The aim of this study was to evaluate the feasibility and safety of SILS for totally extraperitoneal inguinal hernia repair in elderly patients. A retrospective analysis of 365 patients who underwent of SILS for totally extraperitoneal inguinal hernia repair from January 2012 to November 2015 at Osaka Police Hospital was performed, and the outcomes of patients aged <80 years and those aged ≥80 years were compared. There was a greater proportion of patients with an ASA score ≥3 among those ≥80 years than among those <80 years. The mean operative time for unilateral inguinal hernia was 94 min in patients <80 years and 98 min in patients ≥80 years. The mean operative time for bilateral inguinal hernia was 133 min in patients <80 years and 130 min in patients ≥80. Intraoperative bleeding was minimal in all patients. Conversion to a different operative procedure occurred in 3% (10/322) of patients <80 years and in 5% (2/43) of patients ≥80 years (P = 0.6). The mean postoperative hospital stay was 2.2 days for patients <80 years and 2.2 days for patients ≥80 years. The mean follow-up period 21 ± 14 months (range, 3-50 months) for patients <80 years and 17 ± 14 months (range, 3-50 months) for patients ≥80 years (P = 0.3). Postoperative complications were seen in 12% (38/322) of patients <80 years and in 14% (6/43) of patients ≥80 years (P = 0.7). A seroma was seen in 9% (28/322) of patients <80 years and in 12% (5/43) of patients ≥80 years (P = 0.6). A wound infection occurred in 2% (8/322) of patients <80 years. These seromas and wound infections were managed conservatively. Pulmonary embolism was seen in one patient <80 years (0.3%). There was no mortality or recurrence in either group. SILS for totally extraperitoneal inguinal hernia repair has good cosmesis and can be performed in elderly patients with acceptable morbidity and mortality.

SILS-TEP could be safely performed in patients with PLAS and achieved better cosmetic outcomes than conventional laparoscopic surgery.

SILS seems safe and feasible for a wide range of procedures. Based on our findings, we believe that SILS-LA could be a useful teaching procedure for resident doctors to perform on selected patients, under the guidance of an experienced staff surgeon.

SILS-TEP was performed safely, with low morbidity and no recurrence, by the resident surgeons under appropriate guidance by staff surgeons.

BackgroundSome poorly differentiated thyroid carcinomas (PDTC) arise from pre-existing, well-differentiated carcinomas of follicular cell origin; however, others most likely arise de novo. The case of a PDTC adjacent to a pre-existing nodular goiter is very rare.Case presentationA patient had a PDTC, a widely invasive, cellular tumor with cells that lacked the nuclear features of a papillary thyroid carcinoma. Carcinoma cells were arranged in trabecular, solid, and microfollicular histological patterns and displayed high mitotic activity. A nodule partially encapsulated in a thick fibrous capsule was found adjacent to the PDTC. The nodule was composed of small or dilated follicles, without papillary carcinoma-like nuclear features, that were consistent with a nodular goiter. The PDTC showed a high Ki-67 labeling index and an NRAS gene mutation (codon 61, Q61K).ConclusionThese results support our diagnosis of a PDTC, probably arising from a nodular goiter.

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DepartmentsofEndocrineandBreastSurgery 1) andDiagnosticPathology 2) ,OsakaPoliceHospital A60-year-oldwomanpresentedwithadiffusetumormainlyintherightlobeofthethyroidgland, involvingtherightinternaljugularveinandtrachealcartilageandmultiplepulmonarymetastases,which grewrapidly.Basedontheclinicalcourseandacytology,thecytologicalfindingsthediagnosisofundifferentiated carcinoma of the thyroid gland (suspected anaplastic carcinoma) was made (T4aEx2N1aM1 stageIVC).Sincetherewasariskofcausingoncologicalemergencyduetobilateralrecurrentnerveparalysis,lenvatinibwasstartedimmediately.Apartialresponse(PR)wasachievedwithin2weeksandthe patientwasmaintainedonlenvatinibfor2yearsand2months.Atthattime,thepatientunderwenttotal thyroidectomy without leaving gross residual tumor for local control. The pathological diagnosis was widelyinvasivefollicularcarcinomawithextensivescarringofthetumorotherthantheintravascularlesion. Lenvatinib was resumed following I -131 therapy and again a PR was maintained for 1 year and 4 months. We report a case of advanced thyroid cancer that was successfully treated with a multidisciplinaryapproach,withareviewoftheliterature.

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