MINIMALLY INVASIVE TECHNOLOGIES IN THE TREATMENT OF THYROID DISEASES. REVIEW

The Kocher approach, which has already become traditional for many decades, in operations on the thyroid gland (TG) in the 21st century has ceased to meet the standards of minimally invasive surgery. Providing an excellent view of the organ and the convenience of an operative reception, a 4-5 cm incision on the anterior surface of the neck leaves behind a visible scar, which is a cosmetic defect. The development of technologies made it possible to develop and optimize access to the thyroid gland, which have the best cosmetic effect, but also require changes in the surgical technique. This literature review provides a description and analysis of the existing minimally invasive approaches to the thyroid gland.

An unusual labial tumor: A case report and review

Keratoacanthoma is a benign epithelial tumor with favorable evolution which poses a considerable problem of differential diagnosis with squamous cell carcinoma. we report the case of a patient who presented an unusual location of this tumor, causing an essentially diagnostic and aesthetic problem, it is a large keratoacanthoma taking the central part of the lower lip which appeared two months previously and increasing in size suddenly and which required surgical, diagnostic and therapeutic ablation in order to eliminate the risk of squamous cell carcinoma in situ. postoperative treatment was simple but at the cost of a visible scar that can be improved by a combination of aesthetic techniques.

Cosmetic and Functional Results of External Dacryocystorhinostomy with the Subciliary Incision in a Tertiary Eye Care Hospital, Karachi.

Purpose: To assess post-operative cosmetic and functional results of external Dacryocystorhinostomy with Subciliary incision in adults with primary naso lacrimal duct obstruction (NLDO). Study Design: Quasi experimental study. Place and Duration of Study: Oculoplasty clinic, Al Ibrahim Eye Hospital, Malir, from July 2016 to September 2017. Material and Methods: Hundred eyes of hundred patients were included. Inclusion criteria was all the patients between the ages of 20 to 70 years having epiphora with diagnosis of NLDO, chronic Dacryocystitis or Mucocele. Patients having ectropion or entropion of inferior punctum were excluded from the study. DCR with intubation was performed through Sub ciliary incision. Inner canthus was photographed with a Nikon D70S digital camera at 1, 3 and 6 months after surgery. Functional success was determined by subjective improvement in watering and patent drainage passage on syringing. Cosmetic result of the scar was assessed by subjective satisfaction of the patient and grading of the subciliary incision scar according to a four level scale by two ophthalmologists. SPSS version 20.0 was used to analyze the data. Result: DCR was done on 100 eyes in 100 patients. Functional and cosmetic success was noted in 90 (90%) eyes. 83 patients attained successful functional outcome, which was confirmed on syringing. On objective grading of the scars by ophthalmologist at the final follow up it was observed that 85 patients had invisible scar. Whereas, 2 had moderately visible scar and 3 patients had minimally visible scar. Subjective grading revealed 85 scars to be invisible, 2 moderately visible and 2 minimally visible. Conclusion: Post-operative cosmetic as well as functional results of subciliary incision in external Dacryocystorhinostomy were found to be highly encouraging.

Safety of central compartment neck dissection for transoral endoscopic thyroid surgery in papillary thyroid carcinoma

Background Remote access and endoscopic thyroid surgery has been gaining popularity because it allows patients to avoid a visible scar in the neck. There is limited data on transoral endoscopic thyroidectomy when it relates to patients with papillary thyroid carcinoma. We aim to evaluate the safety of ipsilateral central compartment dissection for patients who undergo transoral thyroidectomy (thyroidectomy vestibular approach–compartment lymph node dissection). Patients and Methods A total of 80 patients who underwent thyroidectomy vestibular approach–compartment lymph node dissection for papillary thyroid carcinoma from June 2015 to September 2016 were identified. Over the same period, a matched cohort of 80 patients who underwent open thyroidectomy with routine ipsilateral central compartment dissection was also identified (Open-compartment lymph node dissection). The two groups were analyzed in terms of patient characteristics, perioperative clinical results and post-operative outcomes. Results All patients were female with a mean age of 32-year. There was no difference in mean maximum tumor size and number of lymph nodes dissected. Moreover, there was no difference in average positive lymph nodes between thyroidectomy vestibular approach–compartment lymph node dissection and Open-compartment lymph node dissection (1.48 vs 1.08, P = 0.647). Operative time was longer in the thyroidectomy vestibular approach–compartment lymph node dissection group (193 vs 102 min, P < 0.001). Thyroidectomy specific complications were similar with rates of temporary recurrent laryngeal nerve palsy of 6.3 vs 8.8% and temporary hypocalcemia rates of 2.5 vs 5% in the thyroidectomy vestibular approach–compartment lymph node dissection and Open-compartment lymph node dissection groups, respectively. Conclusions Thyroidectomy vestibular approach–compartment lymph node dissection is a feasible and safe option for select patients with papillary thyroid carcinoma who require central node dissection compared with Open-compartment lymph node dissection, and can be a viable alternative for patients wishing to avoid a visible scar.

Subcutaneoscopic Excision of External Angular Dermoid Cysts: Our Covert Scar Approach in 11 Cases

Introduction External angular dermoid cysts, or epidermoid inclusion cysts, are a common subcutaneous tumor of the head and neck. For the majority of these lesions, excision is relatively simple and performed through an incision immediately overlying the mass. Facial lesions in pediatric patients present a unique challenge in that a direct approach carries the potential for visible scar formation. Objective This article aims to detail our experience with subcutaneoscopic excision of external angular dermoid cysts in pediatric patients using endoscopic instrumentation. Materials and Methods Retrospectively, we reviewed 11 cases, between the ages of 4 months and 3 years with external angular dermoid cysts. An incision is made on the scalp above the hairline, then a tunneled working space is created underneath the skin. 3 mm laparoscopy instruments were then used for providing excellent visualization and precise subcutaneoscopic dissection. Results There were no complications apparent in any of the 11 cases (except cyst rupture in one case), with mean procedure duration at 61 minutes. Final results at follow-up revealed aesthetically pleasing and well-healed skin incisions, hidden from view behind the hairline. Conclusion The subcutaneoscopic technique utilizing endoscopic instrumentation has the advantage of improved visualization of the cyst, greater precision of dissection, and excellent cosmesis. One disadvantage of this procedure is that this involves learning a new technique while the majority of surgeons are already comfortable with the open approach. Given the safety and efficacy observed for this subcutaneoscopic procedure, this technique can have tremendous possibilities.

Lower Eyelid Malposition following Orbital Fracture Surgery: A Retrospective Analysis Based on 198 Surgeries

The aim of this study is to analyze the development of lower eyelid malposition following reconstruction of orbital fractures, in relation to the incisions used for access. A total of 198 surgical orbital floor reconstructions were performed in 175 patients between 2001 and 2011. Preoperative and postoperative presence of lower eyelid malposition of patients was reported. The types of incision used for access were as follows: approach via laceration (4.5%), via preexisting scar (16.2%), infraorbital (40.9%), subciliar (23.7%), transconjunctival (13.1%), and transconjunctival with lateral canthotomy (1.5%). The incidence of ectropion development following surgery was 3.0% and the incidence of entropion development following surgery was 1.0%. The highest rate of ectropion (11.1%) was seen using an approach via a laceration, followed by approach via a scar (6.3%). Our conclusion is that the transconjunctival incision without a lateral canthotomy has a low complication rate, provides adequate exposure, and leaves no visible scar.