Itsuo Nakajima

New technique using an energy-based device versus conventional technique in open thyroidectomy

OBJECTIVE Thyroid surgery is a common basic procedure in otorhinolaryngology. The purpose of this study was to assess the efficiency of using a new LigaSure(®) vessel sealing system (LigaSure(®) Small Jaw Instrument; Covidien, Boulder, CO, USA). METHODS We evaluated 83 patients who underwent thyroid surgery between July 2009 and June 2012. The patients were allocated to two groups, which underwent thyroid surgery using either the LigaSure(®) Small Jaw Instrument or conventional techniques. We investigated the duration of operation, estimated blood loss, pathological characteristics, postoperative complications, and length of hospital stay. As for duration of operation and estimated blood loss, we also performed analyses by subgroups according to the extent of thyroid resection, as either total thyroidectomy or hemithyroidectomy. RESULTS The study groups showed no significant differences in age, sex, indications, extent of operation and estimated blood loss. Complication rates for recurrent laryngeal nerve palsy, hypoparathyroidism, hematoma, and wound infection did not differ between groups, except for temporary hypoparathyroidism. Operation time was significantly shorter in the LigaSure(®) Small Jaw Instrument group than in the conventional group for all extents of thyroid resection. CONCLUSION Use of the LigaSure(®) Small Jaw Instrument seems likely to reduce the operating time for thyroid surgery without increasing estimated blood loss or the frequency of postoperative complications compared to conventional techniques.

Transnasal endoscopic surgery for benign orbital tumors.

Two cases of orbital tumor are presented, and the surgical technique by means of an endoscopic transnasal approach is discussed. In Case 1, a non-vascular, benign tumor was located inside the orbit, and it was able to be completely removed, without any complications. The tumor in Case 2 was also located inside the orbit, but it was determined to be a hemangioma based on the intraoperative pathology. To avoid eye complications arising from performance of the surgery in the presence of bleeding, it was decided to widely open the orbital lamina papyracea and periosteum, and perform only orbital decompression. The eye symptoms disappeared in both patients. Endoscopic transnasal surgery is indicated for benign orbital tumors that are medially located in the orbit. It can be thought that the eye symptoms can be alleviated by avoiding orbital pressure, regardless of whether-based on the intraoperative pathology-the tumor is completely removed or not.

Long-term evaluation after endoscopic sinus surgery for chronic pediatric sinusitis with polyps

OBJECTIVE Long-term retrospective evaluation was performed of computed tomography (CT) images and endoscopic findings after endoscopic sinus surgery for 88 cases of chronic pediatric sinusitis with nasal polyps. The objective was to determine the appropriate duration of such postoperative evaluation for children. METHODS Fifty-one patients had both sinusitis and nasal polyps (BSP group), and the surgical procedure was decided in consideration of each patients age (for less than 10 years of age, polypectomy (n=12); for 10-13 years old, anterior ethmoidectomy plus opening of the fontanelle and nasofrontal duct (n=20); and for serious cases older than 13 years, total sinusectomy (n=19)). On the other hand, for cases of unilateral sinusitis with antrochoanal polyps (USP group), anterior ethmoidectomy plus opening of the fontanelle was performed regardless of the patients age (n=37, 5-15 years old). RESULTS The postoperative endoscopic findings indicated that the polyps had been eliminated in approximately 91% of total patients. Good postoperative findings of CT images in most patients of USP group are observed at one year after the operation like the same of the postoperative course of adult chronic sinusitis. On the other hand CT images in BSP group evaluated one year after the operation were rated as unchanged or worsened in approximately half of the patients. However, at 4 years after the operation nearly all the patients were rated as improved or better. In addition, comparison of the age at final observation and the postoperative course found a striking decrease in the proportion of unchanged and worsened patients aged 12 and above. CONCLUSION Accordingly, it was concluded that there is difference of healing process after the operation between USP and BSP group. Postoperative evaluation of BSP group should be performed for 4 years and up to an age of at least 12 years although post-ESS following of USP group is similar to that of adult sinusitis.