A comparison of swallowing related quality of life in patients undergoing transoral endoscopic versus open thyroid surgery.

INTRODUCTION: It is important for the endoscopic thyroid surgeon to understand the pros and cons of trans-oral endoscopic thyroidectomy-vestibular approach (TOETVA) vis-à-vis, open conventional thyroidectomy (OTx) so he/she can help patients in making informed choices regarding the type of procedure to opt for. Swallowing related quality of life (SWAL-QoL) has not been compared between the two approaches. Using a rigorous qualitative methodology and validated reliable tool, this study set out to compare the swallowing related quality of life in patients undergoing TOETVA versus OTx. METHODS: Prospective study at 3 time points in patients planned for hemithyroidectomy (Preoperative, 1 week and 12 weeks). Data were collected on patients at a tertiary teaching institute in India. Participants ranged from age 18-60 years with a diagnosis of benign euthyroid nodule undergoing hemithyroidectomy. Exclusion criteria were-(1) pre-existing vocal cord abnormalities, (2) undergoing surgery for recurrent nodules, and (3) any neuro-muscular disease affecting swallowing ability. Main outcome measure was comparison of swallowing related quality of life domain scores between patients undergoing hemithyroidectomy via either endoscopic trans-oral or open approach. RESULTS: Of the 82 included patients, 40 underwent TOETVA and 42 OTx. Both the groups were comparable in terms of demographic and clinicopathological profile. The mean preoperative SWAL-QOL scores were comparable in all domains. Mean SWAL-QoL scores for all domains on postoperative day 7 were significantly better in TOETVA group with domains burden, eating desire, mental health and communication having medium effect sizes. Physical symptom domain was better in the OTx group but had a small effect size. The difference in SWAL-QoL domains between the two groups persisted for 3 months also. CONCLUSION: Swallowing related quality of life after trans-oral endoscopic thyroidectomy compared to conventional open surgery has not been reported in the literature. Our findings suggest that trans-oral endoscopic thyroidectomy results in significant superior swallowing related quality of life in the majority of domains.

Frugal indigenous vessel loop made from a surgical glove.

We report a simple cost effective alternative to commercially available vessel loops made from sterilized surgical gloves for retraction of vital structures during vascular trauma, micro-vascular, micro-neural surgery.

Assessment of prevalence and morphology of plantaris tendon in Indian population by ultrasound.

Background: There is wide racial difference in the prevalence of the absence of the plantaris tendon. This study was conducted to determine the prevalence of plantaris tendon in Indian population. Materials and methods: The presence of the plantaris tendon was determined by ultrasound in 250 healthy volunteers using the standard technique. Results: Out of 250 individuals 28 (11.2%) had absence of plantaris tendon either unilaterally or bilaterally. Unilateral absence of plantaris tendon was in 3.2%, bilateral absence in 4.8% and overall absence was in 8%. According to the hand and foot dominance the probability of finding right plantaris tendon in right dominant person was 92.3% and in left dominant is 89.7%. Height of the person also correlated significantly with tendon length. Conclusions: Plantaris tendon was absent in ∼11%, either unilaterally or bilaterally, in this cohort of Indian population.