THYROID SURGERY: A COMPARISON OF COMMON COMPLICATIONS BETWEEN EXPERTS AND SURGEONS IN TRAINING

Objective: To determine the frequency of common complications of thyroid surgery by two types of surgeons. Study Design: Comparative cross sectional. Place and Duration of Study: Combined Military Hospital Rawalpindi & Combined Military Hospital Peshawar, from Jan 2013 to Dec 2017. Methodology: This study was conducted to assess the role of surgical skills in complications of thyroid surgery. Surgeons performing surgery for more than 5 years were considered expert and less than 5 years of experience were considered trainee for this specific surgery. Complications by both were analyzed by SPSS-21 and descriptive statistics were applied. Results: A total of 482 surgeries were performed. Out of 407 were female and 75 were males. Mean age was 43.55 ± 10.9 years. Expert surgeons performed 300 cases and 16 (5.3%) experienced some complication in 6 months of follow up.182 cases were performed by surgeons with lesser experience and 14 (7.5%) cases developed complications over the period of follow up. Recurrent laryngeal nerve paralysis occurred in 2 (0.67%) of experienced surgeons cases while 6 cases (3.2%) of less experienced surgeons had the similar complication. Conclusion: While the overall complication rates are not much different between experienced and lesser experienced surgeons, the rate of recurrent laryngeal nerve paralysis is significantly more, though still within the acceptable international complication rate for this particular surgery.

A Case Report of Ortner's Syndrome, Cardiovocal Hoarseness—An Infrequent Entity in the Contemporary World

Rheumatic fever (RF) and rheumatic valvular disease remain prevalent and are still significant health hazards in developing nations. Hoarseness of voice, although a common symptom in ENT, is a rare finding in cardiac patients. However, hoarseness of voice due to recurrent laryngeal nerve paralysis is an infrequent finding secondary to mitral stenosis. This case illustrates an unusual presentation of rheumatic heart disease (RHD) in young women. This case report highlights the importance of early reporting and diagnosis of RHD-RF, being very prevalent in developing nations and yet neglected.

661 EFFICACY OF ROBOT ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY: PROPENSITY MATCHED ANALYSIS OF RAMIE IN COMPARISON WITH CONVENTIONAL MIE

Robot assisted minimally invasive esophagectomy (RAMIE) has been reported to be potential advantages in previous reports. Here we demonstrate the difference between these two minimally invasive procedures and investigated the surgical results of RAMIE in comparison with MIE using propensity matched-cohort. Methods We investigated 154 cases of thoracic esophagectomy conducted between 2020/1 to 2021/1. Among these cases, we analyzed 30 cases of RAMIE in comparison with 30 cases of matched-cohort which conducted conventional thoracoscopic esophagectomy (MIE) in the prone. Then we evaluated the surgical results between two groups. Results There were no differences in age (69.2 vs 69.1 yo), gender (M:F = 24:6 vs 24:6), cStage (Stage I,II,III,IV:6,3,14,7 vs 8,3,14,5), and preoperative chemotherapy (70% vs 66.7%) between RAMIE and matched-cohort MIE. There was statistically significant difference in total time of thoracic phase (233.1 vs 173.3 min; p < 0.01). There were no significant differences in postoperative events in RAMIE vs MIE (Clavien-Dindo Grade 1≧; Recurrent laryngeal nerve paralysis (RLNP) (16.7 vs 20.0%; p = 0.19). However, after the learning curve archived, seldom cases were diagnosed postoperative RLNP in RAMIE cases in comparison with MIE (p = 0.06). Conclusion We demonstrated the formalization of our procedure and surgical results of RAMIE. There were no significant differences in postoperative events between two groups. However RLNP was lower after the learning peak. Incidence of RLNP could be reduced in RAMIE.

ANATOMY OF ANSA CERVICALIS AND ITS VARIATIONS

BACKGROUND: The ansa cervicalis is usually used to re-innervate the larynx following recurrent laryngeal nerve paralysis in thyroid cancer, oesophageal cancer following lymphadenectomy. Variations have previously been reported on the formation and branching pattern of the ansa cervicalis loop. Objectives: The present study aimed to record anatomical variations of the formation of loop and branches of ansa cervicalis. The study was done in Anatomy depa METHODS: rtment, Assam Medical College, Dibrugarh, Assam. 30 numbers (15 cadaver x 2) of ansa cervicalis were studied. A thorough morphological study was done and the results were recorded. RESULTS: Normal anatomy & variations, if any, of the ansa cervicalis were noted and discussed with previous studies. CONCLUSION: Surgical procedures such as thyroplasty, arytenoid adduction, nerve-muscle pedicle implantation had been reported to cause iatrogenic injuries to the ansa cervicalis. Knowledge of the arrangement of loops and branches of the ansa cervicalis will be helpful for planning a safe surgery in the neck region.

Two cases of left recurrent laryngeal nerve paralysis after right superior mediastinal node dissection

Background Ipsilateral recurrent laryngeal nerve paralysis is one of the rare complications during the superior mediastinal node dissection for lung cancer. However, very few reports of contralateral recurrent laryngeal nerve paralysis during the procedure are available. Case presentation Two women aged 74 and 80 years developed hoarseness after undergoing right upper lobectomy and right superior mediastinal node dissection for primary lung cancer. Postoperative laryngoscopy in the two patients confirmed left vocal cord paralysis. Conclusion Node dissection is performed in the standard procedure for right upper lobe lung cancer. At this time, care must be taken not to cause damage not only to the recurrent laryngeal nerve on the ipsilateral side but also to the recurrent laryngeal nerve on the contralateral side.

Management of benign paediatric thyroid nodules: experience from paediatric ENT services of a tertiary care hospital

<p class="abstract">Thyroid nodules are a common occurrence in adults but are rarely seen in children. We present here four cases of paediatric thyroid nodules. Patients were subjected to a thorough clinical evaluation, blood thyroid level testing, ultrasonography (USG) and fine needle aspiration cytology (FNAC). The size of the nodules ranged from 2 cm to 7.5 cm. All four nodules were reported as “benign” on FNAC, of which three under-went total thyroidectomy owing to the bi-laterality and large size of the nodules. None of the cases had post-operative complications of hypocalcemia or recurrent laryngeal nerve paralysis. Of the 3 patients taken up for surgery one patient was found to have papillary thyroid carcinoma. Subsequent radiological investigation showed no residual disease. All three operated cases were followed-up in the ENT outpatient department for at least 2 years and showed no signs of recurrence. One patient with a small thyroid nodule (2 cm) was managed non – surgically and has been kept on follow up since 12 months. In our experience, total thyroidectomy, even in a benign disease, in expert hands, is a safe procedure and the best management option in children with large goiter, to avoid recurrence and thereby a redo surgery. </p>

A STUDY OF POST OPERATIVE COMPLICATIONS OF THYROID SURGERY AND THEIR MANAGEMENT

Background: Thyroid swelling is one of the most common complaint of patients presenting to the surgery OPD. Depending on the diagnosis, while some of the patients are started on medical treatment, some patients undergo surgical treatment. The type of surgery performed varies depending on the diagnosis. While post operative complications are rare in the hands of experienced surgeons, they may cause considerable morbidity if the occur. However, most of the complications are manageable. Aim: To study the post operative complications of thyroid surgeries and their management. Material and Method: The study material consisted of 100 patients with thyroid swelling who underwent elective thyroidectomy at Department of General Surgery in Narayana General Hospital attached to Narayana Medical College, Nellore. Results: In this study post operative hypocalcaemia, temporary recurrent laryngeal nerve paralysis and airway obstruction were noticed and they were successfully managed.