Application of modified spiral tracheoplasty in thyroid carcinoma with trachea invasion: a retrospective analysis of 15 cases.

BACKGROUND: To describe the indications, techniques and preliminary experience of modified spiral tracheoplasty in the reconstruction of large tracheal defect after thyroidectomy. METHODS: The medical records of patients who underwent tracheal torsion to repair large tracheal defects after thyroid carcinoma surgery from January 2019 to January 2022 were retrospectively reviewed. The extent of tracheal defect, duration of tracheal reconstruction, postoperative complications and surgery results were analyzed. RESULTS: The duration of tracheal reconstruction was 30-60 min. No postoperative bleeding, incision infection, tracheostomy stenosis occurred. Recurrent laryngeal nerve palsy occurred in 5 patients. All patients were followed up for 24 to 60 months. The 2-year overall survival rate was 100%, the 2-year local control rate of trachea was 100%, and the 2-year tumor-free survival rate was 81.8%. CONCLUSION: The modified spiral tracheoplasty is a safe and effective method to repair the large defect of trachea after thyroid carcinoma invading the trachea.

Clinical evaluation of CoolSeal - a new, safe, and fast vessel sealing device in total thyroidectomy.

Objective. CoolSeal is a new vessel sealing system for dissection and hemostasis during surgery. No clinical studies have investigated safety, advantages or disadvantages regarding the use of this device. The aim of the present study was to investigate the safety of CoolSeal and compare it with conventional ligation technique or LigaSure during the total thyroidectomy. We hypothesized that the use of CoolSeal would reduce the operating time and bleeding without complications increase. Study design represents a retrospective cohort study with a tertiary reference center setting. Methods. We analyzed total thyroidectomy data from January 2021 to June 2023. We recorded patients' characteristics, surgical information, and postoperative outcome. Results. We performed 221 total thyroidectomies in the study period. Analysis was restricted to 171 patients operated by only two surgeons. Hemostasis was secured by conventional ligation in 117 patients (68%), LigaSure in 34 patients (20%) and CoolSeal in 20 patients (12%). Median thyroid weight and bleeding were 67 g and 50 ml, respectively. Procedures using LigaSure or Cool-Seal were on larger glands (median 205 g) without increased bleeding (50 ml). Operating time was shortest with CoolSeal (96 min, p=0.003) compared with LigaSure (117 min) or conventional ligation (115 min). Bleeding was reduced with CoolSeal compared with LigaSure (45 vs. 100 ml, p=0.003). With CoolSeal, median hospitalization was one postoperative day, no patients required re-operation. There was no palsy of recurrent laryngeal nerves and no permanent hypoparathyroidism. Conclusion. In our first clinical experience, CoolSeal was safe and efficient for total thyroidectomy. With a small sample size, we saw a clinical benefit with reduced operating time without post-operative complications increase.

[Complications and technical aspects of safe tissue dissection in endoscopic hemithyroidectomy]. / Oslozhneniya i tekhnicheskie aspekty bezopasnoi dissektsii tkanei pri provedenii endoskopicheskoi gemitireoidektomii.

OBJECTIVE: To analyze the complications following endoscopic hemithyroidectomy and to develop the principles of tissue dissection for safe surgical intervention. MATERIAL AND METHODS: The results of surgical treatment of 136 patients were studied. The main group consisted of 44 patients who underwent endoscopic hemithyroidectomy through a «gasless¼ axillary approach (EH group). The first control group consisted of 45 patients who underwent minimally invasive video-assisted hemithyroidectomy (MIVAH group). The second control group consisted of 47 patients who underwent open hemithyroidectomy (OH group). RESULTS. O: Verall complication rate was significantly higher in the EH group (20.5% vs. 6.4% in the OH group and 4.4% in the MIVAH group; p<0.05). In the EH group, Clavien-Dindo grade I complications occurred in 11.4% of cases. There were no similar complications in the control groups (p<0.05). Clavien-Dindo grade II complications occurred in 9.1% of patients in the EH group, 4.3% in the OH group and no similar events were identified in the MIVAH group (p>0.05). Clavien-Dindo grade III complications occurred in 1 (2.1%) case in the OH group and 2 (4.4%) cases in the MIVAH group. There were no Clavien-Dindo grade III complications in the EH group. Thus, minor complications prevailed in the EH group. Their incidence decreased along with accumulation of experience. Moreover, endoscopic procedure is safer regarding the risk of severe complications. CONCLUSION: Endoscopic hemithyroidectomy is safe, and the proposed principles of tissue dissection can further increase surgical safety.

[Prediction of papillary thyroid cancer recurrence according to preoperative data]. / Prognoz retsidiva pri papillyarnom rake shchitovidnoi zhelezy po dooperatsionnym dannym.

OBJECTIVE: To create a formalized method for predicting papillary thyroid cancer recurrence after hemithyroidectomy based on preoperative data. MATERIAL AND METHODS: At this stage of the study, we selected 101 patients with papillary thyroid cancer who underwent surgical treatment in 2017-2023. Recurrence was observed in in 47 patients. Fifty-four patients had no recurrence within 5 years after surgical treatment, i.e. these patients underwent surgery in 2017-2018. To find prediction rules, we used original classification method based on searching for subsets of variables and piecewise linear rules separating classes in pairs with subsequent voting of such rules to make a decision. RESULTS: The exam was carried out using a training sample (101 cases) and sliding control method (10 tests on 10 random cases). On the training sample, sensitivity of predictive algorithm was 91%, specificity 78% and error rate 13%. The aggregated result of 10 trials using sliding control method revealed sensitivity of predictive algorithm 86%, specificity 75% and error rate 15%. This result is close to overall sample and confirms the effectiveness of this method for predicting recurrence. CONCLUSION: The pilot experiments revealed the patterns in data for potential prediction of recurrence based on preoperative indicators. Further study of this problem may be valuable for decision-making and adjustments in the management of patients with papillary thyroid cancer.

The importance of sentinel lymph node intraoperative frozen analysis for indication of lateral neck dissection in patients with medullary thyroid cancer.

Our research seeks to evaluate the utility of intraoperative frozen analysis of sentinel lymph nodes (SLNs) in the lateral cervical compartment (LCC) as a tool to inform decision-making regarding therapeutic neck dissection in patients with medullary thyroid carcinoma (MTC). This is particularly relevant due to the variability observed in guidelines regarding the indication for lateral neck dissection in this patient population. The study comprised 64 patients (25 males, 39 females) aged between 29 and 81 years, with a median age of 59, who underwent surgery for MTC at stage T1-3N0-1M0 between January 1, 2012, and December 31, 2020. A standardized surgical approach involving total thyroidectomy with central neck dissection was adopted. LCC dissection was reserved for patients with clinically apparent nodal metastases. In patients lacking clinical evidence of nodal involvement, SLNs were identified using patent blue dye, excised, and subjected to intraoperative frozen analysis. If metastasis was confirmed, LCC dissection was subsequently performed. Among the study participants, 14 individuals (21.9%) underwent therapeutic LCC dissection due to clinical lymph node (LN) metastases. This intervention resulted in clinical remission for 9 patients, while disease progression was observed in 5 cases, leading to 2 fatalities. In the remaining cohort of 50 patients clinically negative for nodal involvement, SLNs were successfully identified and examined in 38 cases, revealing metastases in 6 patients (15.8%). Among both subsets of patients with analyzed SLNs, irrespective of metastatic status, one patient each required repeat surgery due to disease recurrence; however, all patients eventually achieved clinical remission. Lymphatic mapping in the LCC plays a pivotal role in detecting early metastases, thereby aiding in the avoidance of unnecessary repeat neck surgeries, and ultimately improving the prognosis in patients with MTC.

Enhancing diagnostic precision in thyroid nodule assessment: evaluating the efficacy of a novel cell preservation technique in fine-needle aspiration cytology.

Objectives: This study aimed to evaluate the effectiveness of thyroid fine needle aspiration cytology (FNAC) using a novel-cell preserving matrix called Cytomatrix in improving diagnostic accuracy for thyroid nodules. Materials and methods: Fifty patients undergoing thyroidectomy were enrolled and FNAC was performed on the excised thyroid glands, with the collected sample being placed on the Cytomatrix. The results were compared with histopathological analysis, and diagnostic performance was assessed statistically. Results: Cytomatrix demonstrated an accuracy of 96%, sensitivity of 84.61%, and specificity of 100%. Concordance between cytological and histopathological findings highlighted Cytomatrix's potential to enhance thyroid FNAC accuracy. Conclusion: FNAC using Cytomatrix shows promise in improving diagnostic accuracy for thyroid nodules. Its application, marked by faster processing and efficient resource utilization, coupled with the preservation of cellular architecture, holds considerable potential in enhancing cytological diagnosis, thus optimizing patient management strategies.

Unveiling a rare BRAF mutation in minimally invasive follicular thyroid carcinoma: A case report.

RATIONALE: Molecular testing is becoming more widely used; however, the accuracy of diagnostic testing remains a primary consideration, especially for molecular testing that detects specific mutations associated with cancers. PATIENT CONCERNS: A 45-year-old female without documented comorbidities presented a thyroid nodule during a routine health examination. Initial evaluation revealed a 3.8-cm nodule in the left lobe of thyroid, classified as Bethesda System category III on fine needle aspiration cytology. Genetic molecular testing detected the BRAF V600E mutation via quantitative polymerase chain reaction assay, raising concern for papillary thyroid cancer (PTC). DIAGNOSES: The preoperative impression was PTC based on the detection of BRAF V600E mutation. INTERVENTIONS: The patient underwent thyroidectomy as well as lymph node dissection with the expectation to treat PTC. OUTCOMES: The final pathology unexpectedly revealed minimally invasive follicular carcinoma. Confirmatory Sanger sequencing unveiled a novel sequence variation involving nucleotide duplication within the range of 1794 to 1802, a non-V600E BRAF mutation not previously reported in follicular thyroid carcinoma. LESSONS: This case study demonstrates the clinical relevance of exercising caution in molecular testing and its interpretation of results. For genetic testing used for diagnostic purposes, rigorous validation or cross-checking using different methods should always be considered to ensure appropriate interpretation of molecular results.

Patterns, treatment outcome and associated factors of surgically treated thyroid disease at public hospitals in Eastern Ethiopia: a retrospective cross-sectional study.

BACKGROUND: Thyroid disease is a global health problem and the most common type of endocrine disorder next to diabetic mellitus, accounting for around 30-40% burden of the endocrine disorders. OBJECTIVE: The objective of the study was to assess patterns, treatment outcome and associated factors of surgically treated thyroid disease at Public Hospitals in Eastern Ethiopia. METHODS: The study was conducted among surgically treated patients for thyroid disorders using a retrospective cross-sectional study design by reviewing all patients' charts. A data abstraction sheet was used to collect relevant data, and the collected data was analyzed using SPSS version 26 software. Bi-variable and multivariable binary logistic regression was employed to assess the association between dependent and independent variables. RESULTS: The study was conducted on 200 patients' medical records who had complete information. Out of this, 84.5% were female and 66.5% of patients' age was between 20 and 40 years. Toxic goiter was the most common thyroid disease which accounted for 49.5%. Hemorrhage and Hypocalcemia were the most common complications after surgery. Anterior neck swelling of greater than 15 years [(AOR: 52.892 CI = 95% (6.087-459.5.68) (P-0.000)], Total/ near total thyroidectomy [(AOR: 20.139 CI = 95% (4.059-99.931) P-00.000] were significantly associated with complicated post-operative course, while female sex [(AOR: 0.124 CI = 95% (0.34-0.494) P- 0.003)] was associated with lower risk of developing post-operative complications. CONCLUSION: This study showed that 9.5% of operated patients with thyroid disease had complicated post-operative course. Long standing goiter and total/ near total thyroidectomy were significantly associated with complicated post-operative course.

Analysis of Initial Outcomes of Gas-insufflation One-step Single-port Transaxillary (GOSTA) Robotic Thyroidectomy for Thyroid Cancer.

BACKGROUND/AIM: This study compared the initial outcomes of gas-insufflation one-step single-port transaxillary (GOSTA) robotic thyroidectomy with traditional open thyroidectomy for thyroid cancer at a single institution. PATIENTS AND METHODS: A retrospective analysis was conducted on 77 patients who underwent thyroidectomy for differentiated thyroid cancer from January to June 2024. Exclusion criteria included benign nodules, Graves' disease, and previous thyroid surgeries. Two surgeons performed the procedures, with one having no prior robotic surgery experience. RESULTS: Of the 77 patients, 48 underwent open thyroidectomy and 29 underwent GOSTA thyroidectomy. The GOSTA group had a significantly lower mean age (40.1 vs. 47.6 years, p=0.002) and a higher proportion of female patients (p=0.040). The open group patients had more harvested lymph nodes than the GOSTA group patients (7.9 vs. 2.4, p<0.001). The GOSTA group patients had longer operation time (156.4 vs. 80.6 min, p<0.001), and had extended hospital stay than the open group patients (5.9 vs. 3.4 days, p<0.001). Complication rates were similar between the groups. CONCLUSION: GOSTA robotic thyroidectomy provides comparable safety and effectiveness to open thyroidectomy, with improved cosmetic outcomes despite longer operation times and hospital stays. This technique is feasible for surgeons without prior robotic experience, offering a viable alternative for patients prioritizing cosmetic results.

Surgical Outcomes of Thyroidectomy in Geriatric Patients Aged 80 Years and Older: A Single-Center Retrospective Cohort Study.

Background and Objectives: As the global aging population grows, the incidence of thyroidectomy in elderly patients is increasing. This study aimed to evaluate the surgical outcomes of thyroidectomy in patients aged 80 years and older. Materials and Methods: All patients aged 80 years and older who underwent thyroidectomies at our hospital between January 2015 and December 2022 were reviewed in this retrospective cohort study. Collected data consisted of patients' clinical characteristics, functional status, compression symptoms, preoperative assessments, perioperative outcomes, postoperative complications (such as bleeding events, recurrent laryngeal nerve injury, hypocalcemia), pathological findings, readmission, and follow-up outcomes. Results: Seventeen patients were included in this study, with female predominance (82.4%). The mean age was 85.6 ± 4.8 years. Fourteen patients (82.4%) exhibited compression-related symptoms as surgical indications. Based on pathological reports, patients were categorized into benign (12/17, 70.6%) and malignancy (5/17, 29.4%) groups. The benign group had a shorter operation time compared with the malignancy group (164.3 ± 32.0 min vs. 231.0 ± 79.1 min, p = 0.048). No major postoperative complications developed. The median postoperative follow-up duration was 28 months (range: 2-91 months). Thirteen patients (76.5%) were alive at the end of the study period. Conclusions: Despite potential age-related risks, thyroidectomy is feasible for carefully selected patients aged 80 years and older. It provides benefits not only in terms of oncological curative treatment but also in improving the quality of life, such as compressive symptoms and wound condition.

Risk factors and distribution pattern of lateral lymph node recurrence after central neck dissection for cN1a papillary thyroid carcinoma.

BACKGROUND: The indication and extent of selective lateral neck dissection (LND) for cN1a papillary thyroid carcinoma (PTC) remain uncertain. The present study aimed to identify potential predictors and distribution pattern of lateral lymph node recurrence (LLNR) after central neck dissection in cN1a PTC patients. METHODS: The cN1a PTC patients who underwent initial central neck dissection at our centre were retrospectively reviewed, and the median follow-up period was 6.8 years. Reoperation with LND was performed when LLNR was confirmed. Risk factors for LLNR were identified, and the metastatic status of each lateral level was recorded. RESULTS: Of the 310 patients enrolled in the present study, fifty-eight patients (18.7%) presented with LLNR. Six independent factors, including tumour diameter, pathological T4 stage, number of involved central lymph nodes, pTNM stage, extrathyroidal extension, and I131 treatment (P values < 0.05) were identified via multivariate analysis. LLNR was found at level II in 26 patients (44.8%), level III in 38 patients (65.5%), level IV in 30 patients (51.7%), and level V in 8 patients (13.8%). The number of positive lateral lymph nodes at levels II, III, IV and V was 44 (22.9%), 76 (39.6%), 63 (32.8%), and 9 (4.9%), respectively. CONCLUSIONS: For cN1a PTC patients who underwent central neck dissection, tumour diameter ≥ 2 cm, pathological T4 stage, number of involved central lymph nodes ≥ 3, pTNM stage III-IV, extrathyroidal extension, and failure to receive I131 treatment were independent predictors of LLNR, which was more likely to occur at levels III and IV.

Key points of surgical anatomy for endoscopic thyroidectomy via a gasless unilateral axillary approach.

PURPOSE: Endoscopic thyroidectomy utilizing the Gasless Unilateral Axillary Approach (GUA) offers distinct advantages including clear visibility, simple manipulation, safe oncological outcomes. This technique eliminates postoperative neck scarring, ensures concealed surgical incisions, and minimizes postoperative swallowing discomfort. METHODS: We retrospectively reviewed 150 surgical videos to document key anatomical features and their variations during this procedure. RESULTS: The GUA endoscopic thyroidectomy, which approaches from the contralateral side, presents significant difficulties in identifying anatomical structures, especially anatomical abnormalities in the contralateral neck, while constructing feasible operative fields. This article offers an in-depth discussion of the anatomical challenges, pitfalls, and viable strategies associated with this surgery, particularly for less experienced surgeons. CONCLUSIONS: Given the intricate interplay of muscular, vascular, and neural anatomical structures, novices in surgery must be well-acquainted with the underlying anatomy to minimize potential complications.

Uniportal VATS removal of a giant mediastinal goitre.

We demonstrate the technical nuances and operative strategy of uniportal video-assisted thoracoscopic surgical excision of a giant mediastinal goitre in a patient with a complex medical history, including a prior total thyroidectomy for multinodular goitre and partial gastrectomy for gastrointestinal stromal tumour. The video tutorial presents the surgical removal of a substantial mediastinal goitre, persisting post-total thyroidectomy performed 2 years prior via a collar incision. We opted for a thoracoscopic technique for the removal of the residual mediastinal mass. A 3-cm uniportal incision was made at the fifth intercostal space along the mid-axillary line. Pleural exploration confirmed the absence of adhesions. Subsequent dissection revealed a large retrocaval goitre adjacent to the trachea. Utilizing a combination of LigaSure technology for sharp dissection, and blunt dissection techniques using the peanuts, we severed the goitre's attachments to surrounding critical structures, including the trachea, superior vena cava and oesophagus. The dissection continued, extending into the cervical region from the thoracic approach. The mass was safely enclosed within an endobag and extracted through the uniportal incision. This case demonstrates the feasibility and effectiveness of the uniportal thoracoscopic approach for complex mediastinal pathology. This approach was successfully executed with an uneventful perioperative course and no complications, indicating positive outcomes in complex thoracic cases despite a minimally invasive approach for the resection of mediastinal masses.

Long-Term Outcome of Patients with Low-Risk Differentiated Thyroid Cancer Treated with Total Thyroidectomy Alone.

BACKGROUND: Differentiated thyroid carcinoma (DTC), mainly papillary (PTC), at low risk of recurrence is currently managed with active surveillance strategies or less aggressive surgeries. However, total thyroidectomy with 131I treatment is still performed both if these tumors are diagnosed before or occasionally after surgery. This real-life study aimed to evaluate the rate of biochemical, structural, and functional events in a large series of consecutive DTCs at low risk of recurrence treated by total thyroidectomy, but not with 131I, in a medium-long-term follow-up. PATIENTS AND METHODS: We evaluated clinical-pathologic data of 383 consecutive patients (2006-2012) with unifocal DTC [T1a/b(s)] at low risk of recurrence, treated with total thyroidectomy but without lymph node dissection and 131I treatment after surgery. We evaluated if structural, biochemical, and functional events were detected during the follow-up. RESULTS: Females accounted for 75.7% of our study group, and the median age was 50 years. The median tumor dimension was 0.4 cm (range 0.1-1.2). Most of the patients had a unifocal T1a tumor (98.9%), and 73.6% had a classic variant of PTC. We divided the patients according to the absence (group A-n = 276) or presence (group B-n = 107) of interfering TgAb at first control after surgery. After a median follow-up of 10 years, no structural events were detected. Sixteen out of three hundred and eighty-three (4.2%) patients developed biochemical events: 12/276 (4.3%) in group A and 4/107 (3.7%) in group B. The median time elapsed from surgery to detecting a biochemical event was 14.5 and 77.5 months in groups A and B, respectively. No patients performed additional treatments and were followed up with an active surveillance strategy. CONCLUSIONS: This study confirmed that patients with DTC at low risk of recurrence showed an excellent outcome in a medium long-term follow-up since no structural events were diagnosed. Significant variations in Tg/TgAb were detected in a few cases, all managed with an active surveillance strategy without the need for other treatments. Therefore, a relaxed follow-up with neck ultrasound and Tg/TgAb measurement is enough to early identify those very unusual cases of recurrence.

Total Thyroidectomy versus Subtotal Thyroidectomy as a Suitable Surgery for Benign Thyroid Disorders.

BACKGROUND: Surgical treatment of benign thyroid disease varies from lobectomy, subtotal thyroidectomy, and total thyroidectomy (TT). OBJECTIVE: The current study aimed to compare complications of both total and subtotal thyroidectomy (STT) for patients with bilateral benign thyroid disorders. METHODS: Sixty patients with benign goiter, 32 for TT and 28 for STT, where indications for surgery, operating time, hospital stay, and complications were studied. RESULTS: The incidence of transient recurrent laryngeal nerve (RLN) palsy was (6.25%) for TT vs (3.57%) for STT, and temporary hypoparathyroidism was (9.38%) in TT patients compared to (7.14%) in STT patients. Permanent RLN palsy and hypoparathyroidism occurred only in one case (3.12%) from the TT group. No permanent complications occurred in STT patients. Recurrence of goiter occurred in two patients (7.14%) undergoing STT. Incidental papillary carcinoma was (7.14%) in STT patients and (3.13%) for follicular carcinoma in TT patients. There was no postoperative mortality. CONCLUSION: TT is a suitable surgical procedure in patients with bilateral benign thyroid disease as complication rate, operative time, and hospital stay are less comparable to STT. It will give a permanent cure without recurrences, and incidental thyroid malignancies can be avoided.

CONTEXTE: Le traitement chirurgical des maladies bénignes de la thyroïde varie de la lobectomie, thyroïdectomie subtotale à la thyroïdectomie totale (TT). OBJECTIF: La présente étude visait à comparer les complications de la thyroïdectomie totale et subtotale (STT) chez les patients atteints de troubles thyroïdiens bénins bilatéraux. MÉTHODES: Soixante patients atteints de goitre bénin, 32 pour TT et 28 pour STT, où les indications pour la chirurgie, le temps opératoire, la durée d'hospitalisation et les complications ont été étudiés. RÉSULTATS: L'incidence de la paralysie transitoire du nerf laryngé récurrent (RLN) était de (6,25%) pour TT contre (3,57%) pour STT, et l'hypoparathyroïdie temporaire était de (9,38%) chez les patients TT contre (7,14%) chez les patients STT. La paralysie permanente du RLN et l'hypoparathyroïdie sont survenues chez un seul cas (3,12%) du groupe TT. Aucune complication permanente n'a été observée chez les patients STT. La récidive du goitre est survenue chez deux patients (7,14%) ayant subi une STT. Un carcinome papillaire incidentel a été observé chez (7,14%) des patients STT et un carcinome folliculaire chez (3,13%) des patients TT. Il n'y a pas eu de mortalité postopératoire. CONCLUSION: La TT est une procédure chirurgicale appropriée chez les patients atteints de maladie thyroïdienne bénigne bilatérale, car le taux de complications, le temps opératoire et la durée d'hospitalisation sont moindres par rapport à la STT. Elle offre une guérison permanente sans récidives, et les malignités thyroïdiennes incidentelles peuvent être évitées. MOTS-CLÉS: Troubles thyroïdiens bénins, Thyroïdectomie subtotale, Thyroïdectomie totale.

Echotexture of recurrent laryngeal nerves: the depiction of recurrent laryngeal nerves at high-frequency ultrasound during radical thyroidectomy.

Introduction: To investigate the ultrasound characteristics of recurrent laryngeal nerves (RLNs) during radical surgery for thyroid cancer and to enhance the understanding of RLN ultrasound features. Methods: From October 2021 to December 2022, a prospective study was conducted involving 24 patients scheduled for bilateral thyroid surgery. Near the conclusion of the surgery, intraoperative ultrasonography of the RLN within the tracheoesophageal groove was performed using a 15-7 MHz transducer. The thickness and width of the RLN were measured during the procedure. Results: The internal architecture of the RLN was observed to consist of multiple hypoechoic, parallel, but discontinuous linear hyperechoic areas separated by bands. In the normal RLN group, the diameter of the RLN was relatively consistent, with thickness ranging from 2.20 to 2.71 mm (mean: 2.48 ± 0.14 mm) and width from 1.25 to 1.70 mm (mean: 1.45 ± 0.11 mm). Both weight and the body mass index (BMI) showed a statistically significant correlation with RLN thickness (Weight: r=0.544, P=0.001; BMI: r=0.605, P=0.001). The BMI also showed a statistically significant correlation with the RLN width (r=0.377, P=0.033). In the RLN invasion group, the width of invaded RLNs ranged from 1.9 to 2.3 mm (mean: 2.10 ± 0.11 mm), while the width of non-invaded RLNs ranged from 2.6 to 3.2 mm (mean: 2.93 ± 0.20 mm). Conclusions: Ultrasound effectively reveals the structural features of the RLN and enhances sonographers' understanding of RLN characteristics.

Intraoperative detection of parathyroid glands using artificial intelligence: optimizing medical image training with data augmentation methods.

BACKGROUND: Postoperative hypoparathyroidism is a major complication of thyroidectomy, occurring when the parathyroid glands are inadvertently damaged during surgery. Although intraoperative images are rarely used to train artificial intelligence (AI) because of its complex nature, AI may be trained to intraoperatively detect parathyroid glands using various augmentation methods. The purpose of this study was to train an effective AI model to detect parathyroid glands during thyroidectomy. METHODS: Video clips of the parathyroid gland were collected during thyroid lobectomy procedures. Confirmed parathyroid images were used to train three types of datasets according to augmentation status: baseline, geometric transformation, and generative adversarial network-based image inpainting. The primary outcome was the average precision of the performance of AI in detecting parathyroid glands. RESULTS: 152 Fine-needle aspiration-confirmed parathyroid gland images were acquired from 150 patients who underwent unilateral lobectomy. The average precision of the AI model in detecting parathyroid glands based on baseline data was 77%. This performance was enhanced by applying both geometric transformation and image inpainting augmentation methods, with the geometric transformation data augmentation dataset showing a higher average precision (79%) than the image inpainting model (78.6%). When this model was subjected to external validation using a completely different thyroidectomy approach, the image inpainting method was more effective (46%) than both the geometric transformation (37%) and baseline (33%) methods. CONCLUSION: This AI model was found to be an effective and generalizable tool in the intraoperative identification of parathyroid glands during thyroidectomy, especially when aided by appropriate augmentation methods. Additional studies comparing model performance and surgeon identification, however, are needed to assess the true clinical relevance of this AI model.

Surgical management of papillary thyroid carcinoma coexisting with Hashimoto's disease: a single-center retrospective cohort study.

Background: The mechanism and impact of Hashimoto's disease (HT) in patients with papillary thyroid carcinoma (PTC) remains a subject of ongoing debate. The optimal extent of thyroid resection is also controversial in cases of low-risk PTC. Objective: To investigate the clinical outcomes and prognoses associated with different extents of surgical resection in patients diagnosed with PTC coexisting with HT. Methods: We retrospectively analyzed data on the clinical features and treatment outcomes of patients with PTC concomitant with HT who underwent lobectomy with isthmusectomy and those who underwent total thyroidectomy at Peking University International Hospital between December 2014 and August 2023. Results: Twenty-one patients in group A underwent lobectomy with isthmusectomy and prophylactic central neck dissection, whereas twenty patients in group B underwent total thyroidectomy with prophylactic central lymph node (LN) dissection, except one who did not undergo LN dissection. Group A demonstrated shorter surgery time (105.75 min ± 29.35 vs. 158.81 min ± 42.01, p = 0.000), higher parathyroid hormone (PTH) levels on postoperative day 1 [26.96 pg/ml (20.25, 35.45) vs. 9.01 pg/ml (2.48, 10.93), p = 0.000] and a shorter postoperative hospital stay [2.95 d (2.0, 4.0) vs. 4.02 d (3.0, 5.0), p = 0.008] than those of group B, with statistically significant differences. Both groups exhibited similar recovery patterns in terms of PTH [32.10 pg/ml (22.05, 46.50) vs. 20.47 pg/ml (9.43, 34.03), p = 0.192] and serum calcium (2.37 mmol/L ± 0.06 vs. 2.29 mmol/L ± 0.19, p = 0.409) after 1 montsh following the surgery. According to the Kaplan-Meier curves, no significant difference in the 5-year disease-free survival rates were observed between patients in group A (100%) and group B (97.1%) (Log rank test: p = 0.420, Breslow test: p = 0.420). Conclusion: Lobectomy with isthmusectomy and prophylactic central neck dissection is a safe and feasible treatment option for patients with low-risk PTC coexisting with HT. Clinical trial registration: http://www.chictr.org.cn, identifier ChiCTR2300079115.