Biomedical subjects

Rocco Bellantone

Publications and source records attributed to Rocco Bellantone.

7 recordsLinked to original sources

PubMed2002

Total thyroidectomy for management of benign thyroid disease: review of 526 cases.

Total thyroidectomy is not frequently performed in cases of benign disease because of the associated risk of postoperative hypoparathyroidism and recurrent laryngeal nerve (RLN) damage. We chose a series of patients who had undergone total thyroidectomy (TT) for benign thyroid tumors to evaluate the safety of this approach and its role in the treatment of nonmalignant lesions of the thyroid. We considered only patients with a minimum follow-up of 24 months. Records of 526 patients who underwent TT were carefully reviewed, assessing for perioperative complications and late sequelae. The mean age was 44 +/- 15.7 years; 109 patients (20.7%) were male and 417 (79.3%) were female. Altogether, 65 patients (12.3%) were operated on for toxic goiter, 429 (81.6%) for bilateral nodular goiter, and 32 (6.1%) for thyroiditis. Postoperative hemorrhage requiring reoperation occurred in 8 cases (1.5%). The incidences of permanent RLN palsy (considered as a percentage of the nerves at risk) and permanent hypocalcemia were 0.4% and 3.4%, respectively. A trend toward a decrease in the complication rate was observed during the last 5 years. There were no disease recurrences during a mean follow-up of 44 months. The results of our series show that TT can be performed safely in patients, with a low incidence of lifetime disabilities. TT has the advantage of reducing/avoiding the risk of disease recurrence and reoperation and should therefore be considered a valuable option for treating benign thyroid diseases.

Adult↗

PubMed2002

Minimally invasive video-assisted thyroidectomy: multiinstitutional experience.

Minimally invasive video-assisted thyroidectomy (MIVAT) was described in 1998. In this study we collected the experience of four third-level referral centers that adopted this technique. A total of 336 patients (279 females, 57 males) were selected for MIVAT. Selection criteria were thyroid volume <15 ml, nodules not exceeding 3.5 cm of diameter, and an absence of thyroiditis, previous neck surgery, or previous irradiation. The procedure, totally gasless, is carried out through a 15 mm central incision above the sternal notch. Dissection is performed under endoscopic vision using conventional and endoscopic instruments. The mean operating time was 69.4 +/- 30.6 minutes for lobectomy (range 20-150 minutes) and 87.4 +/- 43.5 minutes for total thyroidectomy (range 30-220 minutes). The mean postoperative stay was 1.9 +/- 0.8 days. Postoperative complications were 7 transient and 1 definitive recurrent nerve palsies and 11 cases of hypoparathyroidism (9 transient, 2 definitive). Conversion to open surgery was necessary in 15 patients (4.5%). This study confirms in a large number of cases the safety and feasibility of MIVAT, even in different surgical settings where similar results were achieved. The complication rate was not different from that of standard thyroidectomy. Although the operating time appears longer than with conventional procedures, the learning curve demonstrates a sharp decrease with increasing experience and the introduction of new technologies. The number of patients eligible for this approach remains low, thereby limiting its use, but it should be considered a valid option in selected surgical centers, offering some advantages to patients in terms of cosmetic results and postoperative distress.

Adolescent↗

PubMed2002

Video-assisted vs conventional thyroid lobectomy: a randomized trial.

HYPOTHESIS: Video-assisted thyroid lobectomy improves the cosmetic outcome of the cutaneous scar and reduces postoperative pain. PARTICIPANTS: Patients admitted to the Division of Endocrine Surgery of the Università Cattolica del Sacro Cuore, Rome, Italy, between March 1999 and December 2000 who were candidates for thyroid lobectomy because of a single, small (< or = 3 cm) thyroid nodule were considered eligible. Of the 62 patients who were randomized, 31 underwent conventional thyroid lobectomy (COS group), and 31 underwent video-assisted surgery without carbon dioxide neck insufflation (VAS group), a new technique created by the authors. RESULTS: The cosmetic outcome was evaluated by scoring patients' satisfaction with their scars. Satisfaction was higher in the VAS group (mean +/- SD, 9.2 +/- 0.5) than the COS group (mean +/- SD, 5.8 +/- 0.7) (P<.001). Postoperative pain in the first and second days after surgery was lower in the VAS group (mean +/- SD, 1.8 +/- 0.2 and 1.2 +/- 0.1, respectively) than in the COS group (mean +/- SD, 6.2 +/- 0.2 and 5.8 +/- 0.2, respectively) (P<.001). There were no significant differences in complications (eg, bleeding, wound infection, permanent recurrent nerve palsy). Postoperative hospital stay was lower in the VAS group (mean +/- SD, 1.1 +/- 0.1 days) than in the COS group (mean +/- SD, 2.2 +/- 0.2 days) (P<.05). CONCLUSION: Video-assisted thyroid lobectomy is a valid alternative to conventional surgery in patients with single, small nodular thyroid lesions.

Cicatrix↗

PubMed2002

Video-assisted thyroidectomy.

OBJECTIVE: In 1998, we developed a technique for video-assisted thyroidectomy (VAT). In this paper, we report on the entire series of patients who underwent VAT and discuss the results obtained. METHODS: Seventy-three patients were selected for VAT. Eligibility criteria were: thyroid nodules </=35 mm in maximum diameter; estimated thyroid volume within normal range or slightly enlarged; small, low-risk papillary carcinomas; no previous neck surgery or irradiation and no thyroiditis. The VAT procedure was totally gasless. It was performed under endoscopic vision through a single 1.5 to 2.0-cm skin incision, using a technique very similar to conventional surgery. RESULTS: Eighty-one VATs were attempted on 73 patients. Forty-five lobectomies, 24 total thyroidectomies and eight completion thyroidectomies were successfully performed. Mean operative time was 82 minutes for lobectomy, 100 minutes for total thyroidectomy and 77 minutes for completion thyroidectomy. The conversion rate was 4.9%. Postoperative complications included two transient recurrent nerve palsies, five transient symptomatic postoperative hypocalcaemias and one wound infection. The cosmetic result was considered excellent by most of the patients. CONCLUSION: VAT is a feasible and and safe procedure that allows for excellent cosmetic results. In selected cases, it can be a valid option for the surgical treatment of thyroid diseases.

Adult↗

PubMed2002

Video-assisted thyroidectomy.

BACKGROUND: In 1998, we developed a technique for video-assisted thyroidectomy (VAT). In this article we report on the entire series of patients who underwent VAT and discuss the results obtained. STUDY DESIGN: Forty-seven patients were selected for VAT. Eligibility criteria were: thyroid nodules of 35 mm or less in maximum diameter; estimated thyroid volume within normal range or slightly enlarged; small, low-risk papillary carcinomas; neither previous neck surgery nor irradiation; and no thyroiditis. After a learning period, VAT was proposed also for completion thyroidectomy (of previous video-assisted lobectomy) and nodules with maximum diameter up to 45 mm. The procedure is performed by a totally gasless video-assisted technique through a single 1.5- to 2.0-cm skin incision. Dissection is performed under endoscopic vision using a technique very similar to conventional operation. RESULTS: Fifty-three VATs were attempted on 47 patients. Thirty-three lobectomies, 10 total thyroidectomies, and 6 completion thyroidectomies were successfully performed. Six patients with papillary carcinoma underwent central neck lymph node removal by the same access. Mean operative time was 86.8 minutes for lobectomy, 116.0 minutes for total thyroidectomy, and 77.5 minutes for completion thyroidectomy. Conversion rate was 7.5%. Postoperative complications included one transient recurrent nerve palsy, three transient symptomatic postoperative hypocalcemias, and one wound infection. The cosmetic result was considered excellent by most of the patients who successfully underwent VAT. CONCLUSIONS: VAT is feasible and safe and allows for an excellent cosmetic result. Not all patients are eligible for this procedure, but in selected cases it can be a valid option for the surgical treatment of thyroid diseases.

Adenocarcinoma, Follicular↗

PubMed2002

Is routine supplementation therapy (calcium and vitamin D) useful after total thyroidectomy?

BACKGROUND: Our goal was to determine whether routine oral calcium (OC) and vitamin D (VD) administration can effectively prevent symptoms of hypocalcemia after total thyroidectomy. METHODS: Seventy-nine patients who underwent total thyroidectomy were randomly allotted to one of the following groups: (1) group A, no treatment; (2) group B, OC 3 g per day; (3) group C, OC 3 g + VD 1 mg per day. Treatment was started on postoperative (PO) day 1 in groups B and C. RESULTS: Fewer patients in groups B and C experienced symptoms when compared with group A (P =.005). Patients in groups B and C had only minor symptoms, whereas 2 patients in group A experienced major symptoms and 6 required intravenous calcium (P <.01). The rate of hypocalcemia was slightly lower in group C (P = not significant). Treatment was discontinued by PO day 7 in all but 8 patients. Two patients still required treatment 6 months after operation (2.5%). PO parathyroid hormone levels did not differ in the 3 groups (P = not significant). CONCLUSIONS: Routine supplementation therapy with OC or VD effectively prevents symptomatic hypocalcemia after total thyroidectomy and may allow for a safe early discharge. Further studies are necessary to determine the best treatment. The combination of OC and VD may further reduce the rate of PO hypocalcemia, without inhibiting parathyroid hormone secretion.

Adult↗

PubMed2002

Central neck lymph node removal during minimally invasive video-assisted thyroidectomy for thyroid carcinoma: a feasible and safe procedure.

BACKGROUND AND PURPOSE: In 1998, we developed a technique for video-assisted thyroidectomy (VAT) which we proposed using also in patients with small low-risk papillary thyroid carcinomas (PTC). In some cases, enlarged lymph nodes are incidentally found at surgery for PTC. These nodes should be removed because of the risk of metastases. In this paper, we report on the patients in whom we removed enlarged central neck lymph nodes during VAT for PTC and discuss the feasibility and safety of video-assisted central neck lymph node dissection (VALD). PATIENTS AND METHODS: The procedure is performed by a totally gasless video-assisted technique through a single 1.5-to 2.0-cm skin incision above the sternal notch. Dissection is performed under endoscopic vision using a technique very similar to that of conventional surgery. Only enlarged lymph nodes were removed and sent for frozen section examination (FS). No other dissection was performed in case of negative FS. Five patients underwent VALD during VAT for PTC. RESULTS: The mean number of lymph nodes removed was 2.4. No metastases were found at FS or final histology examination. Postoperative complications included two transient postoperative hypocalcemias. No evidence of residual or recurrent disease was observed at postoperative follow-up. The cosmetic result was excellent. CONCLUSION: Our experience demonstrates that removal of central compartment lymph nodes is feasible and safe. Perhaps also complete central neck lymph node dissection can be performed. Some doubts persist about the oncologic validity of this approach. For definitive conclusions, larger series and comparative studies are necessary.

Adult↗