10 results on '"Feinmesser, R."'
Search Results
2. ROBOTIC-ASSISTED TRANSAXILLARY THYROID SURGERY - THE RABIN MEDICAL CENTER EXPERIENCE
- Author
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Rabinovics N, Bachar G, Raz-Yarkoni T, and Feinmesser R
- Subjects
- Adult, Aged, Female, Humans, Middle Aged, Patient Satisfaction, Retrospective Studies, Treatment Outcome, Young Adult, Robotic Surgical Procedures methods, Thyroid Neoplasms surgery, Thyroidectomy instrumentation, Thyroidectomy methods
- Abstract
Aims: To review the experience of a single-center with RATS and to assess its outcome, feasibility and safety., Background: With the advent of minimally invasive techniquesin thyroid surgery, robot-assisted transaxillary thyroid surgery (RATS) has become one of the most popular approaches. Its main advantages are improved cosmetic outcome, thereby increasing patient satisfaction, improved visualization and range of motion. Several large-scale studies, have demonstrated its safety and feasibility., Methods: A retrospective review of all RATS consecutive cases at Rabin Medical Center., Results: A total of 38 RATS procedures were performed between July 2012 and May 2015. The mean age of patients was 39 years (22-74); all patients were females; the average BMI was 25 (18-32). Thirty-seven patients underwent partial thyroidectomy and one - total thyroidectomy. The average maximal diameter of nodules pre-operatively was 2.5 cm (0.5- 5). Seventeen patients (44%) had papillary carcinoma; 13 (33%) - hyperplastic nodules and 8 (20%) - benign thyroid adenomas or goiters. The average total operative time was 166 minutes. One case was converted to open due to a large tumor; there were 6 (15.7%) cases of vocal cord paresis, of which 1 (2.6%) was permanent; there were 8 (21%) cases of hypoesthesia - all resolved within 4-12 weeks. There were no cases of permanent brachial plexus injury., Conclusions: In skilled hands, RATS is a safe alternative to conservative thyroidectomy, and should be presented to patients with aesthetic concerns. As with any new emerging technique, careful patient selection is crucial and further evidence must be sought to confirm its indications over time.
- Published
- 2017
3. The cause of brachial plexopathy in robot-assisted transaxillary thyroidectomy-A neurophysiological investigation.
- Author
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Alkan U, Zarchi O, Rabinovics N, Nachalon Y, Feinmesser R, and Bachar G
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- Adult, Axilla, Female, Humans, Retrospective Studies, Brachial Plexus Neuropathies etiology, Brachial Plexus Neuropathies prevention & control, Intraoperative Neurophysiological Monitoring, Postoperative Complications etiology, Postoperative Complications prevention & control, Robotic Surgical Procedures, Thyroidectomy adverse effects, Thyroidectomy methods
- Abstract
Objectives/hypothesis: During robot-assisted transaxillary thyroidectomy, the patient's arm is maintained in an overhead flexed position for a prolonged time, which poses a risk of postoperative brachial plexopathy. The aim of the study was to identify the causes of brachial plexopathy and to assess the benefit of intraoperative neurophysiological monitoring (IONM) in preventing positional brachial plexopathy in this setting., Study Design: Retrospective case series., Methods: The computerized database of a tertiary medical center was searched for all consecutive patients who underwent robot-assisted transaxillary thyroidectomy between 2012 and 2014. Clinical, operative, and outcome parameters were collected from the medical files. Findings were compared between patients operated with and without IONM., Results: The cohort included 30 patients, 14 operated with IONM and 16 without. Three events of impending brachial plexopathy were detected in the monitored group. The monitored group had significantly better shoulder movement (P = .003), a lower rate of hypoesthesia (P = .011), less pain (P = .001) in the early postoperative period than the nonmonitored group and higher quality of life in the early postoperative period (P = .012). The monitored group was significantly younger than the nonmonitored one (P = .02) and had a significantly larger diameter of thyroid nodule than the nonmonitored group (P = .043)., Conclusions: IONM during robot-assisted transaxillary thyroidectomy may improve short-term postoperative pain and shoulder movement and longer-term quality of life., Level of Evidence: 4 Laryngoscope, 126:2187-2193, 2016., (© 2016 The American Laryngological, Rhinological and Otological Society, Inc.)
- Published
- 2016
- Full Text
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4. Is There Justification for Total Thyroidectomy in Low-Risk Papillary Thyroid Carcinoma? A Decision-Analysis Model.
- Author
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Stern S, Hilly O, Horowitz E, Leshno M, and Feinmesser R
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- Adolescent, Adult, Carcinoma, Papillary, Humans, Markov Chains, Middle Aged, Quality of Life, Quality-Adjusted Life Years, Risk Assessment, Thyroid Cancer, Papillary, Young Adult, Carcinoma surgery, Decision Support Techniques, Models, Theoretical, Neoplasm Recurrence, Local surgery, Thyroid Neoplasms surgery, Thyroidectomy methods
- Abstract
Background: Low-risk papillary thyroid carcinoma is commonly treated surgically. However, uncertainties exist in regard to the optimal extent of surgery. We approached this question using a decision-analysis model., Methods: A Markov model was used to compare outcome between patients with small (1-2 cm) low-risk PTC treated by hemithyroidectomy or total thyroidectomy. Probabilities and utilities were derived from the literature. The model was evaluated with Monte Carlo simulation. Sensitivity analysis was used to determine which variables most affected the model., Results: Hemithyroidectomy was associated with a minor increase in mortality risk. After incorporation of mortality risk, complications, and quality-of-life measures, hemithyroidectomy was found to be superior to total thyroidectomy, with an increasing benefit over time. Quality-of-life measures, especially disutility of disease recurrence and undergoing surgery, had the greatest effect on the incremental benefit of hemithyroidectomy., Conclusion: Based on our decision-analysis model, hemithyroidectomy is the preferred option in low-risk PTC.
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- 2015
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5. Treatment decisions and adherence to guidelines in the treatment of low risk papillary carcinoma of the thyroid.
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Hilly O, Stern-Shavit S, Iran S, and Feinmesser R
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- Attitude of Health Personnel, Carcinoma, Papillary, Guideline Adherence statistics & numerical data, Health Care Surveys, Humans, Israel, Neoplasm Grading, Practice Guidelines as Topic, Risk Adjustment methods, Surveys and Questionnaires, Thyroid Cancer, Papillary, Thyroid Gland pathology, Thyroid Gland surgery, Carcinoma diagnosis, Carcinoma therapy, Endocrinology methods, General Surgery methods, Iodine Radioisotopes therapeutic use, Radiotherapy, Adjuvant methods, Thyroid Neoplasms diagnosis, Thyroid Neoplasms therapy, Thyroidectomy adverse effects, Thyroidectomy methods
- Abstract
Background: Treatment guidelines for well-differentiated papillary thyroid carcinoma (PTC) are based on retrospective studies and vary among professional thyroid associations., Objectives: To evaluate physician adherence to guidelines, overall and by specialty., Methods: Questionnaires on the approach to low risk PTC were distributed among 51 surgeons and endocrinologists treating patients with PTC in tertiary medical centers., Results: A wide range of answers was recorded among physicians regarding the danger posed by low risk PTC to the patient's life, urgency with which treatment should be administered, type of treatment, and risks associated with this treatment. There was a significant between-group difference in treatment preference: endocrinologists chose total thyroidectomy with radioactive iodine, while surgeons favored hemithyroidectomy alone., Conclusions: There is a wide difference in treatment recommendations between treating physicians and different specialties with regard to low risk PTC. The wide variation within and between soecialties may be explained by biases.
- Published
- 2014
6. Thyroid surgery in the elderly.
- Author
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Schwartz N, Shpitzer T, Feinmesser R, Robenshtok E, and Bachar G
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- Adult, Age Factors, Aged, Aged, 80 and over, Case-Control Studies, Cohort Studies, Comorbidity, Female, Humans, Male, Middle Aged, Postoperative Complications etiology, Retrospective Studies, Risk Factors, Thyroid Diseases epidemiology, Thyroid Diseases surgery, Thyroid Neoplasms epidemiology, Thyroid Neoplasms surgery, Thyroidectomy methods, Treatment Outcome, Thyroidectomy adverse effects
- Abstract
Background: The increase in life expectancy combined with the relatively high incidence of thyroid disease requiring surgery in the elderly has raised questions concerning the appropriate management of the older patient., Aim: Evaluation of the surgical management and outcome of thyroid disease requiring surgery in elderly patients., Methods: We performed a retrospective cohort study, in which the medical charts of 2,239 patients who underwent total thyroidectomy or hemithyroidectomy between 1995 and 2011 in a tertiary medical center were reviewed for clinical, disease-related, operative and outcome measures. Findings were analyzed between the patients aged more than 75 years for whom complete information was available (n = 255) and a control group of 100 patients aged 40-60 years matched for sex and extent of surgery., Results: The prevalence of comorbidities was significantly higher in the elderly. Presenting symptoms were similar in the two groups; in approximately 25% of both groups thyroid cancer was an incidental finding. There were no between-group differences in surgery duration, time to anesthesia induction, recovery time from anesthesia, or rate of postoperative complications. Hospitalization was 3 days longer on average in the older group. Malignancy rates and distribution of histologic subtypes were similar in the two groups, although the older group presented with significantly higher rates of advanced disease stage and larger tumors. There were no differences in recurrence rate both locoregional and distant metastases. However, a higher proportion of older patients failed to achieve cure., Conclusion: Although older patients with thyroid disease have more comorbidities and advanced disease, there is no practical difference in their operative management and surgical outcome compared to younger patients. Surgery should not be deferred solely on the basis of age in the presence of compelling indications; rather, the decision should be based on individual risk-benefit analysis., (Copyright © 2013 S. Karger AG, Basel.)
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- 2013
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7. [Minimally invasive video-assisted thyroidectomy].
- Author
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Mizrachi A, Hazan A, Sadov R, and Feinmesser R
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- Adult, Female, Hospitalization, Humans, Hyperplasia, Length of Stay, Male, Middle Aged, Minimally Invasive Surgical Procedures adverse effects, Minimally Invasive Surgical Procedures methods, Postoperative Complications etiology, Retrospective Studies, Thyroid Nodule pathology, Thyroidectomy adverse effects, Time Factors, Video-Assisted Surgery adverse effects, Young Adult, Thyroid Nodule surgery, Thyroidectomy methods, Video-Assisted Surgery methods
- Abstract
Background: During the last decade the surgical technique of minimally invasive video-assisted thyroidectomy [MIVAT) has evolved worldwide. This approach provides Less morbidity and better cosmetic results with the same clinical outcome., Purpose: The aim of this study was to assess the feasibility and efficacy of MIVAT, a new minimally invasive technique for thyroid surgery., Methods: A retrospective analysis of patients who underwent MIVAT between 2007 and 2009 was conducted. For control, we used a demographically and clinically similar group of patients who underwent conventional open thyroidectomy., Results: During the study period 18 patients with a solitary thyroid nodule underwent MIVAT. Indication for surgery was a hyperplastic nodule in all cases. The mean nodule diameter was 1.8 cm in the final pathological examination. Mean operating time was 80.3 minutes compared to 50.27 minutes in the open approach group (p < 0.001). Hospitalization time was significantly shorter in the MIVAT group compared to the open thyroidectomy group, 3.2 versus 4.5 days (p < 0.001). There were no major complications, but 4 patients developed transient vocal cord paralysis and two had wound infection in the MIVAT group, compared to none and one respectively in the control group., Conclusions: MIVAT is a technically feasible and safe procedure that leads to an improved cosmetic result and a quicker recovery. The prolonged operation time and minor complications warrant further experience in our institution.
- Published
- 2011
8. Surgery of thyroid cancer in children and adolescents.
- Author
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Segal K, Shvero J, Stern Y, Mechlis S, and Feinmesser R
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- Adolescent, Adult, Carcinoma, Papillary surgery, Carcinoma, Papillary, Follicular surgery, Child, Female, Humans, Lymph Node Excision, Male, Prognosis, Retrospective Studies, Survival Rate, Thyroid Neoplasms mortality, Thyroid Neoplasms surgery, Thyroidectomy
- Abstract
Background: Thyroid carcinoma in young patients under the age of 20 years is uncommon. Because of the slow progression of this disease, there is still a great deal of debate as to which operation strategy is best., Methods: We undertook a retrospective study of 61 patients under 20 years of age with thyroid cancer treated at our institute between 1952 and 1995. They constitute 6.6% of the 921 thyroid cancer patients treated by us during the same period. Factors examined were: symptoms, metastases, treatment, complications, and survival., Results: Total or near-total thyroidectomy was performed in 51 patients. Regional lymph node dissection was performed in 17 patients and modified radical neck dissection in 13. Fifty-one patients underwent pretracheal and paratracheal lymph node dissection. During the 43 years of this study, two patients died of thyroid cancer., Conclusions: Although most children are initially seen with more extensive disease than adults, the overall prognosis is excellent. The excellent prognosis is the product of initial aggressive treatment: near-total or total thyroidectomy and at least pre- and paratracheal lymph node dissection, followed by radioactive iodine therapy.
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- 1998
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9. Treatment decisions in thyroid surgery based upon ultrasonography.
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Cohen M, Lubin E, Olsha M, Freeman JL, and Feinmesser R
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- Aftercare, Biopsy, Needle, Decision Making, Humans, Postoperative Care, Prospective Studies, Reproducibility of Results, Ultrasonography, Interventional, Patient Selection, Preoperative Care, Thyroid Neoplasms diagnostic imaging, Thyroid Neoplasms surgery, Thyroidectomy
- Abstract
Between 1991 and 1994, 600 thyroidectomies were performed at the Beilinson Medical Center in Israel, 120 of which were due to malignancies. Routine preoperative and follow-up ultrasound examinations were performed in 100 cases. A prospective study comparing preoperative ultrasonic and operative findings revealed that ultrasound offered significant preoperative information that could alter operative decisions. Ultrasound also proved to be a valuable tool in follow-up. Based on ultrasound findings, patients were salvaged at an early stage of recurrent disease.
- Published
- 1996
10. Analysis of the prognostic significance of lymph node related characteristics in papillary thyroid carcinoma patients presenting with pre- or intra-operative evidence of cervical lymph node metastases.
- Author
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Soudry, E, Hilly, O, Preis, M, Hadar, T, Segal, K, Bachar, G, and Feinmesser, R
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LYMPH nodes ,THYROID cancer patients ,MULTIVARIATE analysis ,INTRAOPERATIVE awareness ,IODINE isotopes ,ACADEMIC medical centers ,CANCER relapse ,CHI-squared test ,CONFIDENCE intervals ,LYMPH node surgery ,METASTASIS ,STATISTICAL hypothesis testing ,T-test (Statistics) ,THYROID gland tumors ,THYROIDECTOMY ,LOGISTIC regression analysis ,DATA analysis software ,PAPILLARY carcinoma ,DESCRIPTIVE statistics ,TERTIARY care ,PROGNOSIS - Abstract
Objective:To identify the prognostic significance of specific lymph node related characteristics for disease persistence and recurrence in patients with pre- or intra-operative evidence of neck metastases and no other risk factors.Method and resultsSixty-eight patients were identified; 50 per cent had persistent or recurrent disease. All underwent the same treatment strategy. There were no statistically significant differences in any of the patient- or tumour-related parameters when patients with and without persistence or recurrence were compared. Patients with recurrent or persistent disease had significantly larger (>3 cm) metastatic lymph nodes, but there were no differences regarding other lymph node related parameters (i.e. number, extracapsular extension, number of lymph nodes with extracapsular extension, and central vs lateral neck location). On multivariate analysis, however, none of the parameters were predictive of persistent or recurrent disease.Conclusion:In papillary thyroid carcinoma patients with no other risk factors, pre- or intra-operative evidence of cervical metastases was associated with a very high rate of disease persistence or recurrence. Specific lymph node characteristics were not shown to have prognostic significance. [ABSTRACT FROM PUBLISHER]
- Published
- 2014
- Full Text
- View/download PDF
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