Minimally Invasive Therapies for Endocrine Neck Diseases

 

Description:

 

This handy book offers a complete overview of current minimally invasive techniques for the management of endocrine diseases of the neck, reflecting how, in the past few years, the development of various ultrasound-guided procedures and endoscopic/video-assisted surgical techniques has changed the approach to thyroid and parathyroid diseases. The book opens by describing the main diagnostic tools for thyroid, parathyroid and cervical lymph nodes, focusing especially on the new technologies for tissue characterization. The different minimally invasive treatment procedures involving either a percutaneous approach (ethanol injection, laser thermal ablation, radiofrequency thermal ablation, high-intensity focused ultrasound) or minimally invasive surgery are then described in detail. The volume is intended for all clinicians and surgeons with an interest in the field of endocrinology and neck surgery. It provides a synthetic but clear description of the various available techniques from a technical point of view and discusses the main issues concerning each of them, permitting comparative evaluation in order to identify the best option in a particular case. It also reports the evidence available in the current literature.

Table of Contents:

Part I: Ultrasound Imaging

1: Ultrasound Features of Thyroid, Parathyroid, Neck Lymph Nodes: Normal and Pathologic Pattern

1.1 Thyroid

1.1.1 Normal Neck Anatomy and Standard Ultrasound Examination

1.1.2 Diffuse Thyroid Enlargement

1.1.3 Focal Enlargement

1.1.3.1 Echogenicity

1.1.3.2 Calcifications

1.1.3.3 Margins

1.1.3.4 Halo

1.1.3.5 Vascularization

1.1.3.6 Taller Than Wide

1.1.3.7 Stiffness

1.1.3.8 Associated Features

1.2 Neck Lymph Node

1.3 Parathyroid

References

2: Fine Needle Aspiration Biopsy

2.1 Procedure

2.2 Contraindications

2.3 Complications

2.4 Thyroglobulin in Washout Fluid from Lymph Node FNAB

References

3: Cytology of Thyroid Lesions

3.1 Introduction

3.2 Non-neoplastic Lesions

3.3 Indeterminate Lesions

3.4 Suspicious for Malignancy

3.5 Malignant Neoplasms

3.6 Reporting Systems for Thyroid Cytology

References

4: Molecular Markers in Thyroid Fine-­Needle Aspiration Biopsies

4.1 FNAB Material Retrieval, Conservation, Work-Up

4.2 Assessment of Molecular Abnormality in Cytological Sample

4.2.1 MicroRNA

4.2.2 Gene Mutations

4.2.3 Gene Translocations

4.2.4 Gene Amplifications

4.2.5 Gene Expression Variation

4.2.6 Aberrant Gene Methylation

4.2.7 Veracyte Afirma Gene Expression Classifier (GEC): Analytical and Clinical Value

4.3 Impact on Diagnosis

4.4 Impact on Surgical Choice

4.5 Future Perspectives

References

Part II: Ultrasound-Guided Interventional Techniques

5: Percutaneous Ethanol Injection for the Management of Thyroid Lesions

5.1 Introduction

5.2 Cytological Assessment

5.2.1 Technique

5.2.1.1 Cystic Nodules

5.2.1.2 Viscous Cystic Nodules

5.2.1.3 Complex Nodules

5.2.1.4 Solid Nodules

5.2.2 Assessment of the Response to PEIT

5.2.3 Side Effects

5.3 PEIT of Thyroid Cysts

5.3.1 Rationale

5.3.2 Results

5.3.3 Indications for Clinical Practice

5.4 Autonomously Functioning Thyroid Nodules (AFTNs)

5.4.1 Rationale

5.4.2 Results

5.4.3 Indications for Clinical Practice

5.5 Cold Nodules

5.5.1 Rationale

5.5.2 Results

5.5.3 Indications for Clinical Practice

5.6 Cervical Metastasis of Thyroid Cancer

5.6.1 Rationale

5.6.2 Results

5.6.3 Indications for Clinical Practice

5.7 Other Neck Lesions

5.8 Costs

Conclusions

References

6: Percutaneous Laser Thermal Ablation (LAT): Techniques, Indications, Experience and Complications

6.1 Principles and Technique

6.2 Experience

6.2.1 Cold Nodules

6.2.2 Autonomously Functioning Thyroid Nodules

6.2.3 Cystic Lesions

6.2.4 Cervical Recurrences of Thyroid Tumours

6.3 Tolerability and Safety

6.3.1 Tolerability

6.3.2 Complications

6.4 Conclusions and Indications

References

7: Percutaneous Radiofrequency Ablation

7.1 Introduction

7.2 Procedure

7.2.1 Devices

7.2.2 The Trans-isthmic Approach and Moving Shot Technique

7.3 Indications

7.4 Clinical Outcomes

7.5 Complications

Conclusion

References

8: High-Intensity Focused Ultrasound Ablation (HI-FU) in Endocrine Neck Diseases

8.1 Technique

8.2 Indications

8.2.1 Thyroid Disease

8.2.1.1 Euthyroid Nodular Goiters

8.2.1.2 Nodular Hyperthyroidism

8.2.1.3 Not Estimated Indications

8.2.2 Parathyroid Neck Disease

8.3 Experience and Complications

8.4 Management of Complications

Conclusion

References

9: Mini-Invasive Techniques for the Treatment of Thyroid Nodules: Critical Issues

9.1 PEI

9.2 Laser and Radiofrequency Thermal Ablation

9.2.1 Are There US or Clinical Features or Physical Parameters Which Can Predict the Extent of Vo

9.2.2 What Is the Best Nodule Volume for Treatment?

9.2.3 Is Thermal Ablation Better Than PEI in Cystic Nodules? Is There a Limit in the Solid/Coll

9.2.4 How Frequent Is Nodule Regrowth? How Long Does Volume Reduction Last?

9.2.5 Is a Single Treatment Session Enough? How Many Repeated Treatment Sessions Are Required to

9.2.6 Are the Hyperfunctioning Nodules Suitable for Thermal Ablation?

9.2.7 Is There a Risk of Not Detecting Malignancy in Nodules Undergoing Thermal Ablation?

9.2.8 Is There a Precocious Thyroid Hormone Release After Treatment Causing Risk of Transient Thy

9.2.9 Is Thermal Ablation Cost-Effective?

9.2.10 Is Thermal Ablation Suitable for Treating Thyroid Cancer?

9.2.10.1 Local Recurrent Thyroid Cancer

9.2.10.2 Primary Tumor

9.2.11 Is a Technique (Laser or Radiofrequency) More Effective Than the Other?

9.3 HIFU

9.4 Microwave

References

Part III: Minimally Invasive Surgical Techniques

10: Minimally Invasive Video-Assisted Thyroidectomy (MIVAT)

10.1 Introduction

10.2 Indications

10.3 Instruments

10.4 Surgical Technique

10.4.1 Anaesthesia

10.4.2 Patient Position

10.4.3 Surgical Equipment

10.4.4 Surgical Steps

10.5 Personal Series

10.6 MIVAT: Evidence-Based Recommendations

References

11: Locoregional Anesthesia in Thyroid and Parathyroid Surgery

11.1 Introduction

11.2 Benefits of Locoregional Anesthesia

11.3 Contraindications to Locoregional Anesthesia

11.4 Relevant Anatomy

11.5 Types of Locoregional Block

11.6 Types of Local Anesthesia

11.7 Monitored Anesthesia Care

11.8 Patient Selection

11.9 Complications Specific to Locoregional Anesthesia

Conclusion

References

12: Robotic Thyroidectomy

12.1 Remote Access Robotic Thyroidectomy Techniques

12.1.1 RAT Technique

12.1.2 RFT Technique

12.2 Indications for Remote Access Robotic Thyroid Surgery

12.2.1 RAT Patient Selection

12.2.2 RFT Patient Selection

12.3 Experience and Complications

12.3.1 RAT Outcomes

12.3.2 RFT Outcomes

12.4 Management of Complications

References

13: Minimally Invasive Video-Assisted Parathyroidectomy (MIVAP)

13.1 Introduction

13.2 Surgical Technique

13.3 Indications

13.4 Experience and Complications

13.5 Advantages and Disadvantages

13.6 Avoiding Complications

13.6.1 Postoperative Hematoma

13.6.2 Recurrent Laryngeal Nerve Injury

13.6.3 Hypocalcemia and Hypoparathyroidism

References

14: Endoscopic Parathyroidectomy

14.1 Techniques

14.1.1 Minimally Invasive Radioguided Approach (MIRP)

14.1.2 Open Minimally Invasive Parathyroidectomy (OMIP)

14.1.3 Minimally Invasive Video-Assisted Parathyroidectomy (MIVAP)

14.1.4 Endoscopic Minimally Invasive Parathyroidectomy (EMIP)

14.1.5 Lateral Endoscopic Parathyroidectomy

14.1.6 Robotic Transaxillary Parathyroidectomy

14.2 Indications

14.3 Experience and Complications

14.4 Management of Complications

Conclusions

References

15: Minimally Invasive Video-Assisted Neck Dissection

15.1 Introduction

15.1.1 Video-Assisted Central Compartment Dissection (VA-CCD)

15.1.2 Video-Assisted Lateral Neck Dissection (VALNED)

15.2 Indications

15.3 Surgical Technique

15.4 Personal Experience and Complications

References

16: Minimally Invasive Surgical Techniques: Critical Appraisal and Future Perspectives

16.1 Parathyroidectomy

16.2 Thyroidectomy

References

Part IV: Intraoperative Adjuncts

17: Superior Laryngeal Nerve Monitoring

17.1 Introduction

17.2 EBSLN Surgical Anatomy

17.2.1 Classifications

17.2.2 The Sternothyroid–Laryngeal Triangle

17.2.3 EBSLN Anastomoses

17.3 Incidence of EBSLN Injury

17.4 Diagnosis and Treatment of the EBSLN Injury

17.5 EBSLN Monitoring Technique

17.5.1 Equipment and Setup

17.5.2 Definitions of EBSLN Monitoring

17.6 Technique A

17.6.1 IONM of the EBSLN: Stimulation–CTM Twitch [5]

17.7 Technique B

17.7.1 IONM of the EBSLN: Stimulation–Glottic EMG Signal [5]

17.7.2 Normative Data of the EBSLN Monitoring

Conclusion

References

18: Recurrent Laryngeal Nerve Monitoring

18.1 Applications of IONM

18.2 Intraoperative Nerve Monitoring Standards

18.2.1 Introduction

18.2.2 Technique: IONM

18.2.3 The Equipment Setup

18.2.4 Anesthesia

18.2.5 Loss of Signal and Its Interpretation (Fig. 18.3)

18.2.6 Prognostic Testing Errors

18.3 Promising Advances in IONM

18.3.1 Continuous Vagal Monitoring and Neural Injury Prevention

18.3.2 Superior Laryngeal Nerve (SLN) Monitoring

18.3.3 Neural Monitoring and Staged Thyroidectomy in Thyroid Cancer Surgery: An Emerging Concept

18.3.4 Intraoperative Identification of Nonrecurrent Laryngeal Nerve

References

19: Hemostatic Devices

19.1 Introduction

19.2 Harmonic Scalpel

19.3 LigaSure

19.4 BiClamp

19.5 Comparison Between Devices

References

20: Topical Hemostatic Agents

20.1 Introduction

20.2 Indications

20.3 Topical Hemostatic Agents

20.3.1 Passive Hemostatics

20.3.1.1 Cellulose-Based Hemostatic Agents

20.3.1.2 Gelatin-Based Hemostatic Agents

20.3.1.3 Collagen-Based Hemostatic Agents

20.3.2 Active Hemostatics

20.3.2.1 Fibrin Sealants (FS)

20.3.2.2 Thrombin-Based Hemostatic Agents

20.3.3 Tissue Adhesive

20.3.4 Combined THA

20.4 Adverse Effects and Complications

20.4.1 Impaired Wound Healing

20.4.2 Surgical Infection

20.4.3 Allergic Reactions

20.4.4 Blood-Borne Disease

20.4.5 Vascular Thrombosis

20.5 Choice of Topical Hemostatic Agent

20.6 Cost Considerations

Conclusions

References

21: Critical Appraisal

21.1 Introduction

21.2 External Branch Superior Laryngeal Nerve Intraoperative Nerve Monitoring

21.3 Recurrent Laryngeal Nerve Intraoperative Nerve Monitoring

21.4 Hemostatic Devices

21.5 Hemostatic Agents

Conclusion

References

Part V: Key-Points

22: How to Avoid and Manage Post-­operative Complications

22.1 Recurrent Laryngeal Nerve/Voice Injury

22.1.1 Pre-operative Considerations

22.1.2 Operation

22.1.3 Post-operative Management

22.2 Haemorrhage/Haematoma

22.2.1 Pre-operative Considerations

22.2.2 Operation

22.2.3 Post-operative Management

22.3 Hypoparathyroidism

22.3.1 Pre-operative Considerations

22.3.2 Operation

22.3.3 Post-operative Management

22.4 Pain

22.5 Wound Complications

22.6 Rare Complications

22.7 Complaints and Litigation

References

23: Perioperative Medical Treatment

23.1 Preoperative Medical Management

23.2 Medical Treatment of Postsurgical Hypothyroidism

23.3 Medical Treatment of Postsurgical Hypoparathyroidism

References

24: Patient Counselling and Patients’ Involvement in Health Policy

24.1 For Physicians

24.1.1 Informed Patients

24.2 Informed Consent

24.2.1 New Technology and Innovative Surgical Treatments

24.2.2 Patients Organizations and Patients Advocates Role in Health Care Decision-Making Process

24.3 For Patients

24.3.1 Some Hints for Patients to Retrieve Correct Information from the Internet

24.3.2 How Can I Check the Quality of the Information I Find on the Web?

24.3.3 How Can I Choose my Surgeon?

24.3.4 Alternative Options for Benign Nodule Treatment

24.3.5 Thyroid Surgery

 

An aparitie	14 Sep 2015
Autor	Celestino Pio Lombardi, Rocco Bellantone
Dimensiuni	155 x 235 x 25 mm
Editura	Springer
Format	Paperback
ISBN	9783319200644
Limba	Engleza
Nr pag	308