This book is the first to focus on the range of innovations that have been critical to the emergence of modern endocrine surgery. It provides a state-of-the art review of these developments, providing surgeons a single resource to better understand them. The text is broken into five parts. The first two parts cover the diagnosis and preoperative work-up of thyroid disease and parathyroid disease. Part three and four cover surgical adjuncts and surgical techniques. Finally, part five covers post-operative management and reviews developments that have allowed for ambulatory management to become a standard aspect of endocrine surgery. The book is written by experts that have been the primary proponents of the individual innovations. Chapters discuss the challenges and issues that the innovation address, its current state or use, and potential short- and long-term future directions/advances. Equipped with the knowledge provided by this text, surgeons can assess their own practice and choose to integrate innovations that may improve their patients’ outcomes.
Innovations in Modern Endocrine Surgery serves as a valuable resource for all physicians and trainees interested in the how and why of performing modern thyroid and parathyroid surgery. It also allows surgeons to measure the state of their current practice against the most progressive techniques and determine if opportunities exist to update their approach.
Author(s): Michael C. Singer, David J. Terris
Publisher: Springer
Year: 2021
Language: English
Pages: 312
City: Cham
Preface
Contents
Contributors
Part I: Diagnosis and Preoperative Work-up of Thyroid Disease
Chapter 1: Ultrasound for Thyroid Nodule Risk Stratification
Introduction
Ultrasound Setting and Image Acquisition
Gray-scale Ultrasound Characteristics of Thyroid Nodules
Doppler Flow in Thyroid Nodule Evaluation
Elastography
Risk Stratification System
Conclusion
References
Chapter 2: Molecular Assessment of Thyroid Nodules
Introduction
Cytological Nomenclature of Thyroid Nodules
Current Trends in the Management of Indeterminate Nodules and Guideline Recommendations
Machinery of Genomics to Phenotype: DNA, mRNA, ncRNA, and Protein
Genomics of Thyroid Cancer
Papillary Thyroid Cancer
Follicular Adenoma and Follicular Thyroid Cancer
Hürthle Cell Cancer
Medullary Thyroid Cancer
Genomics in Cytologically Indeterminate Results
Commercially Available Thyroid Nodule Molecular Tests
Afirma® Gene Expression Classifier and Afirma Gene Sequencing Classifier
ThyroSeq
ThyGeNEXT+ThyraMIR
How to Use Molecular Testing Results to Guide Surgery
Molecular Diagnostics Beyond Bethesda III/IV Nodules
Future Directions
Guiding Initial Management and Subsequent Follow-Up Strategies in Malignant Cases
Prognostics of Benign Nodules
Summary
References
Chapter 3: Active Surveillance for Thyroid Cancer
Introduction
Incidence of Thyroid Cancer
Cost of Thyroid Cancer Care
Complications of Thyroid Surgery
Reducing Thyroid Cancer Diagnosis
Active Surveillance
Clinical Data
Adoption/Implementation of Active Surveillance
Cost-Effectiveness
Future Directions
Conclusions
References
Chapter 4: Hemithyroidectomy for Differentiated Thyroid Cancer
Historical Context and Overview
Oncologic Outcomes Following Hemithyroidectomy
Clinical Framework to Guide Decision-Making Processes Regarding the Extent of Initial Surgery for Differentiated Thyroid Cancer
Step 1: Preoperative Evaluation
Step 2: Intra-operative Evaluation
Step 3: Postoperative Evaluation
Follow-Up Recommendations Following Hemithyroidectomy
Conclusions
References
Chapter 5: Neoadjuvant Therapy for Anaplastic Thyroid Carcinoma
Introduction
Clinical Presentation, Histopathology, and Staging of Advanced ATC
Molecular Pathogenesis
Neoadjuvant Therapy
External Beam Radiation
Cytotoxic Chemotherapy
BRAF-Directed Therapy
Conclusion
References
Chapter 6: Nonoperative Thyroid Ablation Techniques for Benign Thyroid Nodules
Introduction
HIFU Ablation
Nodule Selection
Before Ablation
Evidence Supporting the Role of HIFU
Clinical Application
Efficacy of HIFU Ablation
Safety of HIFU Ablation
Radiofrequency Ablation (RFA)
Nodule Selection
Preoperative Evaluation and Preparation
RFA
Moving Shot Technique
Efficacy of RFA Ablation
Safety of RFA
Discussion
Conclusion
References
Part II: Diagnosis and Preoperative Work-up of Parathyroid Disease
Chapter 7: Localization Studies for Hyperparathyroidism
Introduction
Historical Perspectives on Parathyroid Localization
The Role of Imaging in Parathyroid Surgery
Anatomical Imaging Modalities
Ultrasonography
Description of Technology and Technique
Four-Dimensional Computed Tomography
Magnetic Resonance Imaging
Functional Imaging Modalities
Nuclear Scintigraphy
SPECT/SPECT-CT
PET/CT
Invasive Techniques
Fine-Needle Aspiration Biopsy
Selective Venous Sampling and Selective Arteriography
Choice of Imaging Modalities
Conclusion
References
Chapter 8: Subtle Variants of Hyperparathyroidism: Normohormonal Hyperparathyroidism
Introduction
Incidence and Etiology
Presentation
Biochemical Profile and Interpretation
Localization Studies
Intraoperative Findings and Decision-Making
Long-Term Success and Outcomes
Conclusions and Future Investigation
References
Chapter 9: Subtle Variants of Hyperparathyroidism: Normocalcemic Hyperparathyroidism
Introduction
Pathophysiology
Diagnostic Criteria
Epidemiology
Clinical Features and Course of Disease
Nonspecific Symptoms
Natural History of NCHPT
Management of NCHPT
Surgical Management of NCHPT
Outcomes After Parathyroidectomy
Conclusion
References
Chapter 10: Indications for Parathyroidectomy
Parathyroid-Related Hypercalcemia
Effects of PTH-Mediated Hypercalcemia
When to Intervene
Indications for Surgery
References
Part III: Surgical Adjuncts
Chapter 11: Intermittent Neuromonitoring of the Recurrent Laryngeal Nerve
Introduction
Background
Challenges in IONM Adoption
IONM Application in Present-Day Clinical Practice
Application of Intraoperative Nerve Monitoring
Negative Predictive Value (NPV)
Positive Predictive Value (PPV)
Technique
Equipment
Anesthesia Considerations
IONM Data Gathering
Electromyography (EMG) Waveform: Amplitude, Latency, and Threshold
Loss of Signal
Establishing an Adequate Baseline
Evaluation of Equipment Malfunction
True Loss of Signal
Troubleshooting a LOS
False Negative vs. False Positive Results
Management Strategies
Staged Surgery
Recent Advances in IONM and Future Directions
Continuous Vagal Monitoring
Superior Laryngeal Nerve (SLN) Monitoring
Intraoperative Identification of Nonrecurrent Laryngeal Nerve
Conclusion
References
Chapter 12: Continuous Neuromonitoring of the Recurrent Laryngeal Nerve
Introduction
Rationale for Use of c-IONM
Standardized Approach to c-IONM
Interpretation of c-IONM EMG Data
Impending Neural Injury
Artifact
Signal Recovery
False Positive and False Negative Events
Staged Thyroidectomy with c-IONM
Safety of c-IONM
c-IONM vs. i-IONM
Future Perspectives
References
Chapter 13: Neuromonitoring of the Superior Laryngeal Nerve
Introduction
Injury to the EBSLN and Its Consequences
Fundamentals of EBSLN Preservation: How It Was Done Prior to IONM
IONM and EBSLN Preservation
Benefits of IONM
Conclusion
References
Chapter 14: Advanced Energy Devices
Introduction
Bipolar Vessel Sealing Systems
Other Vessel Sealing Systems
Ultrasonic Devices
Challenges, Obstacles, and Misconceptions of Advanced Energy Devices
Energy Devices in Remote Access Thyroid Surgery
Future Directions: Radiofrequency Ablation
Conclusion
References
Chapter 15: Parathyroid Gland Fluorescence Imaging
The Need for Parathyroid Gland Identification and Assessment of Viability
Parathyroid Gland Identification and Detection
ICG
Autofluorescence Imaging
The Future of Fluorescence Imaging
References
Chapter 16: Intraoperative PTH Monitoring
Historical Perspective
Technical Considerations
Assay Characteristics
Source of Blood Samples
Modern Application
Previously Proposed Algorithms for Intraoperative Application of the PTH Assay
Modern ioPTH Interpretation
Interpretation of ioPTH in Renal Patients
Novel Uses
Tissue Aspirates: Preoperative and Intraoperative
Bilateral IJ Sampling
Final Considerations and Future Possibilities
Changing Phenotype
Faster Alternatives to the Rapid ioPTH
References
Part IV: Surgical Techniques
Chapter 17: Minimally Invasive Video-Assisted Parathyroidectomy (MIVAP) and Minimally Invasive Video-Assisted Thyroidectomy (MIVAT)
Minimally Invasive Video-Assisted Parathyroidectomy (MIVAP)
Introduction
The Technique
Indications for MIVAP
Advantages and Key Points of the Technique
Limits and Drawbacks
Minimally Invasive Video-Assisted Thyroidectomy (MIVAT)
The Technique
Indications
Advantages of MIVAT
Conclusion
References
Chapter 18: Robotic Transaxillary Thyroidectomy
Introduction
Patient Selection, Indications, and Contraindications
Surgical Technique
Postoperative Care and Complications
Advantages and Disadvantages
Future Directions
References
Chapter 19: Transoral Thyroidectomy
Introduction
Remote-Access Thyroid Surgery
Overview
Limitations of the Previously Described Remote-Access Thyroid Surgery
Development of Transoral Thyroid Surgery
The Value of Avoiding a Cervical Incision
The Role of Robotic Surgical Systems in Transoral Thyroid Surgery
Surgical Technique
Limitations of TOETVA
Future Directions
References
Part V: Postoperative Management
Chapter 20: Ambulatory Endocrine Surgery
Introduction
Potential Benefits of Ambulatory Endocrine Surgery
Ambulatory Thyroid Surgery
Challenges and Risks of Ambulatory Thyroid Surgery
Recurrent Laryngeal Nerve Injury and Risk of Aspiration
Post-Thyroidectomy Neck Hematoma and Risk of Asphyxiation
Hypoparathyroidism and Risk of Severe Hypocalcemia and Tetany
Postoperative Pain, Nausea, and Vomiting
Ambulatory Parathyroid Surgery
Conclusion
References
Chapter 21: Postoperative Calcium Management
Introduction
Patient and Disease Predisposing Risk Factors
Signs and Symptoms of Hypocalcemia
Monitoring of Postoperative PTH and Calcium Levels
Prognostication of Postoperative Hypoparathyroidism/Hypocalcemia
Management of Postoperative Hypoparathyroidism/Hypocalcemia
Hungry Bone Syndrome
Conclusion
References
Index
