Parathyroid Function after Total Thyroidectomy: A Randomized Clinical Trial Concerning the Influence of the Surgical Technique

Background:The insufficient reliability of preoperative imaging technology and limited convenience of intraoperative visualizing techniques have been associated with difficulty in surgical navigation in neck endocrine surgery. Indocyanine green (ICG) fluorescence imaging has stood out as the real-time intraoperative guide amidst research for novel modalities, with an emerging use in endocrine surgery.Methods:We performed a systematic review of the PubMed, Scopus and Embase databases, to identify published studies on parathyroid and thyroid operations employing ICG. Well-described articles were selected according to 7 criteria and analyzed per operation type and organ structure.Results:Twenty-one articles matched our selection criteria. Dosage, equipment, and techniques are well-described in literature. ICG was found to significantly enhance the surgical experience and outcomes. Occasional discrepancy among studies was attributed to the lack of standard quantification of values and divergence of study designs.Conclusion:The most successful applications of ICG are:delineation of hyperplastic or adenomatous or ectopic parathyroids,decision making during subtotal parathyroidectomy,preservation of parathyroid function in thyroid operations andreoperation after failed past neck exploration.Future research is needed for standard quantification of fluorescence intensity and objective comparisons.

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“…[17] Moreover, TT has been shown to impair PG function even in cases of no clinical postoperative hypocalcemia. [18]…”

Section: Resultsmentioning

confidence: 99%

The use of Indocyanine green in endocrine surgery of the neck

et al. 2019

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“…A summary of study characteristics and collected baseline patient variables can be found in Tables 1 and 2 , respectively. 6,8,9,14-33…”

Section: Resultsmentioning

confidence: 99%

Comparing Hematoma Incidence between Hemostatic Devices in Total Thyroidectomy: A Systematic Review and Meta‐analysis

Hua

Quimby

Johnson‐Obaseki

2019

Otolaryngol.--head neck surg.

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Objective Alternative energy devices have become a popular alternative to conventional hemostasis in thyroid surgery. These devices have been shown to reduce operative time and thermal nerve injury. As hemostasis is paramount in thyroid surgery, we sought to examine the relative efficacy of 2 alternate energy devices compared to conventional hemostasis in preventing postoperative hematoma following total thyroidectomy. Data Sources Ovid MEDLINE, EMBASE, PubMed, and Cochrane Central Register of Controlled Trials. Review Methods A systematic literature search was performed for all relevant English-language studies published between 1946 and July 2018. Two authors independently extracted data and analyzed articles for quality using the National Institute of Health Quality Assessment Scale. Our primary outcome of interest was hematoma requiring reoperation. Results A total of 348 studies were screened, with 23 meeting the inclusion criteria. We found no significant difference in postoperative hematoma rates using alternate energy devices compared to conventional hemostasis ( P = .370, .317). Network meta-analysis echoed the results of conventional meta-analysis, demonstrating no significant difference in hematoma rates. Conclusions We found no significant difference in postoperative hematoma rates following total thyroidectomy for any indication with the use of alternate energy devices compared to conventional hemostatic techniques. This suggests that hematoma occurrence does not necessarily need to be considered when choosing between these hemostatic devices. This information may help guide surgeons’ decisions regarding choice of hemostatic technique during thyroid surgery.

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“…Total Thyroidectomy is associated with significant complications, and surgical techniques are one of the important factors which may affect the rate of post thyroidectomy complications [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…In contrast, impaired postoperative parathyroid function with lower PTH level was noticed in total harmonic scalpel thyroidectomy than in the classic clamp-and-tie group [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

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Parathyroid hormone level after total thyroidectomy using conventional versus harmonic focus technique: Prospective randomized study

Elhady

Elghany

Zarad

2022

Annals of Medicine &Amp; Surgery

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Background Total thyroidectomy is a common procedure, we wish to examine the effects of utilizing a harmonic scalpel with traditional procedures on parathyroid hormone levels. Patients and methods 100 patients who underwent total thyroidectomy at the Department of General Surgery, were enrolled in this prospective randomized study, were randomly allocated into two equal groups: Group I: total thyroidectomy using a harmonic scalpel (HS) and Group II: total thyroidectomy using conventional technique. Results There is a significant association between the technique of surgery and the decrease in Postoperative PTH, Mean Difference, Pre and Postoperative and the change Pre PTH (p-value <0.001). Conclusion The postoperative serum level of parathyroid hormone declined significantly after thyroidectomy if the conventional method was used. Using HS during thyroidectomy is safe and effective with low rates of hypoparathyroidism.

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Parathyroid Function after Total Thyroidectomy: A Randomized Clinical Trial Concerning the Influence of the Surgical Technique

Cited by 10 publications

References 18 publications

The use of Indocyanine green in endocrine surgery of the neck

The use of Indocyanine green in endocrine surgery of the neck

Comparing Hematoma Incidence between Hemostatic Devices in Total Thyroidectomy: A Systematic Review and Meta‐analysis

Parathyroid hormone level after total thyroidectomy using conventional versus harmonic focus technique: Prospective randomized study

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