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Background: Thyroidectomy is the typical treatment for pediatric thyroid carcinoma; total thyroidectomy is commonly performed. We aimed to report our experience at a single tertiary institution and to evaluate the risk factors for recurrence, especially based on surgical extent, in pediatric patients with differentiated thyroid carcinoma (DTC)., Methods: A data of 94 pediatric patients who underwent thyroid surgery for DTC from January 1982 to December 2012 at Yonsei University Hospital (Seoul, Korea) were reviewed. The clinicopathologic features and surgical outcomes were retrospectively analyzed through complete chart reviews., Results: The mean age was 16.6 ± 3.0 (range, 5-19) years. Fourteen patients had recurrence. Tumor size >2 cm (hazard ratio [HR], 14.241; p = 0.011) and positive lymph nodes (HR, 1.056; p = 0.039) were significant risk factors for disease-free survival (DFS) in multivariate analysis. In Kaplan-Meier analysis, a statistically significant difference was noted in the DFS according to tumor size 2 cm (p < 0.001). However, the DFS was not significantly different between the bilateral total thyroidectomy (BTT) and less than BTT groups (p = 0.215)., Conclusions: BTT remains the treatment of choice in pediatric patients with DTC. Lobectomy may be considered for patients with limited disease, including those with tumor size <2 cm, no suspicious lymph nodes, intrathyroidal lesion, and no multifocal disease.

Background: The effect of the systemic lidocaine on postoperative recovery has not been definitively investigated despite its analgesic efficacy after surgery. The aim of this randomized, double-blinded, controlled study was to evaluate the effect of intravenously administered lidocaine on the quality of recovery and on acute and chronic postoperative pain after robot-assisted thyroidectomy., Methods: Ninety patients who were undergoing robotic thyroidectomy were randomly assigned to the lidocaine or the control groups. The patients received 2 mg/kg of lidocaine followed by continuous infusions of 3 mg/kg/h of lidocaine (Group L) or the same volume of 0.9% normal saline (Group C) intravenously during anesthesia. The acute pain profiles and the quality of recovery, which was assessed using the quality of recovery-40 questionnaire (QoR-40), were evaluated for 2 days postoperatively. Chronic postsurgical pain (CPSP) and sensory disturbances at the surgical sites were evaluated 3 months after surgery., Results: The QoR-40 and pain scores that were assessed during the 2 days that followed surgery were largely comparable between the groups. However, CPSP was more prevalent in the Group C than in the Group L (16/43 vs. 6/41; p = 0.025). The tactile sensory score 3 months after the operation was significantly greater in the Group L than in the Group C (7 vs. 5; p = 0.001)., Conclusion: Systemic lidocaine administration was associated with reductions in CPSP and sensory impairment after robot-assisted thyroidectomy although it was not able to reduce acute postsurgical pain or improve the quality of recovery. Trial registry number NCT01907997 ( http://clinicaltrials.gov ).

Background: The present study was designed to investigate the necessity of completion thyroidectomy for patients who underwent thyroid lobectomy for low-risk papillary thyroid microcarcinoma (PTMC) that was later pathologically diagnosed as central lymph node (CLN) metastasis., Methods: Between 1986 and 2001, we assessed 551 patients who underwent thyroidectomy with prophylactic ipsilateral central compartment neck dissection, and 409 patients were followed-up completely. Thyroid lobectomy were performed in 281 and 128 patients, respectively. The patients were divided into two groups according to CLN metastasis. Clinicopathological profiles and follow-up details were investigated by retrospective chart review., Results: The CLN-positive and -negative groups were comprised of 43 (15.2 %) and 238 patients (84.8 %), respectively. The mean ages of the two groups were not significantly different (p > 0.05). The mean tumor size of the CLN-positive group (6.8 mm) was significantly larger than that of the CLN-negative group (5.6 mm; p < 0.05). Microscopic capsular invasion was significantly higher in the CLN-positive group (51.2 vs. 23.9 %; p < 0.05). Overall, 21 patients (7.4 %, 21/281) experienced recurrence. Among these, 2 (4.7 %, 2/43) and 19 (8.0 %, 19/238) were in the CLN-positive and -negative groups, respectively. There was no significant correlation between CLN metastasis and tumor recurrence., Conclusions: Postoperative recurrence was lower in the CLN-positive group, and there was no significant correlation between CLN metastasis and tumor recurrence. Our results suggest that it is not necessary to perform completion thyroidectomy for PTMC patients who have undergone thyroid lobectomy and who have been pathologically diagnosed with CLN metastasis.

Background: Adrenal injury secondary to abdominal trauma is quite rare because the adrenal gland is located deep in the retroperitoneum and is well cushioned by surrounding soft tissues. This report presents our experiences of managing patients with adrenal injury following abdominal blunt trauma., Methods: The medical records of 11 patients who had been treated for adrenal gland injury between January 1998 and June 2009 were retrospectively reviewed., Results: Of the 11 patients, nine were male and two were female and the mean age was 31.5 years. The causes of trauma were motor vehicle accident (8 cases) and fall (3 cases). The majority of injuries occurred on the right side (8 cases), two were on the left side, and one patient had bilateral injury. Three cases presented as isolated adrenal gland injuries, and eight were combined with other internal organ injuries. The most common coinjured organ was the liver, followed by the kidney. The most useful diagnostic modality was computed tomography (CT). Ten cases were treated successfully using conservative management, while one required a left partial adrenalectomy and splenectomy due to active bleeding., Conclusions: Adrenal injury due to blunt abdominal trauma is extremely rare. The majority of cases can be diagnosed using CT. Most cases involve the right side and can be treated successfully using conservative management. Surgery is required only in cases of active bleeding.

Background: Postoperative pain following endoscopic thyroidectomy, although less severe than after open methods, is still a source of marked discomfort and surgical stress. This clinical trial was conducted to determine if repeated intravenous paracetamol could decrease postoperative pain and rescue analgesic requirements after robot-assisted endoscopic thyroidectomy via the transaxillary approach., Materials and Methods: This prospective, randomized, double-blinded, and placebo-controlled study enrolled 124 women 21-60 years of age who were scheduled for elective gasless robot-assisted endoscopic thyroidectomy via the transaxillary approach. The patients were given placebo or 1 g of paracetamol as a 100 ml solution infused over 15 min 1 h before the induction of anesthesia, and then at 6-h intervals for the following 24 h., Results: Postoperative pain scores were significantly lower at 1, 3, 6, and 24 h after surgery in the paracetamol group than in the placebo group. Significantly fewer patients in the paracetamol group received rescue analgesics compared to the placebo group (9.5% vs. 65.6%, respectively). First analgesic time was similar in the two groups. Postoperative nausea (44.3% vs. 22.2%) and vomiting (21.3% vs. 6.3%) were more frequent in the placebo group than in the paracetamol group. Other postoperative side effects, including sedation, confusion, and pruritus, were similar in the two groups., Conclusions: We concluded that repeated administration of 1 g of intravenous paracetamol over 24 h is easy, effective, safe, and well tolerated for pain management in patients with moderate to severe postoperative pain after gasless robot-assisted endoscopic thyroidectomy performed via the transaxillary approach.

Background: The purpose of the present study was to evaluate the clinicopathologic characteristics and short-term outcomes of papillary thyroid carcinomas (PTC) located in the isthmus compared to tumors located in other thyroid regions, and to use those findings to establish a surgical strategy for treating these tumors., Patients and Methods: Thyroidectomy was performed in 1,973 thyroid cancer patients in our hospital between January 2006 and December 2007. The patients were analyzed in two groups; group I, patients with tumors located in the isthmus (n = 181) and group II, patients with tumors located in other thyroid regions (n = 1,792). The clinicopathologic characteristics and short-term outcomes were compared between the two groups., Results: The study groups were similar in terms of age and gender ratio. For groups I and II, respectively, the mean primary tumor size was 1.02 cm and 1.13 cm (p = 0.017), capsular invasion frequency was 70.2 and 60.8% (p = 0.008), and multifocality frequency was 48.6 and 39.8% (p = 0.006). In addition, central node involvement was 40.3 and 42.1% (p = 0.350), and lateral node involvement was 9.4 and 18.2% (p = 0.001). At the time of postoperative iodine-131 remnant ablation, 34.3% of group I patients and 38.0% of group II patients showed undetectable serum thyroglobulin concentrations. There were no significant differences in surgical complications between the two groups., Conclusions: Papillary thyroid carcinomas located in the isthmus was more likely to be associated with multiple foci in bilateral lobes and higher rates of capsular invasions than tumors in other thyroid regions. These findings indicate that total thyroidectomy is an appropriate initial surgical procedure for the isthmic PTC.

Background: The location of the parotid gland tumor can affect the duration and difficulty of operation. Therefore, accurate preoperative evaluation of tumor location can affect surgical outcomes., Methods: Results in 100 patients with parotid gland tumors who underwent parotidectomy between January 2000 and October 2005 were retrospectively reviewed. Tumor location was determined relative to four landmarks--facial nerve (FN) line, Utrecht (U) line, Conn's arc (CA), and retromandibular vein (RV)--on computerized tomography (CT) scans, and confirmed by intraoperative findings. The accuracy of each landmark was evaluated. Correlations between accuracy and tumor size were determined for tumors < or =2 cm and >2 cm in diameter., Results: Of the four landmarks, the U line was the most accurate (94%), sensitive (89.3%), and specific (97.7%) in predicting tumor location. However, for tumors < or =2 cm in diameter, FN line (p = 0.022) and RV (p = 0.028) were significantly more accurate than U line and CA., Conclusion: Although the U line was the most accurate in predicting the location of parotid gland tumors, landmarks predicting accurate tumor location should be selected according to tumor size.