Thyroid surgery

'Daycase parathyroidectomy: Time to change the norm?' (2020)

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Type of publication:
Conference abstract

Author(s):
Chang J.; Neophytou C.; Howard E.; Houghton A.

Citation:
British Journal of Surgery; 2020; vol. 107 ; p. 37

Abstract:
Introduction: The most recent BAETs audit report of 2017 shows a surprisingly low rate of same-day discharge following parathyroidectomy (10%). In our unit we have developed a simple and safe protocol which allows same day discharge for almost all patients (95%). The 2017 BAETS report has 11,463 patients recorded for primary hyperparathyroidism. Following this simple protocol could save over 9,500 inpatient bed days.
Method(s): Demographics, histology, biochemistry and length of stay were identified for all patients undergoing parathyroidectomy for primary hyperparathyroidism between 01/01/2010 and 31/12/2019. Following surgery all patients were discharged on Calcichew D3 one tablet tds, with arrangements for serum calcium analysis and outpatient appointment at 7 and 10 days Results: We performed 264 parathyroid procedures during the study period. The cohort had a median age of 63 (range 15 – 90). Day-case procedures were carried out in 95% (n=249). 10 patients stayed 24 hours, 4 for 48 hours and 1 patient for 4 days (urgent parathyroidectomy following acute medical admission with symptomatic hypercalcaemia). 1 patient was admitted overnight for observation of bleeding wound (no return to theatre). The remainder were admitted for a mixture of social and anaesthetic reasons. 6 patients (2%) had 30 day morbidity: 2with symptoms of relative hypocalcaemia (not admitted), 1 patient with hypocalcaemia requiring intravenous calcium, 1 seroma, 1 patient presented with an exacerbation of COPD and 1 haematoma.
Conclusion(s): We have shown that same-day discharge after parathyroid surgery is safe and ought to become the norm in other units.

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Recurrent laryngeal nerve function after central neck dissection (2017)

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Type of publication:
Conference abstract

Author(s):
*Fussey J.; *El-Shunnar S.; *Spinou C.; *Hughes R.; *Ahsan F.

Citation:
European Journal of Surgical Oncology; Dec 2017; vol. 43 (no. 12); p. 2388-2389

Abstract:
It is generally accepted that central compartment neck dissection (CCND) improves locoregional recurrence rates in cases of known central compartment lymph node involvement, however the practice of prophylactic CCND is somewhat more controversial. It is often quoted anecdotally that the risk of damage to the recurrent laryngeal nerve is higher during CND than in thyroidectomy only. The aim of this study was to evaluate recurrent laryngeal nerve injury rates following CND in thyroid cancer patients. Prospectively collected data from three head and neck cancer centres was retrospectively analysed to identify patients who underwent CND with or without concurrent thyroid surgery over a three-year period. Fifty-eight patients underwent CND, 35 of which were bilateral. There were therefore 92 recurrent laryngeal nerves at risk. The temporary recurrent laryngeal nerve palsy rate was 2.2%, and the permanent palsy rate was 3.3%. All cases of permanent recurrent laryngeal palsy occurred in patients undergoing CND and total thyroidectomy for pT4 disease. Many factors can affect recurrent laryngeal nerve palsy rate following CND, including surgeon experience, tumour characteristics and extent of dissection. Our experience suggests that the risk to the nerve in CND is no higher than in standard thyroid surgery.

Current trends in head and neck surgery: Use of recurrent laryngeal nerve monitoring (RLNM) (2014)

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Type of publication:
Conference abstract

Author(s):
Babatola O., *Karamchandani D., *Ahsan S.F.

Citation:
International Journal of Surgery, November 2014, vol./is. 12/(S39)

Abstract:
Introduction: Aim is to understand the patterns of use of nerve monitoring in UK surgical practice. Methods: An electronic questionnaire was sent to the 434 members of the ENT-UK expert panel in 2012. 86 members (22.4%) of the panel identified themselves as having an interest or subspecialty related to thyroid surgery. The survey contained 8 questions on their current practice in thyroid or parathyroid surgery, their typical use of the recurrent laryngeal nerve stimulator and any patient selection criteria that they may have. Demographic data on the surgeon's year of gaining consultancy and number of procedures performed per annum was also obtained. Results: Of 100 respondents (23.04% response rate) of this panel, 50 of these surgeons performed thyroid and/or parathyroid surgery on a regular basis and the following results pertain to this group. 58.3% use the RLNS in almost all cases that they perform. A further 12.5% used it in fewer than half of their cases. 29.2% did not use the stimulator at all. Conclusions: Currently there appears to be no true consensus among the surgeons performing thyroid surgery on use of RLNS in thyroid surgery.

Link to more details or full-text:
http://www.journal-surgery.net/article/S1743-9191(14)00373-2/pdf