Three-dimensional image simulation of primary diaphragmatic hemangioma: A case report

BACKGROUND Fewer than 200 cases of diaphragmatic tumors have been reported in the past century. Diaphragmatic hemangiomas are extremely rare. Only nine cases have been reported in English literature to date. We report a case of cavernous hemangioma arising from the diaphragm. Pre-operative three-dimensional(3D)simulation and minimal invasive thoracoscopic excision were performed successfully, and we describe the radiologic findings and the surgical procedure in the following article.CASE SUMMARY A 40-year-old man was referred for further examination of a mass over the right basal lung without specific symptoms. Contrast-enhanced computed tomography revealed a poorly-enhanced lesion in the right basal lung, abutting to the diaphragm, measuring 3.1 cm × 1.5 cm in size. The mediastinum showed a clear appearance without evidence of abnormal mass or lymphadenopathy. A preoperative 3D image was reconstructed, which revealed a diaphragmatic lesion. Video-assisted thoracic surgery was performed, and a red papillary tumor was found, originating from the right diaphragm. The tumor was resected, and the pathological diagnosis was cavernous hemangioma.CONCLUSION In this rare case of diaphragmatic hemangioma, 3D image simulation was helpful for the preoperative evaluation and surgical decision making.

Minimally invasive video-assisted thyroidectomy for accidental papillary thyroid microcarcinoma： comparison with conventional open thyroidectomy with 5 years follow-up

Background Minimally invasive video-assisted thyroidectomy （MIVAT） has received increasing attention for malignant thyroid diseases. The aim of this study was to compare the outcomes of MIVAT with conventional open thyroidectomy （CT） for papillary thyroid microcarcinoma （PTMC）. Methods Thirty-one patients were treated with MIVAT and 37 with CT. Their pathological characteristics, surgical complications, 5-year postoperative thyroglobulin （TG） and ultrasonic results were followed up. Results All the patients took levothyroxine for suppressing thyroid stimulating hormone （TSH） after surgery, and were followed up with measurement of serum TG and neck ultrasonography at intervals of 6 or 12 months. There was no statistically significant difference between the CT and MIVAT groups for sex ratio, operation time, positive lymph nodes, complications and prognosis, but the MIVAT group had better cosmetic results. Conclusions MIVAT did not differ significantly from CT for PTMC after 5 years follow-up, but it did have better cosmetic results. MIVAT is a safe and valid surgical technique for selected cases.

Endoscopic thyroidectomy： an evidence-based research on feasibility, safety and clinical effectiveness

Background The feasibility and safety of endoscopic thyroidectomy were evaluated by an approach of systematic review of published studies in the past decade.Methods A database searching was performed on MEDLINE, Cochrane Database of Systematic Reviews, American College of Physicians Journal Club, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials. Both comparative and non-comparative studies about endoscopic thyroidectomy were selected and analyzed. For the comparative studies, RevMan 4.2 was used for statistical analysis; and for the non-comparative studies, data analysis was performed by SPSS 13.0.Results Seven comparative studies involving 367 patients （video-assisted thyroidectomy （VAT）, 174 patients; conventional thyroidectomy （CT）, 193 patients） were included in VAT-CT group. Age, gender, operative types, and pathological diagnosis were similar. Compared with CT, the mean operative time for VAT was significantly longer （VAT, 80.0 minutes; CT, 61.9 minutes, P 〈0.01）, but the postoperative hospital stay was shorter （VAT, 1.7 days; CT, 2.5 days, P 〈0.01）. The complication rate for VAT was 6.9%, while that for CT was 9.3% （P=0.35）. Three studies analyzed the postoperative pain and cosmetic evaluation, and indicated that the VAT group was superior to the CT group, but there was no significant difference after a meta-analysis. Three comparative studies involving 273 patients （totally endoscopic thyroidectomy （TET）, 145 patients; CT, 128 patients） were included in TET-CT group and the results generally resembled that of VAT-CT group. There were 18 and 14 non-comparative studies reporting the results of VAT and TET, respectively. The mean operative time for VAT was 76.8 minutes compared with 135.8 minutes for TET. The postoperative hospital stay was 1.8 and 3.8 days for VAT and TET respectively. The rates of conversion to open surgery for VAT and TET were similar （VAT, 2.8%; TET, 3.9%, P=0.105）. The complication rate for VAT was 8.6%, while that for TET was 3.5% （P 〈0.01）.Conclusions The feasibility and safety of endoscopic thyroidectomy were initially verified and accepted, and it should be considered as a valid option, offering some advantages to patients in terms of cosmetic results and postoperative distress.

Transoral endoscopic thyroidectomy with central neck dissection：experimental studies on human cadavers

Background With the development of natural orifice trans-luminal endoscopic surgery, studies on transoral video-assistedthyroidectomy in preclinical experiments （e.g., human anatomy and animal trials） were progressing gradually. From 2009to 2011, embalmed human cadavers were dissected to define the anatomical location, surgical planes, and related neuraland vascular structures to create a safe transoral access to the front cervical spaces. Recently, experimental transoralendoscopic thvroidectomv was performed to verify the feasibility of this approach on 15 fresh specimens.