Thyroid cancer is the most common endocrine malignancy and its incidence is increasing 1, 2. Differentiated thyroid cancer consists of papillary, follicular, and Hurthle cell histological types. ...Although it typically has a good prognosis due to its long, indolent, and well-tolerated natural history, lifelong follow-up is recommended as late recurrences may occur after surgery. Advances in diagnostic modalities and pathologic analysis continue to evolve. High-resolution ultrasound plays an increasingly important role in the management of thyroid cancer, including diagnosis of malignancy, preoperative lymphatic mapping and postoperative surveillance. Surgery remains the mainstay of therapy; however, thyroid suppression and radioactive iodine ablation also contribute to the treatment. The first section of this chapter contains an overview of the clinical characteristics of well-differentiated thyroid cancer including risk factors, symptoms, diagnosis, histologic types, management and follow-up strategies. The second part will provide a more detailed evaluation of the effects of the Chernobyl nuclear accident on the subsequent development of well-differentiated thyroid cancer.
Laparoscopic Adrenalectomy Dhiman, Shamly V.; Lee, James A.
Illustrative Handbook of General Surgery
Book Chapter
In recent years, there has been a shift from open adrenalectomy toward laparoscopic adrenalectomy for the treatment of adrenal tumors due to such factors as decreased postoperative pain and faster ...recovery. Indeed, the majority of adrenalectomies in high-volume centers are performed laparoscopically. Indications for an adrenalectomy, whether open or laparoscopic, include a functional tumor, growth of an adrenal mass of 0.5 cm in 6 months based on imaging, adrenal tumor greater than 3–4 cm (since the risk of adrenal carcinoma increases with increasing tumor size), and isolated metastatic disease. The indications for laparoscopic adrenalectomy are essentially the same as those for open adrenalectomy with the notable exception of adrenocortical cancer, malignant pheochromocytoma, and large metastases. However, as skill and experience with laparoscopy increases, many authors have advocated laparoscopic adrenalectomy even for malignant disease. Contraindications for laparoscopic adrenalectomy also include general contraindications to laparoscopic procedures (such as severe cardiopulmonary risk and coagulopathy).
Laparoscopic adrenalectomy has largely replaced open adrenalectomy as the preferred method for resection of most adrenal tumors. Adrenocortical cancer and malignant pheochromocytoma remain relative ...contraindications to this rule. Over the years, many techniques for laparoscopic adrenalectomy have been developed, including multiple variations on the transabdominal and retroperitoneal approaches (i.e., lateral, supine, prone). The lateral transabdominal approach has become the most widely used technique for laparoscopic adrenalectomy due to the familiar view and well-defined anatomical landmarks while the retroperitoneal approaches fell by the wayside at most centers. However, in recent years a number of advances in the posterior retroperitoneal technique have led to a renaissance in the laparoscopic retroperitoneal approach for selected patients.
