SimLife model: introducing a new teaching device in endocrine surgery simulation.

To evaluate the validity and reliability of an innovative training model for endocrine surgical procedures. A simulator training model for endocrine procedures (SimLife) was developed at an academic center. The model consisted of a realistic operating environment with a coherent simulated patient dynamized by pulsatile vascularization with simulated blood warmed to 37 °C, and ventilation. Training sessions were designed for adrenal and thyroid surgery, as well as neck dissection. The primary outcome of interest was to evaluate learners' performance and satisfaction. Learners' performance was evaluated based on a scoring scale that followed the Downing method for the assessment of competency. While learners' satisfaction was evaluated using a Likert scale of 1 to 10 on four items (ease of learning, anatomic correspondence of landmarks, realism, and overall satisfaction). Participants were engaged in 32 training sessions. These included 24 adrenalectomies (conventional and laparoscopic both transabdominal and posterior), and 4 thyroid lobectomies with concomitant functional lateral compartment neck dissection. competency scores were procedure-specific addressing specific core components of a given procedure. Learners' performance scored above average in all procedures evaluated. Satisfaction scores for the specified four items ranged between 8.43 (SD 0.87) and 8.89 (SD 0.96). No major events were reported for the adrenalectomies, while only one jugular vein injury occurred during neck dissection. SimLife is a hyper-realistic training model that allows for satisfactory acquisition of skills and the evaluation of performance progression. It has the potential to become a cornerstone in specialized surgical training.

Transoral thyroidectomy: a viable surgical option with unprecedented complications-a case series.

PURPOSE: To report the clinical implications of an initial experience with transoral endoscopic thyroidectomy vestibular approach (TOETVA). METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Less is more: time to expand the indications for minimally invasive video-assisted parathyroidectomy.

PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Surgical management of papillary thyroid carcinoma in childhood and adolescence: an Italian multicenter study on 250 patients.

PURPOSE: 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. METHODS: 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. RESULTS: 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 %. CONCLUSION: Pediatric patients are likely to benefit from a tailored surgical strategy. Uniformly offering patients total thyroidectomy seems to be an overly radical approach.

Attitudes of Students at Sultan Qaboos University towards the Nursing Profession.

OBJECTIVES: The aim of this study was to explore the attitudes of Sultan Qaboos University (SQU) students towards the nursing profession. METHODS: A sample of 377 students (male = 130; female = 247) were selected from different colleges of SQU, including the College of Nursing. A questionnaire was constructed and validated to assess the attitudes of SQU students towards the nursing profession. RESULTS: Findings revealed that both male and female students in all academic years and colleges had positive attitudes toward the nursing profession. The findings also revealed that gender and academic year created no significant differences (P <0.05) among the study participants, but that the students' college affiliation did have a significant effect on their attitudes. In particular, nursing students had more positive attitudes than students of other colleges. CONCLUSION: Findings indicated that the attitudes of SQU students towards the nursing profession were positive, especially those of the nursing students. This means that serious efforts should be made to continue to promote the nursing profession and so ensure that it remains positively regarded by all concerned.