Hyoung Shin Lee

Patterns of Post-thyroidectomy Hemorrhage.

Objectives Postoperative hemorrhage is a potentially life-threatening complication in thyroid surgery. This study was performed to review the clinical patterns of post-thyroidectomy hemorrhage, and especially as they are related to the source of bleeding. Methods We performed a retrospective review of 10 patients (0.96%) with post-thyroidectomy hemorrhage that required surgical evacuation. The clinical patterns such as the time interval from surgery to hemorrhage and the signs and symptoms according to the bleeding focus were evaluated. Results The mean time interval from surgery to symptom onset was 7 hr 52 min. Six cases showed bleeding deep to the strap muscles, while the other 4 cases showed bleeding superficial to the muscles. Ecchymosis was prominent and dark in color in 3 of the 4 cases (75%) of superficial bleeding, however it was identified in only 2 of the 6 cases (33%) of deep bleeding. Respiratory distress occurred in two cases of hematoma deep to the strap muscles, but in none of the cases with superficial bleeding. Conclusion The post-thyroidectomy hemorrhage had some different clinical patterns between the superficial cases and the deep cases, showing that life-threatening airway obstruction occurred from the deep hematoma. A thorough understanding of the clinical patterns of post-thyroidectomy hemorrhage between the cases of superficial and those cases of deep hematoma may provide valuable surgical tips to manage this potentially lethal complication.

Transoral laser microsurgery for early glottic cancer as one-stage single-modality therapy

A study was undertaken to determine the oncologic outcomes in a consecutive series of early glottic carcinomas treated with transoral CO2 laser microsurgery (TLM) as a one‐stage single‐modality therapy, without any postoperative radiation therapy or retreatment with laser. We further evaluated correlations between the oncologic outcomes and clinicopathologic factors including tumor location and surgical margin.

Feasibility of Robot-Assisted Neck Dissections via a Transaxillary and Retroauricular (“TARA”) Approach in Head and Neck Cancer: Preliminary Results

BackgroundRecently, robot-assisted neck dissection in thyroid cancer patients with lateral neck node metastasis has been demonstrated to be feasible. We realized the necessity of technical modification in order to apply robotic system to comprehensive neck dissection for head and neck squamous cell carcinoma. This study examined the feasibility and safety of transaxillary and retroauricular (“TARA”) approach for robotic neck dissection in patients with head and neck squamous cell cancer.MethodsFour human cadaveric dissections were followed by robotic neck dissections in seven patients with oral cavity or laryngopharyngeal cancer through TARA incision.ResultsIn all cases, vital structures including major vessels and nerves were preserved. The numbers of retrieved lymph nodes in robotic neck dissections were comparable with those in conventional neck dissections.ConclusionsRobotic neck dissection via TARA approach is a feasible and useful method with excellent cosmetic results for treating nodal metastasis in selected cases of head and neck squamous cell cancer.

Robot-Assisted Selective Neck Dissection via Modified Face-lift Approach for Early Oral Tongue Cancer: A Video Demonstration

Recently, early-stage oral cavity cancers are successfully resected via a transoral approach. Nodal metastasis is a crucial factor in determining the survival of oral cavity cancer patients. However, elective neck dissection in earlystage oral cavity cancers is a still controversial procedure. In recent period, in an attempt to hide the cervical scars, robotic modified neck dissection via a transaxillary approach has been introduced by Kang et al. in thyroid cancer with neck metastasis. However, there are limitations to dissect the upper neck level including level I via transaxillary approach. Therefore, we demonstrate our novel technique for robot-assisted neck dissection (RAND) for level I, II, and III via modified face-lift approach (MFLA) and show the pitfalls of the operation, as well as tips for its successful completion.

The relationship between the BRAF V600E mutation in papillary thyroid microcarcinoma and clinicopathologic factors

BackgroundThe BRAFV600E mutation, which accounts for about 60–80% papillary thyroid carcinoma(PTC), has been identifiedas a prognostic marker for risk stratification of PTC patients. However, the BRAFV600E mutation as a prognostic marker in papillary thyroid microcarcinoma (PTMC) is unclear.MethodsWe performed a retrospective review of 101 patients who underwent surgery for PTMC. We studied the prevalence of the BRAFV600E mutation. The associations between the BRAFV600E mutation and clinicopathologic characteristics were analyzed.ResultsThe BRAFV600E mutation was observed in 72 patients (71.3%). There was no statistically significant correlation in age, gender, multifocality, extrathyroidal extension, presence of Hashimoto thyroiditis, and lymph node metastasis between the BRAFV600E mutant group and wild group.ConclusionsThe BRAFV600E mutation is not significantly associated with prognostic factors in PTMC.

Transoral robotic surgery for neurogenic tumors of the prestyloid parapharyngeal space

The parapharyngeal space is a difficult area for a surgical approach due to anatomical complexity. We performed a minimally invasive and precise surgical technique to remove neurogenic tumors of the prestyloid parapharyngeal space using transoral robotic instrumentation. The mass was successfully removed in the two cases with three-dimensional visualization providing an excellent view of the resection margin and the dissection plane preserving the vital structures. An adequate resection margin was acquired, and no violation of the tumor capsule occurred. No significant complications were noted. Transoral robotic surgery was feasible for neurogenic tumors of the prestyloid parapharyngeal space, providing a sufficient resection margin and delicate dissection through excellent surgical views and instrumentation.

Feasibility of robot-assisted submandibular gland resection via retroauricular approach: preliminary results.

To present the surgical technique and feasibility of robot‐assisted submandibular gland (SMG) resection via retroauricular approach.

Robot-assisted versus endoscopic submandibular gland resection via retroauricular approach: a prospective nonrandomized study

The aim of this study was to compare the short-term clinicopathological results of robot-assisted and endoscopic resection of the submandibular gland by the retroauricular approach. We present a prospective, non-random, study of 35 patients who had endoscope-assisted (n=22), or robot-assisted (n=13), resection of the submandibular gland using a retroauricular approach. Patients selected one of the two methods, and short-term clinical outcomes were then compared, including maximum diameter of the tumour and gland, length of incision, total operating time, amount of operative bleeding, amount and duration of drainage, duration of hospital stay, cosmesis, and complications. The operation was feasible in all patients with no appreciable operative complications or need to convert to a conventional open operation. The operating time of the robot-assisted group (63.4 (6.3)min) was comparable with that of the endoscopic group (66.5 (9.1)min) (p=0.15). There were no differences in the other clinical outcomes between the 2 groups. Both groups of patients were extremely satisfied with their postoperative cosmesis, and did not differ significantly (p=0.89). Robotic and endoscopic resection of the submandibular gland gave comparable early surgical outcomes and excellent cosmetic results. Despite the technical convenience for the surgeon, the robot gave no apparent clinical benefit over the endoscope in this series.

Web-Based Malignancy Risk Estimation for Thyroid Nodules Using Ultrasonography Characteristics: Development and Validation of a Predictive Model

BACKGROUND To establish a practical and simplified method for analyzing thyroid nodules in a clinical setting, the development of a new practical prediction model was required. This study aimed to construct and validate a simple and reliable web-based predictive model using the ultrasonography characteristics of thyroid nodules to stratify the risk of malignancy. METHODS To analyze ultrasonography images, radiologists were asked to assess thyroid nodules according to the following criteria: internal content, echogenicity of the solid portion, shape, margin, and calcifications. Multivariate logistic regression was performed to predict whether nodules were diagnosed as malignant or benign. The developmental data set included 849 nodules (January-June 2003). The validation set included different data (n = 453, June 2008-February 2009). RESULTS Ultrasonography features, including solid content, taller-than-wide shape, spiculated margin, ill-defined margin, hypoechogenicity, marked hypoechogenicity, microcalicifications, and rim calcifications, were selected as predictors for malignant nodules in the development set. A 14-point risk scoring system was developed. Malignancy risk ranged from 3.8% to 97.4%, and the risk of malignancy was positively associated with increases in risk scores. The areas under the receiver operating characteristic curve of the development and validation sets were 0.903 and 0.897, respectively. CONCLUSION A simple and reliable web-based predictive model was designed using ultrasonography characteristics to stratify thyroid nodules according to the probability of malignancy.

Transoral Laser Microsurgery of Recurrent Early Glottic Cancer after Radiation Therapy: Clinical Feasibility and Limitations

Objectives: Transoral laser microsurgery (TLM) is an accepted alternative to open partial laryngectomy for selected glottic cancers, but its role in salvage of radiation failure is debated. Methods: The records of 18 patients treated by TLM for rT1 and rT2 glottic cancer after curative radiation therapy from 2002 to 2007 were retrospectively analyzed. Results: Of the 18 patients, 10 (56%) remained free of disease after the first TLM. The 5-year local control and laryngeal preservation rates showed better outcomes in rpT1 tumors than in rpT2 tumors (87.5% versus 16.6%, p = 0.02; and 87.5% versus 33.3%, p = 0.03, respectively). However, the 5-year overall survival and disease-specific survival rates showed no significant difference between rpT1 and rpT2 tumors. Conclusions: TLM can be a relatively safe and effective salvage option for rT1 glottic cancer. However, because of its high local recurrence rate, TLM may not be generally recommended for rT2 glottic cancer.