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Antiadhesive effect and safety of oxidized regenerated cellulose after thyroidectomy
Kyoung Sik Park,Kyu Eun Lee,Do Hoon Ku,Su-Jin Kim,Won Seo Park2,Hoon Yub Kim3,,Mi Ra Kwon1,Yeo-Kyu Youn1 대한외과학회 2013 Annals of Surgical Treatment and Research(ASRT) Vol.84 No.6
Purpose: To evaluate the antiadhesive effects and safety of an oxidized regenerated cellulose (Interceed) after thyroidectomy. Methods: Seventy-six thyroidectomized patients were prospectively randomized into two groups with regard to the use of Interceed. We evaluated each group for their adhesive symptoms using four subjective and four objective items at the 2nd week, 3rd and 6th month after thyroidectomy. All patients were examined for vocal cord motility by indirect laryngoscope at each period. Results: Total adhesion scores at each postoperative follow-up period decreased with time, but were not significantly different in each group. The median score for swallowing discomfort for liquid was significantly lower in the Interceed group than in the control group 2 weeks after surgery. In addition, the severity of skin adhesion to the trachea was reduced in the Interceed group compared with the control group 6 months after surgery. During the study, there were no adverse effects or significant differences in postoperative complications between the groups. Conclusion: Interceed appeared to be safe and effective in improving neck discomfort at early postoperative periods and preventing skin adhesion to the trachea 6 months after thyroidectomy.
Standards for Intraoperative Neuromonitoring in Thyroid Operations
Hoon Yub Kim,Xiaoli Liu,Young Jun Chai,Ralph Tufano,Henning Dralle,Gianlorenzo Dionigi,the Korean Intraoperative Neural Monitoring Society(KINMoS) 대한갑상선-내분비외과학회 2018 The Koreran journal of Endocrine Surgery Vol.18 No.1
After the introduction of intraoperative neural monitoring (IONM) of the recurrent laryngeal nerve (RLN) in clinical thyroid practice almost 16 years ago, the procedure has expanded rapidly with an area-wide spread in Asia, Europe, and USA. While the visual nerve presentation with the eye or the magnifying glass technique is capable of assessing the anatomical continuity of the RLN, IONM additionally allows a functional analysis that has a high correlation, i.e., prediction of postoperative vocal motility. Although the predictive value of the IONM is much higher (>97%) in the case of an intact signal than in the case of a signal failure (40%-70%), the prediction is also unequally higher than the visual-anatomical assessment of the nerve. Thus, IONM can be used as a basis for an intraoperative decision-making of a 1-side or 2-side procedure to avoid bilateral RLN palsy in a bilateral procedure. A precondition for the safe application of IONM is the perfect knowledge of the technology and technique, the routine execution of preoperative and postoperative laryngoscopy, the strict standardization of the neurostimulation (electromyography documentation of the vagal nerve stimulation before and after resection), and an adequate management of technically or operationally caused incidents (i.e., systematic application of troubleshooting algorithms). The following review provides a synopsis of the experiences of the Korean Intraoperative Neural Monitoring Society (KINMoS) for the correct use of IONM.
Intraoperative Neural Monitoring in Thyroid Surgery: Role and Responsibility of Surgeon
Hoon Yub Kim,Ralph P. Tufano,Young Jun Chai,Marcin Barczynski,ozer Makay,Che-Wei Wu,Eren Berber,Hui Sun,Gianlorenzo Dionigi,the Korean Intraoperative Neural Monitoring Society (KINMoS) 대한갑상선-내분비외과학회 2018 The Koreran journal of Endocrine Surgery Vol.18 No.1
Surgeons who introduce intraoperative neural monitoring (IONM) or a new IONM accessory, or related procedure in their practice should have completed relevant surgical training, possess operating privileges in the affected endocrine system, and be able to address anticipated complications. Surgeon responsibility in monitoring is dual component. First, technical component is using and setting up the IONM equipment correctly and understanding the inherent properties of the system to avoid an erroneous setup (e.g., no muscle relaxation, correct electrode placement, low impedance, etc.). Second, interpretive component is performing the monitoring able to distinguish between a true response versus an artifactual one. Organizations such as the International Neural Study Group and the Korean Intraoperative Neural Monitoring Society provide training courses for surgeon, as well as a means to certify levels of monitoring interpretative competence.
Technical Instructions for Continuous Intraoperative Neural Monitoring in Thyroid Surgery
Hoon Yub Kim,Young Jun Chai,Marcin Barczynski,ozer Makay,Che-Wei Wu,Antonio Giacomo Rizzo,Vincenzo Bartolo,Hui Sun,Gianlorenzo Dionigi,the Korean Intraoperative Neural Monitoring Society (KINMoS) 대한갑상선-내분비외과학회 2018 The Koreran journal of Endocrine Surgery Vol.18 No.1
One of the most significant advancements in neural monitoring for thyroid surgery is currently the permanent recording of the vagus nerve (VN) in order to prevent intraoperatively recurrent laryngeal nerve (RLN) iatrogenic injuries. Continuous intraoperative neuromonitoring (CIONM) seems to be superior to intermitted intraoperative neural monitoring (I-IONM) because it enhances standardization, and it provides entire and constant RLN function surveillance as the surgeon dissects the thyroid gland. It also has to be highlighted that the surgical maneuvers for the CIONM probe placement must be accurate in order to avoid a potential iatrogenic morbidity on the VN function. With this review article the Korean Intraoperative Neural Monitoring Society (KINMoS) provides a comprehensive analyses of CIONM technique.
Cost-Effectiveness Estimate for Neural Monitoring in Thyroid Surgery
Hoon Yub Kim,Young Jun Chai,Francesco Freni,ozer Makay,Bruno Galletti,Francesco Galletti,Hui Sun,Gianlorenzo Dionigi 대한갑상선-내분비외과학회 2018 The Koreran journal of Endocrine Surgery Vol.18 No.1
There is growing evidence for the importance of more detailed cost evaluation of new technologies used in surgery. The innovative impact of technology holds the potential to achieve transformative clinical improvements. Sustainability of innovations is a relatively new concept in health care research and has become an issue of growing interest. Cost-effectiveness studies have been the most established and studied methods for evaluation in surgical patients. Limited information exists regarding the cost-effectiveness of new surgical strategies for monitored thyroid surgeries. We describe the recent evidence regarding methods of evaluation of cost-effectiveness structures and function for intraoperative neural monitoring (IONM) in thyroid surgery. Our findings suggest that health economics modeling to inform the design of a cost-effectiveness studies looking at IONM has been demonstrated to be feasible as a method for improving research efficiency.