Hypothyroidism, a prevalent endocrine disorder characterized by insidious onset and prolonged progression, leads to metabolic slowdown and multiorgan dysfunction, significantly compromising patients' quality of life. While hormone replacement therapy improves most patients' serum thyroid function, it faces limitations, including individual response variations, lifelong medication requirements, and potential risks, with no reversal of existing tissue damage. In recent years, the mesenchymal stem cells (MSCs) and their derivatives have gained prominence in immunomodulation and regenerative medicine because of their abundant sources, low immunogenicity, potent paracrine effects, and multidirectional differentiation capabilities for tissue repair. Their unique advantages in modulating the immune microenvironment, promoting angiogenesis, reducing fibrosis, and stimulating endogenous cell regeneration offer novel strategies to overcome treatment bottlenecks in hypothyroidism and its complications, effectively repairing thyroid and multiorgan damage in animal models. This review synthesizes literature from the PubMed and Web of Science databases, incorporating relevant basic research and clinical trials. This study examined the systemic impacts of hypothyroidism, evaluated the experimental and clinical roles of the MSCs in thyroid tissue reconstruction and organ protection, and analyzed molecular mechanisms, including immune regulation, the antioxidant stress response, anti-apoptosis, and cellular function restoration. Clinical application potential is assessed alongside critical challenges such as standardized preparation, long-term safety, in vivo homing efficiency, and large-scale production.

This study aimed to evaluate the diagnostic utility of next-generation sequencing (NGS) for identifying genetic alterations in fine-needle aspiration (FNA) samples from thyroid nodules, with a specific focus on its clinical implications for surgical management. In total, 631 patients underwent FNA cytology, yielding 683 cytological samples. Of these, 264 patients with indeterminate or suspicious cytological results underwent surgical intervention, and their samples were subjected to molecular analysis targeting single-nucleotide variants (SNVs) and insertion/deletion (InDel) mutations in a 20-gene panel associated with thyroid carcinoma. Genetic alterations were identified in 160 (57.55

BackgroundThe purpose of this study was to investigate the surgical model of hypothyroidism in rats and the feasibility and stability of the model.MethodsForty-eight adult male Wistar rats were randomly divided into 12 sham-operated rats (control group) and 36 operated rats (18 rats in the group with total thyroidectomy and 18 rats in the group with subtotal thyroidectomy). Thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) serum concentrations were measured prior to surgery and on postoperative days 14, 28 and 90; blood calcium (Ca), blood phosphorus (P), and parathyroid hormone (PTH) concentrations were measured on postoperative day 10; and thyroglobulin (Tg) concentrations were measured on postoperative day 60. The postoperative behavioral status of the rats was comprehensively evaluated on the basis of behavioral indicators.ResultsThere was no significant difference in preoperative TSH, FT4, or FT3 between the control and surgical groups (p > 0.05). On postoperative day 10, there were no significant differences in Ca, P, or PTH levels among the groups (p > 0.05). On postoperative days 14, 28 and 90, the TSH level was greater, whereas the FT4 and FT3 levels were lower in the surgical group (p < 0.05). On the 60th postoperative day, the Tg was significantly lower in the surgical group (p < 0.05).ConclusionSurgical removal of the thyroid gland can be used to successfully establish a hypothyroid rat model that is stable and reliable and can provide a model basis for hypothyroidism-related research.

BackgroundPrevious studies have shown that glycolysis-related genes (GRGs) are associated with the development of breast cancer (BC), and the prognostic significance of GRGs in BC has been reported. Considering the heterogeneity of BC patients, which makes prognosis difficult to predict, and the fact that glycolysis is regulated by multiple genes, it is important to establish and evaluate new glycolysis-related prediction models in BC.MethodsIn total, 170 GRGs were selected from the GeneCards database. We analyzed data from the Cancer Genome Atlas Breast Invasive Carcinoma (TCGA-BRCA) database as a training set and data from the Gene Expression Omnibus (GEO) database as a validation cohort. Based on the overall survival data and the expression levels of GRGs, Cox regression analyses were applied to develop a glycolysis-related prognostic gene (GRPGs)-based prediction model. Kaplan (KM) survival and ROC analyses were performed to assess the performance of this model. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses were used to identify the potential biological functions of GRPGs. cBioPortal database was used to explore the tumor mutation burden (TMB). The tumor immune dysfunction and exclusion indicator (TIDE) was used to estimate the patient response to immune checkpoint blockade (ICB). The levels of tumor-infiltrating immune cells (TICs) and stromal cells were quantitatively analyzed based on gene expression profiles.ResultsWe constructed a prediction model of 10 GRPGs (ADPGK, HNRNPA1, PGAM1, PIM2, YWHAZ, PTK2, VDAC1, CS, PGK1, and GAPDHS) to predict the survival outcomes of patients with BC. Patients were divided into low- and high-risk groups based on the gene signature. The AUC values of the ROC curves were 0.700 (1-year OS), 0.714 (3-year OS), 0.681 (5-year OS). TMB and TIDE analyses showed that patients in the high-risk group might respond better to ICB. Additionally, by combining the GRPGs signature and clinical characteristics of patients, a novel nomogram was constructed. The AUC values for this combined prediction model were 0.827 (1-year OS), 0.792 (3-year OS), and 0.783 (5-year OS), indicating an outstanding predictive performance.ConclusionA new GRPGs based prediction model was built to predict the OS and immunotherapeutic response of patients with BC.

The safety and feasibility of transoral endoscopic thyroidectomy vestibular approach in pediatric patients has been clinically proven, and its cosmetic results have been recognized by children and their families. However, there are no reports on using transoral robotic in pediatric thyroid surgery. In this study, we report the experience of 5 cases of transoral vestibular robotic thyroidectomy in treating of thyroid disease in children. Retrospective analysis of clinical data of five children who underwent robotic thyroid surgery via the TOVRT in our hospital from February 2021 to April 2023, including operation time, tumor diameter, postoperative hospitalization time, and surgical complications. All five patients were operated on by the same team, and the postoperative pathological results were all follicular adenoma of thyroid. The children had a strong desire for cosmetic surgery, and their families voluntarily chose the robotic surgical system for their surgery. All five patients underwent unilateral thyroid lobectomy without conversion to open surgery. All patients were female, with a mean BMI of (19.63 ± 1.79) kg/m2 and the mean age was (14.40 ± 2.33) years. The average operation time was (52.00 ± 5.10) mins, the average tumor diameter was (41.60 ± 8.41) mm, and the average postoperative hospital stay was (3.60 ± 0.49) days. There were no complications such as hypoparathyroidism, recurrent laryngeal nerve injury, genioglossal nerve injury, or skin necrosis. The transoral vestibular robotic thyroidectomy is safe and feasible, providing a new treatment option for pediatric thyroid diseases that require surgical treatment.

Purpose:Facklamia hominis is an infrequent opportunistic pathogen. This case report describes a ​young immunocompetent female who developed ​recurrent abscesses after a COVID-19 infection, highlighting the potential link between post-COVID-19 immune dysfunction and opportunistic infections. Methods:A comprehensive review of the patient's clinical course, relevant laboratory tests, treatment, and post-treatment outcomes was conducted. Results:A young female patient with a history of COVID-19 infection developed recurrent abscesses (perineal and breast) 40 days apart, which were managed with antibiotics, local incision and drainage, and traditional Chinese medicine (Xihuang pills, made up with Bezoar, Musk, Frankincense, and Myrrh). Laboratory tests revealed prealbumin deficiency (143 mg/L), a marker associated with poor prognosis in post-COVID-19 patients. Bacterial culture from the breast abscess confirmed Facklamia hominis infection, identified via VITEK 2 Compact system. The patient completed a two-week regimen of antibiotics combined with traditional Chinese medicine therapy, achieving complete resolution without recurrence during follow-up. Conclusion:There is an emerging association between COVID-19 infection and subsequent Facklamia hominis infection, particularly in immunocompromised individuals. Post-COVID-19 lymphopenia and prealbumin deficiency may predispose patients to opportunistic infections. Keywords:COVID-19, Multiple abscesses, breast abscess, Facklamia homini, prealbumin.

To screen the risk factors for lateral lymph node metastasis (LLNM) in unifocal papillary thyroid carcinoma (PTC) with central lymph node metastasis (CLNM) and create a corresponding model. A retrospective analysis of 362 patients from our hospital was performed. All patients were randomized into training and validation groups in a ratio of 7:3. Risk factors were screened using the least absolute shrinkage and selection operator (LASSO) and logistic regression analysis. The analysis indicated that upper location, number of CLNM ≥ 3, rate of CLNM ≥ 0.172, prelaryngeal LNM, pretracheal LNM, and tall cell variant of papillary thyroid carcinoma (TCV-PTC) are independent risk factors. Visualizing the model with a nomogram, receiver operating characteristic (ROC) curves revealed an area under the curve (AUC) of 0.773 for the training group and 0.779 for the validation group. This confirms the stability and outstanding accuracy of the model. Also, the calibration curves and clinical descision curves reflect strong calibration,offering potential clinical benefits. The risk factors for LLNM include metastasis to the prelaryngeal lymph nodes, metastasis to the pretracheal lymph nodes, location in the upper level, number of metastases ≥3 in CLNM, TCV-PTC and metastasis rate ≥0.172. A nomogram incorporating these factors exhibits excellent predictive value and stability.

ObjectiveThis study aimed to develop and apply a prediction model to estimate the probability of lateral lymph node metastasis (LLNM) in patients with cN0 unilateral papillary thyroid carcinoma (PTC) with central lymph node metastasis (CLNM).SettingAll study data were collected from a single tertiary hospital.MethodsUnivariable and multivariable logistic regression analyses were used to explore independent predictors of LLNM in the derivation and internal validation cohorts, which were used to construct and validate a nomogram. Another 96 patients were included prospectively to evaluate the efficacy of this nomogram.ResultsMaximum tumor diameter greater than 1.0 cm (OR, 2.712; 95% CI, 1.412–5.210), multifocality (OR, 2.758; 95% CI, 1.120–6.789), the number of CLNM ≥3 (OR, 2.579; 95% CI, 1.315–5.789), CLNM ratio ≥0.297 (OR, 2.905; 95% CI, 1.396–6.043), and tumors located in the upper portion (OR 2.846, 95% CI 1.151–7.039) were independent predictors associated with LLNM. The prediction model showed excellent discrimination with an AUC of 0.731 (95% CI, 0.635–0.827). Novel risk stratification for LLNM was constructed based on this nomogram. In the prospective cohort, we stratified these patients into three risk subgroups: low-, moderate-, and high-risk subgroups and we found that the probability of LLNM was positively correlated with the total points from the nomogram.ConclusionThis nomogram was applied in prospective clinical practice and distinguished PTC patients with a genuinely high risk of LLNM. Surgeons can use our nomogram to tailor the surgical plan and to credibly determine further postoperative therapy.

Transoral vestibular robotic thyroidectomy can really make the patient’s body surface free of scar. This study aimed to compare the surgical and patient-related outcomes between the transoral vestibular robotic thyroidectomy and traditional low-collar incision thyroidectomy. The clinical data of 120 patients underwent transoral vestibular robotic thyroidectomy (TOVRT) or traditional low-collar incision thyroidectomy (TLCIT) were collected from May 2020 to October 2021. Propensity score matching analysis was used to minimize selection bias. All these patients were diagnosed with papillary thyroid carcinoma (PTC) through ultrasound-guided fine-needle aspiration prior to surgical intervention and surgical plan was tailored for each patient. An intraoperative recurrent laryngeal nerve (RLN) detection system was used in all patients, whose RLNs were identified and protected. We performed transoral vestibular robotic thyroidectomy with three intraoral incisions. Additional right axillary fold incisions were adopted occasionally to enhance fine reverse traction of tissue for radical tumor dissection. Clinical data including gender, age, tumor size, BMI, operation time, postoperative drainage volume and time, pain score, postoperative length of stay (LOS),number of lymph nodes removed, complications, and medical expense were observed and analyzed. Propensity score matching was used for 1:1 matching between the TOVRT group and the TLCIT group. All these patients accepted total thyroidectomy(or lobectomy) plus central lymph node dissection and all suffered from PTC confirmed by postoperative pathology. No conversion to open surgery happened in TOVRT group. The operative time of TOVRT group was longer than that of TLCIT group (P < 0.05). The postoperative drainage volume of TOVRT group was more than that of TLCIT group (P < 0.05). The drainage tube placement time of TOVRT group were longer than that of TLCIT group (P < 0.05). Significant differences were also found in intraoperative bleeding volume, pain score and medical expense between the two groups (P < 0.05). The incidence of perioperative common complications such as hypoparathyroidism and vocal cord paralysis in the two groups was almost identical (P > 0.05). However, there were some specific complications such as surgical area infection (one case), skin burn (one case), oral tear (two cases), and paresthesia of the lower lip and the chin (two cases) were found in TOVRT group. Obviously, the postoperative cosmetic effect of the TOVRT group was better than TLCIT group (P < 0.05). TOVRT is safe and feasible for low to moderate-risk PTC patients and is a potential alternative for patients who require no scar on their neck. Patients accepted TOVRT can get more satisfaction and have less psychologic injury caused by surgery.

Objective:Ipsilateral multiple breast cancer is a unique situation in which multiple breast cancer lesions are present in the same or different quadrant of the breast. While current research on ipsilateral multiple breast cancer primarily focuses on its existence or heterogeneity, it is important to evaluatethe risk level stratification of heterogenous lesion and determine the intensity of anti-tumor treatments for every lesion, achieving a rational and personalized anti-cancer strategy. Case Description:We present a 55-year-old woman with a lump in the lateral quadrant of her left breast, who was diagnosed invasive breast cancer with a background of ductal carcinoma in situ in two lesions of the left breast. The immunohistochemistry examination revealed that the lateral cancer lesion was Luminal B subtype while the lower cancer lesion HER2 positive subtype. Aditionally, the axillary lymph node dissection and immunohistochemistry showed 7 positive lymph nodes originating from ER-positive lesion. After systemic imaging screening, the clinical TNM stage for ER positive subtype was III A and HER2 positive subtype I A. The discovery shifted the conventional understanding that HER2 positive subtype usually had a higher TNM stage than ER positive subtype under the premise of consistent tumor volume and treatment strategy should be readjusted to reduce over-treatment and the risk of recurrence for high-risk tumor. However, little is mentioned about the risk level stratification of foci in ipsilateral multiple breast cancer and its weight in treatment strategy in clinical guidelines for breast cancer. Conclusion:This case highlights the need for more evidence-based data to support risk-level stratification of heterogenous foci and treatment decisions for ipsilateral multiple breast cancer and challenges current clinical practice.

Objective:To explore the safety and feasibility of bilateral axillo-breast approach （BABA） robot in the operation of thyroid cancer in obese women. Methods:The clinical data of 81 obese female patients who underwent da Vinci robotic thyroid cancer surgery（robotic group） at the Department of Thyroid and Breast Surgery, PLA 960 Hospital from May 2018 to December 2021 were retrospectively analyzed and compared with the clinical data of 106 obese female thyroid cancer patients who underwent open surgery（open group） during the same period. The age, body mass index（BMI）, mean time of surgery, mean postoperative drainage, tumor diameter, postoperative tumor stage, number of lymph node dissection in the central and lateral cervical regions, number of positive lymph nodes in the central and lateral cervical regions, postoperative cosmetic outcome satisfaction score, mean postoperative hospital stay and postoperative complications of all patients were counted. The results were analyzed using SPSS 26.0 statistical software, and the count data were compared using the χ² test, and the measurement data were compared using the t test. Results:All patients completed the operation successfully, and there was no conversion in the robot group, postoperative pathological results were all composed of papillary thyroid carcinoma. The operation time in the robot group was（144.62±36.38） min, which was longer than that in the open group（117.06±18.72） min（P<0.05）. The average age of the robot group was（40.25±9.27） years, which was lower than that of the open group（49.59±8.70） years（P<0.05）. The satisfactory score of cosmetic effect in the robot group（9.44±0.65） was higher than that in the open group（5.23±1.07）（P<0.05）. There was no significant difference in tumor diameter, BMI, average postoperative drainage, temporary hypoparathyroidism and recurrent laryngeal nerve injury, number of central and lateral cervical lymph node dissection, number of positive lymph nodes in the central and lateral cervical regions, and average postoperative hospital stay between the two groups. There was no permanent hypoparathyroidism and recurrent laryngeal nerve injury in both groups. Conclusion:The application of BABA pathway robot in thyroid cancer surgery in obese women is safe and feasible, and the cosmetic effect is better after operation.

e18085 Background: With the emergence of mutation-based diagnosis and therapies for patients with papillary thyroid carcinoma (PTC), molecular profiling has become an important component of care. Although next-generation sequencing (NGS) gene panels are accessible to clinicians, the key genetic alterations of PTC in Chinese Shandong population were rarely descripted. Methods: A total of 127 papillary thyroid carcinoma patients were enrolled in this cohort, including 49 (38.6%) males and 78 (61.4%) females from January 2020 to May 2022. The median age were all 48 years. Formalin-fixed, paraffin-embedded (FFPE) tumor tissues were all collected and analyzed from these patients. Somatic and germline mutations were identified including 38 genes associated with tumor development. Sequencing data were analyzed to call tumor specific single nucleotide variants (SNV), small insertions and deletions (InDels), copy number alterations (CNA), gene fusions and rearrangements. Results: A total of 117 out of 127 papillary thyroid carcinoma were NGS-positive (92.1%), with a high prevalence of BRAF V600E mutations (52.0%, 66/127) and MLH1 mutations (23.6%, 30/127), and a low prevalence of RAS mutations (10.2%, 13/127)， ROS1 (9.4%, 12/127). Overall, 257 somatic mutations including 249 SNVs (6 splicing, 4 stopgain, 4 frameshift，and 235 nonsynonymous), 3 fusions, 3 deletions, and 1 insertions in 38 genes were identified in the PTC samples. Gene fusions, involving the RET and NTRK1 genes, were identified in three PTCs (2.4%), including NTRK1-TPM3, NTRK1-SQSTM1 and CCDC6-RET. And the three fusions patients were all BRAF V600E-negative cases. Furthermore, in our cohort, BRAF V600E mutation carriers also owned other actionable, the most frequent one was MLH1 (34.8%), followed by RET (15.2%), ROS1 (10.6%), and ATM (10.6%). We also found that three PTC patients carried germline variants of uncertain significance, including ATM (p.L857P), MET (p.L211W) and RET (p.C515R), which are heterozygous mutations. Conclusions: We described the distinct molecular profile in the Chinese Shandong population with PTC. Most patients had at least one potentially actionable mutation, predominantly driven by BRAF V600E and MLH1 alterations. These findings may help in moving toward the more comprehensive and effective personalized treatment of papillary thyroid carcinoma in Chinese.

Background Robot-assisted and endoscopic thyroidectomy are superior to conventional open thyroidectomy in improving cosmetic outcomes and postoperative quality of life. The procedure of these thyroidectomies was similar in terms of surgical view, feasibility, and invasiveness. However, it remains uncertain whether the robotic-assisted bilateral axilla-breast approach (BABA) was superior to the endoscopic bilateral areolar approach (BAA) thyroidectomy. This study aimed to investigate the clinical benefit of these two surgical procedures to evaluate the difference between these two surgical procedures by comparing the pathological and surgical outcomes of endoscopic BAA and robotic-assisted BABA thyroidectomy in differentiated thyroid carcinoma. Methods From November 2018 to September 2021, 278 patients with differentiated thyroid carcinoma underwent BABA robot-assisted, and 49 underwent BAA approach endoscopic thyroidectomy. Of these patients, we analyzed 42 and 135 patients of endoscopic and robotic matched pairs using 1:4 propensity score matching and retrospective cohort study methods. These two groups were retrospectively compared by surgical outcomes, clinicopathological characteristics, and postoperative complications. Results The mean operation time was significantly longer in the EG than in the RG ( p < 0.001), The number of retrieved lymph nodes was significantly lower in the ET group than in the RT group ( p < 0.001). The mean maximum diameter of the thyroid was more expansive in the EG than in the RG ( p = 0.04). There were no significant differences in the total drainage amount and drain insertion days between the two groups ( p = 0.241, p = 0.316, respectively). Both groups showed that cosmetic satisfaction ( p = 0.837) and pain score ( p = 0.077) were similar. There were no significant differences in complication frequencies. Conclusion Robotic and endoscopic thyroidectomy are similar minimally invasive thyroid surgeries, each with its advantages, both of which can achieve the expected surgical outcomes. Trial registration Retrospectively registered.

对于影响儿童正常生活且无法确定良恶性的甲状腺疾病,手术是首选治疗方案.随着数字信息化的深入、短视频制作的简化普及和生活质量的提高,甲状腺疾病患者对于美的要求越来越高,儿童也不例外.传统开放手术给儿童身体及心理的创伤较大,不利于儿童的健康发育.经口腔前庭入路,可以实现体表完全无疤的目的,满足了有强烈美容需求的患儿.机器人手术系统能够滤除术者手部自然震颤,提供三维放大视野,并且手术器械具有多自由度运动功能,可实现精细化手术操作,减少并发症,为儿童甲状腺手术提供新的选择.本文将报道我中心开展的 2例儿童经口腔前庭入路机器人甲状腺手术.

Objective:To discuss the long-term survival and risk factors of thyroid cancer in the real world in China.Methods:The clinical data of thyroid cancer patients who underwent initial surgery from Apr. 1998 to Dec. 2018 were retrospectively analyzed, including patients’sex, age, surgical records, pathology, hospitalization records and follow-up. According to the prognosis, the patients were divided into disease-free survival group and recurrence/metastasis/death group. Univariate analysis and multivariate regression analysis were conducted to analyze the risk factors affecting the prognosis of thyroid cancer. The clinical features and prognostic risk factors of thyroid cancer patients were investigated.Results:A total of 2038 cases were collected, and the longest follow-up time was more than 20 years. A total of 1876 cases were included in the study, 162 cases were lost, and the rate of follow-up was 7.9%. Among them, 1858 survived, the overall survival rate was 99.04%; 18 died, and the overall mortality rate was 0.96%. According to the prognosis of thyroid cancer, the patients were divided into 2 groups, including 1808 cases in the disease-free survival group and 68 cases in the relapsed-metastatic-death group. The study found that there were statistical differences between the two groups in terms of patients’age [ (45.40±11.016) vs (51.53±15.199, P=0.000) , the male ratio (32.854%, 48.529%, P=0.001) , whether tumor breaks through capsule (20.077%, 33.823%, P=0.006) , central lymph node metastasis (48.834%, 70.588%, P=0.001) and lateral lymph node metastasis (31.084%, 55.882%, P=0.000) , and there was no difference between the number of tumor lesions. Conclusion:Thyroid cancer has a good prognosis, but according to the characteristics of patients with thyroid cancer in my country, it should still be treated early in the clinic, and the standardization and thoroughness of surgery should be adhered to during the treatment.

Objective To compare the surgical outcomes between the transoral-vestibular robotic thyroidectomy (TOVRT) and bilateral axillo-breast approach robotic thyroidectomy (BABART). Methods A total of 99 patients with papillary thyroid carcinoma but no distant metastasis were enrolled in this study from May 2020 to April 2021. Lobectomy or total thyroidectomy with central lymph node dissection were performed in all cases. All 99 patients were received an ultrasound guided fine needle aspiration biopsy prior to surgical intervention, out of which 49 patients underwent TOVRT, while rest 50 patients underwent BABART. During the procedure, intraoperative neuromonitoring system was used and all recurrent laryngeal nerves (RLNs) were preserved, additionally for TOVRT procedure, three intraoral ports or right axillary fold incision was used to allow for fine countertraction of tissue for radical oncological dissection. The clinical data including age, gender, height, weight, BMI, primary tumor size, number of central lymph node removed, central lymph node metastasis, operating time, total hospital stays, postoperative hospital stays, total postoperative drainage volume, postoperative pain score, cosmetic effect and complications were recorded and analyzed. Results There were no significant differences in gender, height, weight, BMI and removed central lymph nodes between the two groups ( P > 0.05). Patients accepted TOVRT were younger and had smaller primary tumor size than those who accepted BABART. The TOVRT group had a longer surgical time than the BABART group, but with smaller postoperative drainage volume and superior cosmetic effect (under visual analogue scale, VAS) ( P < 0.05). There was no significant difference in lymph node metastasis, hospital stay and postoperative pain score (under numerical rating scale, NRS) between the two groups ( P > 0.05). Last but not least, certain peculiar complications were observed in TOVRT group: paresthesia of the lower lip and the chin (one case), surgical site infection (one case) and skin burn (one case). Conclusion Transoral-vestibular robotic thyroidectomy is safe and feasible for certain patients, which could be considered an alternative approach for patients who require no scarring on their neck.

Objective:To investigate the feasibility and safety of transoral robotic selective lateral cervical lymph node dissection for thyroid cancer.Methods:A retrospective analysis was performed on the clinical data of 7 patients who underwent selective cervical lymph node dissection via transoral approach for thyroid cancer treated in department of Thyroid and Breast Surgery, 960 Hospital of PLA from Dec. 2020 to Aug. 2021. The operation time, postoperative hospital stay, postoperative drainage fluid volume, lymph node dissection number, cosmetic effect satisfaction and surgical complications of 7 patients were analyzed. Patients were followed up through outpatient service, telephone, wechat, etc.Results:All the 7 patients completed the operation successfully without transferring to open surgery. Among them, 4 cases underwent total thyroid resection, 3 cases underwent lobes and isthmus resection, 6 cases underwent level Ⅵ, Ⅲ, Ⅵ dissection, and 1 case performed level Ⅵ, Ⅲ, Ⅵ, Ⅴb dissection. The mean operation time was (166.857±10.134) min, the mean postoperative hospital stay was (6.429±1.178) d, the mean postoperative drainage volume was (246.857±92.047) ml, and the mean number of lateral lymph nodes was (12.286±5.336). Two patients presented with temporary hypoparathyroidism without temporary recurrent laryngeal nerve injury, and no patients had permanent recurrent laryngeal nerve injury or permanent hypoparathyroidism. All patients without lymphatic leakage. Average follow-up (9.571±1.989)months, no relapse patients.Conclusions:Selective cervical lymph node dissection for thyroid cancer is safe and feasible by transoral robotic, providing a new option for patients with special needs.

Objective:To investigate the safety and surgical treatment effect of da Vinci robot in male thyroid surgery.Methods:Clinical data of 276 male patients undergoing robotic thyroid surgery with bilateral axillo-breast approach (BABA) admitted to our hospital from Feb. 2014 to Jan. 2020 were retrospectively analyzed. They were compared with 372 male patients (open group) who had open surgery by the same team during the same time. Surgical time, the amount of fluid selitransteise after surgery, the length of hospitalization after surgery, the number of metastatic lymph node (for malignant tumor) , cosmetic effect satisfaction, injury of recurrent laryngeal nerve and decrease of parathyroid function and other related surgical complications were analyzed. SPSS 20.0 software was employed to carry out statistical analysis, the measurement data were compared with t-test, and the counting data were analyzed by χ2 test. Results:All operations were successfully completed and on one in the robot group was converted into open surgery. Compared with the open group, surgical time of the robot group (benign: 96.78±9.67min, malignant: 143.93±15.73min) was significantly longer than that of the open group (benign: 70.40±12.49min, malignant: 112.26±15.72min) ( P<0.05) , but the postoperative beauty effect of the robot group (benign: 9.62±0.33 points, malignant: 9.59±0.31 min) was better than that of the open group (benign: 5.33±0.37 points, malignant: 5.87±1.65 points) ( P<0.05) . In patients with pathological malignancy, the average age of the robot group (40.89±11.45 years) was lower than that of the open group (44.84±11.88 years) (P<0.05) . There was no significant difference in the amount of fluid induced after surgery, the length of hospital stay after surgery or the number of cases with lymph node metastasis in the two groups ( P>0.05) . There were 2 cases in the robot group and 5 cases in the open surgery group had recurrent metastasis in the side of the neck after surgery. None of the patients had permanent larynx reflux nerve damage or permanent parathyroid dysfunction. The average follow-up time was (25.36±16.13) months, ranging from 1 to 72 months. Conclusion:Compared with traditional open surgery, da Vinci robot surgery system is safe and feasible in male thyroid surgery, with better beauty effect, and provides new options for male thyroid surgery patients with neck beauty needs.

目的:总结机器人辅助甲状腺手术经双侧乳晕和腋窝途径(Bilateral axillo-breast approach,BABA)入路手术过程中助手的操作要点,并分析学习曲线.方法:回顾性分析2014年2月～2015年1月中国人民解放军第960医院开展机器人辅助下经BABA入路甲状腺手术患者50例的临床资料,统计装机时间、标本取出时间等临床资料.根据学习曲线将病例分为新手期及熟练期两组,分析两组患者临床资料及术后并发症情况.结果:手术量积累到23例后,装机时间缩短并趋于平稳,维持在(41.67±9.50)min;手术量积累到21例后,取标本时间缩短并趋于平稳,维持在(1.36±1.06)min.两组患者年龄、性别、肿瘤良/恶性比例、手术单/双侧腺叶切除资料比较,差异无统计学意义(P>0.05);而装机时间与取标本时间差异有统计学意义(P<0.05).装机时间与性别、年龄、肥胖及女性是否哺乳有关;取标本时间与性别、年龄有关,而与肥胖及女性是否哺乳无关.结论:机器人辅助下经BABA入路甲状腺手术助手学习曲线约为20例,一名合格的助手可帮助缩短手术时间并减少术后并发症.

目的:探讨达芬奇机器人手术系统与腔镜手术系统治疗甲状腺微小乳头状癌的安全性及有效性.方法:回顾性分析2016年1月至2021年1月解放军第九六〇医院甲状腺乳腺外科收治的144例甲状腺微小乳头状癌患者的临床资料,其中机器人甲状腺手术患者(机器人组)83例,腔镜甲状腺手术患者(腔镜组)61例,比较两组患者的手术时间、术后住院时间、术后引流液体量、淋巴结清扫个数、美容效果满意度及手术并发症等情况.应用SPSS 20.0统计软件对结果进行分析,比较计量资料采用t检验,比较计数资料采用χ2检验.通过门诊、电话、微信等对患者进行随访.结果:所有患者手术均顺利完成,两组均未中转开放手术.腔镜组手术准备时间(32.46±1.11)min及手术操作时间(146.34±28.70)min明显长于机器人组(19.74±1.52)min及(110.78±16.08)min(P<0.05);而机器人组患者的淋巴结清扫数目(10.29±6.41)枚多于腔镜组(7.72±3.47)枚(P<0.05).两组患者的术后引流液体量、术后平均住院时间及美容效果满意度的差异无统计学意义(P>0.05).机器人组与腔镜组随访时间分别为(26.69±17.86)月、(29.12±17.67)月,范围为1～61个月,所有患者均无复发转移,均无永久性喉返神经损伤及永久性甲状旁腺功能减退发生.结论:达芬奇机器人手术系统在甲状腺微小乳头状癌的治疗中安全可行,与腔镜甲状腺手术相比,手术时间短,淋巴结清扫数目多,给有美容需求的患者提供了新的选择.