Highlights from APTS 2024, Bangkok

APTS Board Meeting. Bangkok, Oct 4, 2024.

Again the feeling of being at the cutting edge in Thyroid Surgery. APTS 2024 is over after three days of thrilling debate among world experts in Bangkok. I will just briefly summarize some of the highlights from my personal point of view.

Yoon Woo Koh (Severance Hospital, Yonsei University, Seoul), probably the single surgeon worldwide with the highest personal case-load in robotic surgery in the Head&Neck, did update the numbers on the use of the da Vinci Single Port (SP). The da Vinci SP is used at Yonsei both for TORS and for Remote Access neck surgery, either for neck dissection (ie. retroauricular approach) or TransOral Robotic Thyroidectomy (TORT), which is a gasless technique when using the SP.

Yoon Woo Koh. Severance Hospital. Yonsei Universiy. Seoul (Korea).

Sang Wook Kang did insist in the benefits of the axillary approach for the lateral neck and the thyroid. He argued that the elevation of the skin flap is performed at the chest, while upon reaching the lateral edge of the ECM muscle the dissection proceeds under it.

Although the problem with the axillary approach continues to be that the scar is consistently a bad scar (which depending on the part of the world and the culture might be or not a relevant issue), it is clear that there are many possible approaches Open to Robot.

Arsenio Cabungcal did discuss the particularities of thyroid cancer in the population of the Philippines.

Dr Arsenio Cabungcal. Lecture on “Race and Ethnicity.

No doubt parathyroid glands fluorescence in one of the hot topics. Fredric Triponez (Geneve) presented his experience with the use of autoflurescence (AF), and proposed a protocol for the sequential use of AF and fluorescence after indocianine green (ICG) injection. It is important to remember that AF does not provide information on the viability of the parathyroid glands, and that it is not possible to use it after the ICG injection. This topic deserves an specific post (soon).

Fredric Triponez (Geneva) proposed a sequence to use autofluorencence (AF) and indocianine green (ICG) for the identification and preservation of the parathyroid glands in thyroid gland surgery. At the table (left to right) Gregory Randolph (Boston), Quan Yang Duh (San Francisco) and Kyung Tae (Seoul).

Akira Miyauchi (Kobe) was one of the key-note speakers. I will discuss bellow the update on active surveillance, but first let´s review a proposal for laryngeal nerves monitoring in thyroid surgery, including a systematic effort for the identification of the superior laryngeal nerve (SLN). It is widely acknowledged among experts that the incidence to the SLN damage (which is unknown) is probably very common.

Akira Miyuauchi. Proposal of 3 steps for laryngeal nerves monitorization in thyroid surgery.

So, active surveillance. Already 30 years going on, with strong literature support. Observation is and option for patients with low-risk papillary thyroid cancer. See some updated data on the slides bellow. Take your time to review the last one on unfavourable events for each of the options (active surveillance vs immediate surgery)

My own contribution on new possible technological options.

There is a clear trend towards avoiding total thyroidectomy, as most of the patients with low-risk well differentiated thyroid cancer can be managed with lobectomy. Jyoti Dabholkar (India), president of the Indian Society of Thyroid Surgeons discussed this topic, along with the Indian Guideline for Thyroid Cancer, supported by Jatin P Shah.

Ilya Sleptsov (Russia) did support an unusual technique for thyroidectomy from medial to lateral, and gave a detailed lecture on the surgical technique itself and the reasons to opt for it.

Giuseppe Mercante (Milan) showed a technique for US-guided wire positioning for the surgical management of multiple locoregional recurrences of differentiated thyroid cancer.

And of course, countless valuable insights from other colleagues and friends like Kyung Tae, Gregory Randolph, Angkoon Anuwong, Dan Fliss, Luiz Kowalsky, Kyung Ho Kang and many others.