To test if posterior retroperitoneoscopic adrenalectomy (PRA) is superior to lateral transperitoneal laparoscopic adrenalectomy (LTLA). Most popular LTLA has been recently challenged by an increasing popularity of PRA, which is believed by many surgeons (not evidence-based) as superior to LTLA in the treatment of small and benign adrenal tumors. Participants were assigned randomly to PRA or LTLA and followed for 5 years after surgery. The primary endpoint was the duration of surgery. Secondary endpoints were blood loss, conversion rate, postoperative recovery, morbidity, and costs. Sixty-five patients were included, of whom 61 (PRA 30, LTLA 31) completed the 5-year follow-up. The following differences were identified in favor of PRA vs LTLA: shorter duration of surgery (50.8 vs 77.3 minutes), lower intraoperative blood loss (52.7 vs 97.8 mL), diminished pain intensity within 48 hours postoperatively, lower prevalence of shoulder-tip pain (3.0% vs 37.5%), shorter time to oral intake (4.4 vs 7.3 hours), shorter time to ambulation (6.1 vs 11.5 hours), shorter length of hospital stay, and lower cost (1728 € vs 2315 €), respectively (P<0.001 for all). No differences were noted in conversion rate or morbidity except for herniation occurring more often after LTLA than PRA (16.1% vs 0%, P=0.022) and need for hernia repair (12.9% vs 0%, P=0.050), respectively. Both approaches were equally safe. However, outcomes of PRA operations were superior to LTLA in terms of shorter surgery duration, lower blood loss, lower postoperative pain, faster recovery, improved cost-effectiveness, and abolished risk of surgical access site herniation. NCT01959711 (http://www.clinicaltrials.gov).

Objective: To compare two modes of NIM Vital application in thyroid surgery: NerveTrend^TM vs. NerveAssure^TM with respect to the prevalence of postoperative recurrent laryngeal nerve (RLN) injury. Background: The use of NerveTrend^TM compared to intermittent neuromonitoring (i-IONM) in thyroid surgery has recently been reported to result in a tendency towards reduced RLN injury on postoperative day 1 (POD1) and a significant decrease in the need for staged thyroidectomy. However, it remains unclear whether this technique is inferior to continuous neuromonitoring (NerveAssure^TM). Methods: prospective, single-center, two-arm randomized clinical trial. The primary outcome was the prevalence of RLN injury on POD1. In the NerveTrend^TM group, the surgeon-operated i-IONM stimulation probe was used for trending amplitude and latency changes from the initial vagal electromyographic baseline (at pace based on surgical judgment) to tailor the surgical strategy. In the NerveAssure^TM group, it was performed using an Automatic Periodic Stimulation (APS) electrode placed on the vagus nerve. Results: A total of 264 patients were randomized into the intervention group (NerveTrend^TM) and the control group (NerveAssure^TM), 132 patients, and 264 nerves at risk (NAR), each. RLN injury was found on POD1 in 3/264 (1.14%) versus 1/264 (0.38%) NAR, whereas staged thyroidectomy was not necessary in any of the patients in the study (P=0.624 and P=1.0, respectively). Conclusions: NerveTrend^TM mode was not inferior to the NerveAssure^TM mode in thyroid surgery with respect to the risk of RLN injury, and both modes had the potential to abolish the need for staged thyroidectomy.

Background: An accurate diagnosis of thyroid nodules is crucial for avoiding unnecessary surgical procedures and making timely treatment possible. The objective of the present study was to evaluate the diagnostic accuracy of fine-needle aspiration biopsy (FNAB) using histopathological findings as the reference standard. Patients with the diagnostic categories (DCs) III, IV, and V were subjected to special analysis. In addition, the authors assessed whether other factors, including age, gender, body mass index (BMI), obesity, and histopathologically confirmed lymphocytic thyroiditis, had an impact on the occurrence of malignant tumors. Methods: We performed a retrospective analysis of 535 patients (with a mean age of 52.3) who underwent thyroid surgery between October 2022 and September 2023 at the Department of Endocrine Surgery at the University Hospital in Krakow. To assess the reliability of FNAB, the results obtained using the Bethesda classification were compared with the histopathological results. Results: The risk of malignancy (ROM) values for DCs I–VI were 38.1%, 15.6%, 29.8%, 18.6%, 91.0%, and 93.2%, respectively. DC V (OR 62.34, p < 0.0001) and an age ≤ 50 (OR = 2.31, p < 0.006) had statistically significant effects on the risk of thyroid cancer. DCs III and IV were not statistically significantly associated with the risk of malignancy (OR = 1.68, p = 0.16; OR = 1.51, p = 0.3, respectively). There were no statistically significant differences in sex, BMI, or obesity between the patients with benign and malignant lesions. Conclusions: DC V is associated with a high likelihood of malignancy, especially in patients under 50 years of age, and, therefore, surgery is indicated in this category of subjects. In DCs III and IV, the risk of malignancy is lower, and conservative management with active clinical and ultrasound surveillance can be considered. In patients < 50 years of age, with Bethesda categories III and IV, surgical treatment should be considered.

Primary hyperparathyroidism (PHPT) is rare in children but exhibits a more dynamic course than in adults, often leading to multiorgan complications if diagnosis is delayed. This article aims to highlight diagnostic challenges of parathyroid adenomas in children and discuss associated complications from delayed diagnosis. Three boys, aged 15.5, 10, and 16 years, were retrospectively analyzed for hypercalcemia. The diagnosis was based on biochemical and hormonal tests, as well as imaging studies (ultrasound, scintigraphy, and densitometry). The mean diagnosis delay was 20 months (9–35). All boys experienced appetite loss and bone symptoms. Patient 1 was initially misdiagnosed with slipped capital femoral epiphysis (SCFE) and underwent orthopedic surgery without recognition of severe hypercalcemia. Patient 2 was misdiagnosed with vasopressin deficiency following a tibia fracture. Patient 3’s symptoms were attributed to stress. All patients had parathyroid adenomas, but Patients 2 and 3 had an ectopic thymus location. Following adenoma excision, Patients 2 and 3 developed hypocalcemia, the lasting consequences of which included nephrocalcinosis and low bone mass; Patient 3 also developed hypertension and depression. Conclusions: (1) any child presenting symptoms such as loss of appetite, abdominal pain, weight loss, depression, or bone abnormalities must urgently have serum calcium levels assessed to exclude PHPT. (2) Delayed diagnosis of PHPT in children is dangerous, as it leads to irreversible organ damage, including severe bone loss, nephrocalcinosis, and hypertension. (3) Comprehensive hormonal and genetic evaluation prior to surgery is essential, along with prompt correction of hypocalcemia to minimize complications and improve treatment outcomes. (4) After parathyroid adenoma removal, intensive calcium and vitamin D supplementation is required to prevent hungry bone syndrome and support proper bone recovery. (5) Due to the significant risk of disease recurrence, children with PHPT require long‐term endocrine follow‐up and thorough genetic testing, enabling early detection of relapse and timely intervention.

Objective: This study assessed the relationship between serum calcium (Ca) and parathyroid hormone (PTH) levels, the size and weight of the enlarged parathyroid gland (PG), and the results of technetium-99m-metoxyisobutylisonitrile (MIBI) parathyroid scintigraphy with single-photon emission computed tomography/computed tomography. Methods: Among 252 patients who underwent surgery for hyperparathyroidism between October 2022 and March 2025 at the Department of Endocrine Surgery of the University Hospital in Krakow, 212 patients with primary hyperparathyroidism (PHPT) were selected and divided into the MIBI(−) (n = 49) and MIBI(+) (n = 163) groups. Results: MIBI was positive in 76.9% and negative in 23.1% patients with PHPT. Mean PTH in the MIBI(+) and MIBI(−) groups was 177.3 ± 144.7 and 127.7 ± 59.4 pg/mL, respectively. Significant differences were found in PTH (p < 0.01), maximum excised PG size (p < 0.01), and weight (p < 0.01). PTH predicted positive scintigraphy in univariate analysis (OR = 2.65; 95% CI: 1.19–5.89; p = 0.02) and showed a borderline association in the multivariate model (OR = 2.47; 95% CI: 0.95–6.41; p = 0.06). Optimal cut-offs for predicting MIBI positivity were 135.0 pg/mL for PTH (AUC = 0.64), 0.73 g for PG weight (AUC = 0.81), and 18.0 mm for PG maximum size (AUC = 0.78). The Wisconsin index (Ca × PTH) was associated with positive MIBI (OR = 2.58; 95% CI: 1.15–5.78; p = 0.02), with an optimal cut-off of 256.0. Serum total Ca levels showed no significant association with positive MIBI (p = 0.60). Conclusions: Serum PTH levels, Wisconsin index, and enlarged PG size and weight may help predict parathyroid scintigraphy outcomes.

Background: Our study investigated the association between chronic lymphocytic thyroiditis (CLT) and thyroid cancer (TC). Methods: A retrospective review of 1670 patients who underwent thyroid surgery between October 2022 to February 2025 was performed. The clinicopathological characteristics of patients with TC and CLT were collected. CLT was diagnosed histopathologically. Results: Patients with a positive CLT result (60.39%) compared to a negative CLT result (34.12%) had more frequently TC (p < 0.001), predominantly PTC. In univariate analysis, patients with malignancy + CLT-positive compared to malignancy + CLT-negative were found to be younger in age (p < 0.001), female gender (p < 0.001), smaller tumours focus (p = 0. 013), smaller mass of thyroid removed (p < 0.001) and more often Bethesda category V and VI (p = 0.019), true positive fine needle aspiration biopsy (FNAB) for PTC (p = 0.009), and microcarcinoma (p = 0.021). There were no differences in multifocality, the presence of LNM, or the number of LNMs. The location of metastases at neck lymph nodes was at the borderline of significance (p = 0.065). In multivariate analysis, after accounting for Bethesda and age, CLT+ was found to increase the risk of TC by 73% (OR = 1.73; 95%CI, 1.15-2.29), while the risk of PTC increased more than 2-fold (OR = 2.12; 95% CI, 1.45–3.11). CLT had no statistically significant effect on the presence of LNM. Conclusions: We found that CLT is a risk factor for TC. One should be vigilant concerning the coexistence of these two diseases. We suggest that total thyroidectomy should be considered in patients referred for thyroid nodules and suspected CLT. However, this issue requires further research.