'From Felix to the helix, and from the cradle to the grave - Semon's contribution to thyroid surgery', Royal Society of Medicine, 1 November 2019, London, UK.

Mr President, Mr President Elect, Fellows and Members, Ladies and Gentleman, it is a pleasure to address the Section of Laryngology this morning and deliver the 94th Semon Lecture. I would like to thank the Semon Committee for their kind invitation. My lecture will discuss Sir Felix Semon (the man himself), highlight the history of head and neck surgery, and then discuss the requirements of a modern-day thyroid surgeon. I have no conflict of interest and nothing to declare.

The rebel thyroid of a revolutionary First Lady.

Nadezda Krupskaya, the revolutionary Russian and Lenin's wife, was affected by Graves' disease and many photos and portraits, including the painting of 1933 by Ivan Vladimirovich Kosmin, highlight evident goiter and exoftalmos. To treat Graves' disease, Krupskaya underwent to surgery performed by Theodor Kocher, considered the father of the modern thyroid surgery.

Russian thyroid surgery from the 19th to the early 20th century.

INTRODUCTION: The aim of our study was to investigate the contributions made to thyroid surgery by outstanding Russian surgeons;' (Pirogov N.I., Bujalskiy I.V., Velyaminov N.A., Bobrov A.A., Lezhnev N.F., Fyodorov S.P., Opel V.A. and others) MATERIALS AND METHODS: Research was done on thyroid surgery in Russia in the period from the early 19th century to the early 20th century and the achievements of Russian surgeons were assessed in relation to progress in the field worldwide, including the difficulties that prevented Russian surgeons from gaining extensive attention at an international level and the steps taken by Russia in the 21st century to share expertise in thyroid surgery with other countries. Data was gathered from 178 documents. Books, manuals, and other scientific publications, as well as doctors reports and patient records were analyzed. Research was done on 15 surgical instruments and 10 photographs. RESULTS: The first description of thyroid surgery in Russia dates back to 1804. In 1831 Nikolaiy Ivanovich Pirogov described the anatomy, topography, syntopy and the main principals of thyroid surgery. In 1847 he performed the first "strumectomy" in the world under general anesthesia. For bleeding control he used 30 - 40 ligatures and vascular forceps with locks. The next operation on the thyroid under anesthesia was carried out 13 years later by Eugene S. Cooper (USA). Ilya V. Bujalskiy (Russia), consultant at St.-Petersburg Mariinsky hospital, used an ether narcosis in May, 1847 and chloroform in August 1848 when operating on the thyroid. One other description of the use of chloroform narcosis , by Paul von Sick (Germany) in 1867. In 1886 Nicolay A. Velyaminov performed thyroid resection in the Mariinsky hospital. In 1904 Russian surgeon Nikolai F. Lezhnev reported on 106 thyroid operations performed with visual control of the recurrent laryngeal nerves in Bobrov's clinic in Moscow, where those techniques had been introduced in 1893. He also dealt with the problem of ectopic goiter, and at sessions of the Pirogov Surgical Society gave case presentations of patients with lingual goiter (1908, 1926). Sergey P. Fedorov was well-known in Europe. That is why William Mayo came to observe his operations. He called Fedorov a "master surgeon". CONCLUSION: The contribution of famous Russian surgeons to the field of thyroid surgery is important and should be appreciated at its true value. KEY WORDS: History, Thyroid surgery.

Thyroidectomy Then and Now: A 50-Year Australian Perspective.

BACKGROUND: Since the mid-1800s, thyroidectomy has transformed from a procedure associated with high to near-zero mortality. Nonetheless, surgeons must continue to strive to improve patient care. Using historical records and contemporary data, this study compares the practice and outcomes of thyroid surgery at a tertiary institution during two periods, 50 years apart. METHODS: 'The Alfred Hospital Clinical Reports' recorded all cases of surgically managed thyroid disease from 1946 to 1959. These historical cases were compared to contemporary thyroidectomy cases at the Alfred Hospital from 2007 to 2016. Cases were compared for surgical indication and post-operative outcomes. RESULTS: There were 746 patients in the historical group (mean age 53 years; 87% female) and 787 patients in the contemporary group (mean age 52 years; 80% female). The most common indication for thyroidectomy in both groups was non-toxic nodular goitre. A greater proportion of the contemporary group were diagnosed with thyroid malignancy (27% vs. 8%; p < 0.001). The contemporary group recorded significantly fewer cases of thyrotoxic crisis (2.1% vs. 0%; p = 0.001), permanent nerve palsy (4.6% vs. 0.4%; p < 0.001) and bilateral nerve palsy (1.2% vs. 0%; p = 0.01). There were no mortalities in the contemporary group, while the historical data recorded three deaths (0.44%). CONCLUSIONS: This study compared thyroid surgery in two cohorts separated by a 50-year period. While it is not surprising that outcomes of thyroidectomy have improved, this study uniquely demonstrates trends of thyroid surgery over time and areas in which further improvements may be made.

Robotic Head and Neck Surgery: History, Technical Evolution and the Future.

The first application of robotic technology in surgery was described in 1985 when a robot was used to define the trajectory for a stereotactic brain biopsy. Following its successful application in a variety of surgical operations, the da Vinci® robot, the most widely used surgical robot at present, made its clinical debut in otorhinolaryngology and head and neck surgery in 2005 when the first transoral robotic surgery (TORS) resections of base of tongue neoplasms were reported. Subsequently, the indications for TORS rapidly expanded, and they now include tumours of the oropharynx, hypopharynx, parapharyngeal space, and supraglottic larynx, as well as obstructive sleep apnoea (OSA). The da Vinci® robot has also been successfully used for scarless-in-the-neck thyroidectomy and parathyroidectomy. At present, the main barrier to the wider uptake of robotic surgery is the prohibitive cost of the da Vinci® robotic system. Several novel, flexible surgical robots are currently being developed that are likely to not only enhance patient safety and expand current indications but also drive down costs, thus making this innovation more widely available. Future directions relate to overlay technology through augmented reality/AR that allows real-time image-guidance, miniaturisation (nanorobots), and the development of autonomous robots.

Robotic Thyroid Surgery: Current Perspectives and Future Considerations.

Robotic transaxillary thyroidectomy, pioneered in South Korea, is firmly established throughout the Far East but remains controversial in Western practice. This relates to important population differences (anthropometry and culture) compounded by the smaller mean size of thyroid nodules operated on in South Korea due to a national thyroid cancer screening programme. There is now level 2 evidence (including from Western World centres) to support the safety, feasibility, and equivalence of the robotic approach to its open counterpart in terms of recurrent laryngeal nerve injury, hypoparathyroidism, haemorrhage, and oncological outcomes for differentiated thyroid cancer. Moreover, robotic thyroidectomy has been shown to be superior to open surgery for certain patient-reported outcome measures, namely scar cosmesis and pain. Downsides include its high cost, longer operative time, and risk of complications not encountered in open thyroidectomy (brachial plexus neurapraxia). Careful patient selection is paramount as this procedure is not for every patient, surgeon, or hospital. It should only be undertaken by high-volume surgeons operating as part of a multidisciplinary robotic team in specialised centres. Novel robotic approaches utilising the retroauricular and transoral routes for thyroidectomy have recently been described but further studies are required to establish their respective role in modern thyroid surgery.

[Theodor Billroth: more than a century of artistic greatness]. / Theodor Billroth: más de un siglo de su grandeza artística.

Christian Albert Theodor Billroth, a German surgeon of great artistry and immense culture and promoter of abdominal surgery, who drove the length of the physiology of the surgical field through the use of experimental surgery, is considered the leading German medical figure of the second half of the 19th century in Europe. His works and techniques transcended through time and continue to be implemented (albeit with modifications). He founded a new school of surgery based in criticism, the influence of which affected the development of numerous European and American surgeons. He was also a born artist who excelled in the music field, with many interests in music criticism and public events.

Vignette thyroid surgery: a glimpse into its history.

At present, physicians and surgeons treating thyroid disorders can rely on highly accurate and precise investigations, modern equipment, and state of the art operating theater to achieve optimum results; however, this was not the case at the beginning of the treatment of thyroid diseases centuries ago. We present a short history of the treatment and understanding of thyroid diseases in the past few decades. Also we present the contributions of the important surgeons who tried to perfect the treatment of thyroid diseases, including surgery, thus making modern day management easier.

The early days of thyroidectomy.

Although the normal thyroid gland is invisible and impalpable, its enlargement gives such an obvious swelling in the front of the neck that this pathology has been observed from ancient times. Old names for the swollen gland included 'bronchocele', which means a cystic mass in the neck, 'struma', (Latin for a swollen gland) and 'goitre', which comes from the Latin word 'gutta', the throat, and which is a term which is still used today. The term 'thyroid' was introduced by the 17th century anatomist Thomas Wharton, of London, and is derived from the Greek word thyreos, a shield, based on its shield-like appearance wrapped over the front of the trachea. He believed that its function was to give women a beautifully rounded neck!