Salah Eldin Mohamed

Modified robotic‐assisted thyroidectomy: An initial experience with the retroauricular approach

New approaches for robotic‐assisted thyroidectomy, including the retroauricular approach, were recently described. We have modified the established surgical approach for retroauricular robotic thyroidectomy. Herein, we report our initial experience to identify challenges and limitations of this new surgical approach.

Robotic Thyroidectomy Versus Nonrobotic Approaches A Meta-Analysis Examining Surgical Outcomes

Background. Robotic surgery has been recently used as a novel tool for remote access thyroid surgery. We performed a meta-analysis of the current literature to examine the safety and oncological efficacy of robotic surgery compared to endoscopic and conventional approaches for different thyroid procedures. Methods. A systematic search of the online data bases was done using the following (MeSH) terms “robotic surgery,” “robotic thyroidectomy,” “robot-assisted thyroidectomy,” and “robot-assisted thyroid surgery.” Outcomes measured included total operative time, length of hospital stay, postoperative thyroglobulin levels, and postoperative complications. Statistical differences were analyzed between groups through the standard means and/or relative risk by using STATA analytical software. Results. In this study, 144 articles were identified; of which 18 of them met our inclusion criteria, totaling 4878 patients. Robotic approach was associated with longer total operative time (mean difference of 43.5 minutes) when compared to the conventional cervical approach (95% CI = 20.9-66.2; P < .001). Robotic approach was also found to have a similar risk of total postoperative complications when compared to the conventional and endoscopic approaches. Conclusion. Robotic thyroid surgery is as safe, feasible and provides similar periperative complications and oncological outcomes when compared to both, conventional cervical and endoscopic approaches. However, robotic thyroid surgery is associated with longer operative time when compared to the conventional open approach.

Alternate incision-site thyroidectomy

Purpose of review Thyroid surgery has evolved throughout the years, from being one of the riskiest surgeries into one of the safest surgical procedures performed today. Recent technologic innovations have allowed surgeons to remove the thyroid gland from a remote site while avoiding visible neck scars. This article aims to provide the reader with an overview of the current alternate-site approaches used and their capability to assist the surgeons in accomplishing remote-access thyroid surgery. Recent findings There are many described endoscopic approaches for thyroid surgery. The most common cervical approach is the minimally invasive gasless video-assisted cervical technique. The robotic transaxillary, retroauricular, and axillary breast approaches avoid a neck scar and are becoming popular. Summary A number of surgeons today have adapted new surgical techniques for thyroid surgery. Even though conventional thyroidectomy remains in the gold standard for thyroidectomy with low morbidity and excellent outcomes, minimally invasive and remote-access techniques have been used in an attempt to avoid visible neck scars without compromising patients’ safety and the effectiveness of the procedure.

Safety of same-day thyroidectomy: Meta-analysis and systematic review

BACKGROUND Performance of thyroid surgery as a same day surgery procedure has been a controversial topic. This study aimed to compare the safety and efficacy of outpatient thyroid surgery with inpatient thyroid surgery by meta-analysis of current literature. METHODS Articles were identified from the following keyword searches: outpatient thyroidectomy/thyroid surgery, same day thyroidectomy/thyroid surgery. Outcomes included perioperative complications including recurrent laryngeal nerve (RLN) injury, hypocalcemia, and readmissions. Data were extracted following review of appropriate studies by authors and random effects models were used. RESULTS 34 potentially relevant publications were identified and 14 studies fulfilled the predetermined inclusion criteria, totaling 10,478 patients, 4,565 of whom were discharged the same day following thyroid surgery. There was no difference in malignancy rate between the two groups (95% CI, 0.84-2.31; P=0.196). Inpatient group were 2.23 times (95% CI, 1.36-3.36; P=0.001) more likely to develop transient RLN injury and 2.32 times (95% CI, 1.06-5.06; P=0.034) more likely to have documented transient hypocalcemia compared to outpatients. Inpatient groups were 2.10 times (95% CI, 1.33-3.33; P=0.002) more likely to have documented other complications. The two groups also had similar readmission rates (95% CI, 0.71-1.41; P=1.000). CONCLUSIONS Our meta-analysis suggests that discharging selective patients the same day after a thyroid surgery is as safe, feasible, and efficacious as admitting them for observation. Admitting patients after thyroid surgery is associated with higher reported risk of complications.

Different surgical approaches in parathyroid adenoma resections

Three patients were referred to our clinic for the management of a persistent symptomatic primary hyperparathyroidism. Pre-operative imageological localization revealed evidence of an adenoma. Here we are presenting three videos demonstrating the different surgical approaches of parathyroid adenoma resection, with the use of an intraoperative gamma probe and nerve monitoring.

Robotic Surgery in Otolaryngology: Endocrine

Over the last decade, robotic surgery has evolved from a medical curiosity, with anticipated potential to overcome the limitations of surgical endoscopy, to the favored procedure in several surgical specialties such as urology and gynecology. The application of robotic technology in head and neck endocrine surgery has recently expanded. Different approaches have lately been described that are intended to preserve the safety of these operations, while avoiding visible neck scars. This article aims to provide the reader with an overview of the current robotic approaches and their capability to assist surgeons in accomplishing remote-access thyroid and parathyroid surgery.