A Prospective Randomized Control Study Comparing the Effects of Dermal Staples and Intradermal Sutures on Postoperative Scarring After Thyroidectomy.

BACKGROUND: We compared cosmetic outcomes, pain intensity, and costs between dermal stapling and intradermal suturing in patients who underwent thyroidectomy through cervical incision. PATIENTS AND METHODS: In total, 40 patients were randomly assigned to undergo thyroidectomy through a low cervical incision and dermal closure using either absorbable staples (n = 20, staple group) or interrupted intradermal sutures (n = 20, suture group). Wound complications, cosmetic outcomes (modified Stony Brook Scar Evaluation Scale [SBSES] and Manchester Scar Scale [MSS]), and pain intensity (visual analog scale) were assessed at 1, 4, 12, and 24 weeks postoperatively. The difference in total "wound-closure cost" between the two groups was also analyzed. RESULTS: There were no wound-related complications and no significant differences in SBSES or MSS scores between the two groups (P = 0.609 and P = 0.141, respectively). However, the staple group had significantly higher SBSES scores, compared to the suture group, at 24 wk postoperatively (4.06 ± 0.94 versus 3.26 ± 1.24; P = 0.030, respectively); MSS scores were significantly lower in the staple group than in the suture group at 24 wk postoperatively (6.72 ± 1.27 versus 8.16 ± 2.17, respectively; P = 0.028). Visual analog scale scores were significantly lower in the suture group than in the staple group (P = 0.038). The total wound-closure cost was significantly higher in the staple group than in the suture group (137.10 ± 8.39 versus 81.79 ± 19.95 USD; P < 0.001). CONCLUSIONS: When dermal staples were used, wound complications were absent and long-term cosmetic outcomes were superior; however, pain intensity was higher and the cost was greater, although healing was significantly more rapid, compared to intradermal sutures. Closure using absorbable dermal staples may be safe and effective for cervical incisions during thyroid surgery. Further studies with larger number of participants are needed to confirm our findings.

A prospective, randomized controlled study of the safety and efficacy of gasless bilateral axillo-breast approach (BABA) robotic thyroidectomy.

BACKGROUND: During bilateral axillo-breast approach (BABA) robotic thyroidectomy (RoT), carbon dioxide (CO2) gas is insufflated into the operative cavity, not only triggering hemodynamic and metabolic changes, but also inducing postoperative pain and gas embolism. Here, we explored whether the new gasless BABA RoT approach was as safe and efficacious as conventional robotic surgery using CO2 insufflation. PATIENTS AND METHODS: We performed a prospective, randomized controlled trial comparing conventional BABA RoT to gasless BABA RoT (CO2 group, n = 14; gasless group, n = 14). All clinicopathological and oncological outcomes were evaluated. The hemodynamic parameters [heart rate (HR), mean arterial pressure (MAP), cardiac output (CO), and cardiac index (CI)] and metabolic parameters [partial pressure of carbon dioxide (PaCO2) and pH] were measured at baseline; 30, 60, 90, and 120 min after CO2 insufflation; and 30 min after desufflation. Pain parameters [numeric rating scale (NRS) score, number of analgesics (NA), and bottom hit count (BHC)] were measured at 2, 24, 48, and 72 h after surgery. RESULTS: We found no statistically significant differences between the two groups in terms of any demographic or baseline characteristic. The clinicopathological and oncological outcomes did not differ significantly between the two groups, but the operation time was longer for the gasless group (187.50 ± 42.64 vs. 212.50 ± 35.88 min; P = 0.028). In terms of the hemodynamic, metabolic, and pain parameters, the pH fell significantly less in the gasless group (P = 0.047), but there were no significant between-group differences in the HR, MAP, CO, CI, PaCO2, NRS, NA, or BHC. No safety concerns arose. CONCLUSION: The new, gasless BABA RoT technique employing the da Vinci robotic surgical system is safe. Although metabolic changes during operation are thereby minimized, gasless BABA RoT should be used carefully when engaging in thyroid surgery; more experience is required.

A Propensity Score-matched Comparison Study of Surgical Outcomes in Patients with Differentiated Thyroid Cancer After Robotic Versus Open Total Thyroidectomy.

INTRODUCTION: The aim of this study, from a surgical, oncological, and functional perspective, was to identify whether bilateral axillo-breast approach robotic total thyroidectomy (RTT) for differentiated thyroid cancer (DTC) has different surgical outcomes compared to open total thyroidectomy (OTT). METHODS: Initially, 796 patients who underwent total thyroidectomy were primarily reviewed and 178 who were ineligible for analysis were excluded. Propensity score matching analysis adjusted for clinicopathological characteristics (sex, age, body mass index, extent of central node dissection, tumor size, extrathyroidal extension, and thyroiditis) was conducted, with 246 patients in the OTT group matched with 123 patients in the RTT group. RESULTS: There were no significant differences in surgical outcomes in terms of surgical safety and oncological safety between the OTT and RTT groups, except in mean operation times (123.51 ± 32.63 vs. 198.39 ± 37.93 min, respectively; P < 0.001). However, the median parathyroid and laryngeal function recovery times were shorter in the RTT group than in the OTT group [88 ± 33.09 (95% CI: 23.148-152.852) vs. 100 ± 16.20 (95% CI: 68.242-131.768) days; P = 0.044 and 87 ± 32.40 (95% CI: 23.489-150.511) vs. 118 ± 49.50 (95% CI: 20.985-215.015) days; P = 0.002]. CONCLUSIONS: The recovery times of laryngeal and parathyroid function were significantly shorter in RTT patients than in OTT patients for DTC. To verify a definitive conclusion about the superiority of robotic total thyroidectomy in terms of parathyroid and laryngeal function recovery, further studies may be necessary.

D-Dimer Levels and Vitamin K Antagonist Therapy in Deep Vein Thrombosis of the Legs.

BACKGROUND: D-dimer levels are closely related to the clinical status of deep vein thrombosis (DVT). This study aimed to investigate the factors which were associated with the normalization of D-dimer level by vitamin K antagonist (VKA) therapy, the maintenance of normal D-dimer levels for 6 months during VKA therapy, and the recurrent elevations of D-dimer above normal level after VKA withdrawal, in DVT of the legs. METHODS: The 469 consecutive patients with first-episode leg swelling were examined. All blood tests were measured from the initially sampled blood before the administration of medications. RESULTS: Of the 469 patients, 288 (61.4%) showed positive D-dimer test. Radiologic examinations, including Doppler ultrasound and computed tomography venography, of the 288 patients revealed positive DVT of the legs in 135 (46.9%) patients and of these, 122 with total follow-up durations of >6 months were enrolled in this study. Linear regression analysis of 100 patients who experienced D-dimer normalization revealed initial D-dimer levels were positively correlated with D-dimer normalization time during VKA therapy (P = 0.010). Logistic regression analysis showed initial D-dimer level was negatively associated with the normalization of D-dimer levels by VKA therapy (P = 0.045), and being a woman (P = 0.005) and having lower protein C (P = 0.002) level had negative impacts on the maintenance of normal D-dimer levels for 6 months during VKA therapy. Finally, after VKA withdrawal, the recurrent elevations of D-dimer above normal level were more likely to occur in women than in men (P = 0.004). CONCLUSIONS: From these observations, it is suggested that higher initial D-dimer level, lower protein C level, and female gender may be the adverse risk factors for the treatment of DVT of the legs using VKA.

Clinical Outcome of Remnant Thyroid Ablation with Low Dose Radioiodine in Korean Patients with Low to Intermediate-risk Thyroid Cancer.

Radioiodine activity required for remnant thyroid ablation is of great concern, to avoid unnecessary exposure to radiation and minimize adverse effects. We investigated clinical outcomes of remnant thyroid ablation with a low radioiodine activity in Korean patients with low to intermediate-risk thyroid cancer. For remnant thyroid ablation, 176 patients received radioiodine of 1.1 GBq, under a standard thyroid hormone withdrawal and a low iodine diet protocol. Serum levels of thyroid stimulating hormone stimulated thyroglobulin (off-Tg) and thyroglobulin-antibody (Tg-Ab), and a post-therapy whole body scan (RxWBS) were evaluated. Completion of remnant ablation was considered when there was no visible uptake on RxWBS and undetectable off-Tg (<1.0 ng/mL). Various factors including age, off-Tg, and histopathology were analyzed to predict ablation success rates. Of 176 patients, 68.8% (n = 121) who achieved successful remnant ablation were classified into Group A, and the remaining 55 were classified into Group B. Group A presented with significantly lower off-Tg at the first radioiodine administration (pre-ablative Tg) than those of Group B (1.2 ± 2.3 ng/mL vs. 6.2 ± 15.2 ng/mL, P = 0.027). Pre-ablative Tg was the only significant factor related with ablation success rates. Diagnostic performances of pre-ablative Tg < 10.0 ng/mL were sensitivity of 99.1%, specificity of 14.0%, positive predictive value of 71.1%, and negative predictive value of 87.5%, respectively. Single administration of low radioiodine activity could be sufficient for remnant thyroid ablation in patients with low to intermediate-risk thyroid cancer. Pre-ablative Tg with cutoff value of 10.0 ng/mL is a promising factor to predict successful remnant ablation.

BRAF mutation in follicular variant of papillary thyroid carcinoma is associated with unfavourable clinicopathological characteristics and malignant features on ultrasonography.

OBJECTIVE: Follicular variant of papillary thyroid carcinoma (FVPTC) is a common variant of papillary thyroid carcinoma (PTC), but the association between BRAF mutation and the clinicopathological and ultrasonographical characteristics of FVPTC has not been well studied. The aim of this study was to determine the significance of BRAF mutation in FVPTC. PATIENTS: The medical records of the 137 patients with >5 mm FVPTCs and known BRAF mutation status in the interested nodule were reviewed. BRAF mutation analysis was performed routinely and prospectively by Sanger sequencing. Clinicopathological and ultrasonographical characteristics were compared between BRAF mutation-positive and BRAF mutation-negative groups. RESULTS: BRAF mutation was detected in 35 (25·5%) patients. The BRAF mutation-positive group was associated with smaller tumour size (P = 0·022), extrathyroidal extension (P = 0·001), multifocality (P = 0·046) and higher (III/IV) TNM stages (P = 0·005). In multivariable analysis, higher (III/IV) TNM stage was an independent predictive factor for BRAF mutation-positive status (adjusted OR 2·966, 95% CI 1·321-6·663). In diagnosis of FVPTC, the presence of BRAF mutation was associated with malignant features on ultrasonography (P < 0·001) and higher incidence of suspicious for malignancy or malignant diagnosis on the fine needle aspiration cytology (P = 0·023). Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of US for detecting BRAF mutation were 82·9%, 57·8%, 40·3%, 90·8% and 64·2%, respectively. Conclusions BRAF mutation in FVPTC is associated with unfavourable clinicopathological characteristics and malignant features on ultrasonography and may be a potential prognostic factor as it is in classical PTC.

Current status of robotic thyroid surgery in South Korea: a web-based survey.

BACKGROUND: More than 8,000 cases of robotic thyroidectomy (RoT) were performed in South Korea from 2007 to 2011 using either a transaxillary approach (TAA) or a bilateral axillo-breast approach (BABA). However, there is no consensus regarding patient selection for RoT. This study used a web-based survey questionnaire to examine the current status of RoT in South Korea. METHODS: Thirty-two of 50 surgeons (64.0 %) who had performed RoT in South Korea participated in the web-based survey in August 2011. The questionnaires comprised four main domains: surgeon characteristics, surgical approach, patient selection, and future prospects. RESULTS: In terms of surgical approach, 43.8 % respondents used the TAA method and 53.1 % used the BABA method. The main advantage cited by surgeons using the TAA method was that it made lateral lymph node dissection easier (35.7 %), whereas those using the BABA method cited more cosmesis (100 %) and ease of performing a contralateral thyroidectomy (88.2 %). Papillary thyroid cancer ≤2 cm (65.3 %), intracapsular lesion (76.7 %), nonposterior location (53.6 %), and no clinical evidence of lateral lymph node metastasis (76.7 %) were cited as main indications for RoT. Of respondents, 87.5 % agreed that RoT would play a future role as a treatment modality for thyroid disease. CONCLUSIONS: Opinions differed regarding the advantages and disadvantages of two approaches for RoT. This may be due to differences in surgical procedure itself between two approach methods. Accumulation of RoT surgeon's experiences might establish consensus regarding patient selection and indications for the RoT will need to be further investigated.

Use of spiral computed tomography volumetry for determining the operative approach in patients with Graves' disease.

BACKGROUND: The purposes of the present study were to assess (1) the correlation between the weight of the postoperative thyroid specimen and the spiral computed tomography (CT) volumetry results of the thyroid gland in patients with Graves' disease, and (2) the utility of CT volumetry for determining the operative approach. METHODS: From 2009 to 2010, a total of 56 patients with Graves' disease underwent total or subtotal thyroidectomy. An enhanced spiral CT was taken in all patients prior to the operation. From 2.5 mm-thick slices of the thyroid gland, the surface area was calculated to measure the volume of the thyroid gland. The glandular volume was compared to the weight of the postoperative thyroid specimen. RESULTS: A total of 42 and 14 patients underwent total and subtotal thyroidectomy, respectively. The mean weight of the postoperative thyroid specimen was 43.9 ± 33.4 g, and the mean volume obtained by CT volumetry was 44.2 ± 32.8 mL. A good correlation was observed between the weight of the postoperative thyroid specimen and the volume calculated by CT (r = 0.98, p < 0.001). When 100 mL was set as the higher cut-off value of the thyroid volume for minimally invasive thyroid surgery, the estimated blood loss showed a significant difference between the >100 mL and the ≤100 mL groups (608.3 ± 540.8 vs. 119.7 ± 110.4 mL; p = 0.036). CONCLUSIONS: Spiral CT volumetry may be used to measure the thyroid volume reliably in patients with Graves' disease. For cases in which surgery is indicated in patients with Graves' disease, CT volumetry provides useful information from which to determine the operative approach. One hundred milliliter or less of thyroid volume in CT volumetry is recommended to perform minimally invasive thyroid surgery.

Papillary thyroid carcinoma located in the isthmus or upper third is associated with Delphian lymph node metastasis.

BACKGROUND: Delphian lymph node (DLN) metastasis is a recognized indicator of further lymph node involvement in papillary thyroid carcinoma (PTC). The aim of this study was to evaluate the clinicopathological significance of and risk factors for DLN metastasis. METHODS: The medical records of 1,436 patients who underwent primary thyroidectomy for classical PTC with a tumor size of 2 cm or less were reviewed. Of these, 370 patients from whom the DLN was harvested were enrolled. Metastasis in DLN was present in 46 patients and absent in 324 patients. Clinicopathological features were compared according to DLN metastasis. RESULTS: In univariate analysis, DLN metastasis was associated with suspected lymph node metastasis on preoperative ultrasonography, tumor location in the isthmus or upper third of the thyroid, larger tumor size, extrathyroid extension, lymphovascular invasion, and further lymph node metastasis. Multivariable analysis revealed that DLN metastasis was associated with tumor location in the isthmus or upper third of the thyroid (odds ratio [OR] = 2.420; 95 % confidence interval [CI] 1.193-4.910) and further lymph node metastasis (OR = 4.746; 95 % CI 2.065-10.908). CONCLUSIONS: DLN metastasis in PTC is associated with tumor location in the isthmus or upper third of the thyroid and unfavorable clinicopathological characteristics. Careful consideration and patient management are warranted when preoperative ultrasonography indicates that the tumor is located in the isthmus or upper third of the thyroid.

Robotic thyroidectomy by bilateral axillo-breast approach: review of 1,026 cases and surgical completeness.

BACKGROUND: Good postoperative and excellent cosmetic results have been achieved with bilateral axillo-breast approach (BABA) robotic thyroidectomy (RoT). This study was performed to analyze the surgical outcomes and evaluate the surgical completeness and safety of BABA RoT. METHODS: Between February 2008 and February 2012, a total of 1026 cases of BABA RoT were performed. The clinicopathologic characteristics, operation types, and postoperative outcomes of patients were analyzed. RESULTS: Of the 1026 cases analyzed, 968 cases were a malignant tumor and 58 cases were benign thyroid disease. Mean operating times for BABA total RoT with central lymph node dissection included 38 ± 13 min (range 20-90 min) of working space creation and 75 ± 26 min (range 25-175) of console time. Among the 872 patients who underwent total thyroidectomy with central lymph node dissection, transient hypoparathyroidism occurred in 39.1 %, transient vocal cord palsy occurred in 14.2 %, and permanent hypoparathyroidism and permanent vocal cord palsy occurred in 1.5 % and 0.2 % of patients, respectively. The median stimulated thyroglobulin (Tg) level of patients after their first radioactive iodine therapy was 0.4 ng/mL, with 65.1 % of patients having a stimulated Tg level of <1.0 ng/mL. The median suppressed Tg level at 3 postoperative months of patients without radioactive iodine therapy was <0.1 ng/mL, with 99.4 % of patients showing a suppressed Tg level of< 1.0 ng/mL. There was no recurrence or mortality after a median follow-up of 23 months. CONCLUSIONS: BABA RoT is a safe and effective method that provides good surgical completeness and has low rates of postoperative complications and recurrence.

Bilateral axillo-breast approach robotic thyroidectomy for Graves' disease: an initial experience in a single institute.

BACKGROUND: Bilateral axillo-breast approach (BABA) robotic thyroidectomy has shown excellent cosmetic and surgical outcomes. The aim of the present study was to evaluate the safety, feasibility, and initial outcome of this procedure in patients with Graves' disease. METHODS: From June 2008 to July 2001, a total of 30 patients with Graves' disease were reviewed retrospectively. Patient demographics, operative indications, and surgical variables, including operative time, blood loss, excised thyroid weight, and complications, were collected and investigated. RESULTS: The thyroidectomies were classified as total (n = 21), near-total (n = 6), or subtotal (n = 3). There were five indications for surgery: concomitant thyroid carcinoma or suspicious nodule (n = 22), recurrence after antithyroid medication (n = 2), local compressive symptoms (n = 1), patient's preference (n = 4), and side effects of antithyroid medication (n = 1). The mean operative time, console time, blood loss, and excised thyroid weight were 190 min (range: 105-298 min), 113 min (range: 60-227 min), 229 mL (range: 50-550 mL), and 36.6 g (range: 7.8-123.0 g), respectively. There were no cases of postoperative bleeding or conversions to open surgery. Postoperative transient hypoparathyroidism and vocal cord palsy occurred in 13 (43.3 %) and 4 (13.3 %) cases. Permanent hypoparathyroidism occurred in 1 (3.3 %) case. All patients were satisfied with the cosmetic outcomes. CONCLUSIONS: BABA robotic thyroidectomy is a feasible and safe treatment for Graves' disease. It is recommended as an alternative for patients who are concerned by the cosmetic effects of traditional thyroidectomy.

Prospective study of sensation in anterior chest areas before and after a bilateral axillo-breast approach for endoscopic/robotic thyroid surgery.

BACKGROUND: The bilateral axillo-breast approach for endoscopic/robotic thyroid surgery (BABA) shows good oncologic and surgical outcomes and does not result in neck scars. However, there is concern about potential sensory changes of the skin flaps after BABA, especially of the breast areas. This prospective study was undertaken to evaluate sensory changes in the skin flaps after BABA. PATIENTS AND METHODS: A total of 19 women (mean age 36.9 ± 8.7; age range 21-51 years) who underwent BABA were enrolled. Skin flap sensory assessments were performed for each patient preoperatively and again at 1 and 3 months postoperatively. The Semmes-Weinstein monofilament test was used to evaluate the cutaneous light-pressure thresholds, a biothesiometer was used to evaluate the vibration thresholds, and an infrared thermometer was used to measure skin temperatures of the skin flaps. RESULTS: There were changes in the sensations of the anterior chest areas over time, as determined by the Semmes-Weinstein monofilament test (1.5 vs 4.3 versus 1.4; P < 0.05) and the biothesiometer (26.8 vs 31.2 vs 22.3; P < 0.05). The sensations in the anterior chest areas normalized to preoperative levels at 3 months postoperatively. No significant differences were seen in the infrared thermometer test at any of the time points (36.2 vs 36.2 vs 36.3 °C; P = 0.9927). CONCLUSIONS: While anterior chest area sensations were changed at 1 month postoperatively, the sensations normalized at 3 months after BABA. These results suggest that BABA has minimal adverse effects on anterior chest area sensation.

Endoscopic thyroidectomy via bilateral axillo-breast approach (BABA): review of 512 cases in a single institute.

BACKGROUND: Various techniques for endoscopic thyroidectomy have been introduced in the past decade, and the cosmetic superiority of these techniques has been universally acknowledged. We developed the endoscopic thyroidectomy via bilateral axillo-breast approach (BABA) and have performed more than 500 operations. The aims of this study are to analyze the surgical outcomes and to evaluate the effectiveness and safety of BABA endoscopic thyroidectomy. PATIENTS AND METHODS: Between February 2004 and March 2008, 512 patients with thyroid diseases underwent BABA endoscopic thyroidectomy. The criteria analyzed were clinicopathologic characteristics, types of operation, operation time, tumor-node-metastasis (TNM) stage on the basis of the 7th edition of the American Joint Committee on Cancer (AJCC), results after radioactive ablation therapy, and recurrence of disease in these patients. RESULTS: Of 512 patients, 397 had a malignant tumor and 115 had benign thyroid disease. Eight patients were diagnosed with Graves' disease, and nine patients underwent completion thyroidectomy. Three cases were subjected to open thyroidectomy due to uncontrolled bleeding. Mean operation time was 151.2 ± 38.1 min for total and near-total thyroidectomy, and 141.7 ± 50.1 min for subtotal thyroidectomy and lobectomy. Regarding postoperative complications, transient hypocalcemia occurred in 31.1% of patients and permanent hypoparathyroidism occurred in 4.2% of patients. Transient hoarseness occurred in 20.3% of patients, and permanent vocal cord palsy occurred in 1.7%. Mean hospital stay after operation was 3.34 ± 0.8 days (range 3-7 days), and mean follow-up period was 57.1 ± 17.6 months (range 38.5-71.7 months). There were eight cases of recurrent thyroid carcinoma, and no mortality has occurred up to the present time. CONCLUSIONS: Endoscopic thyroidectomy via bilateral axillo-breast approach is a safe and effective method that gives good surgical completeness, a low rate of postoperative complications and recurrence, and an excellent cosmetic result. Therefore, this method is a good choice for patients with surgical thyroid diseases.

BRAF V600E mutation is associated with tumor aggressiveness in papillary thyroid cancer.

BACKGROUND: The BRAF(V600E) mutation is the most common genetic alteration found in papillary thyroid cancer (PTC). Recent studies show that this mutation occurs more frequently in patients with PTC showing aggressive clinicopathologic features. The aim of the present study was to evaluate the prevalence of the BRAF(V600E) mutation in tumor samples and its association with high-risk clinicopathologic features prospectively. PATIENTS AND METHODS: From February 2009 to January 2010, 547 PTC patients who underwent surgery in Seoul National University Hospital were enrolled in the study. Polymerase chain reaction was used to amplify exon 15 of the BRAF gene from paraffin-embedded thyroid tumor specimens, followed by direct sequencing to detect the BRAF(V600E) mutation. Both univariate and multivariate analyses were performed to analyze associations between the BRAF(V600E) mutation and clinicopathologic features. RESULTS: The BRAF(V600E) mutation was found in 381/547 (69.7%) patients with primary PTC. The BRAF(V600E) mutation was significantly associated with age (≥ 45 years), tumor size (>1 cm), extrathyroidal extension, and cervical lymph node metastases (P < 0.05). Multiple logistic regression showed that it was significantly associated with gender (OR = 1.834; 95% CI 1.021-3.463), tumor size (OR = 1.972; 95% CI 1.250-3.103), and extra-thyroidal extension (OR = 2.428; 95% CI 1.484-3.992), but not with age, multifocality, lymph node metastases, and advanced disease stage. The proportion of BRAF(V600E) mutation was significantly associated with the number of high-risk factors of tumor recurrence (P < 0.001). CONCLUSIONS: The BRAF(V600E) mutation was associated with high-risk clinicopathologic characteristics in patients with PTC. The BRAF(V600E) mutation may be a potential prognostic factor in PTC patients.

Effect of Botulinum Toxin A on Scar Healing after Thyroidectomy: A Prospective Double-blind Randomized Controlled Trial.

The persistence of neck scarring is a common concern among patients undergoing thyroidectomy. Botulinum toxin A (BTA (Botox)) has been shown to suppress scar enlargement at the incision site. The objective of this study was to evaluate the effect of intraoperative Botox administration on neck scarring after thyroidectomy. A prospective double-blind randomized clinical trial was performed in patients undergoing conventional thyroidectomy. Forty patients were randomly allocated to a Botox or a control group (both, n = 20). The wound was closed after injection into the platysma muscle of 50 U of Botox diluted in 1 mL of normal saline or 1 mL of saline alone. Skin scars were assessed using the modified Stony Brook Scar Evaluation Scale (SBSES) and Manchester Scar Scale (MSS) at 1, 12, and 24 weeks postoperatively. The SBSES and MSS scores of the Botox group were significantly better than those of the control group (p = 0.034 and p = 0.039). At 24 weeks postoperatively, the SBSES and MSS scores were significantly better in the Botox group (p = 0.006 and p = 0.030). BTA injected into the incision site can suppress postoperative scar formation and thereby improve the cosmetic outcome.

Prospective, randomized controlled trial on use of ropivacaine after robotic thyroid surgery: Effects on postoperative pain.

BACKGROUND: We evaluated the effects of ropivacaine for pain relief after robotic thyroid surgery. METHODS: One hundred eight patients scheduled for robotic thyroid surgery were randomized into ropivacaine (n = 54) or control (n = 54) groups. After surgery, 40 mL of 0.25% ropivacaine or 0.9% saline (control) was instilled into the skin flap. Postoperative pain intensity (visual analog scale [VAS]), analgesic requirements (fentanyl), and adverse events were assessed at 1, 2, 4, 8, 16, and 24 hours postoperatively. RESULTS: One hundred three patients completed the study protocol. VAS scores were lower in the ropivacaine group than the control group (p = .010); however, VAS scores were not significantly different after 8 hours postoperatively. Total analgesic consumption was higher in controls than ropivacaine-treated patients (p = .01). Adverse events did not differ between the 2 groups. CONCLUSION: Ropivacaine instillation after robotic thyroid surgery reduces acute postoperative pain and analgesic requirements without adverse events. © 2015 Wiley Periodicals, Inc. Head Neck 38: E-E, 2016.

Does Tumor Size Influence the Diagnostic Accuracy of Ultrasound-Guided Fine-Needle Aspiration Cytology for Thyroid Nodules?

Background. Fine-needle aspiration cytology (FNAC) is diagnostic standard for thyroid nodules. However, the influence of size on FNAC accuracy remains unclear especially in too small or too large thyroid nodules. The objective of this retrospective cohort study was to investigate the effect of nodule size on FNAC accuracy. Methods. All consecutive patients who underwent thyroidectomy for nodules in 2010 were enrolled. FNAC results (according to the Bethesda system) were compared to pathological diagnosis. The nodules were categorized into groups A-E on the basis of maximal diameter on ultrasound (≤0.5, >0.5-1, >1-2, >2-4, and >4 cm, resp.). Results. There were 502 cases with 690 nodules. Overall FNAC sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 95.4%, 98.2%, 99.4%, 86.4%, and 96.0%, respectively. False-negative rates (FNRs) of groups A-E were 3.2%, 5.1%, 1.3%, 13.3%, and 50%, respectively. Accuracy rates of groups A-E were 96.8%, 94.8%, 99%, 94.7%, and 87.5%, respectively. Conclusion. Although accuracy rates of FNAC in thyroid nodules smaller than 0.5 cm are comparable to the other group, thyroid nodules larger than 4 cm with benign cytology carry a higher risk of malignancy, which suggest that those should be considered for intensive follow-up or repeated biopsy.

Differences in the characteristics of papillary thyroid microcarcinoma ≤5 mm and >5 mm in diameter.

BACKGROUND: The behavior and optimal management of papillary thyroid microcarcinomas (PTMCs) after thyroidectomy remain unclear. The purpose of this study was to compare the clinicopathologic features and tumor recurrence rates of patients with PTMCs ≤5 mm and >5 mm in diameter after total thyroidectomy. METHODS: A group of patients with PTMCs ≤5 mm (n=83) has been compared to a group with >5 mm (n=122). All of these patients had conventional type PTMCs and were followed up for 5 years. Both the histology and the outcome have been compared. RESULTS: Sex (p=.014) and extrathyroidal extension (p=.003) of patients in the ≤5 mm and >5 mm groups differed significantly. Two and 5 patients from these groups, respectively, experienced tumor recurrence within 5 years (2.4% vs 4.1%; p=.634). CONCLUSION: The clinicopathologic features of PTMCs ≤5 mm and >5 mm are similar, except for sex distribution and extrathyroidal extension. The 5-year recurrence rate in the 2 groups did not differ significantly.

Clinicopathological characteristics and treatment outcomes of 38 cases of primary thyroid lymphoma: a multicenter study.

PURPOSE: Primary thyroid lymphoma (PTL) is a rare disease and it has been investigated in a limited number of studies. The present multicenter study evaluated the clinical features and treatment outcomes of PTL. METHODS: The medical records of patients diagnosed with PTL between 2000 and 2013 in three centers were retrospectively reviewed. RESULTS: The study included 11 men and 27 women with a median age of 63.3 years (range, 42-83 years). The median follow-up was 56.0 months (range, 3-156 months). Of the 38 patients included, 16 had mucosa-associated lymphoid tissue (MALT) lymphoma, six had mixed MALT and diffuse large B-cell lymphoma (DLBCL), and 16 had DLBCL. Thirty-five patients (92.1%) had early stage (stage I/II) disease. Of the 16 MALT lymphoma patients, 14 were treated by surgery, and radiotherapy (RT) or chemotherapy was combined in five patients. Two patients received RT or chemotherapy alone. Of the six mixed MALT and DLBCL patients, three underwent surgery with chemotherapy and three underwent chemotherapy alone, RT alone, or surgery with RT. All of the 16 DLBCL patients received chemotherapy, and surgery and RT was combined in 4 and 1 patients, respectively. The 5-year survival was 100% for MALT lymphoma (7 of 7) and mixed MALT and DLBCL patients (5 of 5) and 87.5% for DLBCL patients (7 of 8). CONCLUSION: Early stage PTL has an excellent prognosis when managed by single or combined treatment modalities. Clinicians should consider PTL in patients with underlying Hashimoto's thyroiditis presenting with an enlarging thyroid mass.

In-Depth Survey of Scarring and Distress in Patients Undergoing Bilateral Axillo-Breast Approach Robotic Thyroidectomy or Conventional Open Thyroidectomy.

PURPOSE: Oncologic and surgical outcomes of bilateral axillo-breast approach (BABA) robotic thyroidectomy (RoT) are comparable with those of open thyroidectomy (OT). We compared degree of scarring and psychological/physical distress between OT and BABA RoT. MATERIALS AND METHODS: Study included 129 cases of thyroidectomy (78 OT, 51 BABA RoT). Patients were evaluated by psychology consultant using 5-point scale questionnaire. RESULTS: BABA RoT was associated with lower degree of scarring than OT (7.8 vs. 11.7, P<0.001). Psychological distress immediately after operation and during surveillance period was higher in OT than in BABA RoT (3.1 vs. 2.6, P=0.009 and 2.4 vs. 1.9, P<0.001). Physical distress (pain and exercise limitation) did not differ between groups (2.5 vs. 2.6, P=0.321 and 2.0 vs. 1.9, P=0.0175). CONCLUSIONS: BABA RoT was associated with less scarring and psychological distress than OT. BABA RoT might be alternative for patients who are concerned about neck scar.