RESUMO
BACKGROUND AND OBJECTIVES: Nowadays, the conventional thyroidectomy may appear an overly aggressive treatment in patients undergoing intervention for small suspicious lesions harboring in low volume glands. In these cases a minimally invasive approach may be a safe and appropriate option. This work aims to evaluate the effectiveness of minimally invasive thyroidectomy in patients indicated to surgery for small lesions with preoperative suspicion of malignancy. PATIENTS AND METHODS: 71 patients, undergoing minimally invasive total thyroidectomy as a single procedure between May 2005 and April 2009, were enrolled in this study. They were indicated to surgery for small suspicious or malignant lesions (up to 20 mm lenght by US; cT1 according to UICC 2002) and satisfied the inclusion criteria of minimally invasive thyroidectomy, with gland volume up to 25 ml, no evidence of locally advanced disease and no previous neck surgery. The outcomes were considered in terms of complication rate, postoperative pain, hospitalisation stay, cosmetic results and completeness of surgical resection in malignancies. RESULTS: A low complication rate was registered. The surgical completeness, with mean serum thyroglobulin of 4.41 +/- 4.03 ng/ml and radioiodine uptake of 2.91 +/- 2.46%, was considered acceptable if compared with other experiences reported in literature. Excellent results with respect to patient comfort, postoperative pain and cosmetic outcome were obtained. CONCLUSION: This study confirms, where a correct selection of patients is made, the safety and the effectiveness of minimally invasive approach in the treatment of small suspicious and malignant nodules, which seem to represent its best indication.
Assuntos
Diferenciação Celular , Doenças da Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Adenocarcinoma Folicular , Adulto , Idoso , Carcinoma , Carcinoma Papilar , Feminino , Humanos , Itália , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Dor Pós-Operatória/etiologia , Satisfação do Paciente , Tireoglobulina/sangue , Câncer Papilífero da Tireoide , Doenças da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Tireoidectomia/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND AND OBJECTIVES: Despite the improvement of the surgical technique and several experiences reported in literature about prosthetic incisional hernioplasty, the prevalence rate of recurrence and of the classic complications has not changed over the years. We analyze our caseload, establishing some technical cornerstones in order to reduce their occurrence. PATIENTS AND METHODS: 283 patients underwent incisional hernioplasty in our Department of Surgery in the decade 1999-2008. They were retrospectively divided into four groups (A-D) according to the surgical technique adopted for a comparative analysis: A, 37 primary direct closure; B, 207 Rives-Stoppa procedures; C, 9 Chevrel procedures; D, 30 intraperitoneal repairs. The outcomes were considered in terms of postoperative surgical complications. RESULTS: In total, we observed 11 cases of hernia recurrence (3.9%), 13 cases of infections (4.6%), 7 cases of seroma/hematoma (2.4%) and one case of acute respiratory insufficiency. DISCUSSION: The Rives-Stoppa procedure is, among all those practised, the treatment of choice in incisional hernioplasty. Thanks to the introduction of some simple modifications to this technique and preventing the postoperative infections, we obtained excellent results in terms of recurrence rate (only 1 case on 207 patients, 0.48%) and morbidity.