Intraoperative acidosis is a new predictor for postoperative pancreatic fistula after pancreaticoduodenectomy.

BACKGROUND: Early diagnosis of postoperative pancreatic fistula (POPF) is important for proper interventions. The preoperative, intraoperative and early postoperative biochemical markers have predictive value of POPF. The present study was to evaluate several simple biochemical parameters in the prediction of POPF. METHODS: Patients who underwent pancreaticoduodenectomy in our center between 2006 and 2015 were reviewed retrospectively. Preoperative and early postoperative biochemical parameters were evaluated. Additionally, the relationship between POPF and pH and lactate level at the end of surgery were analyzed, and neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and red cell distribution width-to-platelet ratio (RPR) were calculated for postoperative days (PODs) 1 and 3. Diagnosis and grading of POPF were performed according to the standards of the International Study Group on Pancreatic Fistula. The patients were divided into two groups: Group 1 with no fistula or grade-A fistula; group 2 with grade-B or -C fistula. These simple biochemical markers were then compared between the two groups. RESULTS: Serum amylase level was significantly higher at POD3, and pH level was significantly lower at the end of operation in group 2 compared with those in group 1. However, the serum amylase was below the upper limit of normal serum level and therefore, the difference was not significant in clinical practice. Receiver operating charecteristic curve analysis showed that pH level was a reliable predictor of POPF (area under the curve: 0.713; 95% CI: 0.573-0.853). CONCLUSIONS: A low pH level at the end of pancreaticoduodenectomy was a risk factor of POPF. NLR, PLR, and RPR had no predictive value of POPF after pancreaticoduodenectomy.

Effect of hyperbaric oxygen treatment on pilonidal disease surgery.

Surgical excision and lay-open is a well-known technique for the treatment of sacrococcygeal pilonidal disease, which impairs a patient's quality of life considerably since wound healing takes a substantial amount of time. It is known that with this method total healing period is longer, but recurrence rate of the disease is lower. The beneficial effects of hyperbaric oxygen (HBO2) therapy on wound healing have been well established since it was first put into in clinical use. The purpose of this prospective randomized clinical trial was to investigate the effects of HBO2 therapy on wound healing in the patients who had sacrococcygeal pilonidal disease and surgical treatment. Total epithelialization times of 12 patients (Group 1) who received surgical intervention were compared with those of 10 patients who had surgical intervention and HBO2 therapy (Group 2). In both groups excised tissue volume, excised skin area, body mass index, blood hemoglobin, albumin levels, ages and duration of the complaints were recorded and there was no statistically significant difference in these parameters except albumin levels when compared. The complete epithelialization time was significantly shorter in Group 2 (50 ± 11 vs. 83 ± 18, p⟨0.001). We conclude that HBO2 had beneficial effects on wound healing, in the patients who had sacrococcygeal pilonidal disease and were treated with surgical excision applying lay-open technique.

Colonic mucosal pseudolipomatosis: Are we aware of it?

OBJECTIVE: Colonic mucosal pseudolipomatosis is rare, and its pathogenesis is controversial. A number of mechanisms, including mechanical injury during an endoscopic procedure or chemical injury by disinfectant, seem to contribute to its pathogenesis. MATERIAL AND METHODS: This retrospective study examined the colonic biopsies of 1370 patients. These biopsies were preserved at the Department of Pathology of Istanbul Training and Research Hospital between January 2012 and June 2013. RESULTS: We found pseudolipomatosis in 14 of 1370 colonoscopy cases (1.02%). Of these 14 patients, 8 were male and 6 were female. The male patients were between 24 and 66 years, with a mean of 39; the female patients were between 26 and 58 years, with a mean of 42. CONCLUSION: Many endoscopists are unaware of the lesion, and the diagnosis is generally possible only after pathological assessment of multiple biopsies taken from suspect lesions. Here we report and discuss colonic pseudolipomatosis incidentally found in a series of patients undergoing routine colonoscopy, and we underline the endoscopic pattern and diagnostic difficulties.

The Relationship Between Serum Lipids and the Formation of Colorectal Polyps.

BACKGROUND AND AIMS: Obesity, metabolic syndrome, and hyperlipidemia are known as risk factors for colorectal tumors. Colorectal polyps are accepted as potential precursors of colorectal cancer (CRC). This study was designed to clarify the association between the levels of serum lipids and the presence of colorectal polyps. METHODS: This study was conducted at Basaksehir Cam and Sakura City Hospital, Gastroenterological Surgery Clinic, Istanbul, Turkey. We retrospectively analyzed patients who underwent colonoscopy with serum lipid profile within one month for a one-year period. Groups were analyzed in terms of the correlation between hyperlipidemia and the formation of polyps. The study group was also evaluated in terms of the polyp type, localization, and number. RESULTS: Among 453 patients, females were 248 and males were 211, with a mean age of 56.7. The study and control groups involved 259 and 194 patients, respectively. The age and serum levels of low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), and triglyceride (TG) were found to be statistically significant in terms of polyp presence and number (p < 0.05). CONCLUSION: Colorectal polyps are well-known precursors of CRC. We found that the combination of elevated serum levels of low-density lipoprotein cholesterol, total cholesterol, and triglycerides may be a risk predictor for the presence of colorectal polyps, which can be advantageous in cancer screening.

Congenital diaphragmatic hernia with gastric perforation in adult: Intrathoracic gastric perforation.

Congenital diaphragmatic hernias are rarely seen and they are usually diagnosed in the neonatal period. Congenital diaphragmatic de-fect, also known as Bochdalek hernia, usually occurs with the persistence of the pleuroperitoneal canal in the left posterolateral region of the diaphragm in the embryological period. Although it is rarely seen in the adults, conditions such as intestinal volvulus, strangulation, or perforation with congenital diaphragm defect progress with high mortality and morbidity. In this study, we reported our case that we operated for intrathoracic gastric perforation with congenital diaphragmatic defect. When the patient admitted to the hospital, he had an atypical abdominal pain, significant back pain, and suspicious respiratory complaints. Radiological imaging showed that the stomach and the spleen were located in the left hemithorax due to diaphragmatic hernia also stomach was very dilated. Tachycardia, hypotension, and low saturation developed on the 2nd day of the patient's hospitalization. In the control imaging of the patient, in the left hemithorax, stomach was collapsed and the surrounding appearance compatible with hydropneumothorax, after that findings emergency laparotomy was decided. During the operation, as demonstrated by the radiological findings, a diaphragm defect was seen in the left posterolateral region of the diaphragm. The stomach and spleen were herniated to the left hemithorax from this defect. The stomach and spleen were reduced into the abdomen. The left hemithorax was lavaged with 2000 cc isotonic, left tube thoracostomy was applied, and the diaphragm was repaired. The anterior stomach was primarily repaired. In post-operative follow-up, there were no complications other than wound infection and thoracic tube of the patient was removed. The patient who tolerated enteral food was discharged from hospital with full recovery.

Colonoscopy following the positron emission tomography/computed tomography scan in patients with incidental colorectal uptake: what is the most effective management?

OBJECTIVE: Colorectal cancer is one of the most common malignancies. Survival rates are directly related to the stage of cancer at the time of diagnosis, emphasizing the value of early diagnosis. Positron emission tomography with 18F-fluorodeoxyglucose is the gold standard imaging technique in staging, monitoring after treatment, and follow-up. We aimed to assess the importance of incidental 18F-fluorodeoxyglucose uptake by colon and rectum in positron emission tomography-computed tomography imaging to determine a significant cutoff value for further investigation using colonoscopy and histopathological assessment. METHODS: We performed a retrospective analysis of patients with both 18F-fluorodeoxyglucose-positron emission tomography/computed tomography scan and colonoscopy during 1 year and included the cases who had undergone a colonoscopy within 3 months following the positron emission tomography/computed tomography scan due to an incidental positive finding. Patients with a diagnosed colorectal malignancy or with a history of previous colorectal operations were excluded. RESULTS: A total of 81 patients were included in this study. Among 81 colonoscopic evaluations, histopathology revealed malignancy in 8 patients, and the prevalence of incidental colorectal cancer 18F-fluorodeoxyglucose uptake was found to be 9.87%. SUVmax was found to be significantly related to malignancy and other colonoscopic findings (p<0.001). SUVmax cutoff value to suggest colorectal cancer was found to be median [7.9 (4.1-12.7)] (p<0.001). CONCLUSION: Regarding the studies determining a significant cutoff value, incidental colonic 18F-fluorodeoxyglucose uptake on positron emission tomography/computed tomography should lead the clinician to further investigation with colonoscopic biopsy, although the cutoff values for SUVmax are not certain and different in almost every published study, and negative positron emission tomography.computed tomography findings should not completely rule out malignancy, especially in high-risk patients.

Predictive value of thyroid tissue density in determining the patients on whom sternotomy should be performed.

BACKGROUND: Retrosternal goiter incidence rates range between 0.2% and 45% of all goiters, and sternotomy is performed in some of patients. There is no consensus for selecting the patients on whom sternotomy should be performed. We aimed to determine the most important factor for predicting requirement of sternotomy. METHODS: This prospective study included 260 patients with retrosternal goiter. The clinical symptoms, history of previous thyroidectomy, presence of tracheal deviation, tracheal compression, site of mediastinal extension, thyroid tissue density, findings of intubation, type of surgical approach, histologic findings of thyroid, weight of thyroid, and postoperative complications were evaluated. RESULTS: Thyroid tissue density, posterior location, and subcarinal extension were found to be independent factors for predicting requirement of sternotomy. The risk for sternotomy increased 47-fold for patients with harder thyroid tissue density (OR: 47.3; 95% CI: 5.8-385.70), 20-fold for patients with subcarinal extension (OR: 20.5; 95% CI: 2.5-168), and 10-fold for patients with posterior location (OR: 10.5; 95% CI:1.8-60). CONCLUSION: Thyroid tissue density was defined the strongest predictive factor for requirement of sternotomy. Preoperatively obtained information thyroid tissue density can be useful for surgical strategy.

The Importance of Mapping Vagus and Laryngeal Nerves Monitoring During Thyroid Surgery.

OBJECTIVE: To determine the location of thyroid-related nerves by nerve monitoring and demonstrate the usefulness of Nerve Integrity Monitor in thyroid surgery. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Department of General Surgery, University of Health Sciences, Istanbul Training and Research Hospital, Turkey, from February 2017 to January 2020. METHODOLOGY: Patients, who underwent thyroid surgery, were evaluated for age, gender, preoperative diagnosis, type of surgery, histopathological result, postoperative hoarseness, and postoperative vocal cord examinations. The vagus nerve, recurrent laryngeal nerve (RLN), and superior laryngeal nerve (SLN) were mapped by nerve monitoring. RESULTS: A total of 328 patients were included in this study. On both sides, the vagus nerve was most often located in the posterior of the internal carotid artery and internal jugular vein and less frequently anterior to this vein. A total of 303 right RLNs and 305 left RLNs were verified. The SLN was visualised or motor activity was verified by nerve monitoring on the right side in 181 patients and on the left side in 179 patients. The SLN's location was classified most frequently as type I and least frequently as type IIb on the right and left sides. CONCLUSION: The reported variations, the experience of the surgeon, and these anatomical markers cannot be adequate in preventing nerve injuries. Furthermore, the variations can be identified more clearly peroperatively with the use of nerve monitoring. KEY WORDS: Laryngeal nerves, Nerve mapping, Nerve monitoring, Nervus vagus, Thyroid surgery, Zuckerkandl tubercles.

Hemogram index parameters in the evaluation of male breast cancer and inflammatory response: a case-control study.

OBJECTIVE: Our aim was to investigate the hemogram index parameters and their clinical significance in the evaluation of the inflammatory response of patients with male breast cancer, who are rarely observed in the literature. METHODS: In total, 22 (n=22) healthy male and 28 (n=28) male breast cancer patients without synchronous/metachronous tumors were included in this study. They were grouped as the healthy male control group (Group 1) and the male breast cancer patient group (Group 2). The male breast cancer was divided into two subgroups, namely, early stage [(stage: 0/I/II) (Group 2A)] and late stage [(stage: III/IV) (Group 2B)], and their hemogram index parameters were compared. RESULTS: A significant (p>0.05) increase was observed in neutrophil/lymphocyte ratio (NLR) and·platelet/lymphocyte ratio (PLR) values in the late stage (Group 2B: stage III/IV) compared to the early stage (Group 2A: stage 0/I/II) and healthy control (Group 1) groups. CONCLUSIONS: In male breast cancer patients, neutrophil/lymphocyte ratio and platelet/lymphocyte ratio values were significantly higher as the stage of cancer increased. These readily available simple tests can be used to evaluate the host's inflammatory response in male breast cancer.

Does focal heterogeneity affect survival in postoperative ipsilateral multifocal and multicentric breast cancers?

OBJECTIVE: In multicentric/multifocal breast tumors, there may be immunological and histological differences between foci that may affect survival and treatment choice. We aimed to evaluate the effect of focal heterogeneity seen in multicentric/multifocal breast tumors on survival. METHODS: We retrospectively collected and analyzed the clinicopathological data of 89 female patients with multifocal/multicentric breast cancer, whose surgical and medical treatment was completed and who were followed up for 5 years. RESULTS: Of all patients, 29.2% (26/89) were heterogeneous. Heterogeneity of these foci was as follows: histologic heterogeneity of index foci (mix type): 15.7% (14/89), histologic heterogeneity of inter-foci: 7.9% (7/89), and immunohistochemical heterogeneity of inter-foci: 10.1% (9/89). When additional foci were evaluated, oncological therapy was changed for 3 (3.3%) of 89 patients. Heterogeneity does not have a significant (p>0.05) effect on recurrence and survival in multicentric/multifocal breast cancers. Pathological N stage is an independent risk factor for disease-free survival (hazard ratio=2.29, 95% confidence interval=1.39-3.76, p=0.001). CONCLUSIONS: In multifocal/multicentric breast cancers, less than 4% of patients may experience heterogeneity requiring change in the therapeutic decision. However, heterogeneity does not have a significant effect on recurrence and survival in multifocal/multicentric breast cancers. The pathological N stage is an independent risk factor for disease-free survival.

Type of lateral internal sphincterotomy incision: parallel or vertical?

BACKGROUND: The lateral internal sphincterotomy (LIS) technique is considered the optimal surgical treatment for chronic anal fissures (CAFs), although questions remain regarding the best technique. The present study investigated whether the type of anoderm incision (vertical or parallel to the anus) affects wound healing, wound-related complications, incontinence, and recurrence rates in CAF patients undergoing open LIS. METHODS: This prospective randomized clinical study divided 52 patients undergoing LIS for CAF into two groups. In group 1 (n=25) the incision was made vertical to the anus; and in group 2 (n=27) it was made parallel to the anus. Incision sites were not sutured in either group. Wound site complications, wound healing times, perianal itching, incontinence, and recurrence rates were evaluated. RESULTS: Complications involving bleeding, hematoma, abscess formation, or fistulization were not observed in either group. Complications were observed in 5 patients of group 1 (1 wound infection, 1 ecchymosis, 2 flatus incontinence, 1 recurrence) and in three patients of group 2 (2 wound infections, 1 flatus incontinence). Overall wound complication, incontinence, and recurrence rates were 7.7, 5.8, and 1.9%, respectively. The two groups did not differ significantly in terms of wound complications, incontinence, or recurrence. Itching duration was significantly longer in group 1 (p<0.0001) Complete wound healing was slower in group 1 than group 2 (19.44±6.82 vs. 10.59±3.48 days, p<0.0001). CONCLUSIONS: Wound healing time and perianal itching duration were significantly reduced when anoderm incisions were made parallel to the anus compared to those made vertical to the anus.

Predictive value of retroperitoneal fat area measurement for detecting metabolic syndrome in patients undergoing adrenalectomy.

BACKGROUND: Visceral obesity is one of the main components of the metabolic syndrome (MetS). The retroperitoneal fat area (RFA) is part of the intraabdominal adipose mass. The aim of this clinical trial was to determine whether there is an association between the RFA measurement and MetS components in patients undergoing laparoscopic lateral transabdominal adrenalectomy. METHODS: The study population consisted of 61 consecutive patients who underwent laparoscopic adrenalectomy between January 2007 and June 2010 at the Istanbul Faculty of Medicine. Anthropometric, demographic, and biochemical parameters as well as cardiometabolic risk factors were recorded. The RFA was calculated using computed tomography. RESULTS: The mean body mass index, waist circumference, and RFA in patients with MetS was significantly higher than that of the patients without MetS. There were positive correlations between RFA and central obesity (r=0.675, p=0.0001) and MetS (r=0.894, p=0.0001). The strongest correlation was observed between RFA and MetS. According to receiver operating characteristic analysis, RFA measurement correctly predicted MetS risk in 96% of patients and failed in only 4%. CONCLUSIONS: Our findings indicate that measurement of the RFA may provide a safe, easy assessment of its metabolic risk.

Diagnostic value of thyroglobulin measurement in fine-needle aspiration biopsy for detecting metastatic lymph nodes in patients with papillary thyroid carcinoma.

PURPOSE: We aimed to compare the diagnostic value of fine-needle aspiration cytology (FNAC) and fine-needle aspiration thyroglobulin measurements (FNA-Tg) for detecting cervical lymph node metastases from differentiated thyroid carcinomas. METHODS: This prospective study included 225 patients with neck node metastases or recurrences of papillary thyroid carcinoma. From the 225 patients, 255 lymph nodes were evaluated by FNAC and FNA-Tg. Final diagnoses confirmed by histological examination were compared to preoperative FNAC and FNA-Tg results. RESULTS: FNAC correctly diagnosed 212 metastatic lymph nodes but failed to diagnose 43 of them. FNA-Tg correctly diagnosed 253 metastatic lymph nodes but failed to diagnose two of them. FNA-Tg levels showed 100% sensitivity, 96% specificity, 99% diagnostic accuracy, a 99% positive predictive value (PPV) and a 100% negative predictive value (NPV) with a threshold level of FNA-Tg with a diagnostic accuracy 28.5 ng/ml. The specificity, diagnostic accuracy, PPV and NPV of FNA-Tg were significantly higher than those of FNAC. CONCLUSION: FNA-Tg measurement can be performed safely for the detection of lymph node metastasis in patients with differentiated thyroid carcinomas.

The effect of mutation status, pathological features and tumor location on prognosis in patients with colorectal cancer.

OBJECTIVE: Colorectal cancer is the most common malignancy of the gastrointestinal tract. It is the third most common tumor in both genders and the second reason of cancer-related deaths. In recent years, tumor location has gained importance as a prognostic indicator. In this study, we aimed to analyze if there was a prognostic effect of tumor location, the pathological features, and the mutation status of patients on survival. METHODS: Two-hundred and ten colorectal cancer patients aged 18 years and older were included into the study. One-hundred and forty-two patients had left-sided tumor and 68 patients had right-sided tumor. Patients who had other malignancies rather than squamous cell skin cancer and in situ cervical cancer were excluded. All statistical tests were carried out using two-sided process, and a p≤0.05 was considered statistically significant. RESULTS: There were 140 men and 70 women in the study. The median age of the patients was 62 years old. There was no statistically significant difference according to tumor location and survival of patients. The overall survival of patients with right-sided tumors was 60.5 months and 47.2 months for left-sided tumors. Disease-free survival of patients was 63.7 months for right-sided tumors and 46 months for left-sided ones. Perineural invasion, grade and stage were crucial prognostic parameters. Disease-free survival was longer for female colorectal cancer patients. CONCLUSION: According to our study, survival of patients was similar regardless of tumor location. This can be explained by the different sequencing of treatment strategies and divergent population genetics.

Number of cells in parathyroid tissue in primary hyperparathyroidism cases and its relationship with serum calcium value.

BACKGROUND: The relationship between serum calcium (Ca) level to serum parathyroid hormone (PTH), phosphorus (P) levels and tissue properties of the parathyroid gland is unknown in primary hyperparathyroidism cases. Revealing this relationship may be useful for understanding the etiopathogenesis of primary hyperparathyroidism and determining the time of treatment. METHODS: Ninety patients (71 females, 19 males, age range; 27-73 years, average age; 46) who underwent single gland excision with the diagnosis of primary hyperparathyroidism were studied. The patients were divided into 2 groups as serum Ca level <12 and serum Ca level ≥12. Age and sex of the patients, mean cell number of the gland, mean volume of the gland, serum levels of PTH, P, and histopathologic type of hyperplasia were evaluated. RESULTS: The mean cell number per cubic centimeter is 22.9 (10-220 range) million in all glands. Serum Ca level was <12 in 82 (91.1%) of the patients, and ≥12 in 8 (8.9%) cases. Mean cell number of the gland, mean volume of the gland, existence of cystic hyperplasia of the gland, serum levels of PTH and P were statistically significant between the 2 groups (P < .001, P < .001, P < .05, P < .001, P < .05 respectively). CONCLUSION: In primary hyperparathyroidism cases serum Ca level is not related to age and sex but directly related to proportionals to the cell number and volume of the gland and serum levels of PTH, inversely related to cystic hyperplasia and serum levels of P. Early surgical intervention should be planned since the serum Ca level will be high in large adenomas with a noncystic radiological appearance.

Effects of contractubex on the prevention of postoperative peritoneal adhesion.

BACKGROUND: There are numerus techniques and agents in use for reducing peritoneal adhesion formation. But in this research we believe this is the first research to reveal that contractubex (allium cepae, sodium heparin, and allantoin mixture) is reducing formed peritoneal adhesions. So it may be used to reduce the number of re-laparotomies/re-laparoscopies caused by peritoneal adhesions related complications. OBJECTIVE: To evaluate the effects of contractubex (CT) in a rat model of postoperative peritoneal adhesion (PPA). METHODS: Fifty rats were divided into four equal groups. In group 1, 1 g of CT was injected into the peritoneal cavity. In group 2, adhesions were generated. In group 3, adhesions were generated, and 1 g of CT was immediately applied into the peritoneal cavity. In group 4, adhesions were generated, and at postoperative d 7, 1 g of CT was applied into the peritoneal cavity. In group 5, adhesions were generated, and at postoperative d1, 3, 5, and 7, 1 g of CT was applied into the peritoneal cavity. The adhesions were scored both macroscopically and microscopically. RESULTS: The mean macroscopic adhesion scores in groups 1-5 were 0 ± 0, 2.9 ± 0.21, 2.3 ± 0.54, 0.8 ± 0.63, and 2.2 ± 0.72, respectively (P < 0.0001); the mean microscopic values were 0 ± 0, 2.8 ± 0.42, 2.8 ± 0.42, 0.6 ± 0.52, and 2.3 ± 0.48, respectively (P < 0.0001). The mean macroscopic adhesion score in group 4 was lower than that in group 2 (P = 0.001). The mean macroscopic adhesion scores in groups 3 and 5 were higher than those in group 4 (P = 0.045 and P = 0.038, respectively) but did not significantly differ from those in group 2 (P = 0.171 and P = 0.124, respectively). COMMENTARY: A single dose of contractubex did not prevent PPA formation but did diminish the amount of formed PPAs.

Radio-guided excision of metastatic lymph nodes in thyroid carcinoma: a safe technique for previously operated neck compartments.

BACKGROUND: Better follow-up of patients with papillary thyroid cancer (PTC) and more sensitive detection leads to detection of recurrences in the neck. Despite excellent outcomes, the major challenge is controlling locoregional recurrence. We aimed to investigate whether the radio-guided excision of metastatic lymph nodes makes it possible to find the affected lymph nodes in patients with previously operated neck compartments. METHOD: This prospective study included 46 patients with recurrent/persistent PTC who had previously undergone operation of the neck compartment. Prior to operation, the pathologic node was localized by ultrasound (US) and radiotracer ((99m)Tc-labeled rhenium colloid) was injected directly into the pathologic node. Careful dissection was carried out following the area of maximum radioactivity until the metastatic lymph node(s) were identified and excised. RESULT: One affected lymph node was removed in 17 patients, and more than one lymph node (affected or additional nodes) was removed in 29 patients. The median count from the lesion was significantly higher than values from the lesion bed (background activity) (16,886 counts/20 s versus 52 counts/20 s; p < 0.001). During follow-up, four patients were lost to follow-up and 27 patients had negative US and basal thyroglobulin (Tg). Five patients had suspicious lymph nodes on the operated side. Although the basal Tg level remained above the normal limit, moderately high in 8 patients, no metastases were detected in the neck. CONCLUSIONS: Radio-guided excision of metastatic lymph nodes can be performed safely for the detection and excision of recurrent thyroid cancer in the central and lateral neck.

Novel hemostatic devices in thyroid surgery: are they necessary in every patient performing thyroidectomy?

TThis study was conducted to compare the outcome of total thyroidectomy using novel hemostatic devices and the classic suture ligation technique. This prospective study included 195 consecutive patients undergoing total thyroidectomy between January 2008 and March 2009. The main outcomes measured were operating time, intraoperative blood loss, postoperative drainage, pain score, and postoperative complications. The three groups tested were similar in terms of demographics, thyroid gland weight and pathology, and postoperative complications. According to two-way analysis of variance, the use of hemostatic devices in thyroid volume less than 40 ml was not found to significantly correlate with operating time, intraoperative blood loss or postoperative drainage. Novel hemostatic devices are safe, useful, and time-saving adjuncts for thyroid surgery, and the use of these devices seems to have great advantages in the patients with large goiters.

The effect of retroperitoneal fat mass on surgical outcomes in patients performing laparoscopic adrenalectomy: the effect of fat tissue in adrenalectomy.

BACKGROUND: Obesity and visceral fat are thought to be the most important factors influencing the technical difficulty during open and laparoscopic surgery. The authors aimed to investigate the effect of retroperitoneal fat mass on surgical outcomes in patients undergoing laparoscopic adrenalectomy. PATIENTS AND METHODS: This prospective study included 51 consecutive patients who underwent lateral transabdominal laparoscopic adrenalectomy. Body mass index (BMI) and retroperitoneal fat area (RFA)/adrenal mass area (AMA) ratio were calculated. RESULTS: There was a positive correlation between BMI and operating time and postoperative complications and hospital stay. According to 2-way analysis of variance, only RFA/AMA ratio (P = .0001) was found to significantly correlate with operating time, whereas BMI did not significantly correlate with operating time (P = .51). In patients with high BMI, high RFA indicated longer operating time and higher complication rate, whereas low RFA was associated with significantly shorter operating time and decreased risk of complications. CONCLUSION: Retroperitoneal fat mass is a more useful parameter than BMI for predicting the surgical outcomes of laparoscopic adrenalectomy.

Is intraoperative nerve monitoring useful for surgical training in thyroid surgery?

OBJECTIVES: Parathyroid glands and recurrent laryngeal nerves (RLNs) are at risk during thyroid surgery. However, the identification of the nerves has reduced these risks. Intraoperative nerve monitoring (IONM) during thyroid surgery has gained widespread acceptance as an aid to the gold standard of visually identifying the RLN. The aim of the present study was to evaluate the effect of the identification of the RLN during thyroidectomy by using IONM. MATERIAL AND METHODS: Seven hundred forty-eight patients were included in our prospectively designed study. Of these 748 patients, 1496 nerves at risk were studied. Group 1 consisted of 736 nerves that were identified using IONM, whereas Group 2 consisted of 760 visually identified nerves. RESULTS: In the non-IONM group, the rate of temporary nerve palsy was lower in patients operated by experienced surgeons than in patients operated by residents (p= 0.001). In the IONM group, RLN injury rates were similar between experienced surgeons and residents. CONCLUSION: In spite of the fact that the duration of the operation was lower with IONM, the abbreviated duration may not appear to have clinical significance. The main advantage is for less experienced surgeons. IONM significantly decreases RLN palsy rates of the surgeons with limited experience in thyroid surgery.