Pub Date : 2023-09-29DOI: 10.1089/ve.2023.0012.correx
VideoEndocrinology™Ahead of Print Open AccessCorrection to: Vocal Cord Monitoring by Flexible Fiberoptic Laryngoscopy During Thyroid Radiofrequency Ablation Videoendocrinology 2023 10(3): pp. 41–43; doi: 10.1089/ve.2023.0012is erratum ofVocal Cord Monitoring by Flexible Fiberoptic Laryngoscopy During Thyroid Radiofrequency AblationPublished Online:29 Sep 2023https://doi.org/10.1089/ve.2023.0012.correxAboutSectionsPDF/EPUB Permissions & CitationsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail In the September 2023 issue of VideoEndocrinology (vol. 10, no. 3; pp. 41–43) the article entitled “Vocal Cord Monitoring by Flexible Fiberoptic Laryngoscopy During Thyroid Radiofrequency Ablation” by Valcavi R et al. requires correction.This article was originally published under the copyright of Mary Ann Liebert, Inc. publishers and American Thyroid Association. It has now been updated to reflect Open Access, with copyright transferring to the author(s), and a Creative Commons License (CC-BY) added (http://creativecommons.org/licenses/by/4.0). The CC-BY license goes into effect October 2, 2023.The online version of this article has been corrected to reflect this.FiguresReferencesRelatedDetailsRelated articlesVocal Cord Monitoring by Flexible Fiberoptic Laryngoscopy During Thyroid Radiofrequency Ablation25 Sep 2023VideoEndocrinology™ Volume 0Issue 0 InformationCopyright 2023, Mary Ann Liebert, Inc. and American Thyroid AssociationTo cite this article:Correction to: Vocal Cord Monitoring by Flexible Fiberoptic Laryngoscopy During Thyroid Radiofrequency Ablation Videoendocrinology 2023 10(3): pp. 41–43; doi: 10.1089/ve.2023.0012.VideoEndocrinology™.ahead of printhttp://doi.org/10.1089/ve.2023.0012.correxcreative commons licenseOnline Ahead of Print:September 29, 2023PDF download
VideoEndocrinology™提前打印开放访问纠正:声带监测柔性纤维喉镜在甲状腺射频消融视频内分泌202310 (3):pp. 41-43;doi: 10.1089/ve.2023.0012is在甲状腺射频消融过程中使用柔性光纤喉镜监测声带的错误发表在线:2023年9月29日https://doi.org/10.1089/ve.2023.0012.correxAboutSectionsPDF/EPUB权限和引用下载CitationsTrack CitationsAdd to favorites Back to Publication分享分享在facebook上推特链接在redditemail在2023年9月的视频内分泌(卷10,no. 10)。3;Valcavi R等人发表的题为“甲状腺射频消融术中使用柔性光纤喉镜监测声带”的文章需要纠正。本文最初由Mary Ann Liebert, Inc.出版商和美国甲状腺协会版权所有。它现在已经更新，以反映开放获取，版权转让给作者，并添加了创作共用许可证(CC-BY) (http://creativecommons.org/licenses/by/4.0)。CC-BY许可证将于2023年10月2日生效。为了反映这一点，本文的在线版本已经进行了更正。图参考资料相关细节相关文章柔性光纤喉镜在甲状腺射频消融期间的声带监测视频内分泌学™卷0期0信息版权所有2023,Mary Ann Liebert, Inc.和美国甲状腺协会引用这篇文章:修正:柔性光纤喉镜在甲状腺射频消融期间的声带监测视频内分泌学2023 10(3):41-43页;doi: 10.1089 / ve.2023.0012.VideoEndocrinology™。提前打印://doi.org/10.1089/ve.2023.0012.correxcreative commons licenseOnline提前打印:2023年9月29日pdf下载
{"title":"<i>Correction to:</i> Vocal Cord Monitoring by Flexible Fiberoptic Laryngoscopy During Thyroid Radiofrequency Ablation <i>Videoendocrinology</i> 2023 10(3): pp. 41–43; doi: 10.1089/ve.2023.0012","authors":"","doi":"10.1089/ve.2023.0012.correx","DOIUrl":"https://doi.org/10.1089/ve.2023.0012.correx","url":null,"abstract":"VideoEndocrinology™Ahead of Print Open AccessCorrection to: Vocal Cord Monitoring by Flexible Fiberoptic Laryngoscopy During Thyroid Radiofrequency Ablation Videoendocrinology 2023 10(3): pp. 41–43; doi: 10.1089/ve.2023.0012is erratum ofVocal Cord Monitoring by Flexible Fiberoptic Laryngoscopy During Thyroid Radiofrequency AblationPublished Online:29 Sep 2023https://doi.org/10.1089/ve.2023.0012.correxAboutSectionsPDF/EPUB Permissions & CitationsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail In the September 2023 issue of VideoEndocrinology (vol. 10, no. 3; pp. 41–43) the article entitled “Vocal Cord Monitoring by Flexible Fiberoptic Laryngoscopy During Thyroid Radiofrequency Ablation” by Valcavi R et al. requires correction.This article was originally published under the copyright of Mary Ann Liebert, Inc. publishers and American Thyroid Association. It has now been updated to reflect Open Access, with copyright transferring to the author(s), and a Creative Commons License (CC-BY) added (http://creativecommons.org/licenses/by/4.0). The CC-BY license goes into effect October 2, 2023.The online version of this article has been corrected to reflect this.FiguresReferencesRelatedDetailsRelated articlesVocal Cord Monitoring by Flexible Fiberoptic Laryngoscopy During Thyroid Radiofrequency Ablation25 Sep 2023VideoEndocrinology™ Volume 0Issue 0 InformationCopyright 2023, Mary Ann Liebert, Inc. and American Thyroid AssociationTo cite this article:Correction to: Vocal Cord Monitoring by Flexible Fiberoptic Laryngoscopy During Thyroid Radiofrequency Ablation Videoendocrinology 2023 10(3): pp. 41–43; doi: 10.1089/ve.2023.0012.VideoEndocrinology™.ahead of printhttp://doi.org/10.1089/ve.2023.0012.correxcreative commons licenseOnline Ahead of Print:September 29, 2023PDF download","PeriodicalId":75302,"journal":{"name":"VideoEndocrinology","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135247851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-25eCollection Date: 2023-09-01DOI: 10.1089/ve.2023.0012
Roberto Valcavi, Francesca Gaino, Roberto Novizio, Giuseppe Mercante
Introduction: Thermal injury to recurrent laryngeal nerve (RLN) during radiofrequency ablation (RFA) can produce temporary or permanent vocal cord paralysis.1 Hydrodissection with cold 5% glucose of "danger triangle" protects RLN during RFA.2 When RFA is performed under local anesthesia, RLN function is monitored by patients producing vocal sounds.3 Large lesions requiring longer RFAs warrant general sedation where voice cannot be assessed, therefore, an additional technique for RLN protection is advisable. Observation of passive symmetrical vocal cord movements during breathing by laryngeal ultrasonography is useful in assessing vocal cord function4; however, flexible-fiberoptic fibrolaringoscopy (FFL) is gold standard for assessing vocal cord movements,5 anticipating potential RLN damage. We report FFL monitoring during RFA under general sedation on a large thyroid nodule. FFL during RFA may detect RLN irritation and dysfunction if asymmetry in passive vocal cord movements is noted. Should asymmetry appear, RFA operator stops delivering energy and repositions electrode needle. Materials and Methods: Thyroid function tests, blood glucose, creatinine, transaminase, International-Normalized-Ratio, and electrocardiogram were performed. Operating room (OR) layout created sufficient space for ear-nose-throat (ENT) and RFA operators. An examination with a fiberscope camera demonstrated normal vocal cord adduction during phonation and abduction during breathing. The procedure was assisted by an anesthetist administering fentanyl 50 mcg, midazolam 1.5 to 5.0 mg, and propofol infusion 2 mg/(kg·h). General sedation was conducted so that reflexes were attenuated but still observable. Incorporating in OR by an anesthetist who performs general sedation reduces side effects and complications.6 Ultrasonography showed a 34-mL right lobe nodule abutting on the RLN area. After sedation with propofol, the ENT specialist inserted an endoscope until the glottic plane. During calm breathing, vocal cords moved symmetrically. After obtaining anterior nodule hydrodissection from strap and sternocleidomastoid muscles with 10 mL of 2% lidocaine, posterior hydrodissection was achieved by ultrasound-guided administration of 30 mL of 5% cold glucose. Anterior and posterior hydrodissections merged, separating nodule from neck structures. The radiofrequency electrode needle was then inserted into the nodule, initially positioned in inferior nodule portion adjacent to danger triangle previously isolated by hydrodissection. Initial power was 30 watts. Moving-shot technique was used. Results: FFL was performed throughout thyroid RFA. Symmetric vocal cord movements during breathing demonstrated no RLN irritation. FFL monitoring allowed observation of natural reflexive phenomena, including swallowing. Complete nodule ablation was achieved. FFL performed post-RFA confirm
引言：射频消融术（RFA）对喉返神经（RLN）的热损伤可导致暂时性或永久性声带麻痹。1用“危险三角形”的5%冷葡萄糖进行水解剖可在RFA期间保护RLN。2在局部麻醉下进行RFA时，RLN功能由发出声音的患者监测。3需要较长RFA的大型病变需要在无法评估声音的情况下进行全身镇静，因此，建议采用额外的RLN保护技术。喉部超声观察呼吸过程中被动对称的声带运动有助于评估声带功能4；然而，柔性纤维光学纤维喉镜（FFL）是评估声带运动的黄金标准，5可预测潜在的RLN损伤。我们报告了一个大型甲状腺结节在全身镇静下RFA期间的FFL监测。如果注意到被动声带运动的不对称性，RFA过程中的FFL可能检测到RLN刺激和功能障碍。如果出现不对称，RFA操作员停止输送能量并重新定位电极针。材料和方法：进行甲状腺功能测试、血糖、肌酐、转氨酶、国际标准化比值和心电图。手术室（OR）的布局为耳鼻咽喉（ENT）和RFA操作员创造了足够的空间。纤维镜检查显示发音时声带内收正常，呼吸时声带外展正常。麻醉师给药芬太尼50，协助手术 mcg，咪达唑仑1.5至5.0 mg和丙泊酚输注2 mg/（kg·h）。进行全身镇静，使反射减弱，但仍可观察到。由执行全身镇静的麻醉师纳入手术室可以减少副作用和并发症。6超声检查显示，RLN区域有一个34mL的右叶结节。在丙泊酚镇静后，耳鼻喉科专家插入内窥镜，直到声门平面。在平静的呼吸过程中，声带对称运动。在用10 mL 2%利多卡因，通过超声引导给予30 mL的5%冷葡萄糖。前部和后部的水分离融合，将结节与颈部结构分离。然后将射频电极针插入结节，最初定位在邻近先前通过水分离隔离的危险三角形的下结节部分。初始功率为30 瓦特。采用了移动射击技术。结果：在整个甲状腺RFA中进行了FFL。呼吸过程中对称的声带运动没有显示RLN刺激。FFL监测允许观察自然反射现象，包括吞咽。结节完全消融。RFA后进行的FFL证实声带运动正常。结论：我们报告了首次在RFA期间使用FFL进行声带监测。耳鼻喉科专家很容易进行FFL，患者耐受性良好。避免危险三角形和精确的RFA针定位是防止RLN损伤的关键。如果不能完全消融，良性结节会再生7，一些作者提出了额外的手术来完成消融8，这显然会增加成本。全RFA结节消融辅助FFL监测消除了重复RFA的需要，从而降低了整体治疗成本。最后，FFL监测不会延长程序，因为它与RFA同时进行。FFL是一种有效的技术，当与水分离结合使用时，可以进一步防止RFA过程中RLN的热损伤，特别适用于大型甲状腺结节消融和专业语音用户。患者同意和许可：患者提供了FFL监测的书面同意书，并允许在RFA期间使用他的肖像和超声图像。该研究是根据2013年修订的《赫尔辛基宣言》完成的。同意遵守机构审查委员会的协议。免责声明：视频中任何仪器的表示并不表明出版商、美国甲状腺协会或作者对该产品和/或公司的任何认可。不存在相互竞争的金融利益。视频运行时间：9 分钟39 秒。
{"title":"Vocal Cord Monitoring by Flexible Fiberoptic Laryngoscopy During Thyroid Radiofrequency Ablation.","authors":"Roberto Valcavi, Francesca Gaino, Roberto Novizio, Giuseppe Mercante","doi":"10.1089/ve.2023.0012","DOIUrl":"10.1089/ve.2023.0012","url":null,"abstract":"<p><p><b><i>Introduction:</i></b> Thermal injury to recurrent laryngeal nerve (RLN) during radiofrequency ablation (RFA) can produce temporary or permanent vocal cord paralysis.<sup>1</sup> Hydrodissection with cold 5% glucose of \"danger triangle\" protects RLN during RFA.<sup>2</sup> When RFA is performed under local anesthesia, RLN function is monitored by patients producing vocal sounds.<sup>3</sup> Large lesions requiring longer RFAs warrant general sedation where voice cannot be assessed, therefore, an additional technique for RLN protection is advisable. Observation of passive symmetrical vocal cord movements during breathing by laryngeal ultrasonography is useful in assessing vocal cord function<sup>4</sup>; however, flexible-fiberoptic fibrolaringoscopy (FFL) is gold standard for assessing vocal cord movements,<sup>5</sup> anticipating potential RLN damage. We report FFL monitoring during RFA under general sedation on a large thyroid nodule. FFL during RFA may detect RLN irritation and dysfunction if asymmetry in passive vocal cord movements is noted. Should asymmetry appear, RFA operator stops delivering energy and repositions electrode needle. <b><i>Materials and Methods:</i></b> Thyroid function tests, blood glucose, creatinine, transaminase, International-Normalized-Ratio, and electrocardiogram were performed. Operating room (OR) layout created sufficient space for ear-nose-throat (ENT) and RFA operators. An examination with a fiberscope camera demonstrated normal vocal cord adduction during phonation and abduction during breathing. The procedure was assisted by an anesthetist administering fentanyl 50 mcg, midazolam 1.5 to 5.0 mg, and propofol infusion 2 mg/(kg·h). General sedation was conducted so that reflexes were attenuated but still observable. Incorporating in OR by an anesthetist who performs general sedation reduces side effects and complications.<sup>6</sup> Ultrasonography showed a 34-mL right lobe nodule abutting on the RLN area. After sedation with propofol, the ENT specialist inserted an endoscope until the glottic plane. During calm breathing, vocal cords moved symmetrically. After obtaining anterior nodule hydrodissection from strap and sternocleidomastoid muscles with 10 mL of 2% lidocaine, posterior hydrodissection was achieved by ultrasound-guided administration of 30 mL of 5% cold glucose. Anterior and posterior hydrodissections merged, separating nodule from neck structures. The radiofrequency electrode needle was then inserted into the nodule, initially positioned in inferior nodule portion adjacent to danger triangle previously isolated by hydrodissection. Initial power was 30 watts. Moving-shot technique was used. <b><i>Results:</i></b> FFL was performed throughout thyroid RFA. Symmetric vocal cord movements during breathing demonstrated no RLN irritation. FFL monitoring allowed observation of natural reflexive phenomena, including swallowing. Complete nodule ablation was achieved. FFL performed post-RFA confirm","PeriodicalId":75302,"journal":{"name":"VideoEndocrinology","volume":"10 3","pages":"41-43"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10551754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41165338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Transoral endoscopic thyroidectomy vestibular approach is the new endoscopic approach to the thyroid. Several attempts to use the advantage of endoscopes today and improve thyroidectomy have been tried for decades. Each approach has its own peculiarities, from displacing the anterior neck scar to a less conspicuous location to unilateral approaches, longer dissection, and longer learning curves to new complications. The benefits of these new approaches still lack robust data, and time will be proof of the merit of those. No competing financial interests exist. Runtime of video: 9 mins 15 secs
{"title":"Advantages of a Conventional Thyroidectomy Approach","authors":"David Goldenberg","doi":"10.1089/ve.2023.0030","DOIUrl":"https://doi.org/10.1089/ve.2023.0030","url":null,"abstract":"Transoral endoscopic thyroidectomy vestibular approach is the new endoscopic approach to the thyroid. Several attempts to use the advantage of endoscopes today and improve thyroidectomy have been tried for decades. Each approach has its own peculiarities, from displacing the anterior neck scar to a less conspicuous location to unilateral approaches, longer dissection, and longer learning curves to new complications. The benefits of these new approaches still lack robust data, and time will be proof of the merit of those. No competing financial interests exist. Runtime of video: 9 mins 15 secs","PeriodicalId":75302,"journal":{"name":"VideoEndocrinology","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134918412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Thyroid hormone, in some form, has been in use for the treatment of hypothyroidism since at least the 15th century. Although thyroid hormone therapy plays an essential role in the management of hypothyroidism, it has also been misused for more dubious indications. Materials and Methods: Authors performed a search of PubMed, the American Thyroid Association (ATA) website, to include the Thyroid History Timeline that is part of the Clark T. Sawin History Resource Center, and a general internet search to identify publications and internet postings relevant to the use and abuse of thyroid hormone. Results: Documented examples of various treatments for goiter and hypothyroidism extend back to 2700 BC when seaweed was used for the treatment of goiter. In 1475, Wang Hei, a Chinese physician, reported the use of minced thyroid as a treatment for goiter. In 1891, Dr. Murray introduced the use of thyroid extract as a therapy for myxedema. Edward Kendall, PhD, at Mayo Clinic went on to isolate thyroxine in 1914 with it becoming commercially available by 1917. T3 was later isolated by Rosalind Pitt-Rivers, PhD, and Dr. Jack Gross in 1953 becoming clinically available in 1956. Various other thyroid hormone analogues, such as D-T4 and TRIAC, later became available as well. In the late 19th century, Dr. Brown-Séquard published self-experiments on the use of gland extracts as a means to improve health and restore vitality in older age. The growing indiscriminate use of various gland extracts for dubious indications led to Dr. Edward Rynearson coining the phrase “Endocriminology,” a term further popularized by Dr. Harvey Cushing as to highlight the concern about misuse and abuse of available gland extracts. Desiccated thyroid gland extract began to be used not just for goiter and hypothyroidism but also for additional “indications” such as obesity, sterility, uterine bleeding, and even feeblemindedness to name a few. In 2013, a study of over-the-counter (OTC) supplements marketed for “thyroid support” found that 9 out of 10 products contained either active T4 and/or T3 with the majority containing clinically relevant amounts. The medical literature contains multiple reports of serious adverse outcomes from exposure to supraphysiologic quantities of thyroid hormone contained in various OTC supplements. Unfortunately, the Dietary Supplement Health and Education Act of 1994 Public Law 103-417 by the 103rd Congress precludes the Food and Drug Administration (FDA) from proactively monitoring such products with the FDA only being able to act when problems are reported with a certain herb or supplement. Conclusion: Although thyroid hormone remains a cornerstone for the treatment of hypothyroidism, its misuse and abuse continue to be a source of concern. The ATA is continuing efforts to educate both health care providers and the public on the appropriate use of thyroid hormone and potential risks with its misuse. No competing financial interests exist. Vide
{"title":"The Use and Abuse of Thyroid Hormone","authors":"Victor J. Bernet, Anne R. Cappola","doi":"10.1089/ve.2023.0025","DOIUrl":"https://doi.org/10.1089/ve.2023.0025","url":null,"abstract":"Introduction: Thyroid hormone, in some form, has been in use for the treatment of hypothyroidism since at least the 15th century. Although thyroid hormone therapy plays an essential role in the management of hypothyroidism, it has also been misused for more dubious indications. Materials and Methods: Authors performed a search of PubMed, the American Thyroid Association (ATA) website, to include the Thyroid History Timeline that is part of the Clark T. Sawin History Resource Center, and a general internet search to identify publications and internet postings relevant to the use and abuse of thyroid hormone. Results: Documented examples of various treatments for goiter and hypothyroidism extend back to 2700 BC when seaweed was used for the treatment of goiter. In 1475, Wang Hei, a Chinese physician, reported the use of minced thyroid as a treatment for goiter. In 1891, Dr. Murray introduced the use of thyroid extract as a therapy for myxedema. Edward Kendall, PhD, at Mayo Clinic went on to isolate thyroxine in 1914 with it becoming commercially available by 1917. T3 was later isolated by Rosalind Pitt-Rivers, PhD, and Dr. Jack Gross in 1953 becoming clinically available in 1956. Various other thyroid hormone analogues, such as D-T4 and TRIAC, later became available as well. In the late 19th century, Dr. Brown-Séquard published self-experiments on the use of gland extracts as a means to improve health and restore vitality in older age. The growing indiscriminate use of various gland extracts for dubious indications led to Dr. Edward Rynearson coining the phrase “Endocriminology,” a term further popularized by Dr. Harvey Cushing as to highlight the concern about misuse and abuse of available gland extracts. Desiccated thyroid gland extract began to be used not just for goiter and hypothyroidism but also for additional “indications” such as obesity, sterility, uterine bleeding, and even feeblemindedness to name a few. In 2013, a study of over-the-counter (OTC) supplements marketed for “thyroid support” found that 9 out of 10 products contained either active T4 and/or T3 with the majority containing clinically relevant amounts. The medical literature contains multiple reports of serious adverse outcomes from exposure to supraphysiologic quantities of thyroid hormone contained in various OTC supplements. Unfortunately, the Dietary Supplement Health and Education Act of 1994 Public Law 103-417 by the 103rd Congress precludes the Food and Drug Administration (FDA) from proactively monitoring such products with the FDA only being able to act when problems are reported with a certain herb or supplement. Conclusion: Although thyroid hormone remains a cornerstone for the treatment of hypothyroidism, its misuse and abuse continue to be a source of concern. The ATA is continuing efforts to educate both health care providers and the public on the appropriate use of thyroid hormone and potential risks with its misuse. No competing financial interests exist. Vide","PeriodicalId":75302,"journal":{"name":"VideoEndocrinology","volume":"75 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134918404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Transoral endoscopic thyroidectomy vestibular approach (TOETVA) emerges as a minimally invasive surgery. Its trajectory since inception has been marked by a steady rise in publications, slightly curtailed by the COVID-19 pandemic. This surge bears testament to scholars' interest in this transformative technique. Initial studies of TOETVA showcased its safety and comparability with existing endoscopic methods. Notably, early complications, typical in pioneering endeavors, such as bruising, skin burns, and perforations, were documented. Anuong's comprehensive assessment of >200 TOETVA cases against open surgery illuminated intriguing parallels in complications and hospital stays, albeit with prolonged operative times and reduced postoperative pain. In subsequent studies with a cohort of 200 cases, TOETVA's statistical analyses showcased its risk parity with the transcervical approach, irrespective of variables such as gender, cancer, or Graves' status. The statistical outlier lay in the prolonged operative time for TOETVA, a trade-off for its distinctive benefits. Global adoption was palpable in Li et al.'s compilation up to 2022.1 This worldwide embrace was mirrored in the Brazilian experience, as numerous groups documented their journey, from initiation in a low-income setting to traversing the learning curve while safeguarding patient safety. Optical augmentation took center stage, from magnifying glasses amplifying surgeons' sight to robotic and endoscopic approaches boasting up to 10-fold optical zoom. The panorama extended into futuristic realms, as augmented reality and artificial intelligence promised to reshape thyroid surgery. Augmented reality platforms envisioned predicting parathyroids, nerves, and lymph nodes. Artificial intelligence offered real-time guidance, from shortening learning curves to identifying critical structures. In conclusion, TOETVA's adoption stands affirmed and resonates globally. Aesthetic concerns reconcile diverse populations. Magnification transcends optics, whereas robotic platforms enrich the endoscopic landscape. This landscape lays a foundation for future technologies. No competing financial interests exist. No funding was received for this article. Runtime of video: 10 mins 54 secs
{"title":"Advantages of TOETVA: A Remote Access Approach","authors":"Leonardo Guimarães Rangel","doi":"10.1089/ve.2023.0026","DOIUrl":"https://doi.org/10.1089/ve.2023.0026","url":null,"abstract":"Transoral endoscopic thyroidectomy vestibular approach (TOETVA) emerges as a minimally invasive surgery. Its trajectory since inception has been marked by a steady rise in publications, slightly curtailed by the COVID-19 pandemic. This surge bears testament to scholars' interest in this transformative technique. Initial studies of TOETVA showcased its safety and comparability with existing endoscopic methods. Notably, early complications, typical in pioneering endeavors, such as bruising, skin burns, and perforations, were documented. Anuong's comprehensive assessment of >200 TOETVA cases against open surgery illuminated intriguing parallels in complications and hospital stays, albeit with prolonged operative times and reduced postoperative pain. In subsequent studies with a cohort of 200 cases, TOETVA's statistical analyses showcased its risk parity with the transcervical approach, irrespective of variables such as gender, cancer, or Graves' status. The statistical outlier lay in the prolonged operative time for TOETVA, a trade-off for its distinctive benefits. Global adoption was palpable in Li et al.'s compilation up to 2022.1 This worldwide embrace was mirrored in the Brazilian experience, as numerous groups documented their journey, from initiation in a low-income setting to traversing the learning curve while safeguarding patient safety. Optical augmentation took center stage, from magnifying glasses amplifying surgeons' sight to robotic and endoscopic approaches boasting up to 10-fold optical zoom. The panorama extended into futuristic realms, as augmented reality and artificial intelligence promised to reshape thyroid surgery. Augmented reality platforms envisioned predicting parathyroids, nerves, and lymph nodes. Artificial intelligence offered real-time guidance, from shortening learning curves to identifying critical structures. In conclusion, TOETVA's adoption stands affirmed and resonates globally. Aesthetic concerns reconcile diverse populations. Magnification transcends optics, whereas robotic platforms enrich the endoscopic landscape. This landscape lays a foundation for future technologies. No competing financial interests exist. No funding was received for this article. Runtime of video: 10 mins 54 secs","PeriodicalId":75302,"journal":{"name":"VideoEndocrinology","volume":"9 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134918403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Danielle A. Kapustin, Jun Yun, Vivian Su, Samuel J. Rubin, Daniel G. Nicastri, Raja M. Flores, Mark L. Urken
Introduction: Approximately 4% of thyroid cancer patients present with bone metastases.1 Only 18.3% of those patients present with metastases to the thorax (rib and sternum).2,3 Bony metastases often correlate with increased morbidity and decreased overall survival.4 Therefore, multimodality treatment including surgical resection is often warranted. This study includes a video demonstration of a subtotal sternectomy for metastatic differentiated thyroid carcinoma and reconstruction using a composite methylmethacrylate and Prolene mesh covered with a pedicled latissimus dorsi flap. Materials and Methods: A 70-year-old woman presented with a 6.7-cm lesion involving the manubrium and sternal body. Informed consent was obtained. Her medical history included bilateral mastectomies with implant reconstruction for ductal carcinoma (2014) and a right thyroid lobectomy for a presumptive benign thyroid adenoma (2015). The right thyroid was removed with pathology analysis demonstrating recurrent well-differentiated thyroid carcinoma with features of both follicular thyroid carcinoma and follicular variant papillary thyroid carcinoma. In addition to the changes to the sternum, imaging showed a 1.4-cm nodular enhancing lesion in the right hemithyroidectomy bed. On positron emission tomography/CT, the sternal mass was intensely fluorodeoxyglucose avid. There was no evidence of additional distant metastases. Sternal biopsy demonstrated BRAF V600E positive metastatic follicular thyroid cancer. Results: This case was discussed at multidisciplinary tumor board, and consensus was for upfront surgical resection with likely adjuvant therapy. External beam radiation and radioactive iodine (RAI) therapy were recommended with possible administration of BRAF V600E inhibitors in the event of the development of an unresectable recurrence or progressive distant metastases. The patient underwent a left completion thyroidectomy to facilitate RAI, a right thyroidectomy bed mass excision, and a subtotal sternectomy extending below the fourth rib. Posterior margins of the sternal mass were positive, and the anterior margin was at risk with a clearance of 1 mm. The remainder of the margins was clear. Reconstruction was performed with methylmethacrylate and Prolene mesh, and a pedicled latissimus dorsi flap was used to cover the composite reconstruction. The patient began adjuvant proton beam radiation therapy to the sternum and anterior chest wall ~4 months later, with plans to undergo RAI. Overall, patients do well after a latissimus dorsi pedicled flap with minimal morbidity. A systematic review of donor site morbidity after latissimus dorsi flap (both pedicled and free flap) including 729 cases demonstrated little difficulty in daily activities after surgery but significant difficulty in participating in sports and art activities.5 Eight of 12 articles reported some shoulder strength weakness over time—shoulder extension, adduction, and internal rotation were commonly involved
{"title":"Subtotal Sternectomy with Reconstruction for Metastatic Thyroid Carcinoma","authors":"Danielle A. Kapustin, Jun Yun, Vivian Su, Samuel J. Rubin, Daniel G. Nicastri, Raja M. Flores, Mark L. Urken","doi":"10.1089/ve.2023.0017","DOIUrl":"https://doi.org/10.1089/ve.2023.0017","url":null,"abstract":"Introduction: Approximately 4% of thyroid cancer patients present with bone metastases.1 Only 18.3% of those patients present with metastases to the thorax (rib and sternum).2,3 Bony metastases often correlate with increased morbidity and decreased overall survival.4 Therefore, multimodality treatment including surgical resection is often warranted. This study includes a video demonstration of a subtotal sternectomy for metastatic differentiated thyroid carcinoma and reconstruction using a composite methylmethacrylate and Prolene mesh covered with a pedicled latissimus dorsi flap. Materials and Methods: A 70-year-old woman presented with a 6.7-cm lesion involving the manubrium and sternal body. Informed consent was obtained. Her medical history included bilateral mastectomies with implant reconstruction for ductal carcinoma (2014) and a right thyroid lobectomy for a presumptive benign thyroid adenoma (2015). The right thyroid was removed with pathology analysis demonstrating recurrent well-differentiated thyroid carcinoma with features of both follicular thyroid carcinoma and follicular variant papillary thyroid carcinoma. In addition to the changes to the sternum, imaging showed a 1.4-cm nodular enhancing lesion in the right hemithyroidectomy bed. On positron emission tomography/CT, the sternal mass was intensely fluorodeoxyglucose avid. There was no evidence of additional distant metastases. Sternal biopsy demonstrated BRAF V600E positive metastatic follicular thyroid cancer. Results: This case was discussed at multidisciplinary tumor board, and consensus was for upfront surgical resection with likely adjuvant therapy. External beam radiation and radioactive iodine (RAI) therapy were recommended with possible administration of BRAF V600E inhibitors in the event of the development of an unresectable recurrence or progressive distant metastases. The patient underwent a left completion thyroidectomy to facilitate RAI, a right thyroidectomy bed mass excision, and a subtotal sternectomy extending below the fourth rib. Posterior margins of the sternal mass were positive, and the anterior margin was at risk with a clearance of 1 mm. The remainder of the margins was clear. Reconstruction was performed with methylmethacrylate and Prolene mesh, and a pedicled latissimus dorsi flap was used to cover the composite reconstruction. The patient began adjuvant proton beam radiation therapy to the sternum and anterior chest wall ~4 months later, with plans to undergo RAI. Overall, patients do well after a latissimus dorsi pedicled flap with minimal morbidity. A systematic review of donor site morbidity after latissimus dorsi flap (both pedicled and free flap) including 729 cases demonstrated little difficulty in daily activities after surgery but significant difficulty in participating in sports and art activities.5 Eight of 12 articles reported some shoulder strength weakness over time—shoulder extension, adduction, and internal rotation were commonly involved","PeriodicalId":75302,"journal":{"name":"VideoEndocrinology","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134918409","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Prior to the twentieth century, thyroid surgery was regarded as “horrid butchery” such that “no honest and sensible surgeon would ever engage in it.”1 Yet by the mid- twentieth century, thyroidectomy had become a respected, life-saving, safe, and increasingly practiced operation. From Kocher to Wells and onward into the twenty-first century, the evolution of thyroid surgery has continued, enhanced by the integration of endocrinology, genetics, immunology, physiology, technology, training, and multidisciplinary care. The ability to personalize and optimize the care of thyroid disorders has been progressively achieved through shared insights and discoveries, highlights of which are described herein. No competing financial interests exist. No funding was received for this article. Runtime of video: 10 mins
{"title":"History of Thyroid Surgery in the Last Century","authors":"Lisa Orloff","doi":"10.1089/ve.2023.0006","DOIUrl":"https://doi.org/10.1089/ve.2023.0006","url":null,"abstract":"Prior to the twentieth century, thyroid surgery was regarded as “horrid butchery” such that “no honest and sensible surgeon would ever engage in it.”1 Yet by the mid- twentieth century, thyroidectomy had become a respected, life-saving, safe, and increasingly practiced operation. From Kocher to Wells and onward into the twenty-first century, the evolution of thyroid surgery has continued, enhanced by the integration of endocrinology, genetics, immunology, physiology, technology, training, and multidisciplinary care. The ability to personalize and optimize the care of thyroid disorders has been progressively achieved through shared insights and discoveries, highlights of which are described herein. No competing financial interests exist. No funding was received for this article. Runtime of video: 10 mins","PeriodicalId":75302,"journal":{"name":"VideoEndocrinology","volume":"144 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134918405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dr. Woody Sistrunk interviews Dr. Robert Levine regarding the invited Centennial Paper: History of Thyroid Ultrasound by Dr. Levine. They discuss the early development and progression of education in thyroid ultrasound and the resultant rapid increase in the diagnosis of thyroid nodules and papillary microcarcinoma. They further review efforts to decrease overdiagnosis by development of guidelines and by certification in endocrine neck ultrasound. They conclude with a discussion of how artificial intelligence using deep convolutional neural networks is likely to aid in the interpretation of thyroid ultrasound in the future. Video Interview Summary Example #1 - https://www.liebertpub.com/doi/10.1089/ve.2023.0004 Example #2 - https://www.liebertpub.com/doi/10.1089/ve.2022.0050 No competing financial interests exist. Runtime of video: 17 mins 15 secs
{"title":"History of Thyroid Ultrasound","authors":"Robert Levine, J. Woody Sistrunk","doi":"10.1089/ve.2023.0027","DOIUrl":"https://doi.org/10.1089/ve.2023.0027","url":null,"abstract":"Dr. Woody Sistrunk interviews Dr. Robert Levine regarding the invited Centennial Paper: History of Thyroid Ultrasound by Dr. Levine. They discuss the early development and progression of education in thyroid ultrasound and the resultant rapid increase in the diagnosis of thyroid nodules and papillary microcarcinoma. They further review efforts to decrease overdiagnosis by development of guidelines and by certification in endocrine neck ultrasound. They conclude with a discussion of how artificial intelligence using deep convolutional neural networks is likely to aid in the interpretation of thyroid ultrasound in the future. Video Interview Summary Example #1 - https://www.liebertpub.com/doi/10.1089/ve.2023.0004 Example #2 - https://www.liebertpub.com/doi/10.1089/ve.2022.0050 No competing financial interests exist. Runtime of video: 17 mins 15 secs","PeriodicalId":75302,"journal":{"name":"VideoEndocrinology","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134918408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The social media editors for Thyroid, Dr. Trevor Angell, and for VideoEndocrinology, Dr. James Wu, discuss Dr. Angeliki Chorti's latest article “Minimally invasive treatments of benign thyroid nodules: a network meta-analysis of short-term outcomes.” No competing financial interests exist. Runtime of video: 13 mins 56 secs
{"title":"Minimally Invasive Treatments for Thyroid Nodules","authors":"Trevor E. Angell, James Wu","doi":"10.1089/ve.2023.0028","DOIUrl":"https://doi.org/10.1089/ve.2023.0028","url":null,"abstract":"The social media editors for Thyroid, Dr. Trevor Angell, and for VideoEndocrinology, Dr. James Wu, discuss Dr. Angeliki Chorti's latest article “Minimally invasive treatments of benign thyroid nodules: a network meta-analysis of short-term outcomes.” No competing financial interests exist. Runtime of video: 13 mins 56 secs","PeriodicalId":75302,"journal":{"name":"VideoEndocrinology","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134918410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: In the original axillary approach described by Ikeda et al. with three points incisions, they began by accessing the central neck region by dissecting the sternocleidomastoid muscle (SCM) off from the sternohyoid muscle. Later this approach was modified by utilizing a gasless approach that is popularized worldwide. The central neck region was accessed directly by dissociation of the sternal and clavicular heads of the SCM. However, this procedure required a 5–6 cm incision and also place a special static retractor. We modified the conventional gasless transaxillary thyroidectomy procedure to a transaxillary gas insufflation approach with shorter incisions, and a smaller flap creation area. This video is aimed to describe the step-by-step procedure of a case of modified endoscopic transaxillary gas insufflation thyroidectomy (ETGT). Case: A 43-year-old woman with a body mass index of 29.6 kg/m2 was found to have a thyroid nodule during physical examination and experienced no tracheal compression or voice changes. However, ultrasonography and CT scan revealed a 1.3 cm nodule in the left lobe of the thyroid, and several enlarged lymph nodes were also identified on the left side of the central neck region. A thyroid biopsy revealed papillary thyroid carcinoma with a mutation in the BRAF gene. Results of all routine preoperative examinations of the patient were within normal ranges. Surgery was indicated and endoscopic transaxillary thyroidectomy plus central neck dissection was chosen. The surgery began with making three incisions of endoscopic portals in the axillary region. After that, the working space was made using an ultrasonic scalpel while running CO2 insufflation. The central neck region was accessed by dissociating the sternal and clavicular heads of the SCM. The sternal heads of SCM, strap muscles, and thyroid gland were lifted by a suture that was retracted by ribbon. The vessels and the thyroid gland around the central neck region were dissociated, and the recurrent laryngeal nerve and the parathyroid glands were protected from injury. The specimen was released from the trap muscle and removed. Results: The technical aspect of the ETGT procedure with a step-by-step description is demonstrated in this video. Conclusions: Thyroidectomy is feasible to be done by this novel transaxillary thyroidectomy procedure with the advantages of shorter incisions and smaller flap creation area than the conventional gasless endoscopic thyroidectomy procedure. Authors' Contributions: Y.L. designed the procedure, conducted procedure, did the operations, and wrote the article. S.C. and J.W. conducted the procedure, acquired data, and edited the video. G.C. conducted the procedure, did the operations, and revised the article. All authors revised and approved the article for publication. Ethical Approval: The data and all the patient's information were anonymous, so the requirement for informed consent and ethical approvement was waived by the eth
{"title":"Novel Endoscopic Transaxillary Gas Insufflation Approach Thyroidectomy Procedure","authors":"Yang Liu, Jiazhong Wang, Shuo Chen, Gang Cao","doi":"10.1089/ve.2023.0008","DOIUrl":"https://doi.org/10.1089/ve.2023.0008","url":null,"abstract":"Background: In the original axillary approach described by Ikeda et al. with three points incisions, they began by accessing the central neck region by dissecting the sternocleidomastoid muscle (SCM) off from the sternohyoid muscle. Later this approach was modified by utilizing a gasless approach that is popularized worldwide. The central neck region was accessed directly by dissociation of the sternal and clavicular heads of the SCM. However, this procedure required a 5–6 cm incision and also place a special static retractor. We modified the conventional gasless transaxillary thyroidectomy procedure to a transaxillary gas insufflation approach with shorter incisions, and a smaller flap creation area. This video is aimed to describe the step-by-step procedure of a case of modified endoscopic transaxillary gas insufflation thyroidectomy (ETGT). Case: A 43-year-old woman with a body mass index of 29.6 kg/m2 was found to have a thyroid nodule during physical examination and experienced no tracheal compression or voice changes. However, ultrasonography and CT scan revealed a 1.3 cm nodule in the left lobe of the thyroid, and several enlarged lymph nodes were also identified on the left side of the central neck region. A thyroid biopsy revealed papillary thyroid carcinoma with a mutation in the BRAF gene. Results of all routine preoperative examinations of the patient were within normal ranges. Surgery was indicated and endoscopic transaxillary thyroidectomy plus central neck dissection was chosen. The surgery began with making three incisions of endoscopic portals in the axillary region. After that, the working space was made using an ultrasonic scalpel while running CO2 insufflation. The central neck region was accessed by dissociating the sternal and clavicular heads of the SCM. The sternal heads of SCM, strap muscles, and thyroid gland were lifted by a suture that was retracted by ribbon. The vessels and the thyroid gland around the central neck region were dissociated, and the recurrent laryngeal nerve and the parathyroid glands were protected from injury. The specimen was released from the trap muscle and removed. Results: The technical aspect of the ETGT procedure with a step-by-step description is demonstrated in this video. Conclusions: Thyroidectomy is feasible to be done by this novel transaxillary thyroidectomy procedure with the advantages of shorter incisions and smaller flap creation area than the conventional gasless endoscopic thyroidectomy procedure. Authors' Contributions: Y.L. designed the procedure, conducted procedure, did the operations, and wrote the article. S.C. and J.W. conducted the procedure, acquired data, and edited the video. G.C. conducted the procedure, did the operations, and revised the article. All authors revised and approved the article for publication. Ethical Approval: The data and all the patient's information were anonymous, so the requirement for informed consent and ethical approvement was waived by the eth","PeriodicalId":75302,"journal":{"name":"VideoEndocrinology","volume":"82 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134918407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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