Melanie W. Seybt

Robotic facelift thyroidectomy: II. Clinical feasibility and safety.

A number of remote access thyroidectomy techniques have been described in the last several years. These approaches are technically challenging, can be performed on only a limited patient population, and have been associated with significant complications. We describe a novel robotic facelift approach for thyroidectomy and report our initial clinical experience.

Outpatient thyroid surgery is safe and desirable

Background Thyroid surgery has traditionally been done on an inpatient basis. With the advent of minimal access techniques, drains are frequently not required and ambulatory thyroidectomy is possible. Design Prospective, nonrandomized analysis of consecutive series of patients. Methods And Materials Patients undergoing thyroid surgery between 12/1/04 and 10/31/05 were stratified based on admission status. Demographic data were collected and outcome measures were considered. Results Ninety-one patients underwent thyroid surgery. Fifty-two were done on an outpatient basis, 26 patients were observed under a 23-hour status, and 13 were admitted. There were two complications in the outpatient group and one in the inpatient group (P = 1.0). Costs were significantly lower for outpatients (

Robotic facelift thyroidectomy: patient selection and technical considerations.

7,814) than for inpatients (

Outpatient thyroidectomy: Experience in over 200 patients†‡

10,288; P < 0.0001). Significance In carefully selected patients who prefer convalescence at home, outpatient thyroidectomy can be performed safely and cost-effectively, particularly when prophylactic calcium supplementation is utilized after total thyroidectomy to prevent transient postoperative hypocalcemia.

Robotic facelift thyroidectomy: I. Preclinical simulation and morphometric assessment

Objectives: A series of remote access thyroidectomy techniques, some using a surgical robot, have been introduced in the last decade. Most of these approaches require awkward positioning, use unfamiliar dissection planes, and have been associated with a number of significant complications. As a result, acceptance has been limited. We describe technical details and patient selection criteria of a recently described robotic facelift thyroidectomy (RFT) approach that avoids these pitfalls. Design: Analysis of preclinical and clinical studies. Methods: Inanimate and cadaver dissection studies and clinical implementation were pursued. A 3-arm RFT technique with a 30-degree offset base location proved optimal. Supine positioning with arms tucked and the patient in slight Trendelenburg position facilitated the dissection of the optical pocket. Demographic and surgical data that have been obtained and considered include patient age, sex, body mass index, pathology, and complications. Results: A series of consecutive RFT procedures has been accomplished in a limited population of patients. All cases were completed robotically with no conversions to open surgery necessary. All but the first case was accomplished on a drainless, outpatient basis. Conclusions: A RFT technique that is gasless and uses a single access port in the postauricular crease and occipital hairline location is feasible, technically less challenging than other remote access methods, and safe. Further study in an expanded patient population and in additional high-volume thyroid centers is warranted. See the videos, Supplemental Digital Content 1, http://links.lww.com/SLE/A36 and Supplemental Digital Content 2, http://links.lww.com/SLE/A37.

Cosmetic Thyroid Surgery: Defining the Essential Principles

Thyroidectomy has historically been performed on an inpatient basis out of fear of hemorrhage and transient but life‐threatening hypocalcemia. An earlier favorable experience with outpatient surgery for a limited number of patients prompted our objective of an expanded evaluation of this practice.

Geriatric Thyroidectomy: Safety of Thyroid Surgery in an Aging Population

Robotic thyroidectomy was introduced in the United States despite scant preclinical data. We pursued a systematic preclinical investigation of a new remote access, robotic thyroidectomy technique via a facelift incision, and sought to define differences in extent of dissection associated with this approach and a second, popular robotic thyroidectomy technique.

Normal Values for Pharyngeal pH Monitoring

Objectives: Minimally invasive thyroid surgery is rapidly becoming a common approach in busy endocrine surgery practices. The surgical concepts necessarily include a number of principles found within the realm of plastic surgery.

Robotic axillary thyroidectomy: Multi-institutional clinical experience with the daVinci

OBJECTIVE To ascertain whether there are incremental risks associated with thyroid surgery in the elderly population. DESIGN Prospective analysis of a consecutive single-surgeon series of patients undergoing thyroid surgery at an academic health center. SETTING Tertiary care health center. PATIENTS The study included patients aged 21 to 35 years and patients 65 years and older who underwent thyroidectomy. MAIN OUTCOME MEASURES Pathology reports, complications (including rates of temporary and permanent hypocalcemia and temporary and permanent true vocal fold [TVF] paralysis), and need for admission or readmission were included in the analysis. RESULTS There were 86 youthful patients who underwent thyroidectomy between November 2003 and December of 2007; 44 elderly patients underwent surgery during that same time frame. There were no deaths in either cohort, no hematomas, and no cases of permanent TVF paralysis. The elderly patients had a similar rate of complications when compared with the youthful patients, including transient hypocalcemia (12.5% vs 11.1%, respectively) and temporary TVF paresis (2.9% vs 3.9%), but a higher rate of readmission (4.5% vs 1.2%, P = .26). CONCLUSIONS Thyroid surgeons will be faced more often with the prospect of elective thyroid surgery in patients of advanced age as an increasingly aged population emerges and the prevalence of thyroid nodules and thyroid cancer increases. Thyroid surgery in elderly patients is safe and no more dangerous than surgery in youthful patients. There is a slightly higher rate of readmission.

Percutaneous Tracheostomy: Don't Beat Them, Join Them†

Objectives: We performed a prospective study of asymptomatic adult volunteers to establish normative values of pharyngeal pH using a novel pH probe. Methods: The Dx-pH probe is a novel pH device capable of measuring liquid and aerosolized acid levels. Twenty asymptomatic patients (Reflux Symptom Index less than 10 and Reflux Finding Score less than 6) underwent simultaneous investigation with this probe placed in the oropharynx and a dual antimony probe placed in the hypopharynx and esophagus. The reflux parameters measured from the oropharyngeal probe included the percentage of time and the number of events in which the pH was less than 5.5, 5.0, 4.5, and 4.0. Results: The upper limits of normal (95th percentile) for the number of events below pH of 5.5, 5.0, 4.5, and 4.0 per 24-hour period were 16.6, 10.7, 7.4, and 0.2, respectively. The upper limits of normal (95th percentile) for an acid exposure time below pH of 5.5, 5.0, 4.5, and 4.0 per 24-hour period were 820 seconds, 385 seconds, 75 seconds, and 3 seconds, respectively. Conclusions: Normative pharyngeal pH values are presented. Further studies are required to determine clinical relevance.