Microscopic Thyroidectomy: The Way We Do It
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ORIGINAL ARTICLE
Microscopic Thyroidectomy: The Way We Do It Satish Jain1 • Nitika Gupta2 • Rohan Gupta3 • Ajay Jain1 • Tekyam Sreepathy Naidu3
Received: 26 March 2020 / Accepted: 2 April 2020 Ó Association of Otolaryngologists of India 2020
Abstract The present study was conducted with an intent to document the reduced morbidity in terms of postoperative hypocalcemia, injury to recurrent laryngeal and external branch of superior laryngeal nerve, in patients undergoing microscope assisted thyroidectomy. The present study enrolled a total of 878 patrients who underwent hemi, total and completion thyroidectomies, over a period of 3 years at Jain ENT Hospital, Jaipur. In the present study, out of 1118 RL nerves dissected temporary paresis was found in 1.52% and permanent palsy in only 0.36%. Temporary hypocalcemia was seen in 8.12% while permanent hypocalcemia in 0.6% patients. EBSLN could be identified in 1082 of the 1118 nerves dissected. We recommend the use microscope routinely for all thyroid surgeries, starting from the very first step in view of the reduced morbidity that it offers. Keywords Microscopic Thyroidectomy Recurrent laryngeal Parathyroid
Introduction Thyroid surgery was started by Kocher in 1878 and since that day the technique to perform thyroidectomies has continuously evolved. There is now increased awareness about techniques to reduce morbidities of thyroid surgery,
& Nitika Gupta [email protected] 1
Jain ENT Hospital, Jaipur, India
2
Department of ENT, GMC, Kathua, India
3
SMVD Narayana SSH, Katra, India
decreasing it to around 0.065% as compared to the data of early 1900s [1]. The most feared complication following thyroidectomy is recurrent laryngeal nerve injury [2]. Injury to RLN results in variable changes which may have an important impact on a patient’s life, like phonation and breathing difficulties [2–6]. RLN injury is a relatively frequent complication with its incidence reported to range from 0 to 4% for permanent and from 0 to 15% for transient injury [2–7]. A deep and thorough knowledge of the surgical anatomy and the route of the nerve is required to protect it from injury [2–4]. Another nerve which is at risk of injury during thyroid surgery is the external branch of superior laryngeal nerve. It is located anatomically in close proximity to the superior thyroid artery and its branches and is therefore at risk while ligating the vessels at the superior pole of the thyroid gland. Most surgeons do not routinely identify this nerve but identification is advocated to preserve the function of the nerve, especially in professional voice users. Cernea et al. [8] and Kierner et al. [9] classified the relationship of external branch of superior laryngeal nerve and superior thyroid artery. The most common complication after total thyroidectomy is postoperative hypocalcemia [10–13], which impacts the quality of life due to the need for lifetime supplementation, regular visits to the hospital and significant long-term financial burden. The estimated prevalence of posto
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