La chirurgia della tiroide - Professor Gaziano Longo

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Intervento durante il convegno: "Il Nodulo Tirodeo" Policlinico Casilino, Roma 11 Novembre 2017

Health & Medicine

“il Nodulo Tiroideo”
Policlinico Casilino
11 Novembre 2017
La Chirurgia della Tiroide
Dott. Graziano Longo
Responsabile
U.O. di Chirurgia Generale e d’Urgenza

“il Nodulo Tiroideo”
Policlinico Casilino
11 Novembre 2017

“il Nodulo Tiroideo”
Policlinico Casilino
11 Novembre 2017
Ma mi asporterete tutte le paratiroidi?
Dopo l’intervento mi hanno detto che non devo
parlare…
E’ vero che aumenterò di peso?
Mi farete l’intervento con il laser?
Ma le corde vocali me le lasciate, vero?
Qui lo fate l’intervento senza cicatrice?
Quanto dura l’intervento?
LE DOMANDE…
🤔

“il Nodulo Tiroideo”
Policlinico Casilino
11 Novembre 2017
La chirurgia tiroidea è in realtà una
chirurgia delle ghiandole paratiroidi
e dei nervi ricorrenti

“il Nodulo Tiroideo”
Policlinico Casilino
11 Novembre 2017
INDICAZIONI ALLA CHIRURGIA
Chi NON deve essere operato

“il Nodulo Tiroideo”
Policlinico Casilino
11 Novembre 2017
INDICAZIONI ALLA CHIRURGIA
Chi NON deve essere operato
• Hashimoto senza nodulo

“il Nodulo Tiroideo”
Policlinico Casilino
11 Novembre 2017
INDICAZIONI ALLA CHIRURGIA
Chi NON deve essere operato
• Hashimoto senza nodulo
• Nodulo ecograficamente sospetto < 1cm

“il Nodulo Tiroideo”
Policlinico Casilino
11 Novembre 2017
INDICAZIONI ALLA CHIRURGIA
Chi DEVE essere operato
• Neoplasie

“il Nodulo Tiroideo”
Policlinico Casilino
11 Novembre 2017
INDICAZIONI ALLA CHIRURGIA
Chi DEVE essere operato
• Neoplasie
• Noduli in crescita

“il Nodulo Tiroideo”
Policlinico Casilino
11 Novembre 2017
INDICAZIONI ALLA CHIRURGIA
Chi DEVE essere operato
• Neoplasie
• Noduli in crescita
• Gozzi non controllati da terapia medica

“il Nodulo Tiroideo”
Policlinico Casilino
11 Novembre 2017
INDICAZIONI ALLA CHIRURGIA

“il Nodulo Tiroideo”
Policlinico Casilino
11 Novembre 2017
QUALE INTERVENTO
Tiroidectomia totale
Emitiroidectomia

“il Nodulo Tiroideo”
Policlinico Casilino
11 Novembre 2017
QUALE INTERVENTO
Tiroidectomia totale
Near total thyroidectomy

“il Nodulo Tiroideo”
Policlinico Casilino
11 Novembre 2017
QUALE INTERVENTO
Tiroidectomia totale
Near total thyroidectomy
Piramide Polo superiore Ricorrente

“il Nodulo Tiroideo”
Policlinico Casilino
11 Novembre 2017
TIROIDECTOMIA TOTALE
Pros
Riduzione recidive
Cons
Radicalità
Terapia medica più efficace
Complicanze ricorrenziali
Ipoparatiroidismo
Tempi chirurgici maggiori
Terapia radiometabolica
Follow-up mediante dosaggio TGB

“il Nodulo Tiroideo”
Policlinico Casilino
11 Novembre 2017
EMITIROIDECTOMIA
Riduzione rischio
ipoparatiroidismo
Riduzione rischio
lesioni ricorrenziali
Follow-up più complesso
Non radicale
Recidiva più probabile
Reintervento più rischioso
Pros Cons

“il Nodulo Tiroideo”
Policlinico Casilino
11 Novembre 2017
QUALE TECNICA

“il Nodulo Tiroideo”
Policlinico Casilino
11 Novembre 2017
QUALE TECNICA
Tiroidectomia mininvasiva videoassistita
Tiroidectomia robotica
Tiroidectomia chirurgica tradizionale

“il Nodulo Tiroideo”
Policlinico Casilino
11 Novembre 2017
QUALE TECNICA
Tiroidectomia robotica

“il Nodulo Tiroideo”
Policlinico Casilino
11 Novembre 2017
QUALE TECNICA
Tiroidectomia mininvasiva videoassistita

“il Nodulo Tiroideo”
Policlinico Casilino
11 Novembre 2017
Harmonic Focus

“il Nodulo Tiroideo”
Policlinico Casilino
11 Novembre 2017
Percorso chirurgico
Intervento lo stesso giorno del ricovero

“il Nodulo Tiroideo”
Policlinico Casilino
11 Novembre 2017
Percorso chirurgico
Intervento lo stesso giorno del ricovero
Due drenaggi, rimossi il giorno dopo l’intervento

“il Nodulo Tiroideo”
Policlinico Casilino
11 Novembre 2017
Grazie per l’attenzione

This document outlines the components of an Enhanced Recovery After Surgery (ERAS) protocol presented by Dr. Sanjay Dange. The goals of ERAS are to decrease postoperative stress, maintain physiological function, and enable early mobilization to reduce recovery time and length of stay without increasing complications. Key elements include preoperative education and optimization, minimally invasive surgery when possible, goal-directed fluid management, multimodal analgesia including epidural anesthesia, early feeding and mobilization within 24 hours of surgery.

I tipi di intervento di chirurgia bariatrica

unavitasumisura

1.OGILVIE SYNDROME.pptx

AftabTHEBEST

Ogilvie's syndrome, also known as acute colonic pseudo-obstruction, is characterized by dilation of the cecum and right colon without mechanical obstruction. It was first described in 1948 and is caused by an imbalance in the autonomic nervous system regulating colonic motility. Symptoms include abdominal distension and pain. Diagnosis involves abdominal x-rays showing colon dilation. Treatment aims to decompress the colon initially with nasogastric tubes, enemas, or neostigmine injections, with surgery considered if decompression fails or complications like perforation occur. Risks include ischemia, perforation and high mortality with perforation.

Rectal prolapse surgical approaches

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This document provides information about rectal prolapse including its anatomy, causes, clinical presentation, and surgical treatment options. It begins with a description of the rectal anatomy including its blood supply, lymphatic drainage, and curves. It then discusses the causes and types of rectal prolapse and explains how factors like pelvic floor weakness can lead to its development. Common signs and symptoms are outlined. Both perineal and abdominal surgical approaches are described in detail including the Thiersch, Delorme, Altemeier, and Wells procedures. Postoperative care is also reviewed. The document provides a comprehensive overview of rectal prolapse.

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Mobile cecum syndrome

Abhilash Cheriyan

Mobile cecum syndrome is an embryological variation where the cecum is improperly fixed to the lateral abdominal wall, leaving it redundant and prone to twisting around its axis. It affects 10% of the population and more commonly females, with 2% presenting as acute intestinal obstruction. Patients often experience right lower quadrant pain, colicky pain, and alternating constipation and diarrhea. Treatment involves surgical fixation of the cecum to the lateral abdominal wall to prevent further twisting.

Eras protocol (3)

asik hossain

The document outlines the Enhanced Recovery After Surgery (ERAS) protocol. ERAS aims to reduce surgical stress, accelerate recovery through a multimodal approach. Key elements of ERAS include pre-admission counseling and nutrition optimization, minimizing preoperative fasting through carbohydrate loading, selective bowel preparation if needed, thoracic epidural anesthesia, early feeding and mobilization, and multimodal pain control to avoid opioid use and ileus. The goal is to minimize length of stay through evidence-based perioperative optimization.

Abdominal Wall.pptx

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1. Laparoscopic anti-reflux surgery is a safe and effective treatment for gastroesophageal reflux disease (GORD) that provides complete heartburn control in over 90% of patients and significantly improves quality of life. 2. While pharmacological therapy with PPIs is often initially recommended, it has limitations including nocturnal breakthrough and failure to control symptoms in 20-30% of patients. 3. Surgery is indicated for patients with chronic GORD symptoms despite PPI therapy or those with complications such as strictures or Barrett's esophagus.

Irritable Bowel Syndrome (IBS)

zeinabnm

This document discusses irritable bowel syndrome (IBS). It begins by defining IBS as a functional disorder of the large intestine that causes abdominal pain and changes in bowel movements. The document then outlines the pathophysiology, diagnosis, clinical presentation and epidemiology of IBS. It describes the different IBS subtypes and reviews non-pharmacological and pharmacological treatment options for managing symptoms of constipation, diarrhea and abdominal pain associated with IBS. The document concludes by summarizing several studies on probiotic therapy for improving IBS symptoms.

ERAS Protocol

ankit0019

The document discusses the Enhanced Recovery After Surgery (ERAS) protocol. ERAS aims to optimize patient care and recovery through a multidisciplinary, evidence-based approach. It challenges traditional practices like prolonged preoperative fasting and use of drains. The ERAS protocol incorporates recommendations across the preoperative, intraoperative and postoperative periods. This includes carbohydrate loading, minimal fasting, optimized fluid management, multimodal analgesia, early nutrition and mobilization to reduce complications and length of stay while improving outcomes.

Using Enhanced Recovery After Surgery (ERAS) to Enhance Postoperative Outcomes

Wellbe

Speaker: Francesco Carli, MD, MPhil, senior staff anesthesiologist at the McGill University Health Centre Cost: Complimentary, sponsored by Wellbe There is strong evidence that many of aspects of surgical care have little evidence, and therefore the Enhanced Recovery After Surgery (ERAS) program has been set up to accelerate the recovery process and decrease the rate of postoperative complications. There is an opportunity to improve outcomes by using team approach and revision of the standard procedures. Learn about: – The elements of ERAS protocols – How to structure the Team approach – The role of the patient in ERAS – How to perform an audit of your program About the Speaker: Francesco Carli, MD, MPhil, is Professor of Anesthesia at McGill University and Associate Professor in the School of Dietetics and Human Nutrition at McGill University and a senior staff anesthesiologist at the McGill University Health Centre. He is currently an Elected Member of the American Academy of Anesthesia and a Board Member of the Enhanced Recovery After Surgery (ERAS) Society. Dr. Carli completed his medical training and anesthesia training in Turin, Italy, Paris, France, and London, England. He completed a Master’s Degree in surgical metabolism at the University of London, England. His research interests are: metabolic changes associated with surgery and the impact of perioperative interventions (regional analgesia, nutrition, hormones, exercise) on postoperative recovery; evaluation of functional outcome measures during the surgical recovery process; prehabilitation of surgical patients. He is the author of over 250 peer-review scientific articles and has been a recipient of over 50 peer and non peer-review grants.

Colon preparation and surgical site infection

Ferstman Duran

This document reviews the evidence on colon preparation methods to reduce surgical site infections for elective colon resection surgery. It finds that mechanical bowel preparation alone does not reduce surgical site infection rates based on 70 years of literature. However, oral antibiotic bowel preparation alone or in combination with systemic preoperative antibiotics is shown to be superior at reducing infection rates compared to systemic antibiotics alone based on multiple clinical trials. While oral antibiotic preparation plus systemic antibiotics provides the lowest infection rates, more research is still needed to determine the optimal combined mechanical and oral antibiotic regimen.

Fast track

Dhaval Mangukiya

Information about Fast Track Surgery by Dr. Dhaval Mangukiya Details of Fast Track Surgery, ERAS, Sir David Cuthbertson, Procedure-Specific fast-track surgery results, Colorectal surgery, Esophageal Resection, Pancreatic Surgery, Liver Surgery, Cochrane Database of Systematic Reveiws, Primary outcomes, Secondary outcomes, and Results https://drdhavalmangukiya.com/ http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat https://gastrosurgerysurat.blogspot.com/

Eras

DeepakGupta825

The document discusses Enhanced Recovery After Surgery (ERAS) protocols. It describes how ERAS aims to reduce surgical stress on patients through multimodal perioperative care, facilitating early recovery. This includes optimizations in pre-, intra-, and postoperative care such as shortened fasting times, carbohydrate loading, minimized fluid administration, and early mobilization. The document provides examples of procedures that can be done as day surgeries and details the key elements of ERAS protocols.

Acute pancreatitis.pptx

masoom parwez

This document provides an overview of acute pancreatitis, including its pathophysiology, grading, phases, epidemiology, etiology, clinical presentation, findings, investigations, severity assessments, management, complications, and follow up. Acute pancreatitis results from premature activation of pancreatic enzymes causing autodigestion and inflammation. It can range from mild interstitial inflammation to severe necrotizing pancreatitis with multi-organ failure and high mortality. Management involves fluid resuscitation, monitoring for organ failure, nutritional support, antibiotics for severe cases, and urgent ERCP for gallstone pancreatitis with ongoing biliary obstruction.

Enhanced Recovery after Surgery its relevance - Evidence Based

Deep Goel

Enhanced recovery programs are evidence-based protocols designed to standardize medical care, improve outcomes, and lower health care costs. These protocols include evidence-based techniques to minimize surgical trauma and postoperative pain, reduce complications, improve outcomes, and decrease hospital length of stay, while expediting recovery following elective procedures.Protocols have been developed for colorectal surgery patients to reduce physiological stress and postoperative organ dysfunction through optimization of perioperative care and recovery

Bile duct injury during laparoscopic cholecystectomy

Easwar Moorthy

1. Bile duct injuries during laparoscopic cholecystectomy can occur due to misidentification of structures or improper surgical techniques. 2. It is important to clearly identify the junction of the cystic duct and gallbladder using cues like the "elephant trunk sign" and Rouviere's sulcus, and obtain the "critical view of safety" to help prevent bile duct injuries. 3. If there is uncertainty in the anatomy, performing an intraoperative cholangiogram can help reduce the risk of bile duct injury. Early recognition of bile duct injuries through imaging and prompt repair by a specialist, often involving hepaticojejunostomy, can lead to the best outcomes.

Laparoscopic Adhesiolysis

George S. Ferzli

Adhesions are abnormal attachments between tissues and organs that commonly form after abdominal or pelvic surgery as part of the body's healing process. The formation of adhesions involves an inflammatory response to injury where fibrin deposits form bridges between tissues that can develop into fibrous bands unless dissolved. Adhesions cause significant complications like small bowel obstruction, chronic pain, infertility and increase the difficulty of future surgeries. They represent a large economic burden on healthcare systems costing an estimated $1-2 billion per year to treat adhesion-related complications. Efforts to prevent adhesions have focused on reducing inflammation, separating tissues and removing fibrin deposits but with limited success.

Gastrointestinal System

Lavina Belayutham

Fast track surgery eras 2

Mohamed Abosdira

Fast-track or enhanced recovery after surgery (ERAS) protocols aim to reduce the stress response to surgery and speed recovery. This document outlines ERAS protocols for several types of surgeries including colorectal, bariatric, liver, breast and gallbladder surgeries. The protocols emphasize preoperative counseling and nutrition, minimal invasive surgery when possible, multimodal pain control, early feeding and mobilization to reduce hospital length of stay and complications compared to traditional care.

Short Bowel syndrome Dr Habibur Rahim

Dr. Habibur Rahim

Short bowel syndrome (SBS) occurs when extensive segments of the small intestine are resected, severely compromising absorptive capacity. It is a leading cause of intestinal failure in infants, with an incidence of 0.1-0.5% among live births and ICU admissions. The minimal length of small intestine needed to survive is 15-38 cm, though adaptation allows survival with even shorter lengths. Management involves total parenteral nutrition, optimizing enteral nutrition, and treating complications until the remnant intestine sufficiently adapts through processes like increased blood flow and growth. With current treatment, 80% of infants with SBS achieve full enteral nutrition within a year.

The role of laparoscopy in acute care surgery

htyanar

The document discusses the role of laparoscopy in acute care surgery. It summarizes that laparoscopy can be used both diagnostically and therapeutically for a variety of non-trauma and trauma abdominal emergencies. Physiologic and technical contraindications to laparoscopy are mentioned. Studies are referenced showing laparoscopy has advantages over open surgery such as less post-operative pain, shorter hospital stays, and lower complication rates for conditions like appendicitis, acute cholecystitis, and perforated peptic ulcers. Emergency laparoscopy is also discussed as an option for pregnant patients and for diagnosing and treating mesenteric ischemia, diaphragmatic injuries, and hollow viscus injuries

Post Operative (Gastro-Jejunostomy) Efferent Loop Obstruction due to Recurren...

Hriday Ranjan Roy

Difficult Laparoscopic Cholecystectomy-When and Where is the Need to Convert?

Apollo Hospitals

Laparoscopic cholecystectomy has now become the treatment of choice for the gall bladder stone. With increasing experience, surgeon has started to take more difficult cases which were considered relative contra indications for laparoscopic removal of gall bladder few years back. We conducted this study at our hospital and included all laparoscopic cholecystectomy done from May'08 to January'10. Total time taken in surgery, conversion rate and complication rate were analysed. Factors making laparoscopic cholecystectomy difficult were also analysed. We defined difficult laparoscopic cholecystectomy when we found -dense fibrotic adhesions in and around Callot's triangle, gangrenous gall bladder, empyma, large stone impacted at gall bladder neck, contracted gall bladder, Mirrizi's syndrome, h/o biliary pancreatitis, CBD stones, acute cholecystitis of <72 hrs duration. Out of 206 cases done during above period, 56 cases were considered difficult. Only two cases were converted to open. With growing experience and technical advancement surgery can be completed in most of the difficult cases. This is important because recently it is shown in literature that laparoscopic cholecystectomy is associated with less morbidity than open method irrespective of duration of the surgery.

Tip and technique for safe LC

kamales Prasitvarakul

IBD - presentation

Mohammed Aljaber

The document discusses inflammatory bowel disease (IBD), which includes ulcerative colitis and Crohn's disease. IBD is characterized by chronic inflammation of the bowel that can affect any part of the gastrointestinal tract from mouth to anus. Common symptoms include abdominal pain, diarrhea, and weight loss. Treatment involves medications to reduce inflammation as well as surgery in severe cases to remove inflamed sections of bowel. Complications can include malnutrition, infection, bowel obstruction, and in rare cases colon cancer. The causes of IBD are not fully understood but involve an abnormal immune response in the gastrointestinal tract.

Laparoscopic anatomy of inguinal canal

Gergis Rabea

This document provides an in-depth overview of the anatomy of the inguinal region as viewed laparoscopically. It describes key anatomical landmarks such as Cooper's ligament, the umbilical artery, and epigastric vessels that define the spaces where direct and indirect inguinal hernias occur. Understanding the complex relationships between osseofascial, vascular, and visceral structures in the preperitoneal space is essential to avoid injury during laparoscopic hernia repair.

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La chirurgia della tiroide - Professor Gaziano Longo

1. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 La Chirurgia della Tiroide Dott. Graziano Longo Responsabile U.O. di Chirurgia Generale e d’Urgenza

2. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017

3. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 Ma mi asporterete tutte le paratiroidi? Dopo l’intervento mi hanno detto che non devo parlare… E’ vero che aumenterò di peso? Mi farete l’intervento con il laser? Ma le corde vocali me le lasciate, vero? Qui lo fate l’intervento senza cicatrice? Quanto dura l’intervento? LE DOMANDE… 🤔

4. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017

5. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017

6. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017

7. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017

8. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 La chirurgia tiroidea è in realtà una chirurgia delle ghiandole paratiroidi e dei nervi ricorrenti

9. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 INDICAZIONI ALLA CHIRURGIA Chi NON deve essere operato

10. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 INDICAZIONI ALLA CHIRURGIA Chi NON deve essere operato • Hashimoto senza nodulo

11. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 INDICAZIONI ALLA CHIRURGIA Chi NON deve essere operato • Hashimoto senza nodulo • Nodulo ecograficamente sospetto < 1cm

12. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 INDICAZIONI ALLA CHIRURGIA Chi NON deve essere operato • Hashimoto senza nodulo • Nodulo ecograficamente sospetto < 1cm • Gozzi stabili sotto terapia

13. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 INDICAZIONI ALLA CHIRURGIA Chi NON deve essere operato • Hashimoto senza nodulo • Nodulo ecograficamente sospetto < 1cm • Gozzi stabili sotto terapia • Lesioni cistiche con citologia di benignità

14. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 INDICAZIONI ALLA CHIRURGIA Chi DEVE essere operato • Neoplasie

15. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 INDICAZIONI ALLA CHIRURGIA Chi DEVE essere operato • Neoplasie • Noduli in crescita

16. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 INDICAZIONI ALLA CHIRURGIA Chi DEVE essere operato • Neoplasie • Noduli in crescita • Gozzi non controllati da terapia medica

17. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 INDICAZIONI ALLA CHIRURGIA Chi DEVE essere operato • Neoplasie • Noduli in crescita • Gozzi non controllati da terapia medica • Gozzi autonomizzati refrattari

18. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 INDICAZIONI ALLA CHIRURGIA Chi DEVE essere operato • Neoplasie • Noduli in crescita • Gozzi non controllati da terapia medica • Gozzi autonomizzati refrattari • Basedow con sintomi oculari

19. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 INDICAZIONI ALLA CHIRURGIA Chi DEVE essere operato • Neoplasie • Noduli in crescita • Gozzi non controllati da terapia medica • Gozzi autonomizzati refrattari • Basedow con sintomi oculari • Diagnosi citologica di neoplasia papillifera su linfonodo locoregionale

20. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 INDICAZIONI ALLA CHIRURGIA Chi DEVE essere operato • Neoplasie • Noduli in crescita • Gozzi non controllati da terapia medica • Gozzi autonomizzati refrattari • Basedow con sintomi oculari • Diagnosi citologica di neoplasia papillifera su linfonodo locoregionale • Insorgenza di fenomeni compressivi

21. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 INDICAZIONI ALLA CHIRURGIA Chi DEVE essere operato • Neoplasie • Noduli in crescita • Gozzi non controllati da terapia medica • Gozzi autonomizzati refrattari • Basedow con sintomi oculari • Diagnosi citologica di neoplasia papillifera su linfonodo locoregionale • Insorgenza di fenomeni compressivi • Noduli con citologia indeterminata

22. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 INDICAZIONI ALLA CHIRURGIA

23. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 INDICAZIONI ALLA CHIRURGIA

24. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 QUALE INTERVENTO Tiroidectomia totale Emitiroidectomia

25. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 QUALE INTERVENTO Tiroidectomia totale Emitiroidectomia

26. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 QUALE INTERVENTO Tiroidectomia totale Near total thyroidectomy

27. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 QUALE INTERVENTO Tiroidectomia totale Near total thyroidectomy Piramide Polo superiore Ricorrente

28. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 TIROIDECTOMIA TOTALE Pros Riduzione recidive Cons Radicalità Terapia medica più efficace Complicanze ricorrenziali Ipoparatiroidismo Tempi chirurgici maggiori Terapia radiometabolica Follow-up mediante dosaggio TGB

29. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 EMITIROIDECTOMIA Riduzione rischio ipoparatiroidismo Riduzione rischio lesioni ricorrenziali Follow-up più complesso Non radicale Recidiva più probabile Reintervento più rischioso Pros Cons

30. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 QUALE TECNICA

31. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 QUALE TECNICA Tiroidectomia mininvasiva videoassistita Tiroidectomia robotica Tiroidectomia chirurgica tradizionale

32. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 QUALE TECNICA Tiroidectomia robotica

33. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 QUALE TECNICA Tiroidectomia robotica

34. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 QUALE TECNICA Tiroidectomia mininvasiva videoassistita Tiroidectomia robotica Tiroidectomia chirurgica tradizionale

35. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 QUALE TECNICA Tiroidectomia mininvasiva videoassistita

36. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 QUALE TECNICA Tiroidectomia mininvasiva videoassistita Tiroidectomia robotica Tiroidectomia chirurgica tradizionale

37. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 QUALE TECNICA Tiroidectomia mininvasiva videoassistita Tiroidectomia robotica Tiroidectomia chirurgica tradizionale MININVASIVA TECNOLOGICAMENTE AVANZATA

38. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 Harmonic Focus

39. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 Harmonic Focus

40. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 Harmonic Focus

41. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017

42. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 Percorso chirurgico Intervento lo stesso giorno del ricovero

43. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 Percorso chirurgico Intervento lo stesso giorno del ricovero Due drenaggi, rimossi il giorno dopo l’intervento

44. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 Percorso chirurgico Intervento lo stesso giorno del ricovero Due drenaggi, rimossi il giorno dopo l’intervento Dimissione in seconda giornata postoperatoria

45. “il Nodulo Tiroideo” Policlinico Casilino 11 Novembre 2017 Grazie per l’attenzione

La chirurgia della tiroide - Professor Gaziano Longo

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