Tension-free thyroidectomy (medial thyroidectomy)—a prospective study: surgical technique and results of 259 operations
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ABSTRACT:
SUBMITTER: Sleptsov I
PROVIDER: S-EPMC10570982 | biostudies-literature | 2023 Aug
REPOSITORIES: biostudies-literature
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Project description:[This corrects the article DOI: 10.21037/gs-23-147.].
| S-EPMC11826259 | biostudies-literature
Project description:The medial patellofemoral ligament is an important patellar stabilizer and, when damaged, can lead to recurrent instability, cartilage injury, and debilitating pain among other conditions. In patients with continued patellar instability after failed nonoperative management, medial patellofemoral ligament reconstruction often is recommended. A key step of the procedure is appropriate graft tensioning. Previously described techniques can help guide the surgeon, but few allow for adjustable tensioning after dynamic examination of patellar tracking to avoid over tensioning. This technique offers the ability to dynamically control graft tension with 2 independent graft limbs while also using knotless onlay type fixation, therefore decreasing the risk of over- or undertensioning and the complications that come with it.
| S-EPMC9827002 | biostudies-literature
Project description:We have successfully carried out single-hole inflator-free endoscopic thyroidectomy through a submental approach, which has the advantages of less trauma, fewer complications, and hidden incisions. However, for patients with submandibular fat accumulation, submental incisions are not easy to hide, which directly affects the cosmetic effect. We developed a new surgical strategy "submandibular suction lipectomy and single-hole inflator-free endoscopic thyroidectomy with a submental approach" for these patients. We initially used submandibular suction lipectomy to reduce the accumulation of submandibular fat and obvious fat protrusion and, thus, restore the normal depression, placing the submental incision back where it is hidden in the submental shadow. Subsequentially, we began to use single-hole inflator-free endoscopic thyroidectomy with a submental approach. We aimed to explore the feasibility and cosmetic effect of this method for the treatment of thyroid disease patients with submandibular fat accumulation. The average operation time was 4.2 hours; and the average hospitalization time was 4.75 days. There were no postoperative complications, such as hoarseness, low calcium, hand and foot numbness, etc., and no special complications and no recurrence or metastasis seen in the 6-month follow-up examination. The aesthetic satisfaction survey results of patients half a year after surgery were satisfactory and above. For thyroid cancer patients with submandibular fat accumulation, this method not only hides the surgical incision in the neck but also meets the patient's requirement for "submental aesthetics"; thus it has good application prospects. It should be pointed out that the current findings are preliminary results, based on data from only four patients.
| S-EPMC10506116 | biostudies-literature
Project description:BackgroundThe development of transoral endoscopic vestibular approach thyroidectomy (TOETVA) has been limited by inherent defects, such as mental nerve injury and carbon dioxide (CO2)-related complications. Herein, we proposed a new technique without CO2 called gasless submental-transoral combined approach endoscopic thyroidectomy (STET) to solve the problems in TOETVA.MethodsWe reviewed 75 patients who successfully underwent gasless STET using novel instruments at our institution from November 2020 to November 2021. A main incision of approximately 2 cm was made in the natural submental crease line and then combined with two vestibule incisions to complete the procedure. Demographic data, surgical technique and perioperative outcomes were retrospectively recorded.ResultsThirteen male and sixty-two female patients with a mean age of 34.0 ± 8.1 years were enrolled in this study. Sixty-eight patients had papillary thyroid carcinomas and seven had benign nodules. We successfully performed all gasless STET without conversion to open surgery. The average postoperative hospital stay was 4.2 ± 1.8 days. One transient recurrent laryngeal nerve injury and two transient hypoparathyroidisms were observed. Three patients complained of slight lower lip numbness on the first postoperative day. One case of lymphatic fistula, subcutaneous effusion, and incision swelling occurred each, all of which were conservatively cured. One patient developed a recurrence six months after surgery.ConclusionsGasless STET using our own designed suspension system is technically safe and feasible with reasonable operative and oncologic results.
| S-EPMC10264817 | biostudies-literature
Project description:The medial patellofemoral ligament (MPFL) and the MPFL/vastus medialis obliquus complex are essential for patellar stability. Insufficiency of the MPFL can lead to altered biomechanics and patellofemoral joint contact pressure, high recurrence rate, osteochondral lesions, compromised knee function, and patellofemoral osteoarthritis. Most frequently surgical reconstruction of the MPFL is performed to address patellar instability; however, open physis and donor site morbidity can be a concern. This Technical Note presents a surgical technique to identify the insufficient MPFL and describes in detail an anatomical retensioning repair of the MPFL to restore patellar stability.
| S-EPMC5984444 | biostudies-literature
Project description:With the introduction of the superficial quad technique, there has been a recent revival of interest in the quadriceps tendon as a graft choice for medial patellofemoral ligament (MPFL) reconstruction. The superficial quad technique has many anatomic advantages because the length, breadth, and thickness of the graft are similar to those of the native MPFL; moreover, the graft provides a continuous patellar attachment at the superior half of the medial border of the patella. The technique requires neither a patellar bony procedure nor patellar hardware. Biomechanically, the mean strength and stiffness of the graft are very similar to those of the native MPFL. The anatomic and biomechanical advantages depend on correct identification of the anatomic superficial lamina of the quadriceps tendon; hence the correct harvesting technique for the superficial lamina is crucial. Various sub-techniques for harvesting the quadriceps graft have emerged recently, such as superficial strip, pedicled, or partial graft harvesting; these can create confusion for surgeons. Additional confusion related to the preparation and fixation of the graft should also be addressed to avoid any potential complications. A step-by-step video of the superficial quad technique is presented, covering the exact dissection of the graft material and its preparation, delivery, and fixation.
| S-EPMC4722361 | biostudies-literature
Project description:This study presents a surgical technique for kinematically aligned medial unicompartmental knee arthroplasty with the MOTO (Medacta Corporate, Switzerland) partial knee implant. This technique aims to replicate the native medial femoral and tibial morphology by providing caliper-verified bone resections and kinematic alignment principles. The paper provides a comprehensive overview of the surgical steps and discusses the implications for implant longevity.
| S-EPMC11345933 | biostudies-literature
Project description:Medial patellofemoral ligament reconstruction risks patellar fracture with the osseous violation necessary for patellar attachment. Anatomic studies identify an entire medial patellofemoral complex of structures responsible for medial restraint to patellar lateral instability. One specific component of this complex is the medial quadriceps tendon femoral ligament (MQTFL). This note presents the technique, pearls and pitfalls, and critical surgical anatomy necessary for successful MQTFL reconstruction-a treatment strategy for patellar instability with no increased risk for patellar fracture. An autograft hamstring tendon or allograft tendon is fixed to the anatomically identified femoral origin and passed deep to the vastus medialis obliquus to then weave around the distal medial quadriceps tendon. This simulates the native anatomic interdigitation of the MQTFL with the quadriceps tendon and provides a stable restraint to prevent lateral patellar subluxation or dislocation.
| S-EPMC6408716 | biostudies-literature
Project description:BackgroundThe closure of high-tension incisions without any assistance can be difficult and challenging for surgeons. A common practice is to fix the first knot with a clamp and then tie a reverse locking knot; however, this practice has certain disadvantages. The aim of this study was to introduce a novel and efficient surgical knotting technique with various advantages.MethodsThe two knotting methods used in this study were the absorbable braided suture where the first suture was fixed with a clamp (with assistance) and the SH-9Hospital knotting technique (without assistance) applied on the smooth surface of a cylinder. Mechanical testing was performed using a universal material testing machine. The load-elongation curve and ultimate tensile load (UTL) were recorded.ResultsThe mean knotting time was 36.40±1.50 s (range, 32-41 s) and 24.80±1.16 s (range, 21-28 s) in the clamp and SH-9Hosptial groups, respectively. The mean UTL was 120.8±10.14 N (range, 81.11-136.55 N)and 126.5±6.29 N (range, 104.88-139.56 N) in the clamp and SH-9Hospital groups, respectively. The knot strength of the SH-9Hospital technique was not inferior to traditional clinical practice.ConclusionsThe SH-9Hospital knotting technique was a secure, convenient, and efficient method for high-tension closure.
| S-EPMC8033369 | biostudies-literature
Project description:Recurrent patella instability is a common condition that may potentiate substantial knee dysfunction resulting in loss of time from work and sports. There are numerous factors that contribute to recurrent patella instability including tearing of the medial patellofemoral ligament (MPFL), shallow trochlea, valgus alignment, externally rotated tibia tubercle, ligamentous laxity, elevated Q angle, and increased tibial tuberosity trochlear groove distance. Reconstruction of the MPFL has been shown to restore patella stability where concomitant pathology is within acceptable limits. Major complications include recurrence from inadequate MPFL reconstruction or failure to address other pathology, patella femoral pain from over constrained MPFL or unaddressed cartilage defects to the patella femoral compartment, or patella fracture. This technique provides a reproducible method of restoring patella stability through MPFL reconstruction while minimizing stress risers in the patella by using suture anchor fixation that creates a ligamentous footprint instead of tendon healing into a socket on the patella.
| S-EPMC6019813 | biostudies-literature