Developing Ideas and New Instruments in Thyroid Surgery_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WEI Tao , ZHU Jingqiang.

Department of Thyroid and Breast Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China;

Corresponding author：

Keywords：

Thyroid surgery; Meticulous capsular dissection; Harmonic scalpel; Bipolar coagulation forceps; Neck lymph node dissection

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ObjectiveTo summarize the new ideas and new instruments in thyroid surgery. MethodsRelated literatures were reviewed and analyzed. ResultsTotal thyroidectomy had become the preferred option for differentiated thyroid cancer and multiple nodule goiter. The key change of surgery was from recurrent laryngeal nerve-protection to parathyroid-protection. Harmonic scalpel, bipolar coagulation forceps and Ligasure were used to thyroid surgery, which could shorten operation time and reduce operative bleeding. ConclusionThe ideas and techniques of thyroid surgery have changed, total thyroidectomy and parathyroid protection are being paid more and more attentions, and new instruments are used more extensively in thyroid surgery.

Citation： WEI Tao,ZHU Jingqiang.. Developing Ideas and New Instruments in Thyroid Surgery. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2011, 18(2): 220-224. doi: Copy

1.	Enewold L, Zhu K, Ron E, et al. Rising thyroid cancer incidence in the United States by demographic and tumor characteristics, 19802005 [J]. Cancer Epidemiol Biomarkers Prev, 2009, 18(3): 784791.
2.	Burgess JR, Tucker P. Incidence trends for papillary thyroid carcinoma and their correlation with thyroid surgery and thyroid fineneedle aspirate cytology [J]. Thyroid, 2006, 16(1): 4753.
3.	Colonna M, Guizard AV, Schvartz C, et al. A time trend analysis of papillary and follicular cancers as a function of tumour size: a study of data from six cancer registries in France (19832000) [J]. Eur J Cancer, 2007, 43(3): 891900.
4.	Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 19732002 [J]. JAMA, 2006, 295(18): 21642167.
5.	Leenhardt L, Grosclaude P, ChériéChalline L. Increased incidence of thyroid carcinoma in France: a true epidemic or thyroid nodule management effects? Report from the French Thyroid Cancer Committee [J].Thyroid, 2004, 14(12): 10561060.
6.	Liu S, Semenciw R, Ugnat AM, et al. Increasing thyroid cancer incidence in Canada, 19701996: time trends and ageperiodcohort effects [J]. Br J Cancer 2001, 85(9): 13351339.
7.	Lubina A, Cohen O, Barchana M, et al. Time trends of incidence rates of thyroid cancer in Israel: what might explain the sharp increase [J].Thyroid, 2006, 16(10): 10331040.
8.	Reynolds RM, Weir J, Stockton DL, et al. Changing trends in incidence and mortality of thyroid cancer in Scotland [J]. Clin Endocrinol(Oxf), 2005, 62(2):156162.
9.	Smailyte G, MiseikyteKaubriene E, Kurtinaitis J. Increasing thyroid cancer incidence in Lithuania in 19782003 [J]. BMC Cancer, 2006, 6: 284.
10.	AlboresSaavedra J, Henson DE, Glazer E, et al. Changing patterns in the incidence and survival of thyroid cancer with follicular phenotype－papillary, follicular, and anaplastic: a morphological and epidemiological study [J]. Endocr Pathol, 2007, 18(1): 17.
11.	Bilimoria KY, Bentrem DJ, Linn JG, et al. Utilization of total thyroidectomy for papillary thyroid cancer in the United States [J]. Surgery, 2007, 142(6): 906913.
12.	Mazzaferri EL, Massoll N. Management of papillary and follicular (differentiated) thyroid cancer: new paradigms using recombinant human thyrotropin [J]. Endocr Relat Cancer, 2002, 9(4): 227247.
13.	Shrime MG, Goldstein DP, Seaberg RM, et al. Costeffective management of lowrisk papillary thyroid carcinoma [J]. Arch Otolaryngol Head Neck Surg, 2007, 133(12): 12451253.
14.	Rosenbaum MA, McHenry CR. Central neck dissection for papillary thyroid cancer [J]. Arch Otolaryngol Head Neck Surg, 2009, 135(11): 10921097.
15.	Duh QY, Sancho JJ, Greenspan FS, et al. Medullary thyroid carcinoma. The need for early diagnosis and total thyroidectomy [J]. Arch Surg, 1989, 124(10): 12061210.
16.	Sippel RS, Kunnimalaiyaan M, Chen H. Current management of medullary thyroid cancer [J]. Oncologist, 2008, 13(5): 539547.
17.	Veyseller B, Aksoy F, Demirhan H, et al. Total thyroidectomy in benign thyroid diseases [J]. Kulak Burun Bogaz Ihtis Derg, 2009, 19(6): 299303.
18.	Barakate MS, Agarwal G, Reeve TS, et al. Total thyroidectomy is now the preferred option for the surgical management of Graves’ disease [J]. ANZ J Surg, 2002, 72(5): 321324.
19.	Friguglietti CU, Lin CS, Kulcsar MA. Total thyroidectomy for benign thyroid disease [J]. Laryngoscope, 2003, 113(10): 18201826.
20.	Yang W, Shao T, Ding J, et al. The feasibility of total or neartotal bilateral thyroidectomy for the treatment of bilateral multinodular goiter [J]. J Invest Surg, 2009, 22(3): 195200.
21.	Hussain M, Hisham AN. Total thyroidectomy: the procedure of choice for toxic goiter [J]. Asian J Surg, 2008, 31(2): 5962.
22.	Colak T, Akca T, Kanik A, et al. Total versus subtotal thyroidectomy for the management of benign multinodular goiter in an endemic region [J]. ANZ J Surg, 2004, 74(11): 974978.
23.	Chiang FY, Lin JC, Wu CW, et al. Morbidity after total thyroidectomy for benign thyroid disease: comparison of Graves’ disease and nonGraves’ disease [J]. Kaohsiung J Med Sci, 2006, 22(11): 554559.
24.	Ayache S, Tramier B, Chatelain D, et al. Evolution of the thyroid surgical treatment to the total thyroidectomy. Study of about 735 patients [J]. Ann Otolaryngol Chir Cervicofac, 2005, 122(3): 127133.
25.	Ku CF, Lo CY, Chan WF, et al. Total thyroidectomy replaces subtotal thyroidectomy as the preferred surgical treatment for Graves’ disease [J]. ANZ J Surg, 2005, 75(7): 528531.
26.	Vaiman M, Nagibin A, Hagag P, et al. Subtotal and near total versus total thyroidectomy for the management of multinodular goiter [J]. World J Surg, 2008, 32(7): 15461551.
27.	Agarwal G, Aggarwal V. Is total thyroidectomy the surgical procedure of choice for benign multinodular goiter? An evidencebased review [J].World J Surg, 2008, 32(7): 13131324.
28.	Acun Z, Comert M, Cihan A, et al. Neartotal thyroidectomy could be the best treatment for thyroid disease in endemic regions [J]. Arch Surg, 2004, 139(4): 444447.
29.	Erbil Y, Barbaros U, Salmaslioˇglu A, et al. The advantage of neartotal thyroidectomy to avoid postoperative hypoparathyroidism in benign multinodular goiter [J]. Langenbecks Arch Surg, 2006, 391(6): 567573.
30.	Unalp HR, Erbil Y, Akguner T, et al. Does near total thyroidectomy offer advantage over total thyroidectomy in terms of postoperative hypocalcemia? [J]. Int J Surg, 2009, 7(2): 120125.
31.	Tezelman S, Borucu I, Senyurek Giles Y, et al. The change in surgical practice from subtotal to neartotal or total thyroidectomy in the treatment of patients with benign multinodular goiter [J]. World J Surg, 2009, 33(3): 400405.
32.	Efremidou EI, Papageorgiou MS, Liratzopoulos N, et al. The efficacy and safety of total thyroidectomy in the management of benign thyroid disease: a review of 932 cases [J]. Can J Surg, 2009, 52(1): 3944.
33.	Bhattacharyya N, Fried MP. Assessment of the morbidity and complications of total thyroidectomy [J]. Arch Otolaryngol Head Neck Surg, 2002, 128(4): 389392.
34.	Hines JR, Winchester DJ. Total lobectomy and total thyroidectomy in the management of thyroid lesions [J]. Arch Surg, 1993, 128(9): 10601064.
35.	Gundry SR, Burney RE, Thompson NW, et al. Total thyroidectomy for Hürthle cell neoplasm of the thyroid [J]. Arch Surg, 1983, 118(5): 529532.
36.	Perri S, Mariani G, Trunfio A, et al. Total thyroidectomy in the surgical treatment of thyroid disease a retrospective clinical study [J]. Minerva Endocrinol, 2001, 26(2): 4151.
37.	Lal G, Ituarte P, Kebebew E, et al. Should total thyroidectomy become the preferred procedure for surgical management of Graves’ disease? [J]. Thyroid, 2005, 15(6): 569574.
38.	Serpell JW, Phan D. Safety of total thyroidectomy [J]. ANZ J Surg, 2007, 77(12): 1519.
39.	Mandel SJ, Brent GA, Larsen PR. Levothyroxine therapy in patients with thyroid disease [J]. Ann Intern Med, 1993, 119(6): 492502.
40.	Vaidya B, Pearce SH. Management of hypothyroidism in adults [J]. BMJ, 2008, 337: a801.
41.	Friedman M, Pacella BL Jr. Total versus subtotal thyroidectomy. Arguments, approaches, and recommendations [J]. Otolaryngol Clin North Am, 1990, 23(3): 413427.
42.	Halsted WS, Evans HM. I. The parathyroid glandules. Their blood supply and their preservation in operation upon the thyroid gand [J]. Ann Surg, 1907, 46(4): 489506.
43.	Thompson NW, Olsen WR, Hoffman GL. The continuing development of the technique of thyroidectomy [J]. Surgery, 1973, 73(6): 913927.
44.	吴在德, 吴肇汉. 外科学 [M]. 北京: 人民卫生出版社, 2003: 310311.
45.	Amaral JF. The experimental development of an ultrasonically activated scalpel for laparoscopic use [J]. Surg Laparosc Endosc, 1994, 4(2): 9299.
46.	Roye GD, Monchik J, Amaral JF. Endoscopic adrenalectomy using ultrasonic cutting and coagulating [J]. Surg Technol Int, 2000, 9: 129138.
47.	Takao S, Shinchi H, Maemura K. Ultrasonically activated scalpel is an effective tool for cutting the pancreas in biliarypancreatic surgery: experimental and clinical studies [J]. J Hepatobiliary Pancreat Surg, 2000, 7(1): 5862.
48.	Miccoli P, Berti P, DonatiniG, et al. Randomized controlled trial of harmonic scalpel use during thyroidectomy [J]. Arch Otolaryngol Head Neck Surg, 2006, 132(10): 10691073.
49.	Siperstein AE, Berber E, Morkoyun E. The use of the harmonic scalpel vs conventional knot tying for vessel ligation in thyroid surgery [J]. Arch Surg, 2002, 137(2): 137142.
50.	Matthews B, Nalysnyk L, Estok R, et al. Ultrasonic and nonultrasonic instrumentation: a systematic review and metaanalysis [J]. Arch Surg, 2008, 143(6): 592600.
51.	Parker DJ, Krupa K, Esler R, et al. Use of the harmonic scalpel in thyroidectomy [J]. ANZ J Surg, 2009, 79(6): 476478.
52.	Foreman E, Aspinall S, Bliss RD, et al. The use of the harmonic scalpel in thyroidectomy: ‘beyond the learning curve’ [J]. Ann R Coll Surg Engl, 2009, 91(3): 214216.
53.	Koh YW, Park JH, Lee SW, et al. The harmonic scalpel technique without supplementary ligation in total thyroidectomy with central neck dissection: a prospective randomized study [J]. Ann Surg, 2008, 247(6): 945949.
54.	Cordón C, Fajardo R, Ramírez J, et al. A randomized, prospective, parallel group study comparing the Harmonic Scalpel to electrocautery in thyroidectomy [J]. Surgery, 2005, 137(3): 337341.
55.	Hallgrimsson P, Lovén L, Westerdahl J, et al. Use of the harmonic scalpel versus conventional haemostatic techniques in patients with Grave disease undergoing total thyroidectomy: a prospective randomised controlled trial [J]. Langenbecks Arch Surg, 2008, 393(5): 675680.
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1. Enewold L, Zhu K, Ron E, et al. Rising thyroid cancer incidence in the United States by demographic and tumor characteristics, 19802005 [J]. Cancer Epidemiol Biomarkers Prev, 2009, 18(3): 784791.
2. Burgess JR, Tucker P. Incidence trends for papillary thyroid carcinoma and their correlation with thyroid surgery and thyroid fineneedle aspirate cytology [J]. Thyroid, 2006, 16(1): 4753.
3. Colonna M, Guizard AV, Schvartz C, et al. A time trend analysis of papillary and follicular cancers as a function of tumour size: a study of data from six cancer registries in France (19832000) [J]. Eur J Cancer, 2007, 43(3): 891900.
4. Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 19732002 [J]. JAMA, 2006, 295(18): 21642167.
5. Leenhardt L, Grosclaude P, ChériéChalline L. Increased incidence of thyroid carcinoma in France: a true epidemic or thyroid nodule management effects? Report from the French Thyroid Cancer Committee [J].Thyroid, 2004, 14(12): 10561060.
6. Liu S, Semenciw R, Ugnat AM, et al. Increasing thyroid cancer incidence in Canada, 19701996: time trends and ageperiodcohort effects [J]. Br J Cancer 2001, 85(9): 13351339.
7. Lubina A, Cohen O, Barchana M, et al. Time trends of incidence rates of thyroid cancer in Israel: what might explain the sharp increase [J].Thyroid, 2006, 16(10): 10331040.
8. Reynolds RM, Weir J, Stockton DL, et al. Changing trends in incidence and mortality of thyroid cancer in Scotland [J]. Clin Endocrinol(Oxf), 2005, 62(2):156162.
9. Smailyte G, MiseikyteKaubriene E, Kurtinaitis J. Increasing thyroid cancer incidence in Lithuania in 19782003 [J]. BMC Cancer, 2006, 6: 284.
10. AlboresSaavedra J, Henson DE, Glazer E, et al. Changing patterns in the incidence and survival of thyroid cancer with follicular phenotype－papillary, follicular, and anaplastic: a morphological and epidemiological study [J]. Endocr Pathol, 2007, 18(1): 17.
11. Bilimoria KY, Bentrem DJ, Linn JG, et al. Utilization of total thyroidectomy for papillary thyroid cancer in the United States [J]. Surgery, 2007, 142(6): 906913.
12. Mazzaferri EL, Massoll N. Management of papillary and follicular (differentiated) thyroid cancer: new paradigms using recombinant human thyrotropin [J]. Endocr Relat Cancer, 2002, 9(4): 227247.
13. Shrime MG, Goldstein DP, Seaberg RM, et al. Costeffective management of lowrisk papillary thyroid carcinoma [J]. Arch Otolaryngol Head Neck Surg, 2007, 133(12): 12451253.
14. Rosenbaum MA, McHenry CR. Central neck dissection for papillary thyroid cancer [J]. Arch Otolaryngol Head Neck Surg, 2009, 135(11): 10921097.
15. Duh QY, Sancho JJ, Greenspan FS, et al. Medullary thyroid carcinoma. The need for early diagnosis and total thyroidectomy [J]. Arch Surg, 1989, 124(10): 12061210.
16. Sippel RS, Kunnimalaiyaan M, Chen H. Current management of medullary thyroid cancer [J]. Oncologist, 2008, 13(5): 539547.
17. Veyseller B, Aksoy F, Demirhan H, et al. Total thyroidectomy in benign thyroid diseases [J]. Kulak Burun Bogaz Ihtis Derg, 2009, 19(6): 299303.
18. Barakate MS, Agarwal G, Reeve TS, et al. Total thyroidectomy is now the preferred option for the surgical management of Graves’ disease [J]. ANZ J Surg, 2002, 72(5): 321324.
19. Friguglietti CU, Lin CS, Kulcsar MA. Total thyroidectomy for benign thyroid disease [J]. Laryngoscope, 2003, 113(10): 18201826.
20. Yang W, Shao T, Ding J, et al. The feasibility of total or neartotal bilateral thyroidectomy for the treatment of bilateral multinodular goiter [J]. J Invest Surg, 2009, 22(3): 195200.
21. Hussain M, Hisham AN. Total thyroidectomy: the procedure of choice for toxic goiter [J]. Asian J Surg, 2008, 31(2): 5962.
22. Colak T, Akca T, Kanik A, et al. Total versus subtotal thyroidectomy for the management of benign multinodular goiter in an endemic region [J]. ANZ J Surg, 2004, 74(11): 974978.
23. Chiang FY, Lin JC, Wu CW, et al. Morbidity after total thyroidectomy for benign thyroid disease: comparison of Graves’ disease and nonGraves’ disease [J]. Kaohsiung J Med Sci, 2006, 22(11): 554559.
24. Ayache S, Tramier B, Chatelain D, et al. Evolution of the thyroid surgical treatment to the total thyroidectomy. Study of about 735 patients [J]. Ann Otolaryngol Chir Cervicofac, 2005, 122(3): 127133.
25. Ku CF, Lo CY, Chan WF, et al. Total thyroidectomy replaces subtotal thyroidectomy as the preferred surgical treatment for Graves’ disease [J]. ANZ J Surg, 2005, 75(7): 528531.
26. Vaiman M, Nagibin A, Hagag P, et al. Subtotal and near total versus total thyroidectomy for the management of multinodular goiter [J]. World J Surg, 2008, 32(7): 15461551.
27. Agarwal G, Aggarwal V. Is total thyroidectomy the surgical procedure of choice for benign multinodular goiter? An evidencebased review [J].World J Surg, 2008, 32(7): 13131324.
28. Acun Z, Comert M, Cihan A, et al. Neartotal thyroidectomy could be the best treatment for thyroid disease in endemic regions [J]. Arch Surg, 2004, 139(4): 444447.
29. Erbil Y, Barbaros U, Salmaslioˇglu A, et al. The advantage of neartotal thyroidectomy to avoid postoperative hypoparathyroidism in benign multinodular goiter [J]. Langenbecks Arch Surg, 2006, 391(6): 567573.
30. Unalp HR, Erbil Y, Akguner T, et al. Does near total thyroidectomy offer advantage over total thyroidectomy in terms of postoperative hypocalcemia? [J]. Int J Surg, 2009, 7(2): 120125.
31. Tezelman S, Borucu I, Senyurek Giles Y, et al. The change in surgical practice from subtotal to neartotal or total thyroidectomy in the treatment of patients with benign multinodular goiter [J]. World J Surg, 2009, 33(3): 400405.
32. Efremidou EI, Papageorgiou MS, Liratzopoulos N, et al. The efficacy and safety of total thyroidectomy in the management of benign thyroid disease: a review of 932 cases [J]. Can J Surg, 2009, 52(1): 3944.
33. Bhattacharyya N, Fried MP. Assessment of the morbidity and complications of total thyroidectomy [J]. Arch Otolaryngol Head Neck Surg, 2002, 128(4): 389392.
34. Hines JR, Winchester DJ. Total lobectomy and total thyroidectomy in the management of thyroid lesions [J]. Arch Surg, 1993, 128(9): 10601064.
35. Gundry SR, Burney RE, Thompson NW, et al. Total thyroidectomy for Hürthle cell neoplasm of the thyroid [J]. Arch Surg, 1983, 118(5): 529532.
36. Perri S, Mariani G, Trunfio A, et al. Total thyroidectomy in the surgical treatment of thyroid disease a retrospective clinical study [J]. Minerva Endocrinol, 2001, 26(2): 4151.
37. Lal G, Ituarte P, Kebebew E, et al. Should total thyroidectomy become the preferred procedure for surgical management of Graves’ disease? [J]. Thyroid, 2005, 15(6): 569574.
38. Serpell JW, Phan D. Safety of total thyroidectomy [J]. ANZ J Surg, 2007, 77(12): 1519.
39. Mandel SJ, Brent GA, Larsen PR. Levothyroxine therapy in patients with thyroid disease [J]. Ann Intern Med, 1993, 119(6): 492502.
40. Vaidya B, Pearce SH. Management of hypothyroidism in adults [J]. BMJ, 2008, 337: a801.
41. Friedman M, Pacella BL Jr. Total versus subtotal thyroidectomy. Arguments, approaches, and recommendations [J]. Otolaryngol Clin North Am, 1990, 23(3): 413427.
42. Halsted WS, Evans HM. I. The parathyroid glandules. Their blood supply and their preservation in operation upon the thyroid gand [J]. Ann Surg, 1907, 46(4): 489506.
43. Thompson NW, Olsen WR, Hoffman GL. The continuing development of the technique of thyroidectomy [J]. Surgery, 1973, 73(6): 913927.
44. 吴在德, 吴肇汉. 外科学 [M]. 北京: 人民卫生出版社, 2003: 310311.
45. Amaral JF. The experimental development of an ultrasonically activated scalpel for laparoscopic use [J]. Surg Laparosc Endosc, 1994, 4(2): 9299.
46. Roye GD, Monchik J, Amaral JF. Endoscopic adrenalectomy using ultrasonic cutting and coagulating [J]. Surg Technol Int, 2000, 9: 129138.
47. Takao S, Shinchi H, Maemura K. Ultrasonically activated scalpel is an effective tool for cutting the pancreas in biliarypancreatic surgery: experimental and clinical studies [J]. J Hepatobiliary Pancreat Surg, 2000, 7(1): 5862.
48. Miccoli P, Berti P, DonatiniG, et al. Randomized controlled trial of harmonic scalpel use during thyroidectomy [J]. Arch Otolaryngol Head Neck Surg, 2006, 132(10): 10691073.
49. Siperstein AE, Berber E, Morkoyun E. The use of the harmonic scalpel vs conventional knot tying for vessel ligation in thyroid surgery [J]. Arch Surg, 2002, 137(2): 137142.
50. Matthews B, Nalysnyk L, Estok R, et al. Ultrasonic and nonultrasonic instrumentation: a systematic review and metaanalysis [J]. Arch Surg, 2008, 143(6): 592600.
51. Parker DJ, Krupa K, Esler R, et al. Use of the harmonic scalpel in thyroidectomy [J]. ANZ J Surg, 2009, 79(6): 476478.
52. Foreman E, Aspinall S, Bliss RD, et al. The use of the harmonic scalpel in thyroidectomy: ‘beyond the learning curve’ [J]. Ann R Coll Surg Engl, 2009, 91(3): 214216.
53. Koh YW, Park JH, Lee SW, et al. The harmonic scalpel technique without supplementary ligation in total thyroidectomy with central neck dissection: a prospective randomized study [J]. Ann Surg, 2008, 247(6): 945949.
54. Cordón C, Fajardo R, Ramírez J, et al. A randomized, prospective, parallel group study comparing the Harmonic Scalpel to electrocautery in thyroidectomy [J]. Surgery, 2005, 137(3): 337341.
55. Hallgrimsson P, Lovén L, Westerdahl J, et al. Use of the harmonic scalpel versus conventional haemostatic techniques in patients with Grave disease undergoing total thyroidectomy: a prospective randomised controlled trial [J]. Langenbecks Arch Surg, 2008, 393(5): 675680.
56. Yildirim O, Umit T, Ebru M, et al. Ultrasonic harmonic scalpel in total thyroidectomies [J]. Adv Ther, 2008, 25(3): 260265.
57. Sebag F, Fortanier C, Ippolito G, et al. Harmonic scalpel in multinodular goiter surgery: impact on surgery and cost analysis [J]. J Laparoendosc Adv Surg Tech A, 2009, 19(2): 171174.
58. Manouras A, Markogiannakis HE, Kekis PB, et al. Novel hemostatic devices in thyroid surgery: electrothermal bipolar vessel sealing system and harmonic scalpel [J]. Expert Rev Med Devices, 2008, 5(4): 447466.
59. Ortega J, Sala C, Flor B, et al. Efficacy and costeffectiveness of the UltraCision harmonic scalpel in thyroid surgery: an analysis of 200 cases in a randomized trial [J]. J Laparoendosc Adv Surg Tech A, 2004, 14(1): 912.
60. Shemen L. Thyroidectomy using the harmonic scalpel: analysis of 105 consecutive cases [J]. Otolaryngol Head Neck Surg, 2002, 127(4): 284288.
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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Developing Ideas and New Instruments in Thyroid Surgery

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