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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.
Treatment Decision Making in Papillary Thyroid Microcarcinoma
Giuseppe Navarra,Guido Nicola Zanghì,Francesco Freni,Bruno Galletti,Francesco Galletti,Grazia Pagano,Andrea Cogliandolo,Alberto Barbera,Salvatore Lazzara,Gianlorenzo Dionigi 대한갑상선-내분비외과학회 2018 The Koreran journal of Endocrine Surgery Vol.18 No.2
The objective of this article is to detail the treatment for papillary thyroid microcarcinoma (PTMC). The literature presents only few contributions, with controversial results, about comparison between ‘active surveillance’ and surgery. Hemithyroidectomy is the treatment of choice for PTMC. Thyroidectomy is indicated in cases of multifocality, extrathyroid tumor growth, and familial PTMCs. Active surveillance can only be done under well-defined and controlled conditions. Collected findings and agreements with the patient must be precisely documented, also for medico-legal reasons. An observation of PTMC seems most appropriate for patients >60 years of age. In the case of observation of a PTMC, a lifelong examination of the tumor disease must be carried out, since tumor growth or metastases can still occur after 10–15 years. The follow-up periods for the ‘active surveillance’ proposed from the literature review are too short to conclude this as a real alternative.
Prevention, Identification and Management of Postoperative Hypoparathyroidism
Salvatore Lazzara,Alberto Barbera,Guido Nicola Zanghì,Francesco Freni,Grazia Pagano,Andrea Cogliandolo,Ozer Makay,Gianlorenzo Dionigi 대한갑상선-내분비외과학회 2018 The Koreran journal of Endocrine Surgery Vol.18 No.2
The objective of this article is to detail and present our experience on the incidence and management of parathyroid dysfunction after thyroid surgery. Selective evaluation of original articles and reviews that were retrieved by a PubMed search over the years 1990 to 2018, as well as of the recommendations of medical societies including the American, European and Asian Thyroid/Endocrine Associations. The literature presents several contributions, with controversial results. The recommended management for the diagnosis and treatment of parathyroid dysfunction after bilateral thyroid surgery or recurrent surgery consists of an intact parathyroid hormone (iPTH) determination 12–24 hours after surgery and calcium substitution in iPTH <15 pg/mL, no substitution with iPTH ≥15 pg/mL. This procedure is safe for the patient and is accepted by patients and social insurances (for short hospital stay).