissector with other energy devices in total thyroidectomy: a pilot study
Publisher: AME Publishing Company
Date: 04-2020
Resuming elective surgery in the time of COVID-19: a safe and comprehensive strategy
Publisher: Springer Science and Business Media LLC
Date: 06-2020
Life threatening presentation of thoracic duct injury post thyroid surgery; a case report
Publisher: Elsevier BV
Date: 2017
Posterior retroperitonoscopic adrenalectomy; a back door access with an unusually rapid learning curve
Publisher: Springer Science and Business Media LLC
Date: 12-04-2017
DOI: 10.1007/S13304-017-0437-9
Abstract: Posterior retroperitonoscopic adrenalectomy (PRA) has become a standard approach to the adrenal gland. The aim of this study was to report an initial experience with the procedure following a proper preparatory phase highlighting the rapidity, safety and effectiveness by which it could be introduced into a surgeon's practice. Between May 2015 and July 2016, 14 PRAs were performed in 14 patients (9 females and 5 males). The average age was 46 years, BMI: 25.5 kg/m
“Sim life model: introducing a new teaching device in endocrine surgery simulation”. Author’s commentary
Publisher: Springer Science and Business Media LLC
Date: 30-01-2022
Indeterminate single thyroid nodule: Synergistic impact of mutational markers and sonographic features in triaging patients to appropriate surgery
Publisher: Mary Ann Liebert Inc
Date: 03-2016
Abstract: Patients labeled as having indeterminate thyroid nodular disease following fine-needle aspiration cytology are at risk of non-optimal initial surgery: an overly radical total thyroidectomy, or an unnecessary two-stage operation. The objective of this study was to assess the impact of combining mutational markers and ultrasonographic (US) features preoperatively on predicting the risk of malignancy in patients with indeterminate nodules, thereby offering them a tailored initial surgical intervention. The records of 258 patients who underwent conventional total thyroidectomy for single nodules reported as suspicious for a follicular neoplasm (Bethesda category IV) in a four-year period were reviewed. Main issues addressed included: certain US findings (in idually and in combination), mutational markers (BRAF and NRAS), and combinations of both. Correlation of these with malignancy was assessed, as was their ability to predict malignancy. The usefulness of combining the absence of suspicious sonographic features and the absence of mutational markers was also evaluated. Among the 258 patients with an indeterminate diagnosis, only 90 lesions were found to be malignant. The sonographic features that correlated significantly with malignancy were irregular margins, microcalcifications, and a "taller than wide" shape. The presence of irregular margins was the feature with the highest positive predictive value. Combinations of two or more features were always associated with predictivity in excess of 90%, and at times at 100%. NRAS mutation was the most common gene alteration. Both BRAF and NRAS mutations were mutually exclusive and correlated significantly with malignancy. Their predictivity of malignancy was high, particularly when combined with suspicious sonographic features (100%). The major limitation of both suspicious sonographic features and/or mutational markers was their low occurrence in malignancy. The absence of both mutational markers and suspicious sonographic features proved extremely useful in tailoring surgical strategy, as it could have ultimately spared 143/258 patients (55%) an overly radical thyroidectomy. The preoperative utility of mutational markers and sonographic features in combination has a synergistic impact. It can predict the risk of malignancy with high accuracy, properly triaging patients to appropriate surgery.
The extent of surgery in thyroglossal cyst carcinoma
Publisher: Springer Science and Business Media LLC
Date: 23-06-2017
DOI: 10.1007/S00423-016-1460-X
Abstract: The optimal management of thyroglossal cyst carcinoma, particularly the extent of surgery required is controversial. The aim of this study was to evaluate the need for routinely adding total thyroidectomy to Sistrunk's operation in the management of this condition. The clinical records of 19 patients with a diagnosis of thyroglossal cyst carcinoma encountered in an 11-year period (2004-2015) were reviewed. All patients underwent total thyroidectomy in addition to Sistrunk's procedure. The rate of concomitant thyroglossal cyst and thyroid carcinomas was calculated and cancers were staged according to the AJCC-TNM staging system. Patients were ided into two groups: those with thyroglossal cyst carcinoma only (group A) and those with a synchronous or metachronous thyroid carcinoma as well (group B). The need for radioactive iodine ablation in group A was assessed. The ability to omit total thyroidectomy based on thyroglossal cancer size and a negative thyroid ultrasound was also evaluated. The rate of concomitant thyroid cancer was 63.2 % (12/19). Based on stage, three out of the seven patients in group A required radioactive iodine ablation. Total thyroidectomy was ultimately justifiable in 78.9 % (15/19) of cases. Omitting total thyroidectomy in T1 thyroglossal cyst cancers or based on a sonographically normal thyroid was associated with a 43 % risk of missing thyroid malignancy. The routine addition of total thyroidectomy to Sistrunk's procedure seems to be appropriate for comprehensive loco-regional control especially that selecting a subset of patients in which it could be omitted is a difficult task.
Developing a tool that could reliably refute total thyroidectomy for solitary Bethesda IV thyroid nodules
Publisher: Springer Science and Business Media LLC
Date: 14-05-2020
Robot-Assisted Transaxillary Thyroidectomy (RATT): A Series Appraisal of More than 250 Cases from Europe
Publisher: Springer Science and Business Media LLC
Date: 08-09-2018
DOI: 10.1007/S00268-017-4213-2
Abstract: Robot-assisted transaxillary thyroidectomy (RATT) is widely accepted in Asian countries. However, concerns regarding the balance between its real advantages and safety and cost have been raised by North American authorities. In Europe, assessments have been limited by small numbers since now. The purpose here is to report a large European experience with RATT. A retrospective analysis was conducted of 257 patients who underwent RATT for nodular disease between February 2012 and September 2016. Data collected included patient demographics, diagnosis, ultrasound-estimated mean thyroid volume and nodule size, type of resection, operative time, postoperative pain and morbidity, and the hospital length of stay. Pain was assessed by visual analog scale score 12 h postoperatively (on the first postoperative day, before discharge). Feasibility, effectiveness, and safety were the outcomes of interest. Follow-up of thyroid carcinoma patients was carried out measuring thyroglobulin levels and ultrasound examination (median follow-up 24 months (6-48 months)). First control after 12 months and successively once a year. There were 253 women and 4 men, with a mean age of 37.3 years. Indications included benign disease in 116, papillary carcinoma in 56, and indeterminate nodule in 85. Mean thyroid volume was 16.8 mL, and nodule size was 25.3 mm. A hemithyroidectomy was performed in 138 patients and total thyroidectomy in 118. The mean operative time was 77.5 min for the former and 99.7 min for the latter. One conversion was required. Complications included transient hypoparathyroidism in 7/118 (total thyroidectomy) patients (5.9%), transient vocal fold palsy in 3/257 (1.1%), 1 delayed tracheal injury (0.4%), and 3 postoperative hematoma (1.1%). Mean visual analog scale score was 1.79, and the mean length of stay was 1.6 days for hemithyroidectomy and 1.9 days for total thyroidectomy. RATT is safe and effective and could serve as a viable treatment modality in selected cases.
Surgical Management of Diffuse Sclerosing Variant of Papillary Thyroid Carcinoma. Experience in 25 Patients.
Publisher: Springer Science and Business Media LLC
Date: 11-10-2020
DOI: 10.1007/S00268-019-05230-5
Abstract: To delineate the clinicopathologic features and biologic behavior of the diffuse sclerosing variant of papillary thyroid carcinoma (DSV-PTC) and to report its outcome. The clinical records of 25 patients who had surgery for DSV-PTC from 2004 to 2017 were retrospectively analyzed. Comparisons were made to similar studies in the literature reporting ≥8 cases and a cohort of classical PTC. There were 20 females and 5 males with an average age of 23 years (range 10-39 years). Bilateral disease occurred in 80% of cases. The mean size of the dominant mass was 4.2 ± 1.92 cm. In 92% of cases, therapeutic neck dissection was performed. Male sex significantly correlated with a higher yield of positive lymphadenopathy (p = 0.045). 62% of patients had recurrent disease. Recurrence significantly correlated with male sex, the number of metastatic lymph nodes (cutoff: 22 lymph nodes), and multifocality (p = 0.044, p ˂ 0.008, p ˂ 0.003, respectively). However, it did not correlate with the age at presentation. No disease-specific mortality occurred after an average follow-up of 77 months (range 12-168 months). The two comparisons made demonstrated a statistically significant greater tendency of the current series of DSV-PTC toward more aggressive clinicopathologic features and biologic behavior. No differences in overall survival were observed. The DSV-PTC should be considered a high-risk PTC that mandates an aggressive therapeutic strategy with the intent of optimizing disease-free survival.
Human Fibrin Glue in Laparoscopic Inguinal Hernia Repair: An Alternative to Invasive Mesh Fixation: A Review of Literature
Publisher: Jaypee Brothers Medical Publishing
Date: 15-09-2012
Analysis of the Peri-Operative Cost of Non-Traumatic Major Lower Extremity Amputation in Jordan
Publisher: Informa UK Limited
Date: 2020
DOI: 10.2147/CEOR.S232779
Successful management of hypothyroidism in gastric outlet obstruction using levothyroxine rectal enemas: A case report
Publisher: International Scientific Information, Inc.
Date: 08-2018
DOI: 10.12659/AJCR.909437
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