Atlas of Thyroid Surgery

Opis:

Atlas of Thyroid Surgery: Principles, Practice, and Clinical Cases is a concise guide for the surgical management of thyroid disease. Divided in three main parts, the book opens with an overview of surgical anatomy and surgical techniques. The author provides a detailed description of the technique of capsular dissection as well as surgical cases that aid in the comprehension of important concepts. The book then features an in-depth discussion of thyroid nodules, including follicular neoplasms and nodules in Graves and Hashimoto disease, covering basic science, genetics, clinical aspects, imaging, diagnosis, and surgical strategies. In the final part, the atlas addresses the management of malignant tumors, including papillary, anaplastic, and medullary carcinoma, and describes the principles of classification, treatment strategies along with current therapeutic controversies, and results. For differentiated thyroid carcinoma, contemporary strategies focus on selective risk-dependent treatment that allows for the protection of patients from overtreatment.

Highlights:
# Descriptions of endocrine pathophysiology and the pathogenesis of nodular goiter and thyroid neoplasms

# Thorough discussion of the capsular dissection technique and its essential advantages as a minimally invasive approach with low morbidity

# Numerous clinical cases with step-by-step demonstrations of surgical procedures and concise comments on management, helping clinicians prepare for range of scenarios encountered in everyday practice

# 120 clear line drawings and full-color photographs that illustrate key concepts

# Surgical videos on an accompanying DVD present detailed surgical technique in five clinical cases with cross references to the text

Atlas of Thyroid Surgery: Principles, Practice, and Clinical Cases is a superb guide for general surgeons and endocrine and ENT surgeons operating on the thyroid. Endocrinologists, oncologists, pathologists, and residents in these specialties will also greatly benefit from the wealth of information provided in the text.

Table of Contents XI
Part 1
Surgical Anatomy and Surgical Technique _ 1
1 Notes on Positioning the Patient _ 2
2 Basic Surgical Anatomy _ 3
3 Incisions; Thyroid Exposure _ 4
3.1 Skin and Platysma _ 4
3.2 Transverse Division of the Superficial Fascia
and Middle Fascia _ 4
3.3 Longitudinal Median Division of the Superficial
Fascia and Middle Fascia _ 6
3.4 Modifications _ 7
4 Capsular Dissection _ 9
4.1 Anatomy _ 9
4.2 Technique _ 12
4.3 Capsular Dissection at the Upper Pole _ 12
4.4 Lateral "Back Door" Approach _ 17
4.5 Historical Remarks on Capsular Dissection _ 22
4.6 Capsular Dissection and Modern
Technologies _ 23
4.7 Minimal-Access Thyroid Surgery _ 23
5 Thyroid Hilus: Suspensory Ligament of Berry;
Inferior (Recurrent) Laryngeal Nerve;
Parathyroids; Posterior Thyroid Process
(Tubercle of Zuckerkandl) _ 25
5.1 Anatomical Relationships between the
Structures around the Thyroid Hilus _ 25
5.2 The Nerve at Risk _ 27
5.3 Investigation of Nerve Function _ 30
5.4 Parathyroid Glands _ 31
5.5 Tubercle of Zuckerkandl
(Madelung-Zuckerkandl) _ 31
6 Further Case Records with Demonstrations
of the Technique of Capsular Dissection _ 42
6.1 Graves Disease _ 46
Part 2
Thyroid Nodules-Modern Concepts _ 51
7 Basic Remarks _ 52
8 Proliferation, Clonality, and Autonomy of Thyroid
Lesions _ 53
8.1 Growth. Nodules Are Genetically Determined
Hyperplastic and Neoplastic Tumors _ 53
Table of Contents
8.2 Endocrine Function. Functional Autonomy. TSH
Receptor Mutations _ 54
9 Molecular Genetic Diagnosis. Gene Profiling _ 58
10 Follicular Neoplasia _ 60
10.1 Preoperative and Intraoperative Evaluation
of Nodules _ 60
10.2 Differential Diagnosis
of Follicular Neoplasia _ 62
11 Thyroid Nodules in Surgical Practice.
Strategy of Adequate Excision _ 63
11.1 Diagnoses in Thyroid Nodules
(Personal Series) _ 63
11.2 Strategy of Adequate Excision _ 63
12 Case Records: Hyperplastic and Neoplastic
Nodules; Functional Autonomy;
Follicular Thyroid Carcinoma _ 67
12.1 Hyperplastic, Adenomatous Goiter _ 67
12.2 Follicular Neoplasia: Minimally Invasive Follicular
Thyroid Carcinoma _ 69
12.3 Solitary Nodule. Diagnosis and Treatment _ 70
12.4 Risk-Group Assignment in Follicular Thyroid
Carcinoma _ 70
12.5 Treatment of Patients with Follicular Thyroid
Carcinoma _ 72
12.6 Plummer Disease and Minimally Invasive
Follicular Thyroid Carcinoma _ 73
12.7 Very Low-Risk Follicular
Thyroid Carcinoma _ 74
12.8 Widely Invasive Follicular
Thyroid Carcinoma _ 75
12.9 Plummer Disease. Mediastinal Goiter.
Acute Respiratory Distress _ 77
12.10 Long-Standing Huge Goiter with Acute
Hemorrhage and Necrosis _ 79
12.11 Plummer Disease in an Older High-Risk Patient
with Large Compressing Goiter; Transsternal
Approach _ 80
12.12 Long-Standing Huge Goiter with Widely Invasive
Follicular Thyroid Carcinoma _ 81
13 Embryological Thyroid Development and
Developmental Anomalies: Clinical Aspects _ 83
13.1 Aberrant, Ectopic or Heterotopic Thyroid
Tissues _ 83
13.2 Further Clinical Aspects. Thymus _ 83
13.3 Case Records _ 85
aus: Gemsenjaeger, Atlas of Thyroid Surgery (ISBN 9783131450319) © 2009 Georg Thieme Verlag KG
XII Table of Contents
14 Total Thyroidectomy for Benign Nodular
Goiter _ 87
14.1 Case Records. Huge Goiters _ 87
14.2 Total Thyroidectomy for Toxic
Multinodular Goiter _ 88
14.3 Surgical Morbidity _ 89
14.4 Conclusion _ 89
15 Long-Standing Solitary Nodule _ 90
15.1 Solitary Toxic Nodule (Goetsch Disease) _ 90
15.2 Solitary Nodule with Normal Thyroid
Stimulating Hormone (Cold Nodule) _ 91
15.3 Solitary Thyroid Nodule in a Personal Series
(Prospective Clinical Study) _ 92
16 Further Clinical Considerations _ 94
16.1 The Small Subclinical and Clinical Nodule _ 94
16.2 Ultrasonographic Findings Relevant for the
Thyroid Surgeon _ 95
17 Nodules in Graves Disease _ 96
17.1 Functioning and Nonfunctioning Nodules _ 96
17.2 Nuclear Scan for Differential Diagnosis _ 96
17.3 Diagnostic and Therapeutic Regimen _ 96
17.4 Case Records: Papillary Thyroid Carcinoma in
Graves Disease _ 97
18 Nodules in Chronic Autoimmune Thyroiditis
(Hashimoto Thyroiditis, Hashimoto Disease,
Lymphocytic Thyroiditis) _ 99
18.1 Hashimoto Thyroiditis _ 99
18.2 Nodules in Hashimoto Disease _ 99
18.3 Primary Thyroid Lymphoma _ 100
18.4 Conclusion _ 100
18.5 Case Records _ 101
18.6 Acute Events. The Firm Thyroid Gland.
The Rapidly Growing Thyroid Mass _ 105
Part 3
Malignant Tumors _ 107
19 Papillary Thyroid Carcinoma _ 108
19.1 Clinical and Biological Features Relevant for
Rational Treatment _ 108
19.2 Low Risk and High Risk, Recurrence,
Survival _ 108
19.3 Treatment Principles: Selective Treatment
Policy _ 109
19.4 Case Records (I). Selective Treatment
Options _ 109
19.5 Age-Related Prognostic TNM Classification _ 113
19.6 Lymph Node Metastasis _ 115
19.7 Case Records (II) _ 117
19.8 Morphological Subclassification of Papillary
Thyroid Carcinoma _ 131
19.9 Familial Papillary Carcinoma (Familial
Nonmedullary Thyroid Carcinoma) _ 132
19.10 Conclusion. Risk-Dependent Amount of Therapy
in Papillary Thyroid Carcinoma _ 135
20 Anaplastic (Undifferentiated)
Thyroid Carcinoma _ 136
20.1 General Remarks _ 136
20.2 Thyroidectomy for Excision of Anaplastic
Carcinoma. Cases _ 137
20.3 Novel Treatment Strategies _ 138
21 Medullary Thyroid Carcinoma (C-Cell
Carcinoma) _ 141
21.1 Introduction (General Remarks) _ 141
21.2 Diagnosis _ 141
21.3 C-Cell Hyperplasia _ 143
21.4 Conclusions (Sporadic Medullary Thyroid
Carcinoma) _ 143
21.5 Hereditary Medullary Thyroid Carcinoma _ 144
21.6 Case Records _ 144
21.7 Casuistic Experience _ 151
Part 4
Concluding Remarks
22 Basic Tools _ 154
22.1 Clinical Examination _ 154
22.2 Recapitulation of the Technique of Capsular
Dissection _ 154
22.3 The Surgeon as a Prognostic Factor _ 154
22.4 Evidence-Based Medicine _ 159
Reference List _ 160
Index _ 174
DVD Contents Overview and Comments _ 179