Risk factors for difficult thyroidectomy and postoperative morbidity do not match: retrospective study from an endocrine surgery academic referral centre.

Hyperthyroidism, goiter and thyroiditis have been associated with complex thyroidectomy. Difficult thyroidectomies may implicate longer operating times and higher complication rates, while literature on quantification and prediction of difficulty in thyroidectomy is scant. We aim at assessing the impact of preoperative and intraoperative factors on the technical difficulty of total thyroidectomy (TT) and on the incidence of postoperative complications. We conducted a retrospective study on 197 TT from 343 thyroidectomies performed with intraoperative neuromonitoring between October 2019 and June 2022 (excluding lobectomies, nodal dissection, extra-thyroidal procedures). Operating time (surrogate of TT difficulty), postoperative hypocalcaemia, recurrent laryngeal nerve palsy and postoperative bleeding were assessed in relation to pre- and intraoperative characteristics. Vocal fold palsy(VFP) was defined as recovering < 12 months postoperatively. There were 87 thyroid cancers and 110 multinodular goiters (21 hyperfunctioning, 51 mediastinal). Median operating time was 136 min (range 51-310). Within 17.4 months overall median follow-up we recorded two transient VFPs and 12% symptomatic transient hypocalcaemia. At univariable analysis male sex (p = 0.005), BMI (p < 0.001), thyroiditis (p < 0.05), hypervascular goiter (p = 0.003) and thyroid adhesions to surrounding anatomical structures (p < 0.001) were associated with longer operating time. At multivariable analysis male male sex (p = 0.01), obesity (p = 0.001) and thyroid adhesions (p = 0.008) were factors for prolonged operating time. Above-normal anti-thyroid peroxidase antibodies correlated to transient symptomatic hypocalcemia (p < 0.001). Risk factors for complex TT were identified and did not correlate with morbidity rates. Results from this study may help optimizing operating room schedule and inform case selection criteria for training programs in thyroid surgery. Further research is required to confirm these findings.

Microcirculation and reperfusion injury in organ transplantation.

There are many interesting aspects regarding hemorheology and tissue oxygenation in organ transplantation (such as liver, kidney, heart, etc.). The ischemia-reperfusion injury syndrome is a very important problem. Much damage in organs appears to be induced by reperfusion injury syndrome. In fact, not only immunological etiopathogenesis but also biochemically-mediated microcirculation alterations can modulate the organ damage induced by ischemia-reperfusion injury during organ transplantation. During ischemia-reperfusion injury, xanthine oxidase activity, the increase in oxygen free-radicals, and the activation of neuthrophils are all very important. Platelet activating factor (PAT) and LTB4 (promoting neuthrophils adhesiveness), activated by the xanthine oxidase-derived oxidants during reperfusion, activates the final post-ischemia injury. Much research is necessary in order to gain a fuller knowledge of the microcirculation conditions and oxygenation during organ transplantation.