Gland surgery最新文献

{"title":"Peri-areolar dermal reinforcement to prevent prosthetic-related complications in prepectoral reconstruction with a compromised nipple-areola complex: a surgical technique.","authors":"Joon-Sung Lee, Sang-Oh Lee, Du-Hyong Cho, Sung-Eun Kim, Il-Kug Kim","doi":"10.21037/gs-2026-0321","DOIUrl":"https://doi.org/10.21037/gs-2026-0321","url":null,"abstract":"<p><p>In prepectoral direct-to-implant (DTI) breast reconstruction following nipple-sparing mastectomy (NSM) via a hemi-periareolar incision, intraoperative ischemia of the nipple-areola complex (NAC) presents a critical challenge. Existing salvage procedures often require secondary interventions or NAC sacrifice, while leaving a vulnerable suture line resting directly over the implant-acellular dermal matrix (ADM) construct. To address this, we modified a de-epithelialized dermal flap technique, executed directly through the pre-existing incision, to interpose a protective biological barrier beneath the NAC base. This technique was applied in three female patients (aged 43 to 50 years) with breast cancer undergoing unilateral NSM and immediate prepectoral DTI reconstruction with ADM-wrapped implants. Following mastectomy and prior to implant placement, compromised NAC perfusion was recognized by dusky skin discoloration, qualitative indocyanine green angiography demonstrating reduced fluorescence, a capillary refill time of approximately 2 seconds, and preserved dermal edge bleeding. The maneuver was initiated based on the operating surgeon's clinical judgment. A 5- to 10-mm crescent adjacent to the areolar margin was de-epithelialized-leaving a 2- to 3-mm dermal bed-onto which the NAC-bearing flap was advanced and inset. Over follow-up periods ranging from 12 to 48 months, all three patients achieved complete NAC viability without partial or full-thickness necrosis, wound dehiscence, infection, implant exposure, or reoperation. Transient superficial epidermolysis developed on postoperative day 2 but resolved completely by days 14 to 17 with routine local wound care, and nipple position symmetry showed improvement in all cases. This preliminary experience demonstrates that immediate crescent de-epithelialization is technically feasible and yields acceptable clinical outcomes in selected cases. By establishing a dermal safety buffer against implant exposure, this maneuver offers a practical intraoperative salvage strategy. However, three cases from a single center cannot establish overall efficacy or superiority over alternative salvage methods, and larger prospective studies with standardized outcome metrics are required.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 9","pages":"268"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of surgical outcomes, safety, and cosmetic satisfaction between immediate implant-based and transverse rectus abdominis myocutaneous (TRAM) flap breast reconstruction following total mastectomy: a retrospective cohort study.","authors":"Putthiporn Yenbutra, Pimmanee Nitisavat","doi":"10.21037/gs-2026-0261","DOIUrl":"https://doi.org/10.21037/gs-2026-0261","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Breast cancer is the most common female cancer. Current oncological therapies aim not only to eradicate the malignancy but also to preserve the patient's aesthetic bodily appearance. Breast reconstruction, either with an implant or via transverse rectus abdominis myocutaneous (TRAM), is an option for immediate post-mastectomy reconstruction; however, these two operations differ in outcomes in terms of operative time, blood loss, and complications. Furthermore, the two reconstructive techniques have distinct long-term complication profiles. Implant-based reconstruction is associated with the risk of capsular contracture, whereas pedicled TRAM flap reconstruction is more prone to fat necrosis related to flap perfusion. As cosmetic satisfaction is another important factor that should be considered, this study aimed to compare surgical outcomes and patient-reported cosmetic satisfaction between immediate implant-based breast reconstruction and pedicled TRAM flap reconstruction following total mastectomy. The two types of operations were performed by a single surgeon in Rajavithi Hospital, a tertiary referral institute in Thailand.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective cohort study was conducted in female patients who underwent total mastectomy with immediate breast reconstruction between January 2018 and July 2023. Thirty patients underwent implant-based reconstruction and 30 underwent pedicled TRAM flap reconstruction. Patients with previous chest wall irradiation, neoadjuvant chemotherapy, clinical stage IV disease, or incomplete follow-up were excluded. After standardized preoperative counseling, reconstructive methods were selected based on patient preference, anatomical suitability, and clinical factors. All procedures were performed by a single breast surgeon experienced in breast surgery and reconstruction. Perioperative outcomes, postoperative complications, and patient-reported cosmetic satisfaction were compared between groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The implant-based reconstruction group was younger than the pedicled TRAM flap reconstruction group (43.03±6.08 &lt;i&gt;vs&lt;/i&gt;. 48.47±9.04 years, P=0.009). Compared with implant-based reconstruction, pedicled TRAM flap reconstruction was associated with longer operative time (4.78±0.77 &lt;i&gt;vs&lt;/i&gt;. 2.45±0.83 hours, P&lt;0.001), greater intraoperative blood loss (331.67±207.81 &lt;i&gt;vs&lt;/i&gt;. 135.83±69.38 mL, P&lt;0.001), and higher postoperative pain scores (7.23±1.04 &lt;i&gt;vs.&lt;/i&gt; 4.80±1.03, P&lt;0.001). Postoperative complication rates were comparable between groups. After adjustment for age and type of mastectomy, implant-based reconstruction remained independently associated with higher overall satisfaction [adjusted B=10.612, 95% confidence interval (CI): 1.477-19.747; P=0.02] and cosmetic satisfaction (adjusted B=13.895, 95% CI: 4.748-23.043; P=0.004).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Implant-based reconstruction after mastectomy was associated with shorter o","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 9","pages":"258"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657708/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181353","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-guided percutaneous fine-needle aspiration in parapharyngeal space lesions: a critical appraisal with illustrative cases.","authors":"Rossella Catona, Salvatore Alessio Angileri, Giovanni Maria Rodà, Carolina Lanza, Chiara Luisa Bianchi, Stefano Fiori, Gianpaolo Carrafiello","doi":"10.21037/gs-2026-0210","DOIUrl":"https://doi.org/10.21037/gs-2026-0210","url":null,"abstract":"<p><p>Parapharyngeal space (PPS) lesions represent a rare and heterogeneous group of deep neck entities whose diagnostic evaluation is often challenging because of their deep anatomical location and their close relationship with major neurovascular structures. Cross-sectional imaging with computed tomography (CT) and magnetic resonance imaging (MRI) plays a central role in lesion characterization and anatomical localization. However, in selected cases cytological confirmation may be required to refine the differential diagnosis and guide clinical management. Ultrasound-guided percutaneous fine-needle aspiration (FNA) may represent a minimally invasive diagnostic option when an adequate acoustic window and a safe percutaneous access corridor can be identified. Nevertheless, PPS sampling differs substantially from routine cervical FNA because of the anatomical complexity of the region and the potential proximity to major vascular structures. This article provides a critical appraisal of ultrasound-guided percutaneous FNA for PPS lesions, focusing on anatomical considerations, technical workflow, and decision-making in patient selection. Three illustrative cases from our institutional experience demonstrate how imaging finding and ultrasound assessment guide the decision-making process in performing - or avoiding - percutaneous sampling of PPS lesions.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 9","pages":"265"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relative change rate of neutrophil-to-albumin ratio (ΔNAR) during neoadjuvant chemotherapy predicts axillary pathological complete response in locally advanced breast cancer.","authors":"Yujie Zhao, Yuxiang Deng, Weicai Chen, Meiyu Liu, Zhaoming Peng, Yajie Liu, Lei Zhang","doi":"10.21037/gs-2026-0411","DOIUrl":"https://doi.org/10.21037/gs-2026-0411","url":null,"abstract":"<p><strong>Background: </strong>Routine blood inflammatory-nutritional markers can predict neoadjuvant chemotherapy (NAC) response in locally advanced breast cancer. Neutrophil-to-albumin ratio (NAR) reflects inflammation and nutrition, but prior studies only use static baseline NAR without tracking its dynamic changes during NAC. Axillary pathological complete response (pCR) strongly guides surgery and prognosis. This study proposed ΔNAR, the relative change rate of NAR pre- <i>vs.</i> post-NAC, and evaluated its predictive value for axillary pCR.</p><p><strong>Methods: </strong>We retrospectively enrolled 169 node-positive locally advanced breast cancer patients who finished standard NAC and radical surgery. Blood neutrophil and albumin were tested 7 days pre-NAC and preoperatively post-NAC to calculate ΔNAR. Receiver operating characteristic (ROC) curves determined the optimal ΔNAR cutoff. Chi-squared tests and univariate/multivariate logistic regression identified predictors of axillary pCR, defined as ypN0 (no invasive axillary tumor cells).</p><p><strong>Results: </strong>ROC analysis set the optimal ΔNAR cutoff at -19.29% (area under curve =0.663). The low ΔNAR subgroup (ΔNAR ≤-19.29%) had a markedly higher axillary pCR rate than the high ΔNAR group (P=0.001). Univariate analysis linked hormone receptor (HR) status, human epidermal growth factor receptor 2 (HER2) status, anti-HER2 chemotherapy and ΔNAR to axillary pCR. Multivariate regression confirmed that ΔNAR >-19.29% was independently associated with lower odds of axillary pCR (P=0.049).</p><p><strong>Conclusions: </strong>ΔNAR acts as an independent biomarker for axillary pCR in locally advanced breast cancer. Patients with ΔNAR above -19.29% have lower odds of axillary pathological remission. Derived from routine blood tests at no extra cost, ΔNAR assists clinicians in preoperative prediction of axillary tumor regression and aids therapeuticplan optimization. Its utility for tailoring surgical plans remains to be further validated.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 9","pages":"262"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breast implant-associated late hematoma: a narrative review of case reports and case series.","authors":"Jianping Long, Tao Zhang, Haicun Zhou, Tao Yang, Qingxia Zhang, Xiufen Ma","doi":"10.21037/gs-2026-0194","DOIUrl":"https://doi.org/10.21037/gs-2026-0194","url":null,"abstract":"<p><strong>Background and objective: </strong>Late hematoma after breast implantation presents with delayed breast swelling or periprosthetic fluid that is clinically indistinguishable from breast implant-associated anaplastic large-cell lymphoma (BIA-ALCL), late seroma, infection, or tumor recurrence. This narrative review synthesized published case reports and small case series to describe clinical presentations, hypothesized mechanisms, diagnostic approaches, and management strategies.</p><p><strong>Methods: </strong>PubMed, Web of Science, and Cochrane Library were searched from inception to December 31, 2025. English-language case reports and case series documenting hematoma occurring ≥4 months after implantation were included. Two reviewers independently screened records and extracted data. Given the heterogeneity of uncontrolled case-level evidence, a qualitative descriptive synthesis was performed.</p><p><strong>Key content and findings: </strong>There were 37 articles involving 47 cases from 12 countries included. The median time from implantation to hematoma onset was 72.0 months. Patients typically presented with acute painful unilateral swelling. Features distinguishing late hematoma from BIA-ALCL included acute pain, absence of persistent effusion beyond 1 year, and magnetic resonance imaging (MRI) signal characteristics consistent with evolving blood products. Proposed mechanisms included capsular microfractures, chronic inflammation with neovascularization, external trauma, and iatrogenic factors such as anticoagulation. Ultrasound was the preferred initial screening tool; MRI provided definitive assessment of hematoma staging and implant integrity. Image-guided aspiration was essential to obtain fluid for cytology, microbiology, and CD30 immunohistochemistry to exclude BIA-ALCL. Surgical evacuation with capsulectomy was the most frequently reported definitive treatment; ultrasound-guided aspiration or arterial embolization were described in select patients with intact implants or poor surgical tolerance. Follow-up and recurrence data were inconsistently reported.</p><p><strong>Conclusions: </strong>Late hematoma should be considered in implant recipients with delayed swelling or periprosthetic fluid. Clinical evaluation, ultrasound, MRI, and image-guided aspiration guide management. Surgical evacuation with capsulectomy remains the primary reported treatment. These findings are descriptive only.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 9","pages":"267"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Modified supraclavicular approach for hemithyroidectomy with central neck dissection in unilateral papillary thyroid microcarcinoma: a feasibility-focused retrospective cohort study.","authors":"Ziyu Wang, Kangcong Liang, Xidi Wang, Zhiqiang Zhang, Jingyu Xun, Heng Cao, Kefeng Lei","doi":"10.21037/gs-2026-0388","DOIUrl":"https://doi.org/10.21037/gs-2026-0388","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Conventional open thyroidectomy provides reliable exposure for hemithyroidectomy and central neck dissection but leaves a visible anterior cervical scar. Remote-access approaches may improve cosmetic outcomes but often require specialized equipment, longer operative time, and greater technical complexity. This study evaluated the feasibility and perioperative outcomes of a modified supraclavicular approach in selected patients with unilateral papillary thyroid microcarcinoma (PTMC).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This single-center retrospective cohort study included 130 patients with unilateral PTMC who underwent hemithyroidectomy with isthmusectomy and central neck dissection between June 2023 and January 2026. Patients were categorized into three surgical groups: modified supraclavicular approach, infraclavicular endoscopic approach, and conventional midline open approach. Perioperative outcomes, central lymph node yield, postoperative day 1 parathyroid hormone levels, hospitalization costs, complications, incision-related outcomes, and the learning curve were assessed. To address baseline imbalance, the primary comparison between the modified supraclavicular and conventional midline open approaches was analyzed using propensity score overlap weighting based on age, sex, body mass index (BMI), comorbidity status, Hashimoto's thyroiditis, tumor size, tumor side, and tumor location.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among the 130 patients included, 29 underwent the modified supraclavicular approach, 65 underwent conventional midline open thyroidectomy, and 36 underwent the infraclavicular endoscopic approach, which was retained as an institutional contextual cohort. In the primary comparison with the midline open group, no statistically significant difference was detected in operative time or central lymph node yield after adjustment for relevant covariates. No intraoperative conversion occurred in the modified supraclavicular group. No postoperative hematoma requiring reoperation, clinically suspected permanent recurrent laryngeal nerve dysfunction, or permanent hypoparathyroidism was documented. The modified supraclavicular group had lower postoperative pain scores and less frequent neck discomfort, although these subjective outcomes should be interpreted cautiously because assessment was retrospective and unblinded. Cosmetic superiority over conventional open or remote-access thyroidectomy was not assessed using a validated scar scale. Cumulative sum (CUSUM) analysis identified an approximate transition in operative performance at case 14.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In selected patients with unilateral PTMC for whom hemithyroidectomy with ipsilateral central neck dissection had already been planned, the modified supraclavicular approach appeared technically feasible as an alternative cervical access route. In the primary adjusted comparison with conventional midline open thyroidectomy, no statistically ","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 9","pages":"255"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subcutaneous translocation of residual thyroid tissue: a novel functional-preserving technique for partial thyroidectomy with 1-year follow-up retrospective case series.","authors":"Jialong Wu, Xue Geng, Yan Yang, Boyang Zhang, Peng Qin, Debin Jin, Zhongfeng Ma, Changdong Yang","doi":"10.21037/gs-2026-0308","DOIUrl":"https://doi.org/10.21037/gs-2026-0308","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Benign thyroid nodules frequently require surgical intervention. Balancing thyroid‑function preservation and re‑operation‑related neuro‑parathyroidal risk represents an unmet clinical challenge. This study aimed to investigate the feasibility of translocating residual normal thyroid tissue into the subcutaneous space after resection of benign thyroid tumors. Conventional thyroid resection commonly compromises native thyroid function and leads to postoperative hypothyroidism. Residual thyroid tissue retained in the neck complicates surveillance and increases risks to the recurrent laryngeal nerve and parathyroid glands during secondary surgery. Although subcutaneous translocation may preserve thyroid function and simplify follow-up, its efficacy and safety require further verification.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This single-center retrospective analysis included 106 eligible patients with benign thyroid tumors who underwent partial thyroidectomy with residual gland translocation between May 2022 and May 2025. Ninety-four patients underwent unilateral resection, and 12 underwent bilateral resection. Residual normal tissue was transposed into the superficial subcutaneous muscular space through the sternocleidomastoid-sternohyoid muscle junction. Prespecified outcomes comprised postoperative thyroid function and ultrasound-confirmed graft viability. Thyroid function was measured by chemiluminescence assay and neck ultrasonography was used to assess graft status. Evaluations were scheduled at 1 month and 1 year postoperatively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;All 106 enrolled patients completed the 1-month postoperative follow-up, and all attended the 1-year follow-up. The cohort consisted of 94 patients receiving unilateral partial thyroidectomy and 12 receiving bilateral partial thyroidectomy. Mild localized anterior neck swelling was observed in several patients at 1 month. Ultrasound confirmed the location and size of translocated thyroid tissue. Thyroid function was normal in all 94 patients with unilateral resection. Among the 12 patients with bilateral resection, 5 developed hypothyroidism and required levothyroxine supplementation. At 1 year postoperatively, cervical appearance was unremarkable, and ultrasound showed no abnormal lesions in transposed tissue. Thyroid function normalized under hormone replacement in the 5 patients. The remaining 101 patients sustained normal thyroid function without levothyroxine therapy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Based on the 1-year follow-up outcomes of this single-center, uncontrolled retrospective case series, subcutaneous translocation of residual normal thyroid tissue during partial thyroidectomy for benign tumors is feasible and effective in preserving short-term thyroid function and maintaining satisfactory cosmetic outcomes in this patient cohort. The potential benefit of reducing recurrent laryngeal nerve and parathyroid gland injury during reoperation rem","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 9","pages":"251"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thyroid-cartilage and anterior-laryngeal electrodes provide higher and more frequently adequate electromyographic signals in intraoperative neuromonitoring during thyroid surgery: a systematic review and meta-analysis.","authors":"Hisham Ali Alghamdi, Muhannad Ali Hendi Alghamdi, Mujtaba A Ali, Majed Ashraf Saeed Alghamdi, Muhannad Saleh Ahmed Alzahrani, Azzam Abdullah Ali Alghamdi, Omar Ahmed Ali Alzahrani, Abdulrahman Suwayyid Zayn Alghamdi, Hassan Ibrahim Alomari, Riyadh Abdulrahman Yahya Alzahrani, Nazih Yassir Alzahrani, Ali Yahya Ali Alzahrani, Khaled Saleh Hamdan Alghamdi","doi":"10.21037/gs-2026-0417","DOIUrl":"https://doi.org/10.21037/gs-2026-0417","url":null,"abstract":"<p><strong>Background: </strong>Endotracheal tube electrodes are commonly used for intraoperative neuromonitoring (IONM) during thyroid and parathyroid surgery, but tube displacement and inconsistent vocal fold contact may compromise electromyographic signal quality. Thyroid cartilage and anterior laryngeal electrodes offer an alternative recording interface that is less dependent on endotracheal tube position. This systematic review and meta-analysis aimed to compare thyroid cartilage or anterior laryngeal recording electrodes with endotracheal tube electrodes in patients undergoing thyroid or parathyroid surgery, and to determine whether they provide higher and more frequently adequate electromyographic signals without compromising clinical safety.</p><p><strong>Methods: </strong>PubMed, Web of Science, Scopus, and the Cochrane Library were searched for comparative studies evaluating thyroid cartilage or anterior laryngeal electrodes against endotracheal tube electrodes. Random effects models were used to pool continuous outcomes as mean differences (MD) and dichotomous outcomes as risk ratios (RRs). Risk of bias was assessed with ROBINS-I and certainty of evidence with GRADE. The review was registered in PROSPERO (CRD420261454193) and received no funding.</p><p><strong>Results: </strong>Nine studies involving 1,206 patients and 2,311 nerve at risk or surgical side observations were included. Thyroid cartilage electrodes produced higher V1, V2, R1, and R2 amplitudes, with MDs of 571.28, 591.86, 604.16, and 847.76 µV, respectively. Adequate initial V1 signals of at least 500 µV were more frequent with thyroid cartilage recording, with an RR of 1.60. S2 amplitude was also higher, while S1 amplitude remained inconclusive. No clear differences were observed in latency, overall loss of signal, transient vocal cord palsy, or permanent vocal cord palsy. False positive loss of signal favored thyroid cartilage electrodes but did not reach statistical significance. No electrode-related complications were reported among 1,096 exposed patients. These small, nonrandomized cohorts, however, cannot establish equivalent safety or exclude uncommon complications.</p><p><strong>Conclusions: </strong>Thyroid cartilage and anterior laryngeal electrodes provide stronger and more frequently adequate electromyographic signals than endotracheal tube electrodes without evidence of increased complications. Their principal advantage appears to be improved recording stability rather than direct prevention of recurrent laryngeal nerve injury.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 9","pages":"253"},"PeriodicalIF":1.9,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13657764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and internal validation of a nomogram for predicting the initial response to radioactive iodine therapy in differentiated thyroid cancer with concurrent Hashimoto's thyroiditis.","authors":"Rui Zhu, Yang-Yang Lei, Zhao-Xia Luo, Yi Wu, Ling-Peng Zeng","doi":"10.21037/gs-2026-0252","DOIUrl":"10.21037/gs-2026-0252","url":null,"abstract":"<p><strong>Background: </strong>Differentiated thyroid cancer (DTC) frequently coexists with Hashimoto's thyroiditis (HT), and HT may influence the response to radioactive iodine (RAI) therapy. This study aims to establish and validate a clinical predictive model for the response to initial RAI therapy in patients with DTC complicated by HT, thereby providing a personalized tool for optimizing clinical decision-making.</p><p><strong>Methods: </strong>A total of 461 patients with DTC and HT were included in the study. Variable selection was conducted using least absolute shrinkage and selection operator (LASSO) regression, followed by the construction of a predictive nomogram based on multivariable binary logistic regression. Model performance was evaluated through receiver operating characteristic (ROC) curve analysis, calibration curve analysis, and decision curve analysis (DCA).</p><p><strong>Results: </strong>Among the 461 patients, 235 achieved an excellent response (ER), while 226 experienced a non-ER (NER). Utilizing five predictors identified by LASSO-N stage, tumor multifocality, lymph node metastasis rate, stimulated thyroglobulin (sTg), and thyroglobulin antibody (TgAb)-a binary logistic regression model and corresponding nomogram were developed. The model demonstrated an area under the ROC curve (AUC) of 0.864 in the training set and 0.882 in the validation set for predicting NER. Moreover, calibration curve analysis and DCA indicated acceptable agreement between predicted and observed outcomes, as well as potential clinical net benefit across a range of threshold probabilities, suggesting that the model may be useful for individualized risk stratification.</p><p><strong>Conclusions: </strong>This study successfully developed and internally validated a clinical prediction model for assessing the response to initial RAI therapy in patients with DTC complicated by HT. The model may serve as a reliable reference for personalized clinical decision-making.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"223"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Robotic nipple-sparing mastectomy after periareolar incision: a surgical technical approach to subareolar dissection in a previously operated field.","authors":"Toshikatsu Nitta, Jun Okuno, Kosei Kimura, Kae Nishihara, Yurika Sugano, Ayumi Tsujino, Yuko Takashima, Tomo Ayukawa, Masatsugu Ishii, Atsushi Takeshita, Takashi Ishibashi, Mitsuhiko Iwamoto","doi":"10.21037/gs-2026-0265","DOIUrl":"10.21037/gs-2026-0265","url":null,"abstract":"<p><p>Nipple-sparing mastectomy (NSM) after a prior periareolar incision is technically demanding because fibrosis, altered tissue planes, and possible vascular compromise around the nipple-areola complex (NAC) may increase the difficulty of subareolar dissection. Although robotic nipple-sparing mastectomy (R-NSM) has been reported as a minimally invasive option, its specific role in re-operative subareolar fields remains uncertain. This surgical technical report describes R-NSM performed with the da Vinci Xi system in a 51-year-old woman who previously underwent diagnostic lumpectomy through a periareolar incision for atypical ductal hyperplasia, followed by an indication for additional resection after ductal carcinoma in situ with microinvasion was identified. A 3.5-cm mid-axillary incision was used for access with a GelPOINT Mini platform. The key technical elements were lateral access without reopening the periareolar incision, low-pressure CO₂ insufflation, hydrodissection, maintenance of uniform flap thickness, limited use of bipolar energy, and cold scissors dissection immediately beneath the NAC under magnified three-dimensional visualization. The retroareolar margin was confirmed intraoperatively by frozen section. The total operative time was 248 min, and console time was 71 min. No intraoperative complications occurred. The postoperative course was uneventful, the patient was discharged on postoperative day 7, no nipple or skin necrosis was observed, and final surgical margins were negative. This case suggests that R-NSM may facilitate controlled subareolar dissection in selected patients with prior periareolar surgery. However, this single-case report does not demonstrate superiority over open or endoscopic approaches, and the absence of objective perfusion assessment precludes conclusions regarding NAC vascular preservation.</p>","PeriodicalId":12760,"journal":{"name":"Gland surgery","volume":"15 8","pages":"238"},"PeriodicalIF":1.9,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13561591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}