To address the lack of guidance for operating the non-dominant side in TOETVA by assessing whether non-dominant-hand TOETVA on the non-dominant side (left hand–left lobe) is a feasible strategy with similar surgical outcomes compared with the conventional dominant-hand approach (right hand–right lobe). This is a single-center, single-surgeon retrospective cohort. Consecutive unilateral TOETVA cases (August 2016–August 2020) were included. Patients were grouped as NDH-TOETVA (left hand on the left lobe) or DH-TOETVA (right hand on the right lobe). Learning curves were segmented using cumulative sum (CUSUM) of operative time into Phase I (initial), Phase II (adaptation), and Phase III (mastery). Phase III outcomes were compared after 1:1 propensity score matching (PSM) on key covariates. CUSUM identified distinct phase boundaries: DH-TOETVA Phase I cases 1–13, Phase II 14–54, Phase III ≥ 55; NDH-TOETVA Phase I 1–17, Phase II 18–37, and Phase III ≥ 38. After PSM in Phase III, 176 patients were analyzed (NDH 88 cases, DH 88 cases). Post-match baseline characteristics were balanced. There were no significant differences between NDH and DH in operative time, estimated blood loss, central neck lymph nodes retrieved/positive, length of stay, postoperative drainage, and complications (P > 0.05). Hand-side matching is a feasible strategy with compared surgical outcomes in TOETVA. Findings support incorporating this strategy and bilateral-hand training into standardized practice with phase-based, objective assessment. Chinese Clinical Trial Registry (UIN: ChiCTR2500097005, https://www.chictr.org.cn ), 2025.2.11.

BackgroundThe transoral endoscopic thyroidectomy vestibular approach (TOETVA) offers a scarless alternative to conventional thyroidectomy. Although established selection criteria exist, clinical scenarios exceeding these parameters are increasingly encountered in practice, yet evidence regarding their safety and feasibility remains limited. This study aimed to systematically review published indications for TOETVA and to preliminarily explore its feasibility in patients with conditions beyond conventional criteria through a case series analysis.MethodsA comprehensive literature review was conducted across PubMed, Web of Science, and the Cochrane Library for studies published up to July 2026, yielding 800 records, of which 131 studies met the inclusion criteria and were analyzed. Articles reporting specific inclusion criteria for TOETVA were analyzed, including thyroid size, gland volume, and maximum resected benign or malignant nodule sizes. In addition, a retrospective case series was performed involving seven patients who underwent TOETVA at a tertiary center between January 2021 and February 2024. Indications included bulky thyroid glands, large benign nodules, intrathyroidal T3a papillary thyroid carcinoma (PTC), and PTC with concomitant neck masses. Surgical feasibility, perioperative outcomes, complications, and recurrence were evaluated.ResultsA total of 131 studies met the inclusion criteria. Most reports limited thyroid diameter to ≤10 cm and gland volume to ≤45–50 mL. For benign nodules, the most frequent upper limit was ≤6 cm, while for malignant tumors, ≤2 cm was the most common criterion. The case series included one bulky thyroid gland, one large benign nodule, two intrathyroidal T3a PTCs, and three PTCs with concomitant neck masses. All operations were successfully completed via TOETVA without conversion to open surgery. The mean operative time was 196 ± 25.3 min, mean drainage volume was 104 ± 67 mL, and mean postoperative hospital stay was 3.14 ± 1.68 days. One patient experienced transient hypoparathyroidism, and no recurrences or major complications were observed during a median follow-up of 34 months (range, 25–58 months).ConclusionsTOETVA is feasible for carefully selected patients beyond standard indications strictly within highly experienced centers, following thorough preoperative imaging and multidisciplinary team (MDT) evaluation. However, we strongly caution against a generalized expansion of indications. In these complex cases, oncologic safety must always be prioritized over cosmetic benefits, and further multicenter evidence is required to confirm long-term outcomes.

ObjectiveWith the growing application of the transoral endoscopic thyroidectomy vestibular approach (TOETVA) for papillary thyroid carcinoma (PTC), understanding patient preferences is critical to improving communication and supporting informed decision-making. This study aimed to identify key factors influencing surgical choices.MethodA discrete choice experiment was conducted with patients diagnosed with PTC who were scheduled for thyroidectomy. Participants evaluated hypothetical surgical scenarios varying in six attributes: incision location, incision size, recurrence rate, operative duration, complication rate, and cost. Preferences and willingness to pay (WTP) were analyzed using a mixed logit model.ResultsA total of 271 patients were included in this study. Patients demonstrated a strong preference for surgical options with lower recurrence rates and scarless approaches. They were willing to pay an additional ¥201,409.60 to reduce the recurrence rate from 10% to 1% and ¥19,141.14 to change the surgical scar location from external to internal. The recurrence rate emerged as the most crucial non-financial factor (β = 8.18, P < 0.001, 95%), followed by incision location (β = 0.78, P < 0.001), and complication rate (β = 0.25, P = 0.030). Demographic factors such as gender, age, education level, marital status, and income exhibited notable differences in postoperative cosmetic concerns.ConclusionRecurrence risk is the primary driver of surgical preference in PTC patients, followed by cosmetic outcomes. Additionally, postoperative cosmetic concerns varied across different demographic groups. These findings highlight the need for surgeons to consider patient-specific values during preoperative consultations to enhance shared decision-making.Clinical Trial Registrationhttps://www.chictr.org.cn/showproj.html?proj=191809, identifier ChiCTR2300069048.

Objective:To overcome certain anatomical limitations of transoral vestibular thyroidectomy, we introduced endoscopic thyroidectomy via the submental approach. During subsequent clinical practice, additional advantages of the submental approach were identified, further enhancing its feasibility and clinical applicability. This study aimed to evaluate the safety, efficacy, and postoperative outcomes of this technique in thyroid surgery. Methods:We retrospectively analyzed patients who underwent endoscopic thyroidectomy via the submental approach at Hunan Cancer Hospital between March and September 2023. Perioperative outcomes, complications, and postoperative quality of life were assessed using validated clinical indicators and the Thyroid Cancer-Specific Quality of Life questionnaire. Results:A total of 50 patients (27 males, 23 females; mean age 41.66 ± 9.70 years) were included. The mean operative time was 93.61 ± 21.78 minutes for unilateral thyroidectomy and 137.39 ± 27.76 minutes for total thyroidectomy. The mean pain score at 48 hours postoperatively was 1.56 ± 0.61, and the mean postoperative hospital stay was 2.84 ± 0.81 days. The mean aesthetic satisfaction score was 4.28 ± 0.67 (1-5, with higher scores indicating better satisfaction). The mean quality-of-life score was 10.23 ± 5.33 (0-130, with lower scores indicating better quality of life). No surgical site infections occurred. Transient hypoparathyroidism occurred in 14.8% of patients, and transient recurrent laryngeal nerve palsy occurred in 4.00%. The mean follow-up duration was 22 months, and no cases of recurrence or distant metastasis were observed during the follow-up period. Conclusions:Endoscopic thyroidectomy via the submental approach effectively balances cosmetic outcomes, surgical trauma, oncological integrity, and surgical feasibility, providing a promising alternative for endoscopic thyroidectomy. Further prospective, multicenter studies are needed to validate its long-term safety and broader clinical applicability. Clinical trial registration:https://www.chictr.org.cn, identifier ChiCTR2400089684.

With the increasing popularity of minimally invasive techniques in thyroid surgery, the transoral endoscopic thyroidectomy vestibular approach (TOETVA) has garnered significant attention. This study aimed to compare the impact of different distances between the observation and operation ports in TOETVA on clinical treatment outcomes. Ninety patients with papillary thyroid carcinoma were retrospectively analyzed. Based on the distance between the observation and operation ports, they were divided into three groups: Group A (2.3–2.7 cm), Group B (less than 2.3 cm), and Group C (more than 2.7 cm). All three groups underwent TOETVA performed by the same surgical team. Operation time, blood loss, postoperative hospital stay, drainage volume, retrieved and metastatic central lymph nodes, postoperative complications, and tumor recurrence were compared among the groups. There were no demographic differences among the three groups. Compared to Groups B and C, patients in Group A had significantly shorter operation times, lower postoperative drainage volumes, and shorter postoperative hospital stays (p < 0.05). There were no significant differences in bleeding amount, retrieved and metastatic central lymph nodes, or incidence of complications among the groups. No postoperative recurrences were observed in any patient. In TOETVA, the best surgical outcomes were achieved when the distance between the observation and operation ports was approximately 2.5 cm (2.3–2.7 cm). This configuration ensures smooth surgical operations and facilitates postoperative rehabilitation, making it worthy of further clinical promotion.

BackgroundIn this study, a novel lymph node tracer—mitoxantrone hydrochloride injection for tracing (MHI)—was intraoperatively administered into suspected metastatic lateral cervical lymph nodes of patients with papillary thyroid carcinoma (PTC), aiming to evaluate its staining efficacy and clinical value in enhancing the completeness of lateral neck dissection (LND).MethodsA prospective controlled study was conducted at Hunan Cancer Hospital between December 2023 and May 2024, enrolling a total of 67 patients diagnosed with thyroid carcinoma. After informed consent, patients were allocated to either MHI or methylene blue group. Subjects were divided into an MHI group (n = 42) and a methylene blue group (n = 25). All patients underwent LND.ResultsThe results demonstrated no statistically significant differences between the two groups in terms of operative time, total number of lymph nodes dissected, cervical drainage volume, or postoperative length of hospital stay (P > 0.05). However, the MHI group exhibited superior staining of suspected metastatic lymph nodes, with a greater number of metastatic lymph nodes and a higher positive ratio compared to the methylene blue group (P < 0.05).ConclusionMHI causes minimal tissue contamination and can effectively enhance the thoroughness of LND in patients with thyroid carcinoma, demonstrating high clinical application value.

Fibroblast activation protein (FAP)-targeted PET/CT has emerged as a promising tool for visualizing tumor stroma. This study aimed to validate the diagnostic efficacy of [18F]AlF-NOTA-FAPI-04 PET/CT in detecting subclinical metastases in recurrent differentiated thyroid cancer (DTC), with direct comparison to [18F]FDG PET/CT. Twenty-three DTC participants with biochemical recurrence (suppressed thyroglobulin [Tg] ≥ 1 ng/mL or Tg antibodies [Tg-Ab] > 115 IU/mL) underwent [18F]AlF-NOTA-FAPI-04 PET/CT, including 16 who underwent paired [18F]FDG scans. Lesion classification followed histopathology or 15.5-month clinical follow-up (median, 8–32 months). [18F]AlF-NOTA-FAPI-04 PET/CT demonstrated significantly higher lesion-level sensitivity (75

Given the scarcity of studies predicting iodine-131 treatment failure based on clinicopathological factors, this study aimed to determine whether clinicopathological features can predict iodine-131 treatment failure in differentiated thyroid carcinoma (DTC) patients. A total of 182 patients were analyzed, including 114 with favorable outcomes and 68 with resistance or poor outcomes. Patients were split into a training set (122 patients) and a validation set (60 patients). Logistic regression identified the number of lateral neck lymph node metastases (P = 0.001) and pre-radioactive iodine therapy serum thyroglobulin levels (P = 0.001) as independent predictors of treatment failure. The predictive model, visualized via a nomogram, achieved area under curves (AUCs) of 0.838 (95% CI, 0.759-0.917) and 0.766 (95% CI, 0.626-0.905) in the training and validation sets, respectively. Calibration curves showed good agreement between predicted and observed outcomes, and decision curve analysis confirmed the model's clinical utility. Subgroup analyses yielded AUCs of 0.777 (95% CI, 0.648-0.906), 0.745 (95% CI, 0.646-0.843), 0.734 (95% CI, 0.649-0.820), and 0.911 (95% CI, 0.769-0.999) for male, female, age < 55, and age ≥ 55 groups, respectively. This model effectively predicts iodine-131 treatment failure risk in DTC patients, providing valuable information for clinical decision-making.

BackgroundAccurate preoperative evaluation of cT1N0M0 papillary thyroid carcinoma (PTC) is essential for guiding appropriate treatment strategies. Although ultrasound is widely used for clinical staging, it has limitations in detecting lymph node metastasis (LNM) and capsular invasion (CI), which may lead to misclassification of high-risk patients. Such undetected risks pose safety concerns for those undergoing radiofrequency ablation. This study aimed to develop an artificial intelligence (AI)-assisted predictive model that integrates ultrasound radiomics and deep learning features to improve the identification of LNM and CI, thereby enhancing risk stratification and optimizing treatment strategies for cT1N0M0 PTC patients.MethodsA total of 203 PTC patients were divided into high-risk (CI or LNM) and low-risk groups, with 142 assigned to the training set and 61 to the internal test set. Regions of interest delineation was performed using ITK-Snap. Radiomic features were extracted with PyRadiomics, and embedding features were obtained through the Vision Transformer (ViT) model. Risk-related features were selected using least absolute shrinkage and selection operator (LASSO), variance thresholding, and recursive feature elimination (RFE). Single-modal and multimodal models were developed using feature-level and decision-level fusion. Feature importance was assessed using Shapley Additive exPlanations (SHAP). Model performance was evaluated using recall, accuracy, and area under curve (AUC).ResultsAmong 1,001 radiomics features, 47 were selected via LASSO and RFE, and 15 relevant features from 768 ViT features. In the internal test set, NeuralNet models based on radiomics and 2D deep learning achieved AUCs of 0.756 and 0.708, respectively, and 0.829 and 0.840 in the training set. The multimodal RandomForest model outperformed single-modality models, with an AUC of 0.763 in the test set and 0.992 in the training set. Decision-level fusion models, such as DLRad_LF_Avg and DLRad_LF_Max, improved the external test set AUC to 0.843. SHAP analysis identified key features linked to tumor heterogeneity.ConclusionThe multimodal AI model effectively predicts high-risk cT1N0M0 PTC, outperforming single-modality models and aiding clinical decision-making.

OBJECTIVE:This review analyzes the learning curves of various endoscopic thyroidectomy approaches, aiming to guide surgeons in improving training efficiency, reducing learning time, and enhancing surgical safety and outcomes. METHODS:A literature search in PubMed and Web of Science for studies published from January 2014 to April 2024 on the learning curves of endoscopic thyroidectomy was conducted. Studies involving human subjects with specific case data were included; duplicates, non-English publications, animal studies, reviews, and unrelated thyroid conditions were excluded. RESULTS:A total of 47 studies were reviewed, covering various endoscopic thyroidectomy techniques. The trans-axillary procedure showed a learning curve peak between 30 and 90 cases (average 45.5 for endoscopic, 34.17 for robotic). The trans-breast/chest approach peaked between 25 and 60 cases (average 34.88). Transoral procedures peaked between 12 and 71 cases (average 37 for endoscopic, 28.63 for robotic). The bilateral axillo-breast approach (BABA) peaked at 30 cases for endoscopic surgeries and 15-51 cases for robotic-assisted surgeries (average 36.44). CONCLUSION:This study highlights the learning curve differences among various approaches to endoscopic thyroidectomy, providing valuable insights for improving training and increasing the adoption of these techniques.

Background Injury to the recurrent laryngeal nerve (RLN) and parathyroid glands (PGs) are the most common and serious complications during the transoral endoscopic thyroidectomy vestibular approach (TOETVA), and their exposure and protection are the most important factors affecting the operation time. Here, we report a novel anatomical landmark and surgical method to shorten the operative time and reduce the chance of injury to the RLN and PGs. Methods According to the different exposure methods of the RLN, patients were divided into the experimental group (from top to bottom, E-group) and the comparison group (from outside to inside, C-group), and 1:1 propensity score-matching (PSM) was performed. The demographics, operative data, postoperative data, and postoperative complications were analyzed by comparing the 2 groups. Results After PSM, a total of 206 patients were included. Except for tumor size, there were no significant differences between the 2 groups in terms of sex, age, body mass index, presence of Hashimoto’s thyroiditis, or extent of surgery. Compared with the C-group, the operative time, in minutes, of the E-group was significantly shorter (hemithyroidectomy with central neck dissection (CND), C = 111.81 ± 25.83 vs E = 100.52 ± 16.47, P = .002 and bilateral thyroidectomy with CND, C = 177.87 ± 36.61 vs E = 156.05 ± 25.60, P = .004), the exposure time, in minutes, of the RLN was reduced (hemithyroidectomy with CND, C = 23.31 ± 7.07 vs E = 11.41 ± 2.75, P < .001 and bilateral thyroidectomy with CND, C = 45.64 ± 14.84 vs E = 21.76 ± 5.57, P < .001). The rate of postoperative temporary PGs and RLN injuries were also reduced (transient hypoparathyroidism, C = 13% vs E = 4%, P = .023 and transient RLN palsy, C = 10% vs E = 2%, P = .017). In addition, the remaining parameters such as the amount of bleeding, number of lymph node metastases, postoperative hospital stay, visual analog scale pain score, recurrence rate, and other complication rates were not significantly different between the 2 groups. Conclusion It is safe and feasible to construct Thyroid-RLN Entry Triangle (Peng’s Triangle) for PGs and RLN protection in TOETVA. It is beneficial to shorten the operation time and reduce postoperative complications, both worthy of clinical promotion. Trial Registration This study was registered at the Chinese Clinical Trial Registry (UIN: ChiCTR2300067673, https://www.chictr.org.cn ) in accordance with the World Medical Association’s Declaration of Helsinki, 2013.

Importance With advancements in robotic surgery, robotic-assisted thyroidectomy is gaining popularity. The introduction of the 3-port transoral robotic thyroidectomy (T-TORT) offers an alternative approach with potential benefits in postoperative recovery compared to traditional methods. Objective To assess the safety and feasibility of T-TORT in comparison to the transoral endoscopic thyroidectomy vestibular approach (TOETVA). Design A retrospective cohort study with 1:1 propensity score matching was conducted to compare perioperative outcomes between T-TORT and TOETVA. The learning curve was analyzed using cumulative summation (CUSUM). Setting Tertiary A hospital. Participants One hundred sixty-two patients who underwent either T-TORT or TOETVA were included. Intervention or Exposures The T-TORT group underwent three-port robotic thyroidectomy, while the TOETVA group received standard transoral vestibular endoscopic thyroidectomy. Main Outcomes and Measures Demographics and perioperative data were compared. The learning curve was evaluated using CUSUM. Results Compared with the TOETVA group the operation time in minutes of the T-TORT group was relatively longer (136.14 ± 36.52 vs 122.49 ± 34.85, P = .012), the postoperative stay, in days, was shorter (2.77 ± 0.78 vs 3.51 ± 0.95, P < .001), the drainage volume on a postoperative day 1 (POD1) and POD2, in milliliter, was less (POD1 56.57 ± 23.29 vs 65.12 ± 26.04, P = .029 and POD2 27.43 ± 25.29 vs 38.21 ± 25.09, P = .008). The other statistics, including bleeding amount, retrieved and metastatic central lymph nodes, visual analog scale score, and drainage volume on an operative day were comparable between the 2 groups. Meanwhile, there were no significant differences between the 2 groups in postoperative complication rates. The turning point of the learning curve was in the 16th case with a hemithyroidectomy with central neck dissection (CND) and the 21st case with a bilateral thyroidectomy with CND. Conclusions and Relevance T-TORT is a safe and feasible option with enhanced postoperative recovery compared to TOETVA. It may be a preferable choice in specific clinical situations. Trial Registration This study was registered at the Chinese Clinical Trial Registry (UIN: ChiCTR2300069021, https://www.chictr.org.cn ) in accordance with the World Medical Association’s Declaration of Helsinki, 2013.

The management of papillary thyroid carcinoma (PTC) concurrent with Hashimoto's thyroiditis (HT) lacks standardized guidelines, especially concerning surgical strategies. This study aimed to compare unilateral thyroidectomy (UT) with total thyroidectomy (TT) in PTC-HT patients to optimize clinical management and improve postoperative outcomes. This retrospective study included PTC-HT patients undergoing thyroid surgery at a tertiary academic medical institution from January 2018 to August 2023. The patients were grouped according to the quartiles of preoperative thyroid peroxidase antibody (TPOAB) levels at the last follow-up. Additionally, patients were divided into UT and TT groups, with propensity score matching (PSM) to ensure comparability. Patients were also stratified by TPOAB levels (L: 100-400, M: 400-1000, H: >1000). Patient-reported outcomes (PROMs), including quality of life and fatigue, were compared between UT and TT groups within each TPOAB subgroup (Delta PROMs = UT-TT). 246 patients were included. Those with higher TPOAB levels at the last follow-up reported increased physical fatigue scores. After PSM, there were no significant demographic differences between UT and TT groups. During a median follow-up of 16 months for UT and 20 months for TT, no recurrence or metastasis occurred. Compared to the UT group, the TT group exhibited lower TPOAB levels at the last follow-up (65.7 +/- 78 vs. 374.6 +/- 331.9, p < 0.001), and lower physical fatigue scores (3.6 +/- 2.5 vs. 4.5 +/- 2.8, p = 0.039). However, TT was associated with a higher incidence of transient hypoparathyroidism (7.8% vs. 1.1%, p = 0.030). Stratified analysis by preoperative TPOAB levels revealed significant differences in Delta PROMs (Physical fatigue) between L and H groups (0.2 +/- 3.5 vs. 4.6 +/- 2, p = 0.004) and between M and H groups (0.6 +/- 4.5 vs. 4.6 +/- 2, p = 0.037). Delta PROMs (Mental fatigue) also significantly differed between L and H groups (0 +/- 1.8 vs. 1.6 +/- 0.9, p = 0.026). For PTC-HT patients, particularly those with high preoperative TPOAB levels, TT offers advantages in alleviating fatigue symptoms but carries a higher risk of complications. Therefore, clinical decision-making should consider patient-specific factors, particularly preoperative TPOAB levels, to determine the optimal surgical approach. Trial registration: Chinese Clinical Trial Registry. ID ChiCTR2300069240.

There are no targeted rehabilitation training modalities and assessment tools for patients after transoral endoscopic thyroidectomy vestibular approach (TOETVA). Herein, we develop a new assessment questionnaire and rehabilitation training modality and evaluate its safety and effectiveness. The THYCA-QoL-TOETVA questionnaire was compiled, and reliability and validity analyses were performed. Patients were divided into the new rehabilitation training group (N) or the conventional rehabilitation training group (C), and 1:1 propensity score matching (PSM) was performed after administering questionnaires to patients in both groups. Cervical range of motion (CROM) data were also measured and collected for statistical analysis. The questionnaire used in this study showed good expert authority, coordination, internal consistency, and questionnaire reliability. A total of 476 patients were included after PSM, and the questionnaire results showed that recovery and quality of life were better in the N group than in the C group (124.55 ± 8.171 vs. 122.94 ± 8.366, p = 0.026). Analysis of cervical spine mobility showed that rehabilitation was better in the N group compared to the C group at postoperative one month (flexion: 1.762°, extension: 4.720°, left lateral bending: 3.912°, right lateral bending: 4.061°, left axial rotation: 5.180°, right axial rotation: 5.199°, p value all of these < 0.001), and at postoperative three months (flexion: 2.866°, extension: 2.904°, left lateral bending: 3.927°, right lateral bending: 3.330°, left axial rotation: 4.395°, right axial rotation: 3.992°, p value all of these < 0.001). The THYCA-QoL-TOETVA provides an appropriate and effective tool for measuring the postoperative quality of life of TOETVA patients. This new rehabilitation training can effectively alleviate the problem of limited neck movement and improve the quality of life of patients after TOETVA surgery. Trial registration: ChiCTR2300069097.

Objective: Conventional cervical lymph node dissection often leaves large surgical scars, which seriously compromises the postoperative aesthetic effect and can affect the quality of life of patients. In this study, the safety and feasibility of robotic-assisted endoscopic thyroidectomy with central neck dissection (CND) and lateral neck dissection (LND) via a combined transoral and breast approach are discussed in detail. Materials and methods: A retrospective analysis was made of the data of 26 patients with stage cN1b papillary thyroid carcinoma who were admitted to the Thyroid Surgery Department of the Hunan Cancer Hospital from March 2021 to September 2022 and who underwent robotic-assisted endoscopic thyroidectomy with LND via a combined transoral and breast approach. The demographic data, surgical indicators, postoperative data, and the postoperative complication rate of the patients were analyzed, and the learning curve was analyzed by cumulative summation. Results: All the patients underwent endoscopic surgery without any conversion to open surgery. The mean operation time was 313.7±50.3 min and the mean number of total positive/retrieved lymph nodes was 11.2±8.1/36.8±13.7. Two patients developed temporary laryngeal recurrent nerve palsy and three patients developed temporary hypoparathyroidism, all of whom recovered within 3 months postoperatively. No tumor recurrence occurred during follow-ups that ranged from 6 to 24 months. The mean postoperative quality of life (QOL) score was 189.1±118.2, test results ranging from 0 to 1300 with a lower score indicating a higher QOL, and the aesthetic satisfaction score was 4.2±0.7, test scores ranging from 0 to 5 with higher scores indicate higher satisfaction. The turning point of the learning curve was in the 11th case. Conclusions: The robotic-assisted endoscopic thyroidectomy with CND and LND via a combined transoral and breast approach is safe and feasible, and the improved cosmetic effect is remarkable, which is conducive to improving the postoperative QOL of patients. It provides a new surgical option for patients.

Background/Aim: MicroRNAs (miRNAs) interact with mRNAs and play important roles in progression and prognosis in multiple cancers. Sterol regulatory element-binding protein 1 (SREBP1) is an important lipid metabolism regulatory gene. The aim of the present study was to analyze the profiles of miRNAs that are associated with SREBP1 expression in differentiated thyroid carcinoma (DTC). Materials and Methods: In the present study, a high-throughput small RNA sequencing (miRNA-Seq) method was used to investigate differences in miRNA profiling with versus without interference with SREBP1 expression via small interfering RNA. Real-time qPCR (qRT-PCR) was performed to confirm the results. Results: A total of 1,393 conserved and 84 novel miRNAs were successfully discovered. In two separate batches, a total of 27 differentially expressed miRNAs (11 up-regulated and 16 down-regulated) were observed in BCPAP cells after SREBF1 interference with two distinct siRNA fragments, as compared to the control siRNA treatment. Hsa-miR-941, hsa-miR-27a-5p, hsa-miR-29a-3p, hsa-miR-100-5p, and hsa-miR-21-3p were selected for validation using qRT-PCR. The qRT-PCR results were consistent with the sequencing data. Gene Ontology enrichment showed that the predicted targets of these miRNAs were mainly involved in the regulation of system development, metabolism and protein binding cellular processes, and metabolic processes. Kyoto Encyclopedia of Genes and Genomes pathways analysis showed that the predicted target genes were involved in several signaling pathways, including the Ras, MAPK, insulin, thyroid hormone, and metabolic pathway signaling pathways. Conclusion: Differentially expressed miRNAs and their target genes may play an important role in the progression and prognosis of DTC that is associated with SREBP1 expression.

腔镜甲状腺手术可以提供良好的美容效果 ［1］，并完成颈侧区淋巴结清扫 ［2, 3］。我们在现有基础上进一步更新，采用经口经耳后联合入路完成腔镜甲状腺手术，现将安全性和有效性的初步结果报告如下。

近年来加速康复外科(enhanced recovery after surgery,ERAS)理念被逐步深入地应用到甲状腺外科领域,极大地加速了患者术后康复过程.而经口腔前庭入路内镜甲状腺手术(transoral endoscopic thyroidectomy vestibular ap-proach,TOETVA)因其独特的优势在国内也得到广泛开展,此类患者术后康复也越来越受到重视.临床实践中应本着规范化应用ERAS的普适性理念和措施外,也要结合具体术式特点处理的原则,将ERAS理念应用到TOETVA人群中,更好地为患者服务.

MicroRNA-195 (miR-195) plays important roles in tumor metastasis and angiogenesis, yet its function and mechanism of action in hepatocellular carcinoma (HCC) remain to be elucidated. In this study, we aimed to confirm whether chromobox homolog 4 (CBX4) is a direct target gene of miR-195 and determine the functions of miR-195 through the CBX4 pathway. miR-195 expression was slightly lower in the HCC tissues compared with that in the adjacent normal tissues. In addition, western blotting and qRT-RCR results showed that both CBX4 mRNA and protein levels were downregulated upon miR-195 overexpression. Luciferase reporter assays revealed that CBX4 is a direct target gene of miR-195. Furthermore, overexpression of CBX4 significantly restored the proliferative, invasive and migratory capacities of the HepG2 cells. Finally, in vivo experiments confirmed that high expression of CBX4 in HepG2 cells promoted tumor growth. In conclusion, our study demonstrated that miR-195 acts as a tumor suppressor by directly targeting CBX4 in HCC. This finding suggests a potential novel strategy for therapeutic interventions of this disease.

Objective:To explore the necessity of combined transverse upper gracilis flap and adductor magnus perforator flap in breast reconstruction.Methods:From December 2016 to February 2019, 16 female breast cancer patients, aged 27-59 years, with an average of 40.3 years, were treated in the Department of Oncoplastic Surgery, Hunan Cancer Hospital. The tumors were unilateral in 9 cases on the left side and 7 cases on the right side, with a diameter of 1.5-4.5 (2.9±0.3) cm, and all of them were stage I. Pathological diagnosis included 9 cases of invasive ductal carcinoma and 7 cases of invasive lobular carcinoma. After the modified radical mastectomy, the medial thigh perforator flap was used to reconstruct the breast. Patients were randomly divided into group A and group B. In group A, the gracilis myocutaneous flap combined with the adductor magnus perforator flap was elevated. In group B, the adductor magnus perforator flap with large size reaching the front edge of gracilis muscle was directly harvested. After all the flaps were harvested with only one major adductor perforator as vascular pedicle, ICG fluorescence imaging technology was used to verify the blood supply of the flaps.Results:Eight cases of gracilis myocutaneous flap combined with adductor magnus perforator flap and 8 cases of adductor magnus perforator flap were transplanted, The length, width and thickness of the flaps were (27.5±0.4) cm, (7.1±0.5) cm and (3.8±0.4) cm, (7.4±0.3) cm and (10.8±0.5) cm respectively. The average weight of the flap was 255 g (195 g-315 g). The mean ischemia time was 75 min (55-90 min). In 16 cases, the proximal and distal ends of internal mammary vessels were used as the recipient vessels. Only anastomosing the adductor magnus perforator vessels could ensure the reliable blood supply of the flap. All flaps survived successfully in one stage. The appearance of reconstructed breast was good and there was no obvious flap contracture and deformation. 16 cases were followed up for an average of 12.5 months, and the patients＇ self perception and appearance were satisfactory. Only hidden linear scar was left on the donor site of the medial thigh flap, and the function of hip joint and leg was not affected.Conclusions:Large size of medial thigh perforator flap pedicled with the perforator of adductor magnus can be safely and reliably cut with no needing additional harvest of gracilis muscle vascular pedicle.