Journal of Laryngology and Otology最新文献

Objective: To compare perioperative and oncological outcomes between stapler and manual closure in patients undergoing total laryngectomy for advanced endolaryngeal squamous cell carcinoma.

Methods: Patients with advanced endolaryngeal tumours operated between July 2017 and July 2023 were retrospectively dichotomised into stapler closure and manual closure cohorts and compared.

Results: Seventy-one patients with a median age of 57 years were included in our study. The median surgical duration was 270 minutes for the manual closure cohort and 245 minutes for the stapler closure cohort. The pharyngo-cutaneous salivary fistula rate was 6 per cent less in the stapler closure cohort. The estimated mean survival was not significantly different 54.5 months (95 per cent, confidence interval 46.3-62.71) in the manual closure cohort versus 28.12 months (95 per cent, confidence interval 23.6-32.63) in the stapler closure cohort (p = 0.79).

Conclusion: Stapler closure can be used in endolaryngeal tumours, and it reduces operating time, thus facilitating efficient utilisation of operation time with non-inferior oncological outcomes as compared to traditional manual closure.

Objectives: To assess the value of corrected calcium decline at 6 hours as a predictor of hypocalcaemia post total thyroidectomy by comparing it to the currently widely used intact parathyroid hormone.

Methods: A retrospective cohort study of patients who underwent total thyroidectomy from January 2016 to February 2020. Serum intact parathyroid hormone and corrected calcium data pre-operatively and 6 hours post-operatively were obtained. Receiver operating characteristic curves were used to compare corrected calcium decline at 6 hours versus 6 hours for relative intact parathyroid hormone decline as predictors of hypocalcaemia, and the area under the curve for each metric was reported.

Results: Patients included in this analysis totalled 209. The receiver operating characteristic analysis suggested that corrected calcium decline at 6 hours has a similar predictive value to 6 hours relative intact parathyroid hormone. The areas under the curves for predicting hypocalcaemia were 0.797 for corrected calcium decline at 6 hours and 0.737 for 6 hours relative intact parathyroid hormone, but the difference (0.06) was not statistically significant.

Conclusions: Our results suggest that corrected calcium decline at 6 hours has a similar predictive value to 6 hours relative intact parathyroid hormone and hence has the potential to predict post-operative hypocalcaemia.

Objective: The healthcare industry is estimated to contribute 4.4 per cent of global greenhouse gas emissions. This pilot study aimed to investigate the impact of rationalising surgical instruments in tonsillectomy trays on greenhouse gas emissions and costs.

Method: We conducted a prospective observational study over a six-month period. All patients who underwent tonsillectomy were included. The instruments used during the procedure and their frequency of use were counted, with the operating surgeon being unaware of the study.

Results: During the 6-month timeframe, 46 tonsillectomies were performed. From the standard tonsillectomy tray containing 38 pieces, 9 pieces were never used. The removal of unused reusable instruments resulted in an estimated total reduction of 594 g of carbon dioxide equivalents and a saving of €9.63 per operation.

Conclusion: Rationalising the contents of the surgical instrument tray can have a positive environmental impact by reducing greenhouse gas emissions. There are also pecuniary benefits for the National Health Service because of the potential for cost savings.