Methods of thyroidectomy: principles and indications

Úvod: Poranění zvratného nervu je jedna znejzávažnějších komplikací chirurgie štítné žlázy, chirurgie příštítných tělísek achirurgie krčních obratlů. Vliteratuře se popisuje poranění zevní větve hrtanových nervů jako méně časté. Tato komplikace je natolik vážná, že může vést kinvalidizaci hlasových profesionálů (učitelů, herců, zpěváků, profesionálních řečníků amanažerů). Současná klinická praxe je spojena se zvýšeným úsilím operoperační ochranu funkce zvratných nervů využíváním elektrofyziologické monitorace funkce inervace hrtanu asoučasné vizualizace zvratných nervů. Metody: Design studie je prospektivní observační. Ze souboru 100 po sobě jdoucích operací byly chirurgy náhodně vytvořeny dvě skupiny: Skupina A- spoužitím neuromonitoringu (IONM) askupina B - identifikace avizualizace zvratného nervu (NLR) bez IONM. Jeden tým chirurgů byl složen zexperta (více než 1000 provedených operací) azačínajícího chirurga (méně než 100 operací) adruhý ze dvou zkušených chirurgů (jeden více než 150 operací adruhý více než 500 operací). Každý tým byl zapojen do operací několikrát vtýdnu. Porovnání bylo provedeno statistickými metodami apomocí indexu poranění zvratného nervu (recurrent nerve injury - IRI). Cílem studie je porovnat incidenci parézy zvratných nervů při využití neuromonitorace (IONM) avyužití peroperační vizualizace anatomicky neporaněného nervu dvěma týmy chirurgů. Výsledky: Bylo analyzováno 100 operací, respektive 50 operací ve skupině Aa50 ve skupině B. Skupina Azahrnovala 43 totálních thyreoidektomií a7 hemithyreoidektomií abyly zjištěny dvě dočasné jednostranné parézy. Skupina Aměla IRI=1,075. Skupina B zahrnovala 48 totálních thyreoidektomií a2 hemithyreoidektomie. Vtéto skupině byly zjištěna také dvě jednostranné dočasné parézy zvratného nervu. Skupina B měla IRI=1,02. Uvedené hodnoty IRI tak charakterizují asymetrické soubory, itato drobná asymetrie je ve výsledku hodnoty patrna. Celková incidence poranění zvratných nervů vcelém souboru operovaných sledovaného roku, ve kterém byl výběr pacientů dle metodiky této práce, byla 1,3%. Vsouboru bylo 16 dočasných a4 permanentní parézy zvratného nervu ve všech případech na jedné straně. Vesledovaném období nebyla zjištěna ani jediná oboustranná paréza trvalá ani dočasná. Index IRI pro operace štítné žlázy vuvedeném období byl 2,26. Tento soubor byl srovnáván se soubory skupiny Aaskupiny B avýsledky nevykazují statisticky významné rozdíly na hladině významnosti 1% (p=0,01). Závěr: Studie neprokázala statisticky významné rozdíly incidence poranění zvratného nervu (trvalá jednostranná paréza) vzávislosti na chirurgické technice bez využití IONM asvyužitím IONM prováděných chirurgem srozdílnou zkušeností vchirurgii štítné žlázy. Studie prokázala, že IONM může pomoci vyrovnat handicap uzačínajících améně zkušených chirurgů aomezit incidenci morbidity zvratného nervu vchirurgii štítné žlázy.

BackgroundThere are concerns regarding early years’ training for junior doctors in Trauma & Orthopaedic Surgery (T&O) in the United Kingdom. Our primary objective was to audit the clinical activities undertaken by junior doctors working in Trauma & Orthopaedic (T&O) surgery in the National Health Service (NHS) in a typical workweek. A secondary objective was to audit the clinical exposure of junior surgeons in training to the Joint Committee on Surgical Training (JCST) standards for minimum weekly clinical exposure in T&O surgery.MethodsWe recruited collaborators in 101 T&O surgery departments in NHS hospitals to participate in this study. Clinical activity diaries from 935 doctors working in T&O surgery in the 101 participating NHS hospitals were involved. All junior doctors covering the junior on call tier were included. Collaborators collected clinical activity data from 08:00 18/01/2015 to 20:00 22/01/2015. Clinical activities recorded in sessions (morning, afternoon, evening) depending on what activity that doctor undertook for the majority of that session. Clinical activities were grouped into operating theatre/room, outpatient clinic, on call, “not in work” (i.e. leave, sickness), teaching, and ward cover sessions. The weekly clinical activity of Core Surgical Trainees (CSTs) were analyzed in accordance to two JCST standards for minimum weekly clinical exposure.ResultsOverall, junior doctors working in T&O surgery attended a theatre list session 8.5% of the time, an outpatient clinic 3.2%, were on call 14.8%, a teaching session 1.7%, providing ward cover 34.6%, and on a zero session 20.7% of the time. Only 5% of core surgical trainees (n = 200) met both the JCST standards for minimum weekly clinical exposure in the specialty.ConclusionsJunior surgeons in training, working in Trauma & Orthopaedic surgery in the United Kingdom are not meeting the minimum weekly clinical sessions laid out by the JCST. Further work to develop models allowing for enhanced training experiences and improved clinical exposure to operating lists and outpatient clinics would be beneficial.

Risk Factors for Mortality and Postoperative Complications After Gastrointestinal Surgery

Surgical Treatment Outcomes of Patients with Conus Medullaris Teratoma: A Single-Center Experience of 39 Patients

Resident standardized training plays an irreplaceable role in the training of medical students in China, including the construction of training bases, and the implementation of national graded diagnosis and treatment. From the perspective of medical education history, this project combined historical research methods and historical thinking methods into the field of standardized training for residents through literature review and expert consultation. The project selected the training mode, training content, tutor system and integration of the system. The four main aspects were historically and longitudinally explored, and the historical evolution of the standardized training of residents in China was described in a point-by-point manner. The regular trends hidden in the history in the system were further explored, and history was transformed into reality logic, so as to build a new pattern of medical and health industry from the cultivation of medical talents. Key words: Resident; Standardized training; Historical research methods

To correlate the pathologic features and heat shock protein 47 (HSP47) expression in the nasal mucosa and lacrimal sac with the surgical outcomes of endoscopic endonasal dacryocystorhinostomy (EDCR). Specimens of the nasal mucosa and lacrimal sac over the rhinostomy site were collected during the operation. Haematoxylin-eosin and immunohistochemical staining were performed to determine the pathologic features (inflammation, fibrosis, squamous metaplasia) and the expression of HSP47 in the epithelium and sub-epithelial glands of the nasal mucosa and lacrimal sac. The success or failure of EDCR was determined 6 months after surgery. A total of 30 patients (30 eyes) were included in this study. Inflammation and squamous metaplasia of the nasal mucosa were not associated with the surgical outcome of EDCR (p = 0.485 and 0.069, respectively), but there was an association with fibrosis of the nasal mucosa (p = 0.003). In addition, HSP47 in the nasal mucosa was associated with the surgical outcomes (p = 0.005). Inflammation of the lacrimal sac was not associated with the surgical outcome of EDCR (p = 0.509), but fibrosis and squamous metaplasia of the lacrimal sac were (p = 0.005 and 0.008, respectively). Additionally, HSP47 in the lacrimal sac was associated with surgical outcomes (p < 0.001). Fibrosis and squamous metaplasia of the nasal mucosa and lacrimal sac lowered the success rate of EDCR. HSP47 also lowered the surgical success rate. Fibrosis was correlated with the expression of HSP47.

Purpose:To analyze the postoperative visual and surgical outcomes following surgery for pediatric-absorbed cataracts and intraoperative difficulties.Methods:This prospective longitudinal study included 43 eyes (30 children) with absorbed cataracts aged between 6 months and 18 years (either sex). All children underwent best-corrected visual acuity (BCVA), anterior and posterior segment evaluation, rubella titer estimation, intraocular lens (IOL) power calculation, superior small incision cataract surgery with or without posterior capsulotomy/anterior vitrectomy/IOL implantation under general anesthesia, visual rehabilitation, and were followed up for 1 year.Results:The mean age was 7.89 ± 4.84 years. Preoperative BCVA distance: 39 eyes had either perception of light (PL) or counting finger close to face (CFCF); near BCVA: all eyes had either PL or N36. Postoperative (12 months) distant BCVA: a majority of the eyes (27) had 6/60–1/60, 11 eyes had 6/18–6/36; near: N18 in 19 eyes, N6 in 7 eyes. Anterior continuous curvilinear capsulorrhexis (ACCC) was possible in eight eyes. Cortical aspiration was difficult in 16 eyes (peripheral calcified ring). A majority (32 eyes) underwent in the sulcus implantation (in-the-bag: eight eyes); two eyes: no IOL, one eye: secondary IOL. Eleven eyes had early postoperative inflammation. At 12 months, one eye underwent membranectomy for visual axis opacification and 38 eyes had well-centered IOLs.Conclusion:Surgery in absorbed cataracts is challenging because of the anatomic disorganization of the absorbed lens. By adopting appropriate surgical methods and good visual rehabilitation, one can achieve satisfactory surgical and visual outcomes, highlighting the need for surgical intervention.

One of the widest variations in contemporary surgical practice between high and low, or low-middle, income countries is the utilisation of endoscopy as a means of treating urological pathology. The endoscopic management of lower urinary tract problems such as benign prostatic hypertrophy, bladder cancer and urethral strictures was established in the UK in the late 1970s, whilst its adoption into everyday practice in sub-Saharan Africa (SSA) has been significantly retarded. It is still neither a major feature of urological training in those countries nor widely available to the patients that established consultants treat. Likewise, the explosion of less invasive technologies for treating upper tract stone disease in the 1980s, particularly the management of renal stone disease, has also lagged behind practice established in the UK over the last 40 years. This is not due to a lack of patients who could be treated endoscopically or restricted by the abilities of the surgeons in SSA. The restraint in assumption of these less-invasive management options is rather due to the physical availability of trained specialist surgeons, their access to basic infrastructure such as electricity and water, access to endoscopes and the peripheral equipment necessary to successfully deploy them, and the ability of patients to afford the disposable items required for less-invasive forms of management. Some endoscopic procedures are viable in resource-poor settings. However, they are largely dependent upon the supply of equipment from non-governmental organisations in high-income countries, frugal innovation to reduce individual procedure costs, adequately skilled mentors, and maintenance and supply chains to make them a durable option in patient management. Urolink and the Medi Tech Trust present their experience of how endoscopic surgery can be taught, and used sustainably, in a resource-poor healthcare environment.

Changes to Training Practices during a Pandemic - The Experience of the Irish National Trauma & Orthopaedic Training Scheme

Spinal disorders represent a substantial global health burden, affecting nearly 5% of the world’s population and contributing significantly to disability and healthcare utilization. Over the past century, spinal neurosurgery has evolved markedly due to advances in neuroanesthesia, antiseptic techniques, and surgical instrumentation. More recently, the integration of minimally invasive techniques, robotic assistance, augmented and virtual reality (AR/VR), machine learning, and three-dimensional (3D) printing has transformed surgical planning, execution, and outcomes. Minimally invasive spinal procedures, including tubular microdiscectomy, endoscopic techniques, and fusion approaches, have reduced tissue trauma, postoperative pain, and recovery time. Robotic-assisted spine surgery has enhanced accuracy in instrumentation placement, reduced radiation exposure, and improved workflow efficiency, albeit with challenges related to cost and operative time. AR and VR technologies have improved intraoperative navigation, surgical precision, and training of residents, while 3D printing has enabled patient-specific preoperative planning, surgical guides, and customized implants. Despite these advancements, widespread adoption remains limited by economic constraints, steep learning curves, and infrastructure requirements. Continued technological refinement, cost reduction, and surgeon training are essential to expand accessibility and maximize the clinical impact of these innovations in spinal neurosurgery.

Surgical Treatment of Degenerative Lumbar Spine Disease in Rural Sub-Saharan Africa: A Retrospective Study of 450 Cases and Its Future Implications

An extra-osseous intra-articular osteochondroma of the elbow

The objective: to learn the features of metabolic syndrome and thyroid pathology for women after natural and surgical menopause.Materials and methods. For the study of features of metabolic syndrome and pathology of thyroid gland in perimenopause one-time research of population is conducted 150 women in age 45–55 (Me [25; 75] = 49 [47,0; 52,0] years). Group 1 – «преmenopause», n = 50; group 2 is «natural menopause», n = 50; for the study of features of pathology of thyroid gland after surgical menopause the third group of women (n = 50), chosen by a casual method from a number operated in the volume of hysterectomy in combination with bilateral oophorectomy was formed. To the complex of the conducted researches clinical, laboratory instrumental and statistical methods were included. Results. The value of body mass index and his changes in development of metabolic syndrome was studied in euthyroid women after surgical menopause during prospective randomized clinical research during 5 years. Obesities to the operation had 40,0% patients. In 5 years after surgical menopause frequency of obesity and was 48,0%. The dynamics of body mass index made, on the average, 1,1 ± 0,3 kg/m2. The broken tolerance to glucose and saccharine diabetes developed in 28,0%, metabolic syndrome of menopause – in 38,0% women. Frequency of hypertension to the end of supervision was 58,0%. Conclusions. Pathology of thyroid gland for women 45–55 years can be instrumental in the risk of development for it of metabolic syndrome during the nearest 5 years, especially at presence of making progress obesity in combination with a hyperglycaemia, surgical menopause and burdened heredity on obesity, hypertension and saccharine diabetes. For the prophylaxis of development of metabolic syndrome an enough decline of body mass index is on 4,5% or absence of increase of mass of body after menopause. Keywords:natural menopause, surgical menopause, pathology of thyroid gland, metabolic syndrome.

Ground-glass nodules-featured lung cancer have been identified in some teenagers in recent years. This study aims to investigate the characteristics and surgical outcomes of these patients and explore proper management strategy. Patients aged ≤20 with incidentally diagnosed lung cancer were retrospectively reviewed from February 2016 to March 2023. Based on lymph node evaluation status, these patients were divided into non-lymph node evaluation and lymph node evaluation groups. The clinical and pathological characteristics were analysed. A total of 139 teenage patients were included, with an obviously increased cases observed from 2019, corresponding to the COVID-19 pandemic. The median age of the 139 patients was 18 years (range 12-20). Eighty-five patients had pure ground-glass nodules, while others had mixed ground-glass nodules. The mean diameter of nodules was 8.87 ± 2.20 mm. Most of the patients underwent wedge resection (64%) or segmentectomy (31.7%). Fifty-two patients underwent lymph node sampling or dissection. None of these patients had lymph node metastasis. The majority of lesions were adenocarcinoma in situ (63 cases) and minimally invasive adenocarcinoma (72 cases), while four lesions were invasive adenocarcinoma. The median follow-up time was 2.46 years, and none of these patients experienced recurrence or death during follow-up. The lymph node evaluation group had longer hospital stays (P < 0.001), longer surgery time (P < 0.001), and greater blood loss (P = 0.047) than the non-lymph node evaluation group. The COVID-19 pandemic significantly increased the number of teenage patients incidentally diagnosed with lung cancer, presenting as ground-glass nodules on CT scans. These patients have favourable surgical outcomes. We propose a management strategy for teenage patients, and suggest that sub-lobar resection without lymph node dissection may be an acceptable surgical procedure for these patients.

Warming up prior to surgery has been shown to enhance surgeons' performance during laparoscopic procedures. It is unknown whether or not warming up prior to total hip arthroplasty (THA) will have a similar effect on surgical outcome. We retrospectively evaluated the effect of warming up on the intraoperative outcome of 82 patients who underwent a primary THA with identical implants. The patients were divided equally into two groups. Group 1 (first case of the day) served as "warm-up procedure," while Group 2 (second case of the day) was the "post-warm-up procedure." We found no statistically significant difference when we compared cup abduction and anteversion angles, femoral offset, postoperative LLD, stem alignment, hip center of rotation and femoral stem canal fill between the two groups (p > 0.05). Warming up prior to performing surgery does not make a difference for primary THA when performed by an experienced surgeon. However, these results may not reflect its effect on procedures that require fine motor skills or done by an orthopedic trainee or less experienced surgeons.