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Minumally invasive videi-assisted thyroidectomy: multinstitutional experience
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Minimally invasive video-assisted thyroidectomy: Multiinstitutional experience
Author(s): Miccoli, P (Miccoli, P); Bellantone, R (Bellantone, R); Mourad, M (Mourad, M); Walz, M (Walz, M); Raffaelli, M (Raffaelli, M); Berti, P (Berti, P)
Source: WORLD JOURNAL OF SURGERY Volume: 26 Issue: 8 Pages: 972-975 DOI: 10.1007/s00268-002-6627-7 Published: AUG 2002
Times Cited: 88 (from Web of Science)
Cited References: 10 [ view related records ] Citation MapCitation Map
Conference: International Surgical Week Conference Location: BRUSSELS, BELGIUM Date: AUG 26-30, 2001
Abstract: Minimally invasive video-assisted thyroidectomy (MINAT) was described in 1998. In this study we collected the experience of four third-level referral centers that adopted this technique. A total of 336 patients (279 females, 57 males) were selected for MINAT. Selection criteria were thyroid volume < 15 ml, nodules not exceeding 3.5 cm of diameter, and an absence of thyroiditis, previous neck surgery, or previous irradiation. The procedure, totally gasless, is carried out through a 15 rum central incision above the sternal notch. Dissection is performed under endoscopic vision using conventional and endoscopic instruments. The mean operating time was 69.4 +/- 30.6 minutes for lobectomy (range 20-150 minutes) and 87.4 +/- 43.5 minutes for total thyroidectomy (range 30-220 minutes). The mean postoperative stay was 1.9 +/- 0.8 days. Postoperative complications were 7 transient and I definitive recurrent nerve palsies and 11 cases of hypoparathyroidism (9 transient, 2 definitive). Conversion to open surgery was necessary in 15 patients (4.5%). This study confirms in a large number of cases the safety and feasibility of MINAT, even in different surgical settings where similar results were achieved. The complication rate was not different from that of standard thyroidectomy. Although the operating time appears longer than with conventional procedures, the learning curve demonstrates a sharp decrease with increasing experience and the introduction of new technologies. The number of patients eligible for this approach remains low, thereby limiting its use, but it should be considered a valid option in selected surgical centers, offering some advantages to patients in terms of cosmetic results and postoperative distress
”The use the Harmonic Scalpel versus conventional knot tyng for thyroidectomy: results of a case-control study”
No full textBackground: The Harmonic Scalpel (HS) coagulates and simultaneously
cuts tissues using mechanical energy with ultrasonic
frequency. Its role in minimally invasive thyroid surgery is well
defined. Despite its routine use has been criticized by some, HS has
been recently proposed also for conventional thyroidectomy (CT) in
small series of patients. The aim of this comparative study is to verify
in a large series of patients the efficiency and safety of HS for CT.
Patients and methods: Between April 2004 and April 2005, 267
consecutive patients were prospectively selected to undergo total
thyroidectomy (TT) with the use of HS (HS-Group). Exclusion
criteria were: previous neck surgery, minimally invasive and/or
video-assisted procedures, lymph node dissection or other associated
procedures. A case-control study including 267 patients who
underwent TT with a conventional haemostasis technique (knot
tying) (KT-group) between January 2003 and March 2004 was
performed. The controls were matched for age and sex. The
following parameters were registered: preoperative diagnosis, operative
time (from incision to skin closure), total operative room
occupation time (from induction to the end of the anaesthesia),
number of drains, total drainage fluid volume, complications, final
histology, postoperative stay, postoperative pain, patients satisfaction
with the cosmetic result and postoperative outcome. Patients of the
HS-Group were compared with those of the KT-Group.
Results: The two groups were well matched for age and sex (P =
NS). No significant difference was found concerning preoperative
diagnosis, final histology, postoperative pain, postoperative stay and
complications rate (P = NS). One postoperative bleeding requiring reoperation
was observed in the HS-Group; no other bleeding episodes
were observed. Three transient recurrent nerve palsies were observed
in each group, no permanent palsy was observed. Transient
hypocalcemia was observed in 95 patients in HS-Group and in 94
in KT-Group; one patients in the KT-Group experienced permanent
hypoparathyroidism (P = NS). Operative time was significantly
shorter in the HS-Group (66.4 ± 17.3 vs 72.3 ± 23.6 minutes,
P < 0.005), as well as the total operative room occupation time
(95.0 ± 22.9 vs 103.9 ± 24.8 minutes, P < 0.001). The mean number
of drains was significantly lower in the HS-Group (1.0 ± 0.4 vs
1.3 ± 0.5 minutes, P < 0.001). No significant difference was found
265
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concerning drainage fluid volume in patients with drains. Patients of
the HS-Group were more satisfied with the cosmetic result and the
postoperative outcome (P < 0.001 and P < 0.005).
Conclusion: HS is a safe and efficacious alternative to KT also for
CT, allowing for a significant reduction of operative time (about
10 %) and drain utilization without increasing the complication
rate. The higher patients satisfaction with the cosmetic result and
the postoperative outcome could be explained by the possibility
HS offers to perform TT through smaller skin incisions
Healthcare costs and outcomes: a value-based assessment tool for Clinical Governance [Pitch presentation]
No full textIssue/problem:
Health systems sustainability is a critical public health issue. A
value-based approach is essential to improve patient-centeredness,
appropriateness, quality and funding allocation in
healthcare.
Description of the problem:
This project was aimed to develop an innovative transferable
tool to assess value-based activities in Hospital by monitoring
care pathways costs and outcomes. Main questions were to:
assess cost and outcome variance in homogeneous groups of
patients; evaluate clinical activities contribution to the hospital
budget; identify and monitor critical points. In 2018 a Business
Intelligence system fed by different Hospital datasets was
developed and tested in a Teaching Hospital in Rome to
quantify and integrate data on pathways efficacy and costs. It
was based on an algorithm of 20 indicators related to Women
and Child Care Pathways.
Results:
Preliminary results showed a great variance for the same
intervention/procedure concerning length of stay (3-8 days),
waiting times (1-4 days), innovative technologies costs (2000-
6000E) and obsolete reimbursement rates (2000-5000E) that
do not guarantee adequate economic contribution margins.
Improvement actions were defined concerning pathways’
workflow and organizational appropriateness. The need for
negotiations with Ministry of Health was highlighted, aimed to
update reimbursement rates.
Lessons:
The tool, built on a value-based process view, allowed
analyzing online outcomes and costs data aggregated by
path, benchmarking results, identifying critical issues and
providing improvement solutions. It turned out to be an
innovative methodology - also applicable in other settings/
countries - to trigger changes in health management and
pursue quality and efficiency in healthcare.
Key messages:
Value-based healthcare is the new public health paradigm.
Assessing simultaneously Hospital costs and outcomes is a
valuable way to derive overall healthcare value, improve
quality and rationalize resources allocation
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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