Innovations in Modern Endocrine Surgery

Description

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. 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