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Purpose: Re-exploration of relapsing nonpalpable thyroid cancers are associated with high rate of false-negative operations, due to postoperative fibrosis. So that, various strategies have been developed to guide the excision of the recurrent disease. The aim of this study is to document the technique of ultrasound-guided hook needle insertion before operation and also to present the results of postinsertion, postoperation and three years follow-up. Materials and methods: Three patients with recurrent papillary thyroid cancer, who had a history of negative reexploration but eleveted thyroglobulin assays underwent US examinations. Sonographically malign lymph nodes were detected, also malign nature of the lymph nodes was proven by US guided fine needle aspiration. There was only one metastatic lymph node in each of the first and second patients, therefore one hook-needle was inserted per each patient. The third patient had three lymph nodes, therefore we used one needle for the biggest node and only one for the smaller nodes, because they were so close. Results: No complication occurred due to biopsy or needle insertion. All patients underwent neck reoperation after needle insertion. Pathologic lymph nodes were identified easily by following hook-needles, and were excited in all patients. All lymph nodes were positive for papillary thyroid cancer on the final pathological examination. No surgical complication occurred and, after 3 years follow-up, all patients were free of any detectable disease in the neck on radiologic examinations. Conclusion: Ultrasound guided hook-needle insertion can be performed safely in patients with relapsing nonpalpable metastatic lymph nodes. [ABSTRACT FROM AUTHOR]

Purpose: In this study we aimed to determine, the multcentricity rates in patients with papillary microcarcinoma and the surgical method that should be applied. Materials and Methods: A total of 1818 patients underwent thyroid surgery and we evaluated 379 patients retrospectively, who were reported to have thyroid cancer histopathologically. In these patients, 137 patients with papillary microcarcinoma were determined. We reviewed medical records of patients, for mulicentricity and frequency of microcarcinoma. Patients were classified according to MACIS, EORTC and TNM classification systems for thyroid cancer. Results: Thirty-three (24%) of 137 patients with papillary microcarcinoma were detected to be multicentric. In 7 (21%) there were two or more tumor foci. The incidence of cancer was 33% in the other lobe when there was more than one foci in the same lobe. In all patients preoperative ultrasonography of the thyroid gland was multinodular. Ultrasonographic findings suspicious for malignancy were sought and in 44% patients these findings were present. Fine needle aspiration biopsy was performed in 31 patients and results of 23 patients were benign. Frozen section was performed 58 patients, where 17 patients had a benign frozen section report. Conclusion: The risk of multicentricity in papillary microcarcinoma patients should be taken into account for determining the optimal surgical treatment. To prevent missing microcarcinoma foci, ultrasonography should be applied meticulously. [ABSTRACT FROM AUTHOR]

Objective: Laparoscopic partial nephrectomy has become an effective alternative for small renal tumors. In this study, we present our 20 retroperitoneal laparoscopic partial nephrectomy (LPN) cases. Materials and methods: Retroperitoneal LPN was performed in 20 patients with renal tumor between December 2006 and June 2009. After retroperitoneal access and balloon dilation in lumbotomy position, the procedure was performed through the trocars located on the middle, anterior, and posterior axillary lines. Renal pedicle was reached by following psoas muscle. Renal artery was occluded by locking with a vascular strip. The tumor tissue was identified, and resected by electrocautery and scissors. Renal artery was not locked with the vascular strip in one case, and tumor was resected with harmonic scalpel. After placement of a surgicel, the parenchymal repair was accomplished with 2/0 vicryl suture. Results: Mean age was 61 (range 52-74) years and tumor size was 3.1 (range 1.8-4.1) cm. Mean duration of warm ischemia and operation were 29 (range 22-36) min and 185 (range 148-234) min, respectively. The collecting system was opened in two patients. The collecting system repair was accomplished with 3/0 vicryl suture. Mean estimated blood loss during operation was 204 (range 165-280) mL. The drain was removed on 2nd (1-8) day postoperatively. Mean hospital stay was 4 (range 3-9) days. Pathological examination has revealed renal cell carcinoma in 19 cases (13 with clear cell, 5 with papillary cell, 1 with chromophobe cell) and angiomyolipoma in 1 case. The surgical margin was negative in all cases. At a median follow-up of 11 months (range 2-30), we did not observe local recurrence or distant metastasis in any patients. Conclusion: LPN is accepted as a less invasive method in comparison with other therapeutic alternatives in treatment of renal tumors. It can be easily performed by experienced surgeons on patients with well-defined indications. [ABSTRACT FROM AUTHOR]