Kim Mi Ra, Jo Sunmi, Shim Hye-Kyung
Department of Otorhinolaryngology-Head and Neck Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea.
Department of Radiation Oncology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea.
Am J Case Rep. 2019 Nov 18;20:1695-1698. doi: 10.12659/AJCR.920451.
BACKGROUND Robotic thyroidectomy using remote access approaches is currently regarded as the optimal surgical protocol for highly selected patients. This approach has excellent cosmetic outcomes compared with conventional open transcervical thyroidectomy. Although the remote access approach offers significant benefits, it can cause complications associated with the large working space required for surgery. Such complications can lead to unusual imaging findings. CASE REPORT We report a case of a 37-year-old woman with thyroid cancer who underwent robotic thyroidectomy and demonstrated unusual port-site implantation findings on post-treatment iodine-131 whole-body scintigraphy and single-photon emission computed tomography-computed tomography. Evaluation of stimulated thyroglobulin and additional imaging studies did not reveal any remarkable findings. Through a multidisciplinary discussion, we discovered that the bag had developed a tear during specimen retrieval. Our patient was administered a therapeutic dose of radioiodine, which accumulated within the target area and successfully ablated the implanted tissue. Follow-up imaging and biochemical studies were normal after a follow-up period of 7 years. CONCLUSIONS Port-site seeding is a rare and unexpected surgical complication; however, it can be treated with radioiodine therapy involving a therapeutic dose. Meticulous surgical manipulation is essential to prevent port-site implantation related to spillage and tearing of thyroid or cancer tissue. Awareness and identification of these rare complications, which manifest as unusual imaging findings, are critical for improving the accuracy of interpretation.
背景 目前，采用远程入路的机器人甲状腺切除术被认为是高度选择患者的最佳手术方案。与传统的开放性经颈甲状腺切除术相比，这种方法具有出色的美容效果。尽管远程入路方法有显著益处，但它可能导致与手术所需的大工作空间相关的并发症。此类并发症可导致异常的影像学表现。病例报告 我们报告一例37岁甲状腺癌女性患者，她接受了机器人甲状腺切除术，术后碘-131全身闪烁扫描和单光子发射计算机断层扫描-计算机断层扫描显示出异常的术口种植表现。刺激甲状腺球蛋白评估及其他影像学检查未发现任何显著异常。通过多学科讨论，我们发现标本取出过程中袋子出现了撕裂。我们的患者接受了治疗剂量的放射性碘，其在靶区域内积聚并成功消融了植入组织。随访7年后，影像学和生化检查均正常。结论 术口种植是一种罕见且意外的手术并发症；然而，它可以通过给予治疗剂量的放射性碘治疗。细致的手术操作对于预防与甲状腺或癌组织溢出和撕裂相关的术口种植至关重要。对这些表现为异常影像学表现的罕见并发症的认识和识别对于提高解读准确性至关重要。
