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Totally endoscopic left hemithyroidectomy: axillary approach for papillary carcinoma, including a critical analysis by M Vix, MD, and point by point answer by Dr. Shah
Introduction:
Endoscopic thyroidectomy is a novel approach used to avoid cervical scar, which represents sequelae of conventional thyroidectomies. This technique is feasible providing equal results under expert hands.
Case presentation:
This is the case of a 20 year-old woman with cervical swelling, a 3 by 3cm solitary nodule in the left thyroid lobe, which was evaluated clinically, radiologically, and withfine-needle aspiration cytology (FNAC). She was diagnosed with a low-risk papillary carcinoma.
Discussion:
The patient underwent an endoscopic transaxillary left hemithyroidectomy under general anesthesia. The recurrent laryngeal nerve and the parathyroid gland were preserved. The patient was discharged with a normal tone on postoperative day 1.
Conclusion:
Endoscopic transaxillary thyroidectomy is a feasible good technique with equal results, which can be considered for patients with small thyroid lesions. Conventional laparoscopic instruments are used without the need for extra instrumentation.

This video is commented upon by Dr. M Vix, MD (University Hospital, Strasbourg, France), providing a comprehensive outline of Dr. Shah's original technique.


Point by point answer by Dr. Shah:

1. Carbon dioxide causing surgical emphysema, especially of an incapacitating nature, has not been experienced since intracavitary pressures are generally maintained at a low level by the almost continuous low-grade suction used throughout the surgery.

2. In our experience, adequate visualization of the thyroid pedicles in close proximity to the gland precludes the need for a deeper and more lateral dissection to identify the jugulocarotid vessels. This potentially decreases the risk of a major vascular mishap.

3. As is the norm with open thyroidectomy, division of the superior thyroid pedicle close to the gland usually does not require the identification of the superior laryngeal nerve.

4. In this approach, the recurrent laryngeal nerve is identified very early on in the dissection. Subsequent dissection is performed in a plane anterior to the visualized nerve, hence preventing any injuries. The recurrent laryngeal nerve is visualized in its entire extent up to Berry's ligament.



AR Shah
Surgical intervention
2 years ago
1041 views
114 likes
0 comments
11:09
Totally endoscopic left hemithyroidectomy: axillary approach for papillary carcinoma, including a critical analysis by M Vix, MD, and point by point answer by Dr. Shah
Introduction:
Endoscopic thyroidectomy is a novel approach used to avoid cervical scar, which represents sequelae of conventional thyroidectomies. This technique is feasible providing equal results under expert hands.
Case presentation:
This is the case of a 20 year-old woman with cervical swelling, a 3 by 3cm solitary nodule in the left thyroid lobe, which was evaluated clinically, radiologically, and withfine-needle aspiration cytology (FNAC). She was diagnosed with a low-risk papillary carcinoma.
Discussion:
The patient underwent an endoscopic transaxillary left hemithyroidectomy under general anesthesia. The recurrent laryngeal nerve and the parathyroid gland were preserved. The patient was discharged with a normal tone on postoperative day 1.
Conclusion:
Endoscopic transaxillary thyroidectomy is a feasible good technique with equal results, which can be considered for patients with small thyroid lesions. Conventional laparoscopic instruments are used without the need for extra instrumentation.

This video is commented upon by Dr. M Vix, MD (University Hospital, Strasbourg, France), providing a comprehensive outline of Dr. Shah's original technique.


Point by point answer by Dr. Shah:

1. Carbon dioxide causing surgical emphysema, especially of an incapacitating nature, has not been experienced since intracavitary pressures are generally maintained at a low level by the almost continuous low-grade suction used throughout the surgery.

2. In our experience, adequate visualization of the thyroid pedicles in close proximity to the gland precludes the need for a deeper and more lateral dissection to identify the jugulocarotid vessels. This potentially decreases the risk of a major vascular mishap.

3. As is the norm with open thyroidectomy, division of the superior thyroid pedicle close to the gland usually does not require the identification of the superior laryngeal nerve.

4. In this approach, the recurrent laryngeal nerve is identified very early on in the dissection. Subsequent dissection is performed in a plane anterior to the visualized nerve, hence preventing any injuries. The recurrent laryngeal nerve is visualized in its entire extent up to Berry's ligament.



Successful laparoscopic reversal of Roux-en-Y gastric bypass in a patient suffering from malnutrition authored by JY Park and YJ Kim (Soonchunhyang University Seoul Hospital, Seoul, South Korea)
The video entitled "Successful laparoscopic reversal of Roux-en-Y gastric bypass in a patient suffering from malnutrition", authored by JY Park and YJ Kim (Soonchunhyang University Seoul Hospital, Seoul, South Korea) is analyzed by Dr. Michel Vix, MD (Nouvel Hôpital Civil, Strasbourg, France), sharing in this way his own personal experience and highlighting the different surgical approaches available with tips and tricks.

Reply from Dr. Ji Yeon Park to the reviewer:
The South Korean surgeon in the current case, who originally was a gastric cancer surgeon, was extremely inexperienced in bariatric surgery at the time of the primary surgery in this patient. He applied “uncut” Roux-en-Y reconstruction for gastric cancer surgery to RYGB in this patient; it is a simple modification of Billroth II with Braun anastomosis with additional occlusion of the jejunogastric pathway with a non-bladed linear stapler. Consequently, sufficient distance between the gastrojejunostomy and the jejunojejunostomy was preserved in order to prevent bile reflux into the remnant stomach when staple-line recanalization occurs. However, intraoperative findings at reversal showed that the previously uncut staple line was found split apart, far from being recanalized. This consequently resulted in a long “true” blind loop at the distal end of the biliopancreatic limb. At reversal, we established a new jejunojejunal anastomosis between the distal end of the blind loop and the cut end of the proximal alimentary limb, and left the old jejunojejunostomy in situ. The operative procedure per se became much simpler by not dismantling the old jejunojejunostomy; as a result, the number of new anastomoses and the operating time could be reduced.
JY Park, YJ Kim, M Vix
Surgical intervention
4 years ago
1287 views
20 likes
0 comments
17:41
Successful laparoscopic reversal of Roux-en-Y gastric bypass in a patient suffering from malnutrition authored by JY Park and YJ Kim (Soonchunhyang University Seoul Hospital, Seoul, South Korea)
The video entitled "Successful laparoscopic reversal of Roux-en-Y gastric bypass in a patient suffering from malnutrition", authored by JY Park and YJ Kim (Soonchunhyang University Seoul Hospital, Seoul, South Korea) is analyzed by Dr. Michel Vix, MD (Nouvel Hôpital Civil, Strasbourg, France), sharing in this way his own personal experience and highlighting the different surgical approaches available with tips and tricks.

Reply from Dr. Ji Yeon Park to the reviewer:
The South Korean surgeon in the current case, who originally was a gastric cancer surgeon, was extremely inexperienced in bariatric surgery at the time of the primary surgery in this patient. He applied “uncut” Roux-en-Y reconstruction for gastric cancer surgery to RYGB in this patient; it is a simple modification of Billroth II with Braun anastomosis with additional occlusion of the jejunogastric pathway with a non-bladed linear stapler. Consequently, sufficient distance between the gastrojejunostomy and the jejunojejunostomy was preserved in order to prevent bile reflux into the remnant stomach when staple-line recanalization occurs. However, intraoperative findings at reversal showed that the previously uncut staple line was found split apart, far from being recanalized. This consequently resulted in a long “true” blind loop at the distal end of the biliopancreatic limb. At reversal, we established a new jejunojejunal anastomosis between the distal end of the blind loop and the cut end of the proximal alimentary limb, and left the old jejunojejunostomy in situ. The operative procedure per se became much simpler by not dismantling the old jejunojejunostomy; as a result, the number of new anastomoses and the operating time could be reduced.