Endocrine Surgery
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When Is It Minimally Invasive?
ORIGINAL ARTICLE Incision Length for Standard Thyroidectomy and Parathyroidectomy When Is It Minimally Invasive? Laurent Brunaud, MD; Rasa Zarnegar, MD; Nobuyuki Wada, MD; Philip Ituarte, PhD; Orlo H. Clark, MD; Quan-Yang Duh, MD Hypothesis: Current techniques for open conven- parathyroidectomy (PϽ.001). It was 4.1 cm for bilateral tional thyroidectomy or parathyroidectomy have evolved parathyroid exploration, but was reduced to 3.2 and 2.8 to enable a shorter incision (main proposition), and the cm for unilateral (PϽ.001) and focal (PϽ.001) explora- length of the incision is influenced by objective factors. tions, respectively. By multiple regression analysis, thy- roid specimen volume and patient body mass index were Design: Case series. independent predictors of incision length in thyroidec- tomy. Extent of exploration and resident training level Setting: University referral center. were independent predictors of incision length in parathyroidectomy. Patients and Intervention: Retrospective study of the most recent 200 primary consecutive routine thyroid and Conclusions: Current techniques for open conven- parathyroid operations (excluding neck dissections). tional thyroidectomy or parathyroidectomy have evolved to enable a shorter incision. Thyroid volume, patient body Main Outcome Measures: The length of incision was mass index, extent of the planned parathyroid explora- routinely measured with a ruler before the incision. tion, and the resident clinical training stage are impor- Univariate and multivariate analysis was performed to dis- tant variables for incision length in open operation and tinguish variables affecting length of incision. should be taken into account when minimally invasive thyroidectomy and parathyroidectomy are evaluated. Results: Mean length of the incision was 5.5 cm for to- tal thyroidectomy, 4.6 cm for lobectomy, and 3.5 cm for Arch Surg. -
Inadvertent Parathyroidectomy During Thyroid Surgery for Papillary Thyroid Carcinoma and Postoperative Hypocalcemia
ORIGINAL J Korean Thyroid Assoc ARTICLE Vol. 5, No. 1, May 2012 Inadvertent Parathyroidectomy during Thyroid Surgery for Papillary Thyroid Carcinoma and Postoperative Hypocalcemia Dongbin Ahn, MD1, Jin Ho Sohn, MD, PhD1, Jae Hyug Kim, MD1, Ji Young Park, MD2 and Junesik Park, MD, PhD3 Departments of Otolaryngology-Head and Neck Surgery1, Pathology2, School of Medicine, Kyungpook National University, Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Catholic University of Daegu3, Daegu, Korea Background and Objectives: The aim of this article is to report our experience of inadvertent parathyroidectomy during thyroid surgery and to analyze its associated factors and clinical implications. In addition, we attempted to determined causative factors that result in permanent hypocalcemia after thyroid surgery. Materials and Methods: We performed a retrospective review of 500 patients who underwent thyroid surgery for the treatment of papillary thyroid carcinoma from 2004 to 2008. Results: Inadvertent parathyroidectomy was identified in 7.4% of patients and only 1 parathyroid gland was inadvertently removed in most cases. The incidence of inadvertent parathyroidectomy was not associated with gender, age, type of surgical procedure, tumor size, coexisting Hashimoto’s thyroiditis (HT), extra-thyroidal extension (ETE), lymph node (LN) metastasis, and surgeon’s experience. Nor was inadvertent parathyroidectomy associated with permanent postoperative hypocalcemia. Although operating time >120 min, ETE, and total thyroidectomy (TT) with central neck dissection (CND) were found to be related to permanent hypocalcemia on univariate analysis, tumor size ≥1 cm and surgeon’s experience ≤5 years was statistically associated with permanent hypocalcemia on both univariate and multivariate analyses. Conclusion: Although inadvertent parathyroidectomy is not an uncommon complication of thyroid surgery, it appears to have only modest clinical implications. -
Postoperative Calcium Requirements in 6000 Patients Undergoing
Postoperative Calcium Requirements in 6,000 Patients Undergoing Outpatient Parathyroidectomy: Easily Avoiding Symptomatic Hypocalcemia Marie Vasher, MD, Arnold Goodman, MD, FACS, Douglas Politz, MD, FACS, FACE, James Norman, MD, FACS, FACE BACKGROUND: To determine the amount and duration of supplemental oral calcium for patients with varying clinical presentations discharged immediately after surgery for primary hyperparathyroidism. STUDY DESIGN: A 4-year, prospective, single-institution study of 6,000 patients undergoing parathyroidectomy for primary hyperparathyroidism and discharged within 2.5 hours. Based on our previous studies, patients are started on a sliding scale of oral calcium determined by a number of preoperative measures (ie, serum calcium, body weight, osteoporosis) beginning 3 hours post- operation and decreasing to a maintenance dose by week 3. Patients reported all hypocalcemia symptoms daily for 2 weeks. RESULTS: Seven parameters were found to have a substantial impact on the amount of calcium required to prevent symptomatic hypocalcemia: preoperative serum calcium Ͼ12 mg/dL, Ͼ13 mg/dL, and Ͼ13.5 mg/dL, bone density T score less than Ϫ3, morbid obesity, removal of Ͼ1 parathyroid, and manipulation/biopsy of all remaining glands (all p Ͻ 0.05). Each independent variable increased the daily calcium required by 315 mg/day. Using our scaled protocol, Ͻ8% of patients showed symptoms of hypocalcemia, nearly all of whom were successfully self-treated with additional oral calcium. Only 6 patients (0.1%) required a visit to the emergency room for IV calcium, all occurring on postoperative day 3 or later. CONCLUSION: After outpatient parathyroidectomy, a specific calcium protocol has been verified that elimi- nates development of symptomatic hypocalcemia in Ͼ92% of patients, identifies patients at high risk for hypocalcemia, and allows self-medication with confidence in a predictable fashion for those patients in whom symptoms develop. -
Radioguided Surgery of Primary Hyperparathyroidism Using the Low
Radioguided Surgery of Primary Hyperparathyroidism Using the Low-Dose 99mTc- Sestamibi Protocol: Multiinstitutional Experience from the Italian Study Group on Radioguided Surgery and Immunoscintigraphy (GISCRIS) Domenico Rubello, MD1; Maria Rosa Pelizzo, MD2; Giuseppe Boni, MD3; Riccardo Schiavo, MD4; Luca Vaggelli, MD5; Giuseppe Villa, MD6; Sergio Sandrucci, MD7; Andrea Piotto, MD2; Gianpiero Manca, MD3; Pierluigi Marini, MD8; and Giuliano Mariani, MD3 1Nuclear Medicine Service, “S. Maria della Misericordia” Hospital, Rovigo, Italy; 2Department of Surgery, University of Padua Medical School, Padua, Italy; 3Regional Center of Nuclear Medicine, University of Pisa Medical School, Pisa, Italy; 4Nuclear Medicine Service, “S. Camillo-Forlanini” Hospital, Rome, Italy; 5Nuclear Medicine Service, “Careggi” University Hospital, Florence, Italy; 6Nuclear Medicine Service, “S. Martino” University Hospital, Genoa, Italy; 7Department of Surgery, University of Turin Medical School, Turin, Italy; and 8Division of Surgery, “S. Camillo-Forlanini” Hospital, Rome, Italy (11%) of transient postoperative hypocalcemia. The probe was 99m This study evaluated the accuracy of 99mTc-sestamibi scintigra- of little help in patients with concomitant Tc-sestamibi–avid phy and neck ultrasonography in patients with primary hyper- thyroid nodules and not helpful at all in patients with negative parathyroidism (PHPT) and the role of intraoperative hand-held scan findings preoperatively. IQPTH measurement helped to ␥-probes in minimally invasive radioguided surgery (MIRS) of disclose some cases of multigland parathyroid disease. Con- patients with a high likelihood of a solitary parathyroid adenoma clusion: 99mTc-Sestamibi scintigraphy, especially if combined (PA). The study was undertaken under the aegis of the Italian with neck ultrasonography, is highly accurate in selecting PHPT Study Group on Radioguided Surgery and Immunoscintigraphy candidates for MIRS. -
Minimally Invasive Parathyroidectomy Versus Bilateral Neck Exploration for Primary Hyperparathyroidism
Minimally Invasive Parathyroidectomy Versus Bilateral Neck Exploration for Primary Hyperparathyroidism Amanda M. Laird, MD*, Steven K. Libutti, MD KEYWORDS Primary hyperparathyroidism Parathyroidectomy Intraoperative parathyroid hormone Surgery Minimally invasive parathyroidectomy KEY POINTS The gold-standard surgical management of primary hyperparathyroidism (10HPT) is cer- vical exploration and identification of all 4 parathyroid glands. Imaging techniques, including ultrasound, sestamibi scans, and 4D-CT scans, have made identification of single parathyroid adenomas possible. Intraoperative parathyroid hormone (PTH) monitoring is a method to confirm biochemical cure before a patient leaves the operating room. There is some debate surrounding optimal surgical management of 10HPT because cure rates between minimally invasive parathyroidectomy (MIP) and bilateral neck exploration (BNE) are equivalent. Advantages of MIP include reduced operative time, reduced recovery time, less postop- erative pain, and lower complication rate with respect to injury to parathyroid glands and recurrent laryngeal nerves. INTRODUCTION 10HPT is a common disease, with a prevalence as high as 3%.1 Many advances in the surgical management of 10HPT have been made since the first parathyroidectomy was performed by Felix Mandl in 1925.2 Traditional surgical management consists of identification of all 4 parathyroid glands through a transverse cervical incision.3 Bet- ter understanding of the disease, interest in the practice of endocrine neck surgery, The authors have nothing to disclose. Montefiore Medical Center/Albert Einstein College of Medicine, Greene Medical Arts Pavilion, 3400 Bainbridge Avenue, 4th Floor, Bronx, NY 10467, USA * Corresponding author. E-mail address: [email protected] Surg Oncol Clin N Am 25 (2016) 103–118 http://dx.doi.org/10.1016/j.soc.2015.08.012 surgonc.theclinics.com 1055-3207/16/$ – see front matter Ó 2016 Elsevier Inc. -
Endocrine Surgery Goals and Objectives
Lenox Hill Hospital Department of Surgery Endocrine Surgery Goals and Objectives Medical Knowledge and Patient Care: Residents must demonstrate knowledge and application of the pathophysiology and epidemiology of the diseases listed below for this rotation, with the pertinent clinical and laboratory findings, differential diagnosis and therapeutic options including preventive measures, and procedural knowledge. They must show that they are able to gather accurate and relevant information using medical interviewing, physical examination, appropriate diagnostic workup, and use of information technology. They must be able to synthesize and apply information in the clinical setting to make informed recommendations about preventive, diagnostic and therapeutic options, based on clinical judgement, scientific evidence, and patient preferences. They should be able to prescribe, perform, and interpret surgical procedures listed below for this rotation. All Residents are expected to understand: 1. Normal physiology and anatomy of the thyroid glands. 2. Normal physiology and anatomy of the parathyroid glands. 3. Normal physiology and anatomy of the adrenal glands 4. Normal physiology of the pancreatic neuroendocrine cells. 5. Normal physiology of the pituitary gland. Disease-Based Learning Objectives: Hyperfunctioning Thyroid and Hypothyroid State: 1. Physiology of Grave’s disease and toxic goiter. 2. Management of a patient in hyperthyroid storm. 3. Medical and surgical treatment options for hyperthyroidism. 4. Physiology of Hashimoto’s thyroiditis and hypothyroidism. Thyroid Neoplasm: 1. Workup of a cold thyroid nodule. 2. Surgical management of papillary, follicular, medullary, and anaplastic thyroid carcinoma. 3. Adjuvant therapy for thyroid neoplasms. 4. Postoperative medical management and long-term follow-up of thyroid cancer. Hyperparathyroidism: 1. Diagnosis and work-up of hypercalcemia and primary, secondary, and tertiary hyperparathyroidism. -
Gonadotrophin-Releasing Hormone Agonist-Induced Pituitary Adenoma Apoplexy and Casual Finding of a Parathyroid Carcinoma: a Case Report and Review of Literature
World Journal of W J C C Clinical Cases Submit a Manuscript: https://www.f6publishing.com World J Clin Cases 2019 October 26; 7(20): 3259-3265 DOI: 10.12998/wjcc.v7.i20.3259 ISSN 2307-8960 (online) CASE REPORT Gonadotrophin-releasing hormone agonist-induced pituitary adenoma apoplexy and casual finding of a parathyroid carcinoma: A case report and review of literature Vanessa Triviño, Olga Fidalgo, Antía Juane, Jorge Pombo, Fernando Cordido ORCID number: Vanessa Triviño Vanessa Triviño, Olga Fidalgo, Antía Juane, Fernando Cordido, Department of Endocrinology, (0000-0001-5649-1310); Olga Fidalgo Complejo Hospitalario Universitario A Coruña, A Coruña 15006, Spain (0000-0002-8559-9416); Antia Juane (0000-0001-8090-2802); Jorge Pombo Jorge Pombo, Department of pathological anatomy, Complejo Hospitalario Universitario A (0000-0002-9624-7053); Fernando Coruña, A Coruña 15006, Spain Cordido (0000-0003-3528-8174). Corresponding author: Fernando Cordido, MD, PhD, Professor, Department of Endocrinology, Author contributions: Triviño V Complejo Hospitalario Universitario A Coruña, University of A Coruña, As xubias 84, A and Fidalgo O were the patient’s Coruña 15006, Spain. [email protected] endocrinologists, reviewed the Telephone: +34-981-176442 literature and contributed to manuscript drafting; Juane A reviewed the literature and contributed to manuscript drafting; Pombo J performed the microscope Abstract study of the tissue and BACKGROUND immunohistochemistry, took the Pituitary apoplexy represents one of the most serious, life threatening endocrine photographs and contributed to emergencies that requires immediate management. Gonadotropin-releasing manuscript drafting; Cordido F was responsible for revision of the hormone agonist (GnRHa) can induce pituitary apoplexy in those patients who manuscript for relevant intellectual have insidious pituitary adenoma coincidentally. -
Fluorescence-Guided Cancer Surgery
a Fluorescence-guided cancer surgery Quirijn Tummers surgeryFluorescence-guided cancer Quirijn Fluorescence-guided cancer surgery using clinical available and innovative tumor-specifc contrast agents Quirijn Tummers 46151 Tummers cover.indd 1 09-08-17 11:17 Fluorescence-guided cancer surgery using clinical available and innovative tumor-specifc contrast agents Quirijn Tummers 46151 Quirijn Tummers.indd 1 16-08-17 13:01 © Q.R.J.G. Tummers 2017 ISBN: 978-94-6332-197-6 Lay-out: Ferdinand van Nispen, Citroenvlinder DTP & Vormgeving, my-thesis.nl Printing: GVO Drukkers & Vormgevers All rights reserved. No parts of this thesis may be reproduced, distributed, stored in a retrieval system or transmitted in any form or by any means, without prior written permission of the author. The research described in this thesis was fnancially supported by the Center for Translational Molecular Imaging (MUSIS project), Dutch Cancer Society and National Institutes of Health. Financial support by Raad van Bestuur HMC Den Haag, Quest Medical Imaging, On Target Laboratories, Centre for Human Drug Research, Curadel, LUMC, Nederlandse Vereniging voor Gastroenterologie, Karl Storz Endoscopie Nederland B.V., ABN-AMRO and Chipsoft for the printing of this thesis is gratefully acknowledged. 46151 Quirijn Tummers.indd 2 16-08-17 13:01 Fluorescence-guided cancer surgery using clinical available and innovative tumor-specifc contrast agents Proefschrift ter verkrijging van de graad van Doctor aan de Universiteit Leiden, op gezag van Rector Magnifcus prof. mr. C.J.J.M. Stolker, volgens besluit van het College voor Promoties te verdedigen op woensdag 11 oktober 2017 klokke 15:00 uur door Quirijn Robert Johannes Guillaume Tummers geboren te Leiden in 1986 46151 Quirijn Tummers.indd 3 16-08-17 13:01 Promotor Prof. -
Surgical Indications and Techniques for Adrenalectomy Review
THE MEDICAL BULLETIN OF SISLI ETFAL HOSPITAL DOI: 10.14744/SEMB.2019.05578 Med Bull Sisli Etfal Hosp 2020;54(1):8–22 Review Surgical Indications and Techniques for Adrenalectomy Mehmet Uludağ,1 Nurcihan Aygün,1 Adnan İşgör2 1Department of General Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey 2Department of General Surgery, Bahcesehir University Faculty of Medicine, Istanbul, Turkey Abstract Indications for adrenalectomy are malignancy suspicion or malignant tumors, non-functional tumors with the risk of malignancy and functional adrenal tumors. Regardless of the size of functional tumors, they have surgical indications. The hormone-secreting adrenal tumors in which adrenalectomy is indicated are as follows: Cushing’s syndrome, arises from hypersecretion of glucocorticoids produced in fasciculata adrenal cortex, Conn’s syndrome, arises from an hypersecretion of aldosterone produced by glomerulosa adrenal cortex, and Pheochromocytomas that arise from adrenal medulla and produce catecholamines. Sometimes, bilateral adre- nalectomy may be required in Cushing's disease due to pituitary or ectopic ACTH secretion. Adenomas arise from the reticularis layer of the adrenal cortex, which rarely releases too much adrenal androgen and estrogen, may also develop and have an indication for adrenalectomy. Adrenal surgery can be performed by laparoscopic or open technique. Today, laparoscopic adrenalectomy is the gold standard treatment in selected patients. Laparoscopic adrenalectomy can be performed transperitoneally or retroperitoneoscopi- cally. Both approaches have their advantages and disadvantages. In the selection of the surgery type, the experience and habits of the surgeon are also important, along with the patient’s characteristics. The most common type of surgery performed in the world is laparoscopic transabdominal lateral adrenalectomy, which most surgeons are more familiar with. -
NCCN Neuroendocrine Tumors Guidelines Are Divided Into 6 Endocrine Systems, Which Produce and Secrete Regulatory Hormones
NCCN Clinical Practice Guidelines in Oncology™ Neuroendocrine Tumors V.1.2007 Continue www.nccn.org Guidelines Index ® Practice Guidelines Neuroendocrine TOC NCCN in Oncology – v.1.2007 Neuroendocrine Tumors MS, References NCCN Neuroendocrine Tumors Panel Members * Orlo H. Clark, MD/Chair ¶ John F. Gibbs, MD ¶ Thomas W. Ratliff, MD † UCSF Comprehensive Cancer Center Roswell Park Cancer Institute St. Jude Children's Research Hospital/University of Tennessee Jaffer Ajani, MD †¤ Martin J. Heslin, MD ¶ Cancer Institute The University of Texas M. D. University of Alabama at Anderson Cancer Center Birmingham Comprehensive Leonard Saltz, MD † Cancer Center Memorial Sloan-Kettering Cancer Al B. Benson, III, MD † Center Robert H. Lurie Comprehensive Fouad Kandeel, MD Cancer Center of Northwestern City of Hope Cancer Center David E. Schteingart, MD ð University University of Michigan Anne Kessinger, MD † Comprehensive Cancer Center David Byrd, MD ¶ UNMC Eppley Cancer Center at The Fred Hutchinson Cancer Research Nebraska Medical Center Manisha H. Shah, MD † Center/Seattle Cancer Care Alliance Arthur G. James Cancer Hospital & Matthew H. Kulke, MD † Richard J. Solove Research Gerard M. Doherty, MD ¶ Dana-Farber/Partners CancerCare Institute at The Ohio State University of Michigan Comprehensive University Cancer Center Larry Kvols, MD † H. Lee Moffitt Cancer Center & Stephen Shibata, MD † Paul F. Engstrom, MD † Research Institute at the University City of Hope Cancer Center Fox Chase Cancer Center of South Florida David S. Ettinger, MD † John A. Olson, Jr., MD, PhD ¶ The Sidney Kimmel Comprehensive Duke Comprehensive Cancer Cancer Center at Johns Hopkins Center * Writing Committee Member ¶ Surgery/Surgical oncology † Medical oncology ¤ Gastroenterology ð Endocrinology Continue Version 1.2007, 03/14/07 © 2007 National Comprehensive Cancer Network, Inc. -
Pituitary Apoplexy After Subtotal Thyroidectomy In
CASE REPORT Pituitary Apoplexy after Subtotal Thyroidectomy in an Acromegalic Patient with a Large Goiter Kazunobu Kato, Masakazu Nobori*, Yoshihiro Miyauchi, Motoki Ohnisi, Shyoji Yoshida, Shigeru Oya**, Shin Tomita** and Tomoshige Kino*** A case of pituitary apoplexy occurring after subtotal thyroidectomy in an acromegalic woman with a large adenomatous goiter is described. The patient had severe apnea because the large goiter was causing airway compression. Prior to the planned hypophysectomy, a subtotal thyroidectomy was performed to relieve tracheal stenosis. Shortly after the operation, the patient developed a headache that lasted for several days. The serum levels of growth hormoneand somatomedin-C spontaneously normalized seventeen days after this episode and have remained normal for two years. Pituitary apoplexy was thought to have caused the observed results without deterioration of the pituitary function. (Internal Medicine 35: 472-477, 1996) Key words: acromegaly, thyroid goiter, airway obstruction, diabetes mellitus Introduction and noticed enlargement of her hands. In February 1991, thirst and general fatigue developed and she consulted a local physi- Pituitary apoplexy is an uncommonevent, sometimes fatal, cian and was found to have diabetes mellitus and an abnormal but sometimes it induces complete reversal of acromegaly. It mass adjacent to the right side of the trachea, according to chest occurs in various situations, such as during the course of drug X-ray films. The patient, an unmarried desk clerk, was referred therapy for pituitary adenoma,during pregnancy, or after to us, with the complaint ofdyspnea that was moresevere lying cholecystectomy. However,there are no reports documenting down than in the sitting position. She had excessive nocturnal pituitary apoplexy after thyroidectomy. -
Ese-Ensat-Acc-Guidelines-13-5-2018
European Society of Endocrinology Clinical Practice Guidelines on the Management of Adrenocortical Carcinoma in Adults, in collaboration with the European Network for the Study of Adrenal Tumors Martin Fassnacht1,2*, Olaf M. Dekkers3,4,5, Tobias Else5, Eric Baudin7,8, Alfredo Berruti9, Ronald R. de Krijger10, 11, 12, 13, Harm R. Haak14,15, 16, Radu Mihai17, Guillaume Assie19, 20, Massimo Terzolo20* 1 Dept. of Internal Medicine I, Div. of Endocrinology and Diabetes, University Hospital, University of Würzburg, Würzburg, Germany 2 Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany 3 Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands 4 Department of Clinical Endocrinology and Metabolism, Leiden University Medical Centre, Leiden, the Netherlands 5 Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark 6 Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI, USA 7 Endocrine Oncology and Nuclear Medicine, Institut Gustave Roussy, Villejuif, France 8 INSERM UMR 1185, Faculté de Médecine, Le Kremlin-Bicêtre, Université Paris Sud, Paris, France 9 Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology, University of Brescia at ASST Spedali Civili, Brescia, Italy. 10 Dept. of Pathology, Erasmus MC University Medical Center, Rotterdam, The Netherlands 11 Dept. of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands 12 Dept. of Pathology, Reinier de Graaf Hospital, Delft, The Netherlands 13 Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands 14 Department of Internal Medicine, Máxima Medical Centre, Eindhoven/Veldhoven, the Netherlands 15 Maastricht University, CAPHRI School for Public Health and Primary Care, Ageing and Long-Term Care, Maastricht, the Netherlands 16 Department of Internal Medicine, Division of General Internal Medicine, Maastricht University Medical Centre+, Maastricht, the Netherlands.