25th Anniversary International Scientific Conference-2016
Permanent URI for this collectionhttp://repository.kln.ac.lk/handle/123456789/12769
Plenaries, Symposia and free papers presented at the 25th Anniversary International Scientific Conference, held on 6-8th April 2016, Faculty of Medicine, University of Kelaniya to celebrate the Silver Jubilee Anniversary of Faculty of Medicine
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Item Mini incision thyroidectomy: alternative approach to cosmetic thyroidectomy(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Munasinghe, B.N.L.; Fernando, R.; Kumarasinghe, K.A.P.R.; Sandaruwan, C.; Pinto, M.D.P.; Amaraweera, P.C.; Dissanayake, D.M.C.D.BACKGROUND: Technique of thyroidectomy has evolved from conventional open technique to minimally access techniques over the past few years. Regardless of the technique, outcome depends on meticulous surgical technique used. Mini incision is defined as surgical incision less than 3 cm or less in length. Once the small incision is made, retraction is used and thyroidectomy done in the conventional manner. Main advantage is the superior cosmetic outcome compared to conventional method. Size of the gland is a main factor before deciding on a mini incision thyroidectomy (MIT) and careful patient selection must be done as large glands cannot be retrieved with the mini incision. METHODS: A longitudinal descriptive study was carried out on all patients undergoing MIT between 2008 to 2015 in Professorial Surgical Unit, University of Kelaniya, Sri Lanka. Patients with small sized glands and nodules less than 2cm were included. Skin incision was marked by measuring 3 cm with a sterile measuring tape and Methyline blue dye. The thyroid gland was delivered in to the incision and both pedicles were ligated. Capsular dissection with nerve encountering technique was adhered to. Recurrent laryngeal nerves, external branch of the superior laryngeal nerves and parathyroid glands were demonstrated and preserved. Drains were not used and routine closure was done after absolute haemostasis. RESULTS: Twenty nine MITs were performed (Male -3 , Female – 26, median age 34.26 years, range 22 – 42 years, total thyroidectomy -18, hemi-thyroidectomy -11). The commonest indication for total thyroidectomy was small MNG. None had recurrent laryngeal nerve injuries or significant haematoma formation. Transient hypocalcaemia was seen in 3%. The cosmetic outcome was satisfactory. The longest follow up is 7 years. CONCLUSIONS: MIT is a safe alternative to conventional approach in carefully selected patients and also it gives a superior cosmetic outcome.Item Lateral approach to thyroid(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Dissanayake, D.M.C.D.; Kumarasinghe, K.A.P.R.; Pinto, M.D.P.; Amaraweera, P.C.; Munasinghe, B.N.L.; Chandrasinghe, P.C.; Fernando, R.BACKGROUND: Thyroidectomy is the commonest endocrine surgical procedure, undertaken throughout the world. Re-do thyroidectomies are challenging procedures with a higher morbidity rate. Lateral approach to thyroid (LATT) is a good alternative to the standard midline exploration. The key to the technique is the development of the natural tissue plane between the strap muscle and the ipsilateral sternocledomastoid muscle to explore the thyroid bed. OBJECTIVE: This study was done to assess the efficacy, safety and complications of LATT. METHODS: Data on patients undergoing LATT in Professorial Surgical Unit, Colombo North Teaching Hospital, Ragama from 2008 to 2015 was collected prospectively and analyzed. All procedures were done by a single surgeon. RESULTS: A total 36 LATTs were done. Data from 32 people were collected as 4 patients were lost to follow up. 29 (90.6%) were females and 3 (9.4%) were males. Age ranged between 28 and 61 (Median 43.37) years. Three (9.4%) LATTs were for parathyroid explorations and out of which one (3.1%) was for redo parathyroid explorations. Nine (28.1%) were redo thyroidectomies and 18 (56.2%) were mini incision thyroidectomies with lateral approach. Hemi thyroidectomies were performed for 28 (87.5%). Bilateral explorations done for 3(9.4%) patients and 4(12.5%) lateral approaches done for completion thyroidectomies were for follicular malignant lesions. Transient clinical hypocalcaemia was noticed in 4 (12.5%) patients and 1 (3.1%) developed hoarseness of voice which was temporary. None of them had complications such as haematoma or post-surgery stridor. CONCLUSIONS: LATT is a safe alternative to the standard approach, for re-explorative thyroid surgery.Item Incidental thyroid carcinoma in benign thyroid disease: a longitudinal descriptive study(Faculty of Medicine, University of Kelaniya, Sri Lanka, 2016) Pinto, M.D.P; Pradeep, I.H.D.S.; Amaraweera, P.C.; Munasinghe, B.N.L.; Kumarasinghe, K.A.P.R.; Dissanayake, D.M.C.D.; Fernando, R.BACKGROUND: An incidental thyroid carcinoma (ITC) is a thyroid malignancy that is not clinically or cytologically detected preoperatively. The incidence of ITC is between 10% - 20% in the literature. OBJECTIVES: The study was undertaken to assess the incidence of ITC in patients presenting with benign disease of the thyroid to University Surgical Unit, Colombo North Teaching Hospital, Sri Lanka. METHODS: A longitudinal descriptive study was conducted spanning from November, 2002 to October, 2015 on a cohort of all patients who underwent total thyroidectomy with cytologically benign thyroid disease. FNAC was performed on all palpable lesions to detect presence of malignancy. Presence of autoimmune thyroiditis was taken as an exclusion criterion due to its known association with malignancy of the thyroid. Post-thyroidectomy histopathological diagnoses were provided by Department of Pathology, University of Kelaniya, Sri Lanka and were collected prospectively. Statistical analysis was done by Fisher’s exact test using SPSS software, version 20. RESULTS: Hundred and sixty seven patients (n=167) underwent total thyroidectomy (Male – 2, Female – 17, Median age = 40.25 years, Range 28 – 62 years). ITC was found in 11.38% (19/167) with a female preponderance (13/19). A majority (89.4%) were euthyroid. CONCLUSIONS: Incidence of ITC in benign thyroid disease is 11.38% which may have implications for the management in benign thyroid disease.