A rare case of non-surgical vocal cord paralysis: Vocal cord hematoma.

Although vocal cord paralysis (VCP) following thyroidectomy is primarily associated with surgical trauma, it is not the sole etiology. Vocal cord paralysis following thyroidectomy can be caused by a vocal cord hematoma with an incidence of 1.4% due to direct injury during orotracheal intubation. In this article, we present a case of VCP caused by vocal cord hematoma. A 32-year-old male patient who has been receiving propylthiouracil treatment for toxic multinodular goiter since 10 years was admitted to our hospital to be operated because of persisting complaints. The patient was hospitalized for sutureless thyroidectomy after he became euthyroid. Preoperative fiberoptic laryngoscopy performed by the ear, nose, and throat department revealed bilaterally motile vocal folds and a completely open airway. Patient underwent sutureless total thyroidectomy with a vessel sealing device (LigasureTM LF1212, Covidien, CO), and a minivac drainage system was placed in the thyroid lodge. On the morning of the first postoperative day, 50 mL of serosanguinous fluid was drained. The patient's voice was normal, and there was no ecchymosis. Postoperative fiberoptic laryngoscopy revealed a hematoma near the right vocal fold and paralysis of the right vocal fold; however, the airway was open. It should be kept in mind that VCP is not solely due to surgery but can also result from intubation, as observed in this case.

Is Nerve Monitoring Required in Total Thyroidectomy? Cerrahpasa Experience.

Thyroidectomy is an elective operation performed in an anatomically complex region in which certain structures are responsible for vital functions and special senses. This study aims to compare the effects of two different technical approaches-nerve dissection combined with intraoperative nerve monitoring (IONM) and no nerve identification-on recurrent laryngeal nerve (RLN) damage in total thyroidectomy. One hundred and sixty-one consecutive cases that underwent total thyroidectomy and 322 RLN under risk were evaluated. In group 1 (n = 162), nerve dissection combined with IONM was performed, whereas no RLN identification was performed in group 2 (n = 160). While the duration of operation in group 1 (34.23 ± 12.21 min) was statistically shorter than that in group 2 (36.98 ± 16.79 min, p = 0.017), there was no significant difference between groups related to RLN palsy (group 1 n = 10, group 2 n = 7). Use of IONM was found only to shorten the duration of operation. According to our presented experience, there is no benefit of IONM-combined routine dissection of RLN during total thyroidectomy on the prevention of RLN palsy.

Short-stay Sutureless Thyroidectomy is Safe and Effective: Cerrahpasa Experience.

Hospitalizing patients up to 72 hours after thyroidectomy is a classical approach. However, the length of hospitalization has decreased following surgical procedures with new technological devices. Seven hundred one consecutive patients who underwent sutureless total thyroidectomy (STT) between October 2011 and 2013 were included in this study. Six hundred seventy-two (95.9%) were discharged before 24 hours following surgery (short-stay = SS), and 29 were discharged later (delayed-discharge = DD). This study aims to assess short-stay STT with early postoperative complications and readmission to hospital. One hundred forty-three SS patients were male and 529 were female. Mean age was 48 ± 13 years, BMI was 28.7 ± 8.3 kg/m2. Mean hospital stay for SS was 18.13 ± 1.97 (17-23) hours. Histopathology was benign in 443 (65.92%) and malignant in 229 (34.08%) in the SS group. In three (0.4%) of the SS group drainage was required because of hematoma, and in seven (1%) wound infection was observed. One hundred seven (7.9%) [permanent = 7 (0.52%)] of 1344 recurrent laryngeal nerves (RLNs) in SS were seen paralyzed in postoperative vocal cord examination. Hypocalcemia (all transient) was observed in 52 (7.74%) of the SS group. Eight of those 52 readmitted to hospital with symptomatic hypocalcemia and were treated as outpatients. There was no mortality. Of the DD group, two stayed in the intensive care unit, two had dysphonia, two had hematoma with anti-coagulant use, one had fever, four did not tolerate diet, five refused discharge, and 13 had symptomatic hypocalcemia. Sutureless total thyroidectomy can be performed safely and effectively as short-stay surgery.

Sutureless thyroidectomy with energy-based devices: Cerrahpasa experience.

Total thyroidectomy makes up the majority of all thyroidectomy cases. Energy-based advanced vessel-sealing devices which were developed in recent years for the control of vascular pedicles allowed significant progress in thyroid surgery. This study is designed to compare the efficiency and safety of the two energy-based vessel-sealing devices (Ligasure™ LF1212 and Harmonic FOCUS(®)) in sutureless thyroidectomy. Two hundred and forty-five consecutive patients underwent sutureless total thyroidectomy. Patients were randomized for the Ligasure™ LF1212 (n = 126) or Harmonic FOCUS(®) (n = 119). The parameters of demographics, surgical indications, morbidity, incision length, duration of operation, weight of specimen, amount of drainage, postoperative pain, hospital stay, and histopathology of specimen were recorded. Mean duration of operation was 37.98 ± 14.98 min (16-92 min) and was significantly shorter for Harmonic FOCUS(®) (p < 0.001). Mean hospital stay was 1.09 ± 0.3 (1-3) days. Morbidity rate was 9.8 % in total, whereas no mortality was observed. In terms of morbidity rates, no significant difference was determined between the two groups (p = 0.476). In both groups, there was no need for extra analgesic application other than the routine given after surgery. According to our experience, sutureless thyroidectomy can be performed with low morbidity rates in secure and efficient way.

Minimal invasive parathyroidectomy with local anesthesia for well-localized primary hyperparathyroidism: "Cerrahpasa experience".

Imaging guided well-localized single gland excision via smaller incision without intraoperative parathormone (ioPTH) can be performed in ambulatory settings. Forty-six consecutive patients with solitary parathyroid adenoma causing primary hyperparathyroidism (PHPT), who underwent laterally approached minimal invasive parathyroidectomy (MIP) through 2-3 cm incision between January 2011 and April 2012, were included in the study. All data were collected prospectively; analyzed retrospectively. Intervention with local anesthesia was applied to 46 patients. Parathyroidectomy with local anesthesia and IV sedation was successfully completed in 42 of those. Forty-two patients had biochemically confirmed PHPT; single gland disease was supported by imaging methods. Localization was decided in 15 patients just with USG, in 11 patients just with scintigraphy, and in 16 patients with both. Preoperative mean serum total calcium value was 11.13 ± 1.02 mg/dl. Immediate postoperative and postoperative 2nd week's serum calcium levels were 10.62 ± 1.43 mg/dl (p = 0.006), 9.24 ± 0.79 mg/dl (p < 0.001), respectively. Preoperative mean serum PTH value was 434.17 ± 550.22 pg/ml. Immediate postoperative and postoperative 2nd week's PTH values were 34.69 ± 28.50 pg/ml (p < 0.001), 91.21 ± 81.86 pg/ml (p < 0.001), respectively. In all interventions, no ioPTH assay or frozen section was performed. Forty-one patients (97.62 %) had reduction of serum PTH levels equal or more than 50 %. Cure rate for short-term follow-up was also 97.62 %. One patient had persistent hypercalcemia. Mean operation time was 15:09 ± 6:38 min (range 5:30-35:00). For all excised parathyroid adenomas, average weight was 2,278 ± 1,653.01 mg (range 100-8,000). For patients with well-localized single gland disease, MIP with local anesthesia and IV sedation have high cure rates and less morbidity at experienced centers without general anesthesia and hospital stay.