73 results on '"Makay Ö"'
Search Results
2. 259 DEVELOPMENT OF AN ONTOLOGY FOR LAPAROSCOPIC TRANSABDOMINAL ADRENALECTOMY FOR SURGICAL TRAINING AND VIDEO ANALYSIS WITH MACHINE LEARNING ALGORITHMS AND ITS VALIDATION VIA A COMPREHENSIVE MODIFIED DELPHI SURVEY
- Author
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Di Lorenzo, S, primary, Seeliger, Barbara, additional, Francesco, A P, additional, Brunaud, L, additional, Chiapponi, C, additional, De Crea, C, additional, Donatini, G, additional, Iacobone, M, additional, Makay, Ö, additional, Mihai, R, additional, Mogl, M, additional, Mutter, D, additional, Padoy, N, additional, Palazzo, F, additional, Vidal, O, additional, Vix, M, additional, and Raffaelli, M, additional
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- 2024
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3. Réintervention après échec d’une parathyroïdectomie pour hyperparathyroïdie primaire sporadique : étude multicentrique européenne
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Brunaud, L., primary, Van Slycke, S., additional, Makay, Ö., additional, and Bergenfelz, A., additional
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- 2022
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4. Rare Tumors of the Thyroid
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Odemir M. and Makay Ö.
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[No abstract available]
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- 2021
5. Transoral endoscopic thyroidectomy by a vestibular approach: cadaver simulation experience and ethicolegal issues
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Oliva, A, primary, Grassi, S, additional, Minelli, N, additional, Zedda, M, additional, Arena, V, additional, Romaniello, N, additional, Dionigi, G, additional, Makay, Ö, additional, De Crea, C, additional, Celik, S, additional, Spagnolo, A Gioacchino, additional, Bellantone, R, additional, and Raffaelli, M, additional
- Published
- 2021
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6. Transoral endoscopic thyroidectomy by a vestibular approach: cadaver simulation experience and ethicolegal issues
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Oliva, A, Grassi, S, Minelli, N, Zedda, Massimo, Arena, Vincenzo, Romaniello, N, Dionigi, G, Makay, Ö, De Crea, Carmela, Celik, S, Spagnolo, A Gioacchino, Bellantone, Rocco Domenico Alfonso, Raffaelli, Marco, Zedda, M, Arena, V (ORCID:0000-0002-7562-223X), De Crea, C (ORCID:0000-0002-7303-9657), Bellantone, R (ORCID:0000-0002-0844-3469), Raffaelli, M (ORCID:0000-0002-1259-2491), Oliva, A, Grassi, S, Minelli, N, Zedda, Massimo, Arena, Vincenzo, Romaniello, N, Dionigi, G, Makay, Ö, De Crea, Carmela, Celik, S, Spagnolo, A Gioacchino, Bellantone, Rocco Domenico Alfonso, Raffaelli, Marco, Zedda, M, Arena, V (ORCID:0000-0002-7562-223X), De Crea, C (ORCID:0000-0002-7303-9657), Bellantone, R (ORCID:0000-0002-0844-3469), and Raffaelli, M (ORCID:0000-0002-1259-2491)
- Abstract
This article describes the use of transoral endoscopic thyroidectomy by a vestibular approach on cadavers to improve the technical and non-technical skills of surgeons.
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- 2021
7. Impact of healthcare resources on management of indeterminate thyroid tumors
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Alci E. and Makay Ö.
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Indeterminate thyroid nodules ,Follicular neoplasm (FN) ,Atypia of undetermined significance (AUS) ,Follicular lesion of undetermined significance (FLUS) ,Healthcare resource - Abstract
Thyroid nodules are being encountered more and more in clinical practice, occurring in at least 33% of the population. Making a good differential diagnosis between malignant and benign nodules is of utmost importance in clinical management. Fine needle aspiration biopsy (FNAB) is a very useful tool for the assessment of thyroid nodules. With the development of the Bethesda Thyroid Cytopathology Reporting System (TBSRTC), some of the leading problems related to the reporting of thyroid FNA samples and communication between clinicians and cytopathologists have been resolved. The TBSRTC categorizes thyroid FNAB reports under six headings, including three indeterminate categories. The TBSRTC has brought molecular testing into use as an ancillary diagnostic tool for the FNAB cytology, allowing unnecessary operations to be avoided. Performing surgery in low- and middle-income countries has the potential to lead to unwarranted damage and interruptions to the healthcare system. Clinical risk evaluation tools and algorithms must be incorporated into the clinical practice to ensure the personalized management of indeterminate thyroid tumors (ITTs). The international guidelines for the management of thyroid nodules and cancers usually cannot be used when healthcare resource are limited. Healthcare resources play an important role in ITT management. Western countries, which have access to more advanced healthcare resources, make faster diagnostic surgery decisions than Asian countries when encountering indeterminate nodules. From an economic perspective, in when faced with limited healthcare resources, surgery should not be considered as a diagnostic procedure for ITTs. In this review we investigate the impact of healthcare resources on the management of ITTs and the cost-effectiveness of the diagnosis and management options of indeterminate nodules in the light of literature data and the challenges faced in their diagnosis and management. © Annals of Thyroid. All rights reserved.
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- 2021
8. Edward D. Churchill (1895-1972): An Innovative Surgeon, His Work, and His Contribution to Parathyroid Surgery
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Spartalis, E.D. Kouriannidi, E. Athanasiadis, D.I. Chrysikos, D.T. Makay, Ö. Troupis, T.
- Abstract
Edward Delos Churchill, one of the most notorious American surgeons of the 20th century, influenced countless surgeons and set medical practices that were used for decades. His scope of interests included surgery of the lungs, heart, thyroid, parathyroid glands, and military surgery among others. Churchill was one of the first to expand the field of the newly found parathyroid bodies by performing several experimental excisions of the glands and publishing numerous guidelines based on his innovative work. Additionally, he aspired to address many of the literature gaps that led him to conclusions that would benefit both the surgeons and patients throughout the country. Most importantly, his deep interest in endocrinology and his aggregate approach of medicine led him to discoveries that paved the way to the modern endocrine surgery practices. © The Author(s) 2020.
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- 2021
9. Anesthesiological hazards during laparoscopic transhiatal esophageal resection: a case control study of the laparoscopic-assisted vs the conventional approach
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Makay, Ö., den Broek, W. T. van, Yuan, J. Z., Veerman, D. P., Helfferich, D. W. H., and Cuesta, M. A.
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- 2004
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10. Laparoscopically assisted transhiatal resection for malignancies of the distal esophagus
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Van den Broek, W. T., Makay, Ö., Berends, F. J., Yuan, J. Z., Houdijk, A. P. J., Meijer, S., and Cuesta, M. A.
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- 2004
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11. European multicentre study on outcome of surgery for sporadic primary hyperparathyroidism
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Bergenfelz, A, primary, van Slycke, S, additional, Makay, Ö, additional, and Brunaud, L, additional
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- 2020
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12. Adrenalectomy for incidental and symptomatic phaeochromocytoma: retrospective multicentre study based on the Eurocrine® database.
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Thompson, L. Hallin, Makay, Ö, Brunaud, L., Raffaelli, M., and Bergenfelz, A.
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ADRENALECTOMY , *MINIMALLY invasive procedures , *ADRENAL tumors , *SYMPTOMS , *RETROSPECTIVE studies - Abstract
Background: Phaeochromocytoma is sometimes not diagnosed before surgery and may present as an adrenal incidentaloma. The aim of this study was to investigate differences in clinical presentation and perioperative outcome in patients with subclinical and symptomatic phaeochromocytoma, and in patients operated with and without preoperative a-blockade. Methods: This was a retrospective observational study of patients with a histopathological diagnosis of phaeochromocytoma registered in EurocrineVR, the European registry for endocrine tumours, between 1 January 2015 and 31 March 2020. Patient characteristics, clinical presentation, tumour detection, and perioperative variables were analysed. Results: Some 551 patients were included. Of these, 486 patients (88.2 per cent) had a preoperative diagnosis of phaeochromocytoma. Tumours were detected as incidentalomas in 239 patients (43.4 per cent) and 265 (48.1 per cent) had a preoperative diagnosis of hypertension. Preoperative a-blockade was more frequently used in patients with a known phaeochromocytoma (350, 90.9 per cent) than in patients with other indications for adrenalectomy (16, 31 per cent). Complications did not differ between patients who had surgery because of catecholamine excess compared with those who had other indications for surgery (19 (3.9 per cent) versus 2 (3 per cent); P=0.785), nor did the conversion rate from minimally invasive to open surgery differ between the groups. There were no obvious differences in complications, according to the Clavien-Dindo classification, based on preoperative a-blockade or not. Conclusion: Subclinical phaeochromocytoma detected incidentally is common. A significant proportion of patients with phaeochromocytoma did not have a-blockade before surgery, without an apparent effect on complications. [ABSTRACT FROM AUTHOR]
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- 2021
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13. Complications after medullary thyroid carcinoma surgery: multicentre study of the SQRTPA and EUROCRINE® databases.
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van Beek, D.-J., Almquist, M., Bergenfelz, A. O., Musholt, T. J., Nordenström, E., Barczynski, M., Brunaud, L., Clerici, T., Hansen, M. H., Iacobone, M., Makay, Ö., Palazzo, F. F., Mu~noz-Pérez, N., Raffaelli, M., Riss, P., van Slycke, S., and Vriens, M. R.
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MEDULLARY thyroid carcinoma ,PREOPERATIVE risk factors ,RECURRENT laryngeal nerve ,LYMPHADENECTOMY ,LARYNGOSCOPY ,INTRAMEDULLARY rods ,LOGISTIC regression analysis - Abstract
Background: Surgery is the curative therapy for patients with medullary thyroid carcinoma (MTC). In determining the extent of surgery, the risk of complications should be considered. The aim of this study was to assess procedure-specific outcomes and risk factors for complications after surgery for MTC. Methods: Patients who underwent thyroid surgery for MTC were identified in two European prospective quality databases. Hypoparathyroidism was defined by treatment with calcium/active vitamin D. Recurrent laryngeal nerve (RLN) palsy was diagnosed on laryngoscopy. Complications were considered at least transient if present at last follow-up. Risk factors for at-least transient hypoparathyroidism and RLN palsy were identified by logistic regression analysis. Results: A total of 650 patients underwent surgery in 69 centres at a median age of 56 years. Hypoparathyroidism, RLN palsy and bleeding requiring reoperation occurred in 170 (26·2 per cent), 62 (13·7 per cent) and 17 (2·6 per cent) respectively. Factors associated with hypoparathyroidism were central lymph node dissection (CLND) (odds ratio (OR) 2·20, 95 per cent c.i. 1·04 to 4·67), CLND plus unilateral lateral lymph node dissection (LLND) (OR 2·78, 1·20 to 6·43), CLND plus bilateral LLND (OR 2·83, 1·13 to 7·05) and four or more parathyroid glands observed (OR 4·18, 1·46 to 12·00). RLN palsy was associated with CLND plus LLND (OR 4·04, 1·12 to 14·58) and T4 tumours (OR 12·16, 4·46 to 33·18). After compartment-oriented lymph node dissection, N0 status was achieved in 248 of 537 patients (46·2 per cent). Conclusion: Complications after surgery for MTC are procedure-specific and may relate to the unavoidable consequences of radical dissection needed in some patients. [ABSTRACT FROM AUTHOR]
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- 2021
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14. European multicentre study on outcome of surgery for sporadic primary hyperparathyroidism.
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Bergenfelz, A., van Slycke, S., Makay, Ö., and Brunaud, L.
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TREATMENT effectiveness ,HYPERPARATHYROIDISM ,HYPERCALCEMIA ,PARATHYROID hormone - Abstract
Background: International multicentre outcome studies of surgery for primary hyperparathyroidism (pHPT), especially for rate of conversion to bilateral neck surgery and persistent hypercalcaemia, are scarce. Methods: EurocrineVR is a European database for endocrine surgery. Data are entered according to predefined data fields. Outcomes for patients who underwent first surgery for sporadic pHPT were analysed. Multivariable analysis was performed to identify risk factors for adverse outcome using Cox regression with constant follow-up. Results: A total of 5861 patients were registered between 2015 and 2018. Preoperative localization procedures were used in most patients, with moderate sensitivity. Intraoperative parathyroid hormone (ioPTH) measurement was used in three-quarters of patients. Bilateral surgery was performed in 1574 patients (26·9 per cent). Among 4683 patients (79·7 per cent) for whom unilateral or focused operation was planned, the procedure was converted to bilateral surgery in 396 (8·5 per cent). The risk of conversion decreased with the use of ioPTH monitoring (relative risk (RR) 0·77). Persistent hypercalcaemia was registered in 253 patients (4·3 per cent), and was less likely with the use of two (RR 0·55) or three (RR 0·44) localization procedures. In patients with a concordant localized single lesion, the rate of persistent hypercalcaemia was 2·5 per cent. The risk of persistent hypercalcaemia decreased with the use of ioPTH measurement, but was increased in patients with negative localization procedures and conversion to bilateral surgery. Conclusion: The use of ioPTH measurement decreased the risk of conversion and persistent hypercalcaemia. The use of two or three localization procedures decreased the risk of persistent hypercalcaemia; in patients with a concordant single lesion, the risk of persistent hypercalcaemia was low. [ABSTRACT FROM AUTHOR]
- Published
- 2021
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15. A case of thyroid hemiagenesis: An exceptional case [Tiroid hemiagenezi vakası: Sıra dışı bir vaka]
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Şarer Yürekli B.P., Özdemir Kutbay N., Erdoğan M., Makay Ö., İçöz G., Özgen G., and Ege Üniversitesi
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endocrine system ,endocrine system diseases ,Thyroid hemiagenesis ,Primary hyperparathyroidism ,Thyroid papillary microcarcinoma - Abstract
Thyroid hemiagenesis is a rare congenital anomaly in which one thyroid lobe fails to develop. We recently observed a case of thyroid hemiagenesis accompanied by parathyroid adenoma and papillary thyroid microcarcinoma in a 51-years-old woman. The patient’s serum calcium level was 10.9 mg/dL and that of intact parathyroid hormone was 218 pg/mL. Although she had a history of thyroid hemiagenesis, the patient was in a euthyroid state without thyroxine replacement. Thyroid ultrasonography detected no right lobe and four nodules of varying sizes in the left thyroid lobe. Tc-99m scintigraphy also demonstrated the absence of the right thyroid lobe. In addition, MIBI-parathyroid scintigraphy showed a parathyroid adenoma at the lower pole of the right cervical region. Based on the diagnosis, parathyroid adenoma excision and thyroidectomy were performed. Postoperative pathological diagnosis revealed parathyroid adenoma and papillary thyroid microcarcinoma in the form of a 0.4 cm sized tumor in the left thyroid lobe. The coexistence of thyroid hemiagenesis, primary hyperparathyroidism, and papillary thyroid microcarcinoma is truly exceptional and has never been reported in the literature before. © 2018 by Turkish Journal of Endocrinology and Metabolism Association.
- Published
- 2018
16. Risk of malignancy in the non-dominant thyroid nodule
- Author
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Erol, V., Makay, Ö., Ertan, Y., Icoz, G., Akyildiz, M., Erol, V., Makay, Ö., Ertan, Y., Icoz, G., and Akyildiz, M.
- Abstract
Purpose. The purpose of this study was to assess how frequently thyroid cancer is located only in the non-dominant nodules.Methods. A total of 111 thyroid patients, whose primary operation were carried out at our institute and were confirmed to have thyroid cancer, were evaluated. Tumor characteristics were recorded in a retrospective database. Variables analyzed included patients’ age and sex, nodule and tumor size, ultrasound features of nodules, fine needle aspiration biopsy result and the presence of multifocality of malignancy.Results. There were 91 females and 20 males. Mean age was 48±12 years (range 16-80 years). Mean dominant nodule size was 2.1±1.3 cm, while mean malignant tumor size was 1.4±1.4 cm (range 0.1-7 cm). Carcinomas were located in the dominant nodule in 61 (55%) cases, while it was present in the non-dominant nodules – without a neoplastic focus in the dominant nodule – in 50 (45%) cases. In 20 (18%) cases the carcinoma was found in both the dominant and the non-dominant nodule. Multifocality of the malignant tumor was present in 64/111 (58%) cases.Conclusions. Risk of malignancy in the non-dominant thyroid nodule should be kept in mind before carrying out a biopsy from the dominant nodule. Assessment of multinodular goiter should not be restricted to the dominant nodule., Цель. Целью нашего исследования было оценить, как часто рак щитовидной железы локализуется только в недоминантных узлах.Методы. Обследовано 111 пациентов, которых первично оперировали в нашем учреждении и у которых был подтвержден диагноз рака щитовидной железы. Характеристики опухолей анализировали по записям в ретроспективной базе данных. В анализ включали данные о возрасте и поле больных, размерах узлов и опухолей, ультразвуковые характеристики узлов, результаты тонкоигольной аспирационной биопсии, наличие мультифокальности злокачественного процесса.Результаты. Женщин было 91, мужчин 20. Средний возраст пациентов составил 48±12 лет (от 16 до 80 лет). Средний размер доминантного узла 2,1±1,3 см, средний размер злокачественной опухоли 1,4±1,4 см (от 0,1 до 9 см). Карциномы локализовались в доминантном узле в 61 (55%) случаев, а в недоминантных узлах (без неопластического фокуса в доминантном узле) – в 50 (45%) случаев. В 20 случаях (18%) карциномы были обнаружены и в доминантном, и в недоминантных узлах. Мультифокальность злокачественной опухоли присутствовала в 64 из 111 (58%) случаев. Выводы. Риск злокачественного процесса в недоминантном узле следует иметь в виду перед проведением биопсии доминантного узла. Объем обследования при многоузловом зобе не следует ограничивать только доминантным узлом., Мета. Метою нашого дослідження було оцінити, як часто рак щитоподібної залози локалізується лише у недомінантних вузлах.Методи. Було обстежено 111 пацієнтів, яких первинно оперували в нашому закладі і в яких було підтверджено діагноз раку щитоподібної залози. Характеристики пухлин аналізували за записами в ретроспективній базі даних. До аналізу включали дані про вік та стать хворих, розміри вузлів та пухлин, ультразвукові характеристики вузлів, результати тонкоголкової аспіраційної біопсії, наявність мультифокальності злоякісного процесу.Результати. Жінок було 91, чоловіків 20. Середній вік пацієнтів становив 48±12 років (від 16 до 80 років). Середній розмір домінантного вузла 2,1±1,3 см, середній розмір злоякісної пухлини 1,4±1,4 см (від 0,1 до 9 см). Карциноми локалізувалися в домінантному вузлі в 61 (55%) випадку, а в недомінантних вузлах (без неопластичного фокусу в домінантному вузлі) у 50 (45%) випадках. У 20 (18%) випадках карциноми було виявлено і в домінантному, і в недомінантних вузлах. Мультифокальність злоякісної пухлини була присутня у 64 зі 111 (58%) випадків. Висновки. Ризик злоякісного процесу в недомінантному вузлі слід враховувати перед проведенням біопсії домінантного вузла. Об'єм обстеження при багатовузловому зобі не слід обмежувати лише домінантним вузлом.
- Published
- 2017
17. Risk of malignancy in the non-dominant thyroid nodule
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Erol, V., primary, Makay, Ö., additional, Ertan, Y., additional, Icoz, G., additional, and Akyildiz, M., additional
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- 2017
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18. Incidentally found pharyngoesophageal diverticulum and parathyroid adenoma during thyroid surgery [Tiroid cerrahisi sirasinda insidental olarak saptanan paratiroid adenomu ve faringoözofageal divertikül]
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Isayev C., Makay Ö., Ertan Y., Sözbilen M., Içöz G., and Ege Üniversitesi
- Subjects
Pharyngoesophageal diversifolium ,endocrine system diseases ,Parathyroid adenoma ,Zenker diverticulum ,digestive system diseases ,Thyroid surgery - Abstract
Pharyngoeosophageal diverticula are the most common type of diverticula of the eosophagus and are often encountered in the elderly. Parathyroid adenomas are the most common cause of primary hyperparathyroidism. In this case report, we present the case of a 73 year old female patient who was admitted to the endocrinology outpatient clinic in our hospital, complaining of profuse weight gain. The patient was later operated on due to the discovery of a multinodular goitre. Incidentally, the patient appeared to have a synchronous parathyroid adenoma and Zenker diverticulum, both of which were diagnosed intraoperatively. A total thyroidectomy along with excision of the adenoma and stapler-assisted diverticulectomy was performed. The patient did well during her postoperative course. To our knowledge, this is the first report in the literature of a patient that was operated on due to a multinodular goitre with synchronous parathyroid adenoma and Zenker diverticulum.
- Published
- 2012
19. Robot-assisted laparoscopic bilateral adrenalectomy: A case report [Robot yardimli laparoskopik bilateral adrenalektomi: Olgu sunumu]
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Makay Ö., Uguz A., Şimşir I., Akyildiz M., and Ege Üniversitesi
- Subjects
Laparescopie adrenalectomy ,Ectopic ACTH syndrome ,Robotic surgery - Abstract
Recently, laparoscopic adrenalectomy has been carried out safely in most adrenal diseases and is becoming the gold standard of treatment. This minimal invasive technique is offering definitive treatment with reduced morbidity compared with open techniques. Ectopic ACTH syndrome is one of the diseases where a laparoscopic bilateral adrenalectomy can be carried out for treatment. Herein, we report an ectopic ACTH syndrome patient where a synchronous robot-assisted laparoscopic bilateral adrenalectomy was carried out. To our knowledge, the usage of the robotic approach for bilateral adrenalectomy has not been reported previously in the national literature.
- Published
- 2012
20. Do Clinical and Immunohistochemical Findings of Pure Mucinous Breast Carcinoma Differ from Mixed Mucinous Breast Carcinoma ?
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Erhan, Y., primary, Ciris, M., additional, Zekioglu, O., additional, Erhan, Y., additional, Kapkac, M., additional, Makay, Ö., additional, and Özdemir, N., additional
- Published
- 2009
- Full Text
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21. Laparoscopically assisted transhiatal resection for malignancies of the distal esophagus
- Author
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Broek, W., Makay, Ö., Berends, F., Yuan, J., Houdijk, A., Meijer, S., and Cuesta, M.
- Abstract
Resection of the esophagus remains the only curative therapy for esophageal cancer. Conventional resections are right-side thoracotomy in combination with laparotomy, gastric tube creation, and the transhiatal approach according to Orringer. This study evaluated laparoscopically assisted transhiatal esophagus resection, which offers perfect visualization of the esophagus during mediastinal dissection without the necessity of a thoracotomy. In this study, 25 laparoscopically assisted transhiatal esophagus resections were compared with a historical control group consisting of 20 open transhiatal esophagus resections. Nine laparoscopically assisted resections (36%) were converted to open procedures. The operating time was longer in the laparoscopically assisted group (300 vs 257 min; p< 0.05), but laparoscopically assisted esophagus resection was associated with less blood loss (600 vs 900 ml; p< 0.05) and shorter intensive care unit stay (1 vs 2 days; p< 0.05). There were no differences in morbidity, mortality, and hosptital stay. During a shorter follow-up time for the laparoscopic group (17 vs 54 months), 11 patients (44%) in the laparoscopically assisted group and 10 (50%) patients in the open group had recurrence of the disease. Laparoscopically assisted transhiatal esophagus resection is a safe procedure with important advantages, as compared with the open procedure, such as less blood loss and shorter intensive care unit stay. At this point, the oncologic consequences are not clear.
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- 2004
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22. New Paradigms for Neural Monitoring in Thyroid Surgery
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Sun, H., Wu, C. -W, Zhang, D., Makay, Ö, Zhao, Y., Carcofaro, P., Kim, H. Y., Dionigi, G., Pino, A., Ettore Caruso, Pontin, A., Pappalardo, V., and Ege Üniversitesi
- Abstract
EgeUn###, Intraoperative neuromonitoring (IONM) in thyroid gland surgery provides real-time feedback to the endocrine surgeon regarding the electrophysiological consequences of surgical manipulation of the laryngeal nerves. The goal of monitoring modalities is to detect surgical or physiological insults to the recurrent laryngeal nerve (RLN) while they are still reversible or, in cases where prevention is not an option, to minimize the damage done to these structures during thyroidectomy. In recent decades, monitoring of the RLN has become a fundamental part of endocrine surgery. IONM is a feasible procedure in both open and endoscopic, robotic thyroidectomy. Experts in IONM have organized a working group of general, endocrine, head and neck ENT surgeons and endocrinologists (International Neural Monitoring Study Group; INMSG) to develop standards for practicing this technique in endoscopic and robotic thyroidectomy. This paper presents recent clinical and research experience with intraoperative neural monitoring for thyroid gland surgery.
23. Missed intra-abdominal malignancies after laparoscopic cholecystectomy
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Icoz Gokhan, Makay Ozer, Dayangac Murat, Zeytunlu Murat, Kilic Murat, and Korkut Mustafa
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Medicine - Published
- 2005
24. Next generation sequence-based targeted somatic mutation analysis in thyroid nodules with pathologically diagnosed as indeterminate cytology.
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Kök G, Nart D, Ertan Y, Özbek SS, Mizrak A, Makay Ö, Erdoğan M, Özışık H, Akın H, Durmaz B, Özgür S, Özdemir M, and Karaca E
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- Humans, Female, Middle Aged, Male, Adult, DNA Mutational Analysis methods, Aged, Thyroid Neoplasms genetics, Thyroid Neoplasms pathology, Thyroid Neoplasms diagnosis, Biomarkers, Tumor genetics, Sensitivity and Specificity, Biopsy, Fine-Needle, Cytology, Thyroid Nodule genetics, Thyroid Nodule pathology, Thyroid Nodule diagnosis, High-Throughput Nucleotide Sequencing methods, Mutation
- Abstract
Purpose: The management of indeterminate thyroid nodules remains a topic of ongoing debate, particularly regarding the differentiation of malignancy. Somatic mutation analysis offers crucial insights into tumor characteristics. This study aimed to assist the clinical management of indeterminate nodules with somatic mutation analysis., Methods: Aspiration samples from 20 indeterminate thyroid nodules were included in the study. A next-generation sequencing panel containing 67 genes was used for molecular profiling. The results were compared with pathology data from surgical material, which is considered the gold standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated., Results: Variants in six genes (NRAS, BRAF, TP53, TERT, PTEN, PIK3CA) were detected in 10 out of 20 samples. We identified nine Tier 1 or 2 variants in 10 (67 %) out of 15 malignant nodules (NRAS, BRAF, TP53, TERT, PTEN, PIK3CA) and one Tier 2 (PIK3CA) variant in one out of five benign nodules. The study demonstrated an NPV of 40 %, a PPV of 90 %, a specificity of 80 %, and a sensitivity of 60 %., Conclusion: Based on the detected molecular markers, at least nine patients (45 %) could be managed correctly without needing a repeat FNAB attempt. This study underscores the clinical practicality of molecular tests in managing nodules with indeterminate cytology. Additionally, this study emphasizes the importance of considering the patient's age when determining the DNA- or RNA-based genetic testing method. Finally, we discussed the significance of the somatic mutation profile and its impact on the current pathological classification., Competing Interests: Declaration of Competing Interest The authors declare that the research was conducted without any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Elsevier GmbH. All rights reserved.)
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- 2024
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25. Development of an ontology for laparoscopic transabdominal adrenalectomy via a comprehensive modified Delphi survey and its validation on a multicentric pilot data set for surgical training and future video analysis with machine learning algorithms.
- Author
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Seeliger B, Di Lorenzo S, Alesina PF, Brunaud L, Chiapponi C, De Crea C, Donatini G, Iacobone M, Makay Ö, Mihai R, Mogl MT, Mutter D, Padoy N, Palazzo F, Vidal O, Pennestrí F, Marescaux J, Vix M, and Raffaelli M
- Subjects
- Humans, Pilot Projects, Video Recording, Adrenalectomy education, Adrenalectomy methods, Delphi Technique, Laparoscopy education, Laparoscopy methods, Machine Learning
- Published
- 2024
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- View/download PDF
26. Consensus statement of the European Society of Endocrine Surgeons (ESES) on advanced parathyroid cancer: definitions and management.
- Author
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Makay Ö, Agcaoglu O, Nominé-Criqui C, Van Den Heede K, Staubitz-Vernazza JI, Pennestrì F, Brunaud L, Raffaelli M, Iacobone M, Van Slycke S, Musholt TJ, and Villar-Del-Moral J
- Subjects
- Humans, Consensus, Parathyroidectomy, Europe, Parathyroid Neoplasms surgery, Parathyroid Neoplasms pathology
- Published
- 2024
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- View/download PDF
27. The INMSG Survey on the Loss of Signal Management on the First Side During Planned Bilateral Thyroid Surgery.
- Author
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Huang TY, Tseng HY, Frattini F, Russell MD, Ahmed AHA, Weber F, Wierzbicka P, Lu IC, Jung KY, Makay Ö, Chai YJ, Chiang FY, Schneider R, Barczyński M, Dralle H, Randolph GW, Wu CW, and Dionigi G
- Subjects
- Humans, Surveys and Questionnaires, Intraoperative Neurophysiological Monitoring, Thyroid Diseases surgery, Practice Patterns, Physicians' statistics & numerical data, Recurrent Laryngeal Nerve Injuries prevention & control, Recurrent Laryngeal Nerve Injuries etiology, Vocal Cord Paralysis etiology, Female, Male, Thyroidectomy methods
- Abstract
Background: The aim of this study is to describe the management and associated follow-up strategies adopted by thyroid surgeons with different surgical volumes when loss of signal (LOS) occurred on the first side of planned bilateral thyroid surgery, and to further define the consensus on intraoperative neuromonitoring (IONM) applications., Methods: The International Neural Monitoring Study Group (INMSG) web-based survey was sent to 950 thyroid surgeons worldwide. The survey included information on the participants, IONM team/equipment/procedure, intraoperative/postoperative management of LOS, and management of LOS on the first side of thyroidectomy for benign and malignant disease., Results: Out of 950, 318 (33.5%) respondents completed the survey. Subgroup analyses were performed based on thyroid surgery volume: <50 cases/year (n = 108, 34%); 50 to 100 cases/year (n = 69, 22%); and >100 cases/year (n = 141, 44.3%). High-volume surgeons were significantly ( P < .05) more likely to perform the standard procedures (L1-V1-R1-S1-S2-R2-V2-L2), to differentiate true/false LOS, and to verify the LOS lesion/injury type. When LOS occurs, most surgeons arrange otolaryngologists or speech consultation. When first-side LOS occurs, not all respondents decided to perform stage contralateral surgery, especially for malignant patients with severe disease (eg, extrathyroid invasion and poorly differentiated thyroid cancer)., Conclusions: Respondents felt that IONM was optimized when conducted under a collaborative team-based approach, and completed IONM standard procedures and management algorithm for LOS, especially those with high volume. In cases of first-site LOS, surgeons can determine the optimal management of disease-related, patient-related, and surgical factors. Surgeons need additional education on LOS management standards and guidelines to master their decision-making process involving the application of IONM., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
- Published
- 2024
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28. Video gaming improves robotic surgery simulator success: a multi-clinic study on robotic skills.
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Kılınçarslan Ö, Türk Y, Vargör A, Özdemir M, Hassoy H, and Makay Ö
- Subjects
- Child, Humans, Prospective Studies, Computer Simulation, Clinical Competence, Robotic Surgical Procedures methods, Mobile Applications, Video Games, Robotics, Laparoscopy education
- Abstract
We aimed to investigate the effects of video game habits, duration of experience, and training in different surgical clinics on the success of robotic surgery simulators. In this prospective, observational, comparative, and multi-clinical study, all participants played Temple Run and Piano Tiles 2
™ mobile games for 1 month, after answering a questionnaire including their sociodemographic characteristics, surgical experience, and past and current video game experience. At the end of the period, participants experienced four different robotic surgery simulator tasks (Camera Targeting 1, Energy Switching 1, Ring and Rail 2, Vertical Defect Suturing) in da Vinci® Skills Simulator™ . Additionally, sociodemographic data were statistically analyzed with mobile game scores and 13 different performance scores obtained from the simulator. All robotic surgery simulator skill applications were carried out at Ege University Hospital in Izmir. All surgical residents in the general surgery, urology, and pediatric surgery clinics were included in the study. Sixty of the sixty-four participants in total completed all the processes. Four participants were excluded from the study. When clinical performances were compared, it was seen that the general surgery clinic performed better than other clinics in two parameters (overall score, time to complete) of the 'Camera Targeting' task (p = 0.01 and p = 0.006). Participants with mobile phone games experience were successful in the 'Energy Switching' task with less misapplied energy time (p = 0.039). Participants with high scores in Piano Tiles 2™ were more successful in the 'Energy Switching' task and completed the 'Ring Rail' task with fewer movements (p < 0.05). Participants with more surgical and laparoscopic surgery experience scored higher in the 'Camera Targeting' and 'Energy Switching' tasks and completed the assignments with less movement. Again, these participants completed the 'Vertical Defect Suturing' task faster and the 'Ring Rail' task with less movement. In addition, participants with more laparoscopy experience scored higher in the 'Ring Rail' task (p < 0.05). In this study, we showed the effect of recent gaming experience on robotic surgery abilities along with previous video game experience. For surgeons and surgeon candidates in robotic surgery training, the importance of video game-based learning techniques will increase when combined with rapidly developing simulation technologies.ClinicalTrials.gov Identifier: NCT05510960., (© 2023. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)- Published
- 2023
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29. Posterior retroperitoneal versus transperitoneal laparoscopic adrenalectomy in adults: results from the EUROCRINE® surgical registry.
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Van Den Heede K, Vatansever S, Girgin T, Van Slycke S, and Makay Ö
- Subjects
- Humans, Adult, Male, Retrospective Studies, Adrenalectomy methods, Retroperitoneal Space pathology, Retroperitoneal Space surgery, Length of Stay, Laparoscopy methods, Adrenal Gland Neoplasms surgery, Adrenal Gland Neoplasms pathology
- Abstract
Purpose: This study aims to compare posterior retroperitoneal laparoscopic adrenalectomy (PRLA) and laparoscopic transperitoneal adrenalectomy (LTA) in adults using pan-European data as conflicting results have been published regarding length of hospital stay, institutional volume, and morbidity., Methods: This retrospective cohort study analyzed data from the surgical registry EUROCRINE®. All patients undergoing PRLA and TLA for adrenal tumours and registered between 2015 and 2020 were included and compared for morbidity, length of hospital stay, and conversion to open surgery., Results: A total of 2660 patients from 11 different countries and 69 different hospitals were analyzed and 1696 LTA were compared to 964 PRLA. Length of hospital stay was shorter after RPLA, with less patients (N = 434, 45.5%, vs N = 1094, 65.0%, p < 0.001) staying more than 2 days. In total, 96 patients (3.6%) developed a complication Clavien-Dindo grade 2 or higher. No statistical difference was found between both study groups. After propensity score matching, length of hospital stay was shorter after PRLA (> 2 days 45.2% vs 63.0%, p < 0.001). After multivariable logistic regression, factors associated with morbidity were age (OR 1.03), male sex (OR 1.52), and conversion to open surgery (OR 5.73)., Conclusion: This study presents the largest retrospective observational analysis comparing LTA and PRLA. Our findings confirm the shorter length of hospital stay after PRLA. Both techniques are safe leading to comparable morbidity and conversion rates., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)
- Published
- 2023
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30. Intraoperative freehand SPECT as an alternative imaging technique for use in radioguided parathyroidectomy.
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Alci E, Ozdemir M, Miftari A, Oral A, Gumus T, Icoz G, and Makay Ö
- Subjects
- Humans, Parathyroidectomy methods, Radiopharmaceuticals, Technetium Tc 99m Sestamibi, Tomography, Emission-Computed, Single-Photon methods, Adenoma diagnostic imaging, Adenoma surgery, Parathyroid Neoplasms diagnostic imaging, Parathyroid Neoplasms surgery
- Abstract
Freehand single photon emission computed tomography (fhSPECT) is a technique that is used to monitor body's radioactivity intraoperatively. Accordingly, in this study, the feasibility of using fhSPECT for intraoperative 3D mapping in radioguided parathyroidectomy has been assessed. Patients, who were diagnosed with primary hyperparathyroidism consecutively, were scanned intraoperatively using fhSPECT to locate parathyroid adenomas before surgical procedure. The fhSPECT images were acquired intraoperatively using a declipse
® SPECT device (SurgicEyeTM ). The fhSPECT protocol could not be completed due to the technical problems in one patient. Parathyroid adenoma was located in the first patient with no lateral deviation. Nevertheless, a deviation of 8 mm was detected in the depth of the parathyroid adenoma, which is the distance of parathyroid adenoma from the skin. A 20 mm lateral deviation and a 10 mm deviation in depth were detected in the second patient. In the third patient, as was the case in the first patient, parathyroid adenoma was located with no lateral deviation. However, there was a 15 mm deviation in the depth of the parathyroid adenoma. A 5 mm lateral deviation was detected in the fourth patient yet with no deviation in the depth of parathyroid adenoma. Finally, neither lateral nor vertical deviation was detected in fifth patient. Based on the findings of this study, it was concluded that the fhSPECT technology can be helpful to a certain degree in locating the parathyroid adenoma. However, further studies are needed to support the findings of this preliminary study., (© 2022. Italian Society of Surgery (SIC).)- Published
- 2022
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31. Robot-assisted versus conventional laparoscopic adrenalectomy: Results from the EUROCRINE Surgical Registry.
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Vatansever S, Nordenström E, Raffaelli M, Brunaud L, and Makay Ö
- Subjects
- Adrenalectomy adverse effects, Adrenalectomy methods, Case-Control Studies, Humans, Middle Aged, Registries, Retrospective Studies, Laparoscopy adverse effects, Laparoscopy methods, Robotic Surgical Procedures adverse effects, Robotic Surgical Procedures methods, Robotics
- Abstract
Background: Adrenalectomy is routinely performed via the minimally invasive approach. Safety of adrenalectomy using the robot-assisted technique has been widely demonstrated by several series, but the literature is scarce regarding the comparison of conventional laparoscopic versus robot-assisted approach. We decided to carry out a multicenter study to compare clinical and surgical outcomes between laparoscopic and robotic adrenalectomy., Methods: This is a retrospective case-control study, including data from centers affiliated to the Surgical Registry EUROCRINE. Patients undergoing laparoscopic surgery for adrenal tumors and registered between 2015 and 2018 were included. Robot-assisted versus laparoscopic adrenalectomy was compared. All comparisons were carried out in terms of complication rate, conversion rate and duration of stay., Results: A total of 1,005 patients from 46 clinics underwent robotic or conventional laparoscopic adrenalectomy. Median age was 55 (interquartile range: 45-65) years. Robotic adrenalectomy was performed in 189 (18.8%) patients. According to Clavien-Dindo classification, complication rate was lower in the robotic surgery group (1.6% vs 16.5%, P < .001). Laparoscopic surgery and active hormonal status were significantly correlated with complications, both in univariate and multivariate analysis. There was no significant difference between laparoscopic and robotic surgery groups, in terms of conversion rate (2.1% vs 0.5%, respectively, P = .147). Duration of stay was shorter in the robotic adrenalectomy group (82.1% vs 28.8%, P < .001)., Conclusion: Analysis of the EUROCRINE database supports that robotic adrenalectomy resulted in a lower complication rate and shorter duration of stay, compared with laparoscopic adrenalectomy. Granular data to support this is warranted., (Copyright © 2021. Published by Elsevier Inc.)
- Published
- 2022
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32. Transoral endoscopic parathyroidectomy vestibular approach (TOEPVA) for primary hyperparathyroidism: Turkey's experience.
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Makay Ö, Sabuncuoğlu MZ, Turan Mİ, Sormaz IC, Özdemir M, Aygün N, Buldur S, Türk Y, Sarıdemir D, Sezer A, Teksöz S, Uludağ M, Zihni İ, Tunca F, Hacıyanlı M, Arıcı C, and Giles Şenyürek Y
- Subjects
- Endoscopy, Female, Humans, Middle Aged, Parathyroidectomy methods, Thyroidectomy adverse effects, Turkey, Hyperparathyroidism, Primary surgery, Parathyroid Neoplasms surgery
- Abstract
Aim: Parathyroid surgery has witnessed a significant evolution with the introduction of more efficacious preoperative localization imaging techniques and the use of rapid intraoperative parathormone assays. Parathyroid surgery can now be performed with the minimum of invasion. Through the adaptation of the transoral endoscopic thyroidectomy vestibular approach (TOETVA), the technique has now been adopted for parathyroid surgery, known as the transoral endoscopic parathyroidectomy vestibular approach (TOEPVA). We present here the initial experiences of 11 centers carrying out TOEPVA surgery in Turkey., Materials and Methods: Participating in the study were 11 centers, all of which were tertiary care institutions carrying out endocrine surgery. A retrospective review was made of 35 primary hyperparathyroidism patients who underwent the TOEPVA procedure between July 2017 and January 2020., Results: Of the total 35 patients, 32 patients underwent the TOEPVA procedure successfully. All patients but one were female, and the mean age was 47.2 (20-73) years. According to localization studies, 18 of the lesions were lower left, 12 were lower right, 3 were upper right and 2 were upper left. The mean operative time was 116 (30-225) min, and three cases were converted to an open procedure. Simultaneous thyroidectomy was performed in seven cases. The average PTH level dropped to normal within 20 min. after the resection in all cases. The complication rate was 19% (ecchymosis, subcutaneous emphysema, nasal bleeding, surgical site infection and seroma). There were neither recurrent nerve palsies, nor mental nerve root or branch injuries. The average hospital stay was 1 day. No persistence was documented on follow up., Conclusion: TOEPVA is a "hidden scar" parathyroidectomy procedure that can be safely performed on parathyroid adenomas, in cases that have scar-related concerns. Having its own procedure-related complications, the procedure provides satisfactory objective results, particularly in centers experienced in endoscopic and endocrine surgery., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC part of Springer Nature.)
- Published
- 2022
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33. Association of biochemical and clinical parameters with parathyroid adenoma weight. Turkish-Bulgarian endocrine and breast surgery study group, hyperparathyroidism registry study.
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Özçınar B, Öner G, Makay Ö, Soyder A, Zafer Cantürk N, Ümit Uğurlu M, Atakan Sezer Y, Görgülü S, Girgin M, Özemir Aİ, Özbaş S, Ünal B, Pandev R, Erel S, Uğur Emre A, İlker Filiz A, Nuran Akçay M, Demircioğlu S, Güler SA, Öztürk E, Yıldız R, Çakmak GK, Kurt Y, Erbil Y, and Güllüoğlu BM
- Subjects
- Bulgaria, Calcium, Female, Humans, Parathyroidectomy, Prospective Studies, Registries, Retrospective Studies, Turkey epidemiology, Breast Neoplasms, Hyperparathyroidism, Primary diagnosis, Hyperparathyroidism, Primary epidemiology, Hyperparathyroidism, Primary surgery, Parathyroid Neoplasms diagnosis, Parathyroid Neoplasms epidemiology, Parathyroid Neoplasms surgery
- Abstract
Background: Primary hyperparathyroidism (pHPT) caused by a single benign parathyroid adenoma is a common endocrine disorder that is affected by regional differences. Living in different geographical regions reveals differences in the laboratory results and pathological findings, but studies on this subject are not sufficient. The article focuses on biochemical and pathological effects of geographical differences in parathyroid adenoma. In addition, the present study seeks to elaborate on treatment methods and effectiveness of screening in geographical area of Bulgaria and Turkey., Method: In this prospective study, 159 patients were included from 16 centres. Demographic characteristics, symptoms, biochemical markers and pathologic characteristics were analysed and compared between 8 different regions., Results: Patients from Turkish Black Sea had the highest median serum calcium (Ca) level, whereas patients from Eastern Turkey had the lowest median serum phosphorus (P) level. On the other hand, there was no significant difference between Ca, parathormone (PTH) and P levels according to regions. Patients from Eastern Turkey had the highest adenoma weight, while patients from Bulgaria had the lowest adenoma weight. The weight of adenoma showed statistically significant differences between regions (p < 0.001). There was a correlation between adenoma weight and serum PTH level (p = 0.05) and Ca level (p = 0.035)., Conclusion: This study has provided a deeper insight into the effect of the regional differences upon clinicopathological changing and biochemical values of pHTP patients with adenoma. Awareness of regional differences will assist in biochemical screening and treatment of this patient group., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interests. Availability of data and material (data transparency):, (Copyright © 2021. Published by Elsevier Taiwan LLC.)
- Published
- 2022
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34. The use of thyroid cartilage needle electrodes in intraoperative neuromonitoring during thyroidectomy: Case-control study.
- Author
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Türk Y, Kıvratma G, Özdemir M, İçöz G, and Makay Ö
- Subjects
- Case-Control Studies, Electrodes, Electromyography, Humans, Recurrent Laryngeal Nerve, Retrospective Studies, Thyroid Cartilage, Thyroidectomy
- Abstract
Background: The most commonly used recording-side method in intraoperative neural monitoring (IONM) detects the stimulus with the endotracheal tube surface (ETS) electrodes placed in the endotracheal tube during thyroidectomy. The thyroid cartilage needle (TCN) electrode method is an alternative recording-side system in IONM. This study compared two recording-side techniques in IONM., Methods: Data were retrospectively analyzed from 885 patients who underwent thyroidectomy between January 2012 and December 2020, with 110 ETS and 775 TCN electrodes. Patients' demographics, diagnosis, surgery type, and amplitudes of all stimulation steps were compared. Costs per patient were calculated., Results: No significant differences were found in the demographic data between the two groups. All amplitudes were higher in the IONM system where TCN electrodes were used than that with ETS electrodes (all stimulation steps p < 0.001, except left-V2 p = 0.007). Further, TCN electrodes were 20 times cheaper than the ETS electrodes., Conclusion: TCN electrodes are an inexpensive and efficient alternative to ETS electrodes in IONM., (© 2021 Wiley Periodicals LLC.)
- Published
- 2021
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35. Adrenalectomy for incidental and symptomatic phaeochromocytoma: retrospective multicentre study based on the Eurocrine® database.
- Author
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Hallin Thompson L, Makay Ö, Brunaud L, Raffaelli M, and Bergenfelz A
- Subjects
- Adrenal Gland Neoplasms complications, Adrenal Gland Neoplasms drug therapy, Adrenal Gland Neoplasms pathology, Adrenal Insufficiency etiology, Adrenalectomy adverse effects, Adrenergic alpha-Antagonists therapeutic use, Aged, Conversion to Open Surgery, Female, Humans, Hypertension etiology, Length of Stay, Male, Middle Aged, Pheochromocytoma complications, Pheochromocytoma drug therapy, Pheochromocytoma pathology, Postoperative Complications, Retrospective Studies, Tumor Burden, Adrenal Gland Neoplasms surgery, Pheochromocytoma surgery
- Abstract
Background: Phaeochromocytoma is sometimes not diagnosed before surgery and may present as an adrenal incidentaloma. The aim of this study was to investigate differences in clinical presentation and perioperative outcome in patients with subclinical and symptomatic phaeochromocytoma, and in patients operated with and without preoperative α-blockade., Methods: This was a retrospective observational study of patients with a histopathological diagnosis of phaeochromocytoma registered in Eurocrine®, the European registry for endocrine tumours, between 1 January 2015 and 31 March 2020. Patient characteristics, clinical presentation, tumour detection, and perioperative variables were analysed., Results: Some 551 patients were included. Of these, 486 patients (88.2 per cent) had a preoperative diagnosis of phaeochromocytoma. Tumours were detected as incidentalomas in 239 patients (43.4 per cent) and 265 (48.1 per cent) had a preoperative diagnosis of hypertension. Preoperative α-blockade was more frequently used in patients with a known phaeochromocytoma (350, 90.9 per cent) than in patients with other indications for adrenalectomy (16, 31 per cent). Complications did not differ between patients who had surgery because of catecholamine excess compared with those who had other indications for surgery (19 (3.9 per cent) versus 2 (3 per cent); P = 0.785), nor did the conversion rate from minimally invasive to open surgery differ between the groups. There were no obvious differences in complications, according to the Clavien-Dindo classification, based on preoperative α-blockade or not., Conclusion: Subclinical phaeochromocytoma detected incidentally is common. A significant proportion of patients with phaeochromocytoma did not have α-blockade before surgery, without an apparent effect on complications., (© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd.)
- Published
- 2021
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36. Influence of rocuronium on achieving optimal vagal stimulation during intraoperative nerve monitoring in thyroid surgery.
- Author
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Alçi E, Özdemir M, Mi Ftari A, Vatansever S, Sergi N D, Nuri Deni Z M, Ulukaya S, İçöz G, Akyildiz M, and Makay Ö
- Subjects
- Humans, Monitoring, Intraoperative, Rocuronium, Recurrent Laryngeal Nerve surgery, Thyroid Gland, Thyroidectomy
- Abstract
Background: In the present study we determine the feasibility of intraoperative neuromonitoring following the administration of a nondepolarizing neuromuscular blocking agent during thyroid operations, as well as the influence of rocuronium on the achievement of optimal vagal stimulation during intraoperative neuromonitoring in thyroid surgery. We further investigate whether accelerometry is a reliable approach to obtaining an ipsilateral vagus signal prior to recurrent laryngeal nerve dissection., Methods: Included in the study were 61 thyroidectomized patients whose demographic data, indications, type of surgery, vagus, and recurrent nerve values before and after resection were obtained. We created five groups of patients based on the twitch values recorded during ipsilateral vagus stimulation prior to the recurrent laryngeal nerve dissection: (1) <10%, (2) 11-25%, (3) 26-50%, (4) 51-75% and (5) >75%., Results: The average electromyography amplitudes of the vagus nerve prior to the determination of the recurrent laryngeal nerve for each group were 552 μV, 463 μV, 543 μV, 513 μV and 551 μV, respectively. No difference between the groups was observed in this regard (p > 0.05)., Conclusion: It can be expected that as soon as the effects of neuromuscular blockers on the peripheral muscles begin to abate, it will be possible to obtain the ipsilateral vagus signal prior to recurrent laryngeal nerve dissection at the desired levels. It can be concluded from this study that accelerometry using the pollicis muscle is an unreliable tool for the interpretation of the proper electromyography signals of the vagus nerve prior to the determination of the recurrent laryngeal nerve., Competing Interests: Declaration of competing interest The authors report no potential financial and non-financial conflicts of interest., (Copyright © 2020. Published by Elsevier Taiwan LLC.)
- Published
- 2021
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37. Edward D. Churchill (1895-1972): An Innovative Surgeon, His Work, and His Contribution to Parathyroid Surgery.
- Author
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Spartalis ED, Kouriannidi E, Athanasiadis DI, Chrysikos DT, Makay Ö, and Troupis T
- Subjects
- History, 20th Century, Humans, Parathyroid Glands surgery, United States, General Surgery, Surgeons
- Abstract
Edward Delos Churchill, one of the most notorious American surgeons of the 20th century, influenced countless surgeons and set medical practices that were used for decades. His scope of interests included surgery of the lungs, heart, thyroid, parathyroid glands, and military surgery among others. Churchill was one of the first to expand the field of the newly found parathyroid bodies by performing several experimental excisions of the glands and publishing numerous guidelines based on his innovative work. Additionally, he aspired to address many of the literature gaps that led him to conclusions that would benefit both the surgeons and patients throughout the country. Most importantly, his deep interest in endocrinology and his aggregate approach of medicine led him to discoveries that paved the way to the modern endocrine surgery practices.
- Published
- 2021
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38. Transoral endoscopic thyroidectomy using the vestibular approach with an endoscopic retractor in thyroid cancer: experience with the first 132 patients.
- Author
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Kim SY, Kim SM, Makay Ö, Chang H, Kim BW, Lee YS, Park CS, and Chang HS
- Subjects
- Adult, Female, Humans, Male, Retrospective Studies, Endoscopy methods, Thyroid Neoplasms diagnostic imaging, Thyroid Neoplasms surgery, Thyroidectomy methods
- Abstract
Background: Transoral endoscopic thyroidectomy using the vestibular approach (TOETVA) is a novel technique for thyroid cancer surgery. We aimed to review our initial experiences with TOETVA for the management of thyroid carcinoma, using retrospective analyses of a larger single-center case series., Methods: From September 2016 to April 2018, 132 patients with thyroid cancer underwent TOETVA. A three-port technique through the oral vestibule was used to perform endoscopic thyroidectomy with ipsilateral central compartment dissection using conventional laparoscopic instruments, and an endoscopic retractor that we developed., Results: All patients had papillary thyroid carcinoma. Less-than total or total thyroidectomy with ipsilateral central compartment node dissection was performed (124 vs. 8). The mean operation time was 87.6 min (range 56-213 min). The average number of lymph nodes resected was 2.6 (range 1-12). Six patients experienced transient hoarseness, which was resolved within 3 months. Most of the patients were discharged within 3 days after surgery., Conclusions: In this large series from a single center, we found that TOETVA with the endoscopic retractor can be performed safely and radically in selected patients with thyroid cancer.
- Published
- 2020
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39. Introduction to series on robotic adrenalectomy.
- Author
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Makay Ö
- Abstract
Competing Interests: Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/gs-2019-ra-09). The series “Robotic Adrenalectomy” was commissioned by the editorial office without any funding or sponsorship. OZ served as the unpaid Guest Editor for the series and serves as an unpaid editorial board member of Gland Surgery from May 2019 to Apr 2021.
- Published
- 2020
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40. Intraoperative neuromonitoring of the RLNs during TOETVA procedures.
- Author
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Erol V, Dionigi G, Barczyński M, Zhang D, and Makay Ö
- Abstract
Transoral endoscopic thyroidectomy by vestibular approach (TOETVA) is now being performed in increasing frequency and getting more and more attention. TOETVA is carried out through three incisions in the oral vestibular area. Thyroidectomy is performed endoscopically using conventional laparoscopic instruments, an energy based device and neuromonitoring instruments. Intraoperative neuromonitoring is one of the tools of utmost importance, used for navigation and confirmation of the functional integrity of the recurrent nerve during TOETVA. The aim of this study is to give information about the standards and technique of intraoperative neuromonitoring of the recurrent laryngeal nerves during TOETVA procedures. TOETVA is a safe technique with no visible scarring and hence resulting in an excellent cosmetic effect. We believe that neuromonitoring of the recurrent laryngeal nerves also minimizes the risk of nerve damage and is an essential safety component in this technique., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare., (2020 Gland Surgery. All rights reserved.)
- Published
- 2020
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41. Patient and Surgeon Candidacy for Transoral Endoscopic Thyroid Surgery.
- Author
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Fama F, Zhang D, Pontin A, Makay Ö, Tufano RP, Kim HY, Sun H, and Dionigi G
- Abstract
The transoral thyroidectomy (TT) is a feasible novel surgical procedure that does not need visible incisions, a truly cutaneous scar-free surgery. Inclusion criteria are (a) patients who have a ultrasonographically (US) estimated thyroid diameter not larger than 10 cm, (b) US estimated gland volume ≤45 mL, (c) nodule size ≤50 mm, (d) a benign tumor, such as a thyroid cyst, single-nodular goiter, or multinodular goiter, (e) follicular neoplasm, and (f) papillary microcarcinoma without evidence of metastasis. The procedure is carried out through a three-port technique placed at the oral vestibule; one 10-mm port for a 30° endoscope and two additional 5-mm ports for dissecting and coagulating instruments. CO
2 insufflation pressure is set at 6 mmHg. An anterior cervical subplatysmal space is created from the oral vestibule down to the sternal notch, laterally to the sternocleidomastoid muscle medial edges. TT is done fully endoscopically using conventional endoscopic instruments., Competing Interests: Conflict of Interest: The authors have no conflicts of interest to declare.- Published
- 2019
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42. New Paradigms for Neural Monitoring in Thyroid Surgery.
- Author
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Sun H, Wu CW, Zhang D, Makay Ö, Zhao Y, Carcofaro P, Kim HY, Dionigi G, Pino A, Caruso E, Pontin A, and Pappalardo V
- Subjects
- Humans, Recurrent Laryngeal Nerve surgery, Recurrent Laryngeal Nerve Injuries etiology, Thyroidectomy methods, Monitoring, Intraoperative methods, Recurrent Laryngeal Nerve Injuries prevention & control, Thyroid Gland surgery, Thyroidectomy adverse effects
- Abstract
Intraoperative neuromonitoring (IONM) in thyroid gland surgery provides real-time feedback to the endocrine surgeon regarding the electrophysiological consequences of surgical manipulation of the laryngeal nerves. The goal of monitoring modalities is to detect surgical or physiological insults to the recurrent laryngeal nerve (RLN) while they are still reversible or, in cases where prevention is not an option, to minimize the damage done to these structures during thyroidectomy. In recent decades, monitoring of the RLN has become a fundamental part of endocrine surgery. IONM is a feasible procedure in both open and endoscopic, robotic thyroidectomy. Experts in IONM have organized a working group of general, endocrine, head and neck ENT surgeons and endocrinologists (International Neural Monitoring Study Group; INMSG) to develop standards for practicing this technique in endoscopic and robotic thyroidectomy. This paper presents recent clinical and research experience with intraoperative neural monitoring for thyroid gland surgery.
- Published
- 2019
43. Prediction of Postoperative Vocal Fold Function After Intraoperative Recovery of Loss of Signal.
- Author
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Schneider R, Randolph G, Dionigi G, Barczynski M, Chiang FY, Wu CW, Musholt T, Uludag M, Makay Ö, Sezer A, Teksöz S, Weber T, Sekulla C, Lorenz K, Özdemir M, Machens A, and Dralle H
- Subjects
- Adult, Aged, Decision Support Techniques, Female, Humans, Male, Middle Aged, Postoperative Complications, Postoperative Period, Prospective Studies, ROC Curve, Recurrent Laryngeal Nerve Injuries etiology, Treatment Outcome, Vocal Cord Paralysis etiology, Vocal Cords physiopathology, Vocal Cords surgery, Electromyography statistics & numerical data, Intraoperative Neurophysiological Monitoring statistics & numerical data, Recurrent Laryngeal Nerve Injuries epidemiology, Thyroidectomy adverse effects, Vocal Cord Paralysis epidemiology
- Abstract
Objectives/hypothesis: This multicenter study aimed to 1) evaluate early postoperative vocal fold function in relation to intraoperative amplitude recovery, and 2) determine optimal absolute and relative thresholds of intraoperative amplitude recovery heralding normal early postoperative vocal fold function, both after segmental type 1 and after global type 2 loss of signal (LOS)., Study Design: Prospective outcome study., Methods: This study, encompassing nine surgical centers from four countries, correlated intraoperative amplitude recovery with early postoperative vocal fold function using receiver operating characteristic analysis., Results: Included in this study were 68 patients, 48 women and 20 men, who sustained transient recurrent laryngeal nerve injury during thyroid surgery under continuous intraoperative nerve monitoring. Early transient vocal fold palsy was seen in 18 (64%) of 28 patients with ipsilateral segmental LOS type 1, and in 10 (25%) of 40 patients with ipsilateral global LOS type 2. On receiver operating characteristic analysis, relative amplitude thresholds were superior to absolute amplitude thresholds in predicting vocal fold function after LOS type 2 (area under the curve [AUC]: 0.83 vs. 0.65; P = .01 vs. P = .15; Youden index 44% and 253 µV) and LOS type 1 (AUC: 0.96 vs. 0.97; P < .001 each; Youden index 49% and 455 µV). Amplitude recovery ≥50% of baseline after LOS always indicated intact vocal fold function., Conclusions: When the nerve amplitude recovers ≥50% of baseline after segmental LOS type 1 or global LOS type 2, it is appropriate to extend completion thyroidectomy to the other side during the same session., Level of Evidence: 2b Laryngoscope, 129:525-531, 2019., (© 2018 The American Laryngological, Rhinological and Otological Society, Inc.)
- Published
- 2019
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44. Preventive medicine of von Hippel-Lindau disease-associated pancreatic neuroendocrine tumors.
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Krauss T, Ferrara AM, Links TP, Wellner U, Bancos I, Kvachenyuk A, Villar Gómez de Las Heras K, Yukina MY, Petrov R, Bullivant G, von Duecker L, Jadhav S, Ploeckinger U, Welin S, Schalin-Jäntti C, Gimm O, Pfeifer M, Ngeow J, Hasse-Lazar K, Sansó G, Qi X, Ugurlu MU, Diaz RE, Wohllk N, Peczkowska M, Aberle J, Lourenço DM Jr, Pereira MAA, Fragoso MCBV, Hoff AO, Almeida MQ, Violante AHD, Quidute ARP, Zhang Z, Recasens M, Díaz LR, Kunavisarut T, Wannachalee T, Sirinvaravong S, Jonasch E, Grozinsky-Glasberg S, Fraenkel M, Beltsevich D, Egorov VI, Bausch D, Schott M, Tiling N, Pennelli G, Zschiedrich S, Därr R, Ruf J, Denecke T, Link KH, Zovato S, von Dobschuetz E, Yaremchuk S, Amthauer H, Makay Ö, Patocs A, Walz MK, Huber TB, Seufert J, Hellman P, Kim RH, Kuchinskaya E, Schiavi F, Malinoc A, Reisch N, Jarzab B, Barontini M, Januszewicz A, Shah N, Young WF Jr, Opocher G, Eng C, Neumann HPH, and Bausch B
- Subjects
- Adolescent, Adult, Aged, Child, Humans, Middle Aged, Mutation, Neuroendocrine Tumors etiology, Neuroendocrine Tumors pathology, Neuroendocrine Tumors therapy, Pancreatic Neoplasms etiology, Pancreatic Neoplasms pathology, Pancreatic Neoplasms therapy, Registries, Tumor Burden, Young Adult, von Hippel-Lindau Disease pathology, von Hippel-Lindau Disease therapy, Neuroendocrine Tumors prevention & control, Pancreatic Neoplasms prevention & control, von Hippel-Lindau Disease complications
- Abstract
Pancreatic neuroendocrine tumors (PanNETs) are rare in von Hippel-Lindau disease (VHL) but cause serious morbidity and mortality. Management guidelines for VHL-PanNETs continue to be based on limited evidence, and survival data to guide surgical management are lacking. We established the European-American-Asian-VHL-PanNET-Registry to assess data for risks for metastases, survival and long-term outcomes to provide best management recommendations. Of 2330 VHL patients, 273 had a total of 484 PanNETs. Median age at diagnosis of PanNET was 35 years (range 10-75). Fifty-five (20%) patients had metastatic PanNETs. Metastatic PanNETs were significantly larger (median size 5 vs 2 cm; P < 0.001) and tumor volume doubling time (TVDT) was faster (22 vs 126 months; P = 0.001). All metastatic tumors were ≥2.8 cm. Codons 161 and 167 were hotspots for VHL germline mutations with enhanced risk for metastatic PanNETs. Multivariate prediction modeling disclosed maximum tumor diameter and TVDT as significant predictors for metastatic disease (positive and negative predictive values of 51% and 100% for diameter cut-off ≥2.8 cm, 44% and 91% for TVDT cut-off of ≤24 months). In 117 of 273 patients, PanNETs >1.5 cm in diameter were operated. Ten-year survival was significantly longer in operated vs non-operated patients, in particular for PanNETs <2.8 cm vs ≥2.8 cm (94% vs 85% by 10 years; P = 0.020; 80% vs 50% at 10 years; P = 0.030). This study demonstrates that patients with PanNET approaching the cut-off diameter of 2.8 cm should be operated. Mutations in exon 3, especially of codons 161/167 are at enhanced risk for metastatic PanNETs. Survival is significantly longer in operated non-metastatic VHL-PanNETs., (© 2018 Society for Endocrinology.)
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- 2018
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45. 65 YEARS OF THE DOUBLE HELIX: Genetics informs precision practice in the diagnosis and management of pheochromocytoma.
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Neumann HP, Young WF Jr, Krauss T, Bayley JP, Schiavi F, Opocher G, Boedeker CC, Tirosh A, Castinetti F, Ruf J, Beltsevich D, Walz M, Groeben HT, von Dobschuetz E, Gimm O, Wohllk N, Pfeifer M, Lourenço DM Jr, Peczkowska M, Patocs A, Ngeow J, Makay Ö, Shah NS, Tischler A, Leijon H, Pennelli G, Villar Gómez de Las Heras K, Links TP, Bausch B, and Eng C
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- Endocrine Gland Neoplasms diagnosis, Endocrine Gland Neoplasms therapy, Genetic Predisposition to Disease, Germ-Line Mutation, Humans, Neurofibromatosis 1 genetics, Paraganglioma genetics, Pheochromocytoma diagnosis, Pheochromocytoma therapy, Precision Medicine, Syndrome, von Hippel-Lindau Disease genetics, Endocrine Gland Neoplasms genetics, Pheochromocytoma genetics
- Abstract
Although the authors of the present review have contributed to genetic discoveries in the field of pheochromocytoma research, we can legitimately ask whether these advances have led to improvements in the diagnosis and management of patients with pheochromocytoma. The answer to this question is an emphatic Yes ! In the field of molecular genetics, the well-established axiom that familial (genetic) pheochromocytoma represents 10% of all cases has been overturned, with >35% of cases now attributable to germline disease-causing mutations. Furthermore, genetic pheochromocytoma can now be grouped into five different clinical presentation types in the context of the ten known susceptibility genes for pheochromocytoma-associated syndromes. We now have the tools to diagnose patients with genetic pheochromocytoma, identify germline mutation carriers and to offer gene-informed medical management including enhanced surveillance and prevention. Clinically, we now treat an entire family of tumors of the paraganglia, with the exact phenotype varying by specific gene. In terms of detection and classification, simultaneous advances in biochemical detection and imaging localization have taken place, and the histopathology of the paraganglioma tumor family has been revised by immunohistochemical-genetic classification by gene-specific antibody immunohistochemistry. Treatment options have also been substantially enriched by the application of minimally invasive and adrenal-sparing surgery. Finally and most importantly, it is now widely recognized that patients with genetic pheochromocytoma/paraganglioma syndromes should be treated in specialized centers dedicated to the diagnosis, treatment and surveillance of this rare neoplasm., (© 2018 Society for Endocrinology.)
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- 2018
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46. Surgical approaches for papillary microcarcinomas: Turkey's perspective.
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Makay Ö, Özdemir M, Şenyürek YG, Tunca F, Düren M, Uludağ M, Hacıyanlı M, Içöz G, Işgör A, Özbaş S, Özcan Z, and Tezelman S
- Abstract
Objectives: The incidence of papillary microcarcinomas, which are defined as thyroid cancers of <10mm in size, has been increasing in the last decade. Herein, we present internet-based questionnaire results performed by the Turkish Association of Endocrine Surgery with the aim to evaluate the perspective of the management of papillary microcarcinomas in Turkey., Material and Methods: The user-friendly questionnaire consisted of 13 questions in total. These questions mainly addressed the surgical management of nodules and cancer of <1 cm in size. Patient management before, during, and after surgical intervention was also included; additionally, the "active surveillance approach" was questioned., Results: There were 420 responders in total who were of multidisciplinary origin (endocrinologists, surgeons, nuclear medicine specialists, pathologists, and oncologists). Total thyroidectomy was the predominant treatment approach (65%) for the classical type of microcarcinoma limited in one lobe, whereas in cases of microcarcinomas incidentally diagnosed during hemithyroidectomy, complementary surgery approach was advised by 40% of the responders. The responders found capsule invasion (86%) and patient based management (94%) of high importance. The percentage of the responders who recommended radioactive iodine ablation in incidental cancers having no aggressive criteria was 51%. The survey participants that were against routine central dissection in these cases accounted for 73% of the responders. The recommendation of active surveillance (follow-up without any interventional therapy) was limited with 9% responders., Conclusion: The results of the questionnaire demonstrated that there have been various choices in Turkey for the surgical treatment of the papillary microcarcinomas., Competing Interests: Conflict of Interest: The authors has no conflicts of interest to declare.
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- 2018
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47. Robot-assisted endoscopic mediastinal parathyroidectomy.
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Makay Ö, Durmaz SF, Özdemir M, Şimşir I, İçöz G, and Akyıldız M
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Ectopic parathyroid glands can be located at any anatomical location from the base of the tongue to the mediastinum. One-third of these glands migrate deep into the mediastinum, which are not accessible with a low cervical incision. In this article, we described the robotic approach to an ectopic mediastinal parathyroid gland. This management method of mediastinal adenomas has significant advantages when compared to conventional surgery.
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- 2018
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48. Less than total thyroidectomy for goiter: when and how?
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Makay Ö
- Abstract
Benign goiter is the most common endocrine disease that requires surgery, especially in endemic areas suffering from iodine-deficiency. Recent European and American guidelines recommended total thyroidectomy for the surgical treatment of multinodular goiter. Total thyroidectomy has now become the technique of choice and is widely considered the most reliable approach in preventing recurrence. Nevertheless, total thyroidectomy carries a substantial risk in terms of hypoparathyroidism and the morbidity associated with injury to the inferior laryngeal nerve. In this context, partial/less-than-total thyroidectomy is being considered once again as a viable alternative. This review will discuss the extent of thyroid surgery for benign disease and the impact of the surgical protocol on the patient- and surgeon-specific risk factors for specific complication rates., Competing Interests: Conflicts of Interest: The author has no conflicts of interest to declare
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- 2017
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49. Clinical Characterization of the Pheochromocytoma and Paraganglioma Susceptibility Genes SDHA, TMEM127, MAX, and SDHAF2 for Gene-Informed Prevention.
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Bausch B, Schiavi F, Ni Y, Welander J, Patocs A, Ngeow J, Wellner U, Malinoc A, Taschin E, Barbon G, Lanza V, Söderkvist P, Stenman A, Larsson C, Svahn F, Chen JL, Marquard J, Fraenkel M, Walter MA, Peczkowska M, Prejbisz A, Jarzab B, Hasse-Lazar K, Petersenn S, Moeller LC, Meyer A, Reisch N, Trupka A, Brase C, Galiano M, Preuss SF, Kwok P, Lendvai N, Berisha G, Makay Ö, Boedeker CC, Weryha G, Racz K, Januszewicz A, Walz MK, Gimm O, Opocher G, Eng C, and Neumann HPH
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- Adolescent, Adrenal Gland Neoplasms diagnostic imaging, Adult, Age of Onset, Aged, Aged, 80 and over, Basic Helix-Loop-Helix Leucine Zipper Transcription Factors genetics, Child, DNA Mutational Analysis, Early Detection of Cancer methods, Electron Transport Complex II genetics, Female, Genetic Testing, Genotype, Germ-Line Mutation, Head and Neck Neoplasms diagnostic imaging, Humans, Longitudinal Studies, Magnetic Resonance Imaging, Male, Membrane Proteins genetics, Middle Aged, Mitochondrial Proteins genetics, Paraganglioma, Extra-Adrenal diagnostic imaging, Penetrance, Pheochromocytoma diagnostic imaging, Prospective Studies, Registries, Young Adult, Adrenal Gland Neoplasms genetics, Genetic Predisposition to Disease, Head and Neck Neoplasms genetics, Neoplasms, Second Primary genetics, Paraganglioma, Extra-Adrenal genetics, Pheochromocytoma genetics
- Abstract
Importance: Effective cancer prevention is based on accurate molecular diagnosis and results of genetic family screening, genotype-informed risk assessment, and tailored strategies for early diagnosis. The expanding etiology for hereditary pheochromocytomas and paragangliomas has recently included SDHA, TMEM127, MAX, and SDHAF2 as susceptibility genes. Clinical management guidelines for patients with germline mutations in these 4 newly included genes are lacking., Objective: To study the clinical spectra and age-related penetrance of individuals with mutations in the SDHA, TMEM127, MAX, and SDHAF2 genes., Design, Setting, and Patients: This study analyzed the prospective, longitudinally followed up European-American-Asian Pheochromocytoma-Paraganglioma Registry for prevalence of SDHA, TMEM127, MAX, and SDHAF2 germline mutation carriers from 1993 to 2016. Genetic predictive testing and clinical investigation by imaging from neck to pelvis was offered to mutation-positive registrants and their relatives to clinically characterize the pheochromocytoma/paraganglioma diseases associated with mutations of the 4 new genes., Main Outcomes and Measures: Prevalence and spectra of germline mutations in the SDHA, TMEM127, MAX, and SDHAF2 genes were assessed. The clinical features of SDHA, TMEM127, MAX, and SDHAF2 disease were characterized., Results: Of 972 unrelated registrants without mutations in the classic pheochromocytoma- and paraganglioma-associated genes (632 female [65.0%] and 340 male [35.0%]; age range, 8-80; mean [SD] age, 41.0 [13.3] years), 58 (6.0%) carried germline mutations of interest, including 29 SDHA, 20 TMEM127, 8 MAX, and 1 SDHAF2. Fifty-three of 58 patients (91%) had familial, multiple, extra-adrenal, and/or malignant tumors and/or were younger than 40 years. Newly uncovered are 7 of 63 (11%) malignant pheochromocytomas and paragangliomas in SDHA and TMEM127 disease. SDHA disease occurred as early as 8 years of age. Extra-adrenal tumors occurred in 28 mutation carriers (48%) and in 23 of 29 SDHA mutation carriers (79%), particularly with head and neck paraganglioma. MAX disease occurred almost exclusively in the adrenal glands with frequently bilateral tumors. Penetrance in the largest subset, SDHA carriers, was 39% at 40 years of age and is statistically different in index patients (45%) vs mutation-carrying relatives (13%; P < .001)., Conclusions and Relevance: The SDHA, TMEM127, MAX, and SDHAF2 genes may contribute to hereditary pheochromocytoma and paraganglioma. Genetic testing is recommended in patients at clinically high risk if the classic genes are mutation negative. Gene-specific prevention and/or early detection requires regular, systematic whole-body investigation.
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- 2017
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50. Regional Clinical and Biochemical Differences among Patients with Primary Hyperparathyroidism.
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Makay Ö, Özçınar B, Şimşek T, Arıcı C, Güngör B, Özbaş S, Akça T, Emre AU, Karadeniz Çakmak G, Akçay M, Ünal B, Girgin M, Girgin S, Görgülü S, Sezer A, Karataş A, Özemir İA, Aksakal N, Erel S, Uğurlu MÜ, Filiz Aİ, Atalay C, Uzunköy A, Deveci U, Kotan Ç, İçöz G, Kurt Y, Kebudi A, Cantürk NZ, Erbil Y, Pandev R, and Güllüoğlu BM
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- Adolescent, Adult, Aged, Aged, 80 and over, Black Sea epidemiology, Calcium analysis, Calcium blood, Female, Humans, Hyperparathyroidism, Primary epidemiology, Hyperparathyroidism, Primary pathology, Male, Mediterranean Region epidemiology, Middle Aged, Parathyroid Hormone analysis, Parathyroid Hormone blood, Retrospective Studies, Turkey epidemiology, Vitamin D Deficiency blood, Vitamin D Deficiency epidemiology, Biochemical Phenomena, Hospital Distribution Systems statistics & numerical data, Hyperparathyroidism, Primary physiopathology
- Abstract
Background: Environmental habitat may play a role in clinical disparities of primary hyperparathyroidism (pHPT) patients., Aims: To compare preoperative clinical symptoms and associated conditions and surgical findings in patients with pHPT, living in different geographical regions from the Black Sea, Mediterranean and Anatolia regions., Study Design: Retrospective, clinical-based multi-centric study of 694 patients with pHPT., Methods: Patients from 23 centers and 8 different geographical regions were included. Data related to baseline demographics, clinical, pathologic and treatment characteristics of 8 regions were collected and included age, gender, residential data, symptoms, history of fracture, existence of brown tumor, serum total Ca and p levels, serum parathormone (PTH) levels, serum 25-OH vitamin D levels, bone mineral density, size of the resected abnormal parathyroid gland(s), histology, as well as the presence of ectopia, presence of dual adenoma, and multiple endocrine neoplasia (MEN)- or familial-related disease., Results: The median age was 54. Asymptomatic patient rate was 25%. The median PTH level was 232 pg/mL and serum total Ca was 11.4 mg/dL. Eighty-seven percent of patients had an adenoma and 90% of these had a single adenoma. Hyperplasia was detected in 79 patients and cancer in 9 patients. The median adenoma size was 16 mm. Significant parameters differing between regions were preoperative symptoms, serum Ca and p levels, and adenoma size. All patients from South-East Anatolia were symptomatic, while the lowest p values were reported from East Anatolia and the largest adenoma size, as well as highest Ca levels, were from Bulgaria., Conclusion: Habitat conditions vary between geographical regions. This affects the clinicopathological features of patients with pHPT., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors.
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- 2017
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