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Preoperative Treatment with Lugol Solution for Graves' Disease
Özer Makay,Hui Sun,Ettore Caruso,Antonella Pino,Alessandro Pontin,Tommaso Mandolfino,Gianlorenzo Dionigi 대한갑상선-내분비외과학회 2019 The Koreran journal of Endocrine Surgery Vol.19 No.4
Graves' disease is one of the commonest causes of hyperthyroidism. Pre-treatment with Lugol solution, containing iodine/potassium iodide, to induce euthyroidism before surgery may be suggested, especially in case of adverse events due to antithyroid medication. Whether post-operative outcomes are any different following a course of Lugol solution in patient with Graves' disease is not well-documented in the literature. It is definite that large, prospective, randomized controlled trials of clinical and scientific are warranted to answer whether or not preparation with Lugol solution is necessary prior to surgery for Graves' disease.
Transoral Robotic Thyroidectomy: Description of the Surgical Technique in the Cadaveric Model
Özer Makay,Varlık Erol 대한갑상선-내분비외과학회 2018 The Koreran journal of Endocrine Surgery Vol.18 No.2
Purpose: Nowadays, minimally invasive surgical approach in thyroid surgery is getting more and more attention. The purpose of this report is to describe the surgical technique of transoral robotic thyroidectomy (TORT) in the cadaveric model which is the one of these minimally invasive methods. Methods: Transoral thyroidectomy through vestibular approach was performed on 67 year old lady fresh cadaveric model. The da Vinci Xi surgical system (Intuitive Surgical, Inc.) was used to complete TORT. Total thyroidectomy was successfully completed. Results: Total thyroidectomy was successfully completed and all vital structures (recurrent laryngeal nerves and parathyroid glands) were identified and preserved. Conclusion: TORT is a technique that can be successfully applied on the cadaver. We believe that this tecnique is an alternative approach in scarless thyroid surgery that can be safely applied to selected patients.
Venous Thromboembolism Following Thyroid Surgery
Özer Makay,Hui Sun,Alessandro Pontin,Ettore Caruso,Antonella Pino,Tommaso Mandolfino,Gianlorenzo Dionigi 대한갑상선-내분비외과학회 2019 The Koreran journal of Endocrine Surgery Vol.19 No.4
Venous thromboembolism is viewed as a serious health care issue. Patients who experience venous thromboembolism often have an detoriorated quality of life after the event that may require anticoagulation. This results to the risks of spontaneous bleeding. Bleeding after thyroid surgery can present acutely and can lead to airway compromise and death if not recognized and treated appropriately. Whether prophylaxis in a low-risk patient puts the patient at a greater risk of developing a bleeding complication is not well documented. The literature is scarce regarding the prevalence of venous thromboembolism following thyroid and parathyroid surgery.
Transoral Robotic Thyroidectomy: Description of the Surgical Technique in the Cadaveric Model
Özer Makay;Varlık Erol 대한갑상선-내분비외과학회 2018 The Koreran journal of Endocrine Surgery Vol.18 No.2
Purpose: Nowadays, minimally invasive surgical approach in thyroid surgery is getting more and more attention. The purpose of this report is to describe the surgical technique of transoral robotic thyroidectomy (TORT) in the cadaveric model which is the one of these minimally invasive methods. Methods: Transoral thyroidectomy through vestibular approach was performed on 67 year old lady fresh cadaveric model. The da Vinci Xi surgical system (Intuitive Surgical, Inc.) was used to complete TORT. Total thyroidectomy was successfully completed. Results: Total thyroidectomy was successfully completed and all vital structures (recurrent laryngeal nerves and parathyroid glands) were identified and preserved. Conclusion: TORT is a technique that can be successfully applied on the cadaver. We believe that this tecnique is an alternative approach in scarless thyroid surgery that can be safely applied to selected patients.
Omega-3 fatty acids inhibit oxidative stress in a rat model of liver regeneration
Ozgur Firat,Ozer Makay,Levent Yeniay,Goksel Gokce,Cigdem Yenisey,Ahmet Coker 대한외과학회 2017 Annals of Surgical Treatment and Research(ASRT) Vol.93 No.1
Purpose: Lipid peroxidation and consequent reactive oxygen species in the setting of oxidative stress have crucial roles in liver regeneration, which may adversely affect the regeneration itself and lead to liver failure. The aim of the current study is to investigate whether omega-3 fatty acid supplementation inhibits oxidative stress in an experimental model of liver regeneration. Methods: Forty rats were allocated to four groups. Rats in group A received a sham operation. Rats in group B were subjected to right portal vein ligation (RPVL) and saline infusion. Rats in groups C and D were subjected to RPVL and total parenteral nutrition (TPN) with an all-in-one admixture containing a soybean oil based lipid emulsion. Rats in group D were additionally supplemented with omega-3 fatty acid infusion. Oxidative stresses in the blood and liver were measured by glutathione, superoxide dismutase, catalase, glutathione peroxidase, malondialdehyde, and nitric oxide. Results: Omega-3 supplementation to the TPN solution significantly corrected alterations in the blood and tissue concentrations of oxidants and anti-oxidants during regeneration (P < 0.05). Conclusion: Omega-3 fatty acid supplementation to the TPN solution revealed promising results in removal of oxidative stress that emerges during liver regeneration.
Routine calcitonin measurement in nodular thyroid disease management: is it worthwhile?
Yigit Turk,Ozer Makay,Murat Ozdemir,Gozde Ertunc,Batuhan Demir,Gokhan Icoz,Mahir Akyildiz,Mustafa Yilmaz 대한외과학회 2017 Annals of Surgical Treatment and Research(ASRT) Vol.92 No.4
Purpose: To evaluate the diagnostic accuracy of routine calcitonin measurement in patients with nodular thyroid disease. Methods: Consecutive patients with nodular thyroid disease (n = 640) were studied. Serum calcitonin levels were measured under basal conditions, and when basal values were between 10–100 pg/mL, testing was repeated after pentagastrin (PG) stimulation. Patients with previously diagnosed or familial medullary thyroid cancer (MTC) were excluded. Patients were operated on when basal or stimulated calcitonin >100 pg/mL or when other surgical indications were present. Results: Four cases of MTC were identified. MTC was diagnosed in 75% of patients with basal calcitonin >100 pg/mL. One out of 11 patients with basal calcitonin between 10–100 pg/mL was diagnosed with MTC. PG stimulation resulted in elevation in 4 cases, where 1 case was diagnosed with MTC. Positive predictive value for basal calcitonin levels in the preoperative diagnosis of MTC was 5% for values between 10–100 pg/mL and 100% for values >100 pg/mL. Possible reasons for false positivity were papillary thyroid cancer in 17%, renal insufficiency in 8.3%, Hashimoto thyroiditis in 17% and β-blocker use in 33%. Positive predictive value for the PG test (>100 pg/mL) was 25% in the entire series. The cost of adding calcitonin measurement (±PG stimulation) to the preoperative work-up, resulted in €912.68 per MTC patient to detect the disease. Conclusion: Basal calcitonin measurement together with PG stimulation in cases of basal calcitonin >10 pg/mL detects MTC in 0.62% of patients with nodular thyroid disease.
The Consistency of Intraoperative Neural Monitoring in Thyroid Surgery
Gianlorenzo Dionigi,채영준,Francesco Freni,Özer Makay,Bruno Galletti,Francesco Galletti,김훈엽 대한갑상선-내분비외과학회 2018 The Koreran journal of Endocrine Surgery Vol.18 No.2
Numerous operating tools and technology transfers are available for thyroid surgery teams performing open, endoscopic and robotic procedures but none, or very few, of them constitutes a mandatory prerequisite. Over the past decade, the choice of intraoperative neurophysiological monitoring (IONM) of the recurrent laryngeal nerve (RLN), has been reached certain consensus, which must at least be selected on an individual basis. Identification and intraoperative assessment of the RLN seems to be more effectively performed with IONM than solely visually or endoscopically. Today, IONM has evolved sufficiently to increase the likelihood of successful functional outcomes in many patients. The transition from the concept of intermitted neural monitoring of the RLN to that of continuous functions evaluation that must be appreciate requires highly skilled knowledge of IONM. This goal will be more likely achieved in centers highly specialized in thyroid surgery.
Cost-Effectiveness Estimate for Neural Monitoring in Thyroid Surgery
Hoon Yub Kim,Young Jun Chai,Francesco Freni,ozer Makay,Bruno Galletti,Francesco Galletti,Hui Sun,Gianlorenzo Dionigi 대한갑상선-내분비외과학회 2018 The Koreran journal of Endocrine Surgery Vol.18 No.1
There is growing evidence for the importance of more detailed cost evaluation of new technologies used in surgery. The innovative impact of technology holds the potential to achieve transformative clinical improvements. Sustainability of innovations is a relatively new concept in health care research and has become an issue of growing interest. Cost-effectiveness studies have been the most established and studied methods for evaluation in surgical patients. Limited information exists regarding the cost-effectiveness of new surgical strategies for monitored thyroid surgeries. We describe the recent evidence regarding methods of evaluation of cost-effectiveness structures and function for intraoperative neural monitoring (IONM) in thyroid surgery. Our findings suggest that health economics modeling to inform the design of a cost-effectiveness studies looking at IONM has been demonstrated to be feasible as a method for improving research efficiency.
Intraoperative Neural Monitoring in Thyroid Surgery: Role and Responsibility of Surgeon
Hoon Yub Kim,Ralph P. Tufano,Young Jun Chai,Marcin Barczynski,ozer Makay,Che-Wei Wu,Eren Berber,Hui Sun,Gianlorenzo Dionigi,the Korean Intraoperative Neural Monitoring Society (KINMoS) 대한갑상선-내분비외과학회 2018 The Koreran journal of Endocrine Surgery Vol.18 No.1
Surgeons who introduce intraoperative neural monitoring (IONM) or a new IONM accessory, or related procedure in their practice should have completed relevant surgical training, possess operating privileges in the affected endocrine system, and be able to address anticipated complications. Surgeon responsibility in monitoring is dual component. First, technical component is using and setting up the IONM equipment correctly and understanding the inherent properties of the system to avoid an erroneous setup (e.g., no muscle relaxation, correct electrode placement, low impedance, etc.). Second, interpretive component is performing the monitoring able to distinguish between a true response versus an artifactual one. Organizations such as the International Neural Study Group and the Korean Intraoperative Neural Monitoring Society provide training courses for surgeon, as well as a means to certify levels of monitoring interpretative competence.