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Antiadhesive effect and safety of oxidized regenerated cellulose after thyroidectomy
Kyoung Sik Park,Kyu Eun Lee,Do Hoon Ku,Su-Jin Kim,Won Seo Park2,Hoon Yub Kim3,,Mi Ra Kwon1,Yeo-Kyu Youn1 대한외과학회 2013 Annals of Surgical Treatment and Research(ASRT) Vol.84 No.6
Purpose: To evaluate the antiadhesive effects and safety of an oxidized regenerated cellulose (Interceed) after thyroidectomy. Methods: Seventy-six thyroidectomized patients were prospectively randomized into two groups with regard to the use of Interceed. We evaluated each group for their adhesive symptoms using four subjective and four objective items at the 2nd week, 3rd and 6th month after thyroidectomy. All patients were examined for vocal cord motility by indirect laryngoscope at each period. Results: Total adhesion scores at each postoperative follow-up period decreased with time, but were not significantly different in each group. The median score for swallowing discomfort for liquid was significantly lower in the Interceed group than in the control group 2 weeks after surgery. In addition, the severity of skin adhesion to the trachea was reduced in the Interceed group compared with the control group 6 months after surgery. During the study, there were no adverse effects or significant differences in postoperative complications between the groups. Conclusion: Interceed appeared to be safe and effective in improving neck discomfort at early postoperative periods and preventing skin adhesion to the trachea 6 months after thyroidectomy.
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.
Technical Instructions for Continuous Intraoperative Neural Monitoring in Thyroid Surgery
Hoon Yub Kim,Young Jun Chai,Marcin Barczynski,ozer Makay,Che-Wei Wu,Antonio Giacomo Rizzo,Vincenzo Bartolo,Hui Sun,Gianlorenzo Dionigi,the Korean Intraoperative Neural Monitoring Society (KINMoS) 대한갑상선-내분비외과학회 2018 The Koreran journal of Endocrine Surgery Vol.18 No.1
One of the most significant advancements in neural monitoring for thyroid surgery is currently the permanent recording of the vagus nerve (VN) in order to prevent intraoperatively recurrent laryngeal nerve (RLN) iatrogenic injuries. Continuous intraoperative neuromonitoring (CIONM) seems to be superior to intermitted intraoperative neural monitoring (I-IONM) because it enhances standardization, and it provides entire and constant RLN function surveillance as the surgeon dissects the thyroid gland. It also has to be highlighted that the surgical maneuvers for the CIONM probe placement must be accurate in order to avoid a potential iatrogenic morbidity on the VN function. With this review article the Korean Intraoperative Neural Monitoring Society (KINMoS) provides a comprehensive analyses of CIONM technique.
Loss of the Neuromonitoring Signal on the First Side in Planned Total Thyroidectomy
Hoon Yub Kim,Hui Sun,Young Jun Chai,Ralph Tufano,Henning Dralle,Giuseppe Navarra,Gianlorenzo Dionigi 대한갑상선-내분비외과학회 2017 The Koreran journal of Endocrine Surgery Vol.17 No.3
With an increased use of intraoperative neural monitoring (IONM), an adaptation of the resection strategy appears to be necessary in case of an intraoperative loss of signal (LOS) of the first operated side with total thyroidectomy planned. The contralateral side resection with intact recurrent laryngeal nerve (RLN) function from the surgical point of view, basically has 3 options: 1) no contralateral resection in bilateral goiter, Graves disease, or low risk thyroid carcinoma (differentiated and medullary thyroid carcinomas) with the aim of 2-stage completion surgery after recovery of nerve function; 2) contralateral subtotal resection ventrally of the RLN plane in benign goiter with a safety distance to the nerve with the aim of avoiding further surgery; and 3) total thyroidectomy as planned for advanced thyroid carcinomas (including undifferentiated thyroid carcinomas) with the aim of immediate postoperative radioiodotherapy. The following document provides a synopsis of the experiences of the Korean Intraoperative Neural Monitoring Society (KINMoS) for the strategy for planned total thyroidectomy and loss of the neuromonitoring signal on the first thyroid lobe.
Future Directions of Neural Monitoring in Thyroid Surgery
Hoon Yub Kim,Xiaoli Liu,Che-Wei Wu,Young Jun Chai,Gianlorenzo Dionigi 대한갑상선-내분비외과학회 2017 The Koreran journal of Endocrine Surgery Vol.17 No.3
Dissecting and identifying the recurrent laryngeal nerve (RLN) are considered routine procedures now that safe and effective methods have been established. Preventing RLN injury during thyroid surgery requires good visualization and exposure of the RLN, adequate knowledge of RLN anatomy, adequate surgical experience and training, and pre- and post-operative laryngoscopy. Whereas these requirements are widely accepted for routine thyroid surgery, new technical developments have emerged in the past 15 years. Literature show that both intermittent intraoperative neural monitoring (I-IONM) and continuous IONM (C-IONM) are recognized as effective techniques for RLN. The aim of this paper is to discuss advantages, limits and possible future directions for use of IONM and C-IONM in thyroid and parathyroid surgery.
Monitoring the Bifurcated Recurrent Laryngeal Nerve
Hoon Yub Kim,Xiaoli Liu,Hui Sun,Young Jun Chai,Woong Youn Chung,Gianlorenzo Dionigi 대한갑상선-내분비외과학회 2017 The Koreran journal of Endocrine Surgery Vol.17 No.2
Anatomical anomalies of the recurrent laryngeal nerve (RLN) can not only mean an operational challenge in thyroid operations for the endocrine surgeon, but also an increased risk of postoperative vocal cord paralysis (VCP). Atypical courses of the RLN are frequent and observed in about a quarter of the thyroid gland operations. Anatomical RLN variations are represented by an atypical RLN pattern as anterior or lateral to the thyroid gland, an anteriorly RLN to a Zuckerkandl tuberculum nodule, a fixed, splayed, or entrapped RLN with capsular association through fascial bands, an invaded RLN, a nerve posterior to ligament of Berry, a thin <1 mm nerve, or antevascular RLN, a non-RLN, a ramificated RLN. Anatomical variations of RLN rarely can be identified preoperatively. The bifurcated RLN represent a significant anatomical variation because prevention of VCP requires preservation of all branches of the RLN. An awareness of the surgical anatomy and the possible dispositions and ramifications of the RLN is very helpful in avoiding its injury during thyroidectomy. The current report derives from a review of the literature and personal experience on identification, confirmation, and monitoring the bifurcated RLN.