Suveica Luminita, Sima Oana-Claudia, Ciobica Mihai-Lucian, Nistor Claudiu, Cucu Anca-Pati, Costachescu Mihai, Ciuche Adrian, Nistor Tiberiu Vasile Ioan, Carsote Mara
Department of Family Medicine, "Nicolae Testemiţanu" State University of Medicine and Pharmacy, 2004 Chisinau, Moldova.
PhD Doctoral School of "Carol Davila", University of Medicine and Pharmacy, 050474 Bucharest, Romania.
J Clin Med. 2024 Sep 10;13(18):5347. doi: 10.3390/jcm13185347.
The risk of post-operatory hypothyroidism and hypocalcaemia, along with recurrent laryngeal nerve injury, is lower following a less-than-total thyroidectomy; however, a previously unsuspected carcinoma or a disease progression might be detected after initial surgery, hence indicating re-intervention as mandatory (so-called "redo" surgery) with completion. This decision takes into consideration a multidisciplinary approach, but the surgical technique and the actual approach is entirely based on the skills and availability of the surgical team according to the standard protocols regarding a personalised decision. We aimed to introduce a review of the most recently published data, with respect to redo thyroid surgery. For the basis of the discussion, a novel vignette on point was introduced. This was a narrative review. We searched English-language papers according to the key search terms in different combinations such as "redo" and "thyroid", alternatively "thyroidectomy" and "thyroid surgery", across the PubMed database. Inclusion criteria were original articles. The timeframe of publication was between 1 January 2020 and 20 July 2024. Exclusion criteria were non-English papers, reviews, non-human studies, case reports or case series, exclusive data on parathyroid surgery, and cell line experiments. We identified ten studies across the five-year most recent window of PubMed searches that showed a heterogeneous spectrum of complications and applications of different surgeries with respect to redo interventions during thyroid removal (e.g., recurrent laryngeal nerve monitoring during surgery, other types of incision than cervicotomy, the use of parathyroid fluorescence, bleeding risk, etc.). Most studies addressing novel surgical perspectives focused on robotic-assisted re-intervention, and an expansion of this kind of studies is expected. Further studies and multifactorial models of assessment and risk prediction are necessary to decide, assess, and recommend redo interventions and the most adequate surgical techniques.
次全甲状腺切除术后发生术后甲状腺功能减退和低钙血症以及喉返神经损伤的风险较低;然而,在初次手术后可能会发现先前未被怀疑的癌症或疾病进展,因此需要进行再次干预(即所谓的“再次”手术)并完成手术。这一决定需考虑多学科方法,但手术技术和实际操作完全基于手术团队的技能以及根据个性化决策的标准方案的可用性。我们旨在对最近发表的关于再次甲状腺手术的数据进行综述。为了进行讨论,引入了一个相关的典型案例。这是一篇叙述性综述。我们在PubMed数据库中根据不同组合的关键搜索词,如“再次”和“甲状腺”,或者“甲状腺切除术”和“甲状腺手术”,搜索英文论文。纳入标准为原创文章。发表时间范围为2020年1月1日至2024年7月20日。排除标准为非英文论文、综述、非人体研究、病例报告或病例系列、甲状旁腺手术的独家数据以及细胞系实验。我们在PubMed搜索的最近五年窗口中确定了十项研究,这些研究显示在甲状腺切除术中再次干预方面,不同手术的并发症和应用情况存在异质性(例如,手术中喉返神经监测、除颈部切开术以外的其他切口类型、甲状旁腺荧光的使用、出血风险等)。大多数涉及新型手术观点的研究都集中在机器人辅助再次干预上,预计这类研究将会扩展。需要进一步的研究以及多因素评估和风险预测模型来决定、评估和推荐再次干预以及最适当的手术技术。