Surgical tips and techniques to avoid complications of thyroid surgery

Stefanou, Christos K; Παπαθανάκος, Γεώργιος; Stefanou, Stefanos K; Tepelenis, Kostas; Kitsouli, Aikaterini; Barbouti, Alexandra; Tsoumanis, Periklis; Kanavaros, Panagiotis; Kitsoulis, Panagiotis

doi:10.1515/iss-2021-0038

Cited by 8 publications

(16 citation statements)

References 46 publications

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“…Thyroid surgery is rarely associated with patients’ mortality but can be followed by a significant complication. The perfect thyroidectomy includes removing the gland with the salvation of RLN, EBSLN, and parathyroids together with the least amount of blood loss 15 – 17 .…”

Section: Discussionmentioning

confidence: 99%

An assessment of the role of surgical loupe technique in prevention of postthyroidectomy complications: a comparative prospective study

Nagaty¹,

Shehata²,

Elkady³

et al. 2023

Annals of Medicine &Amp; Surgery

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Objective: The magnification technique offered by surgical loupe is a new method that enhances visualization and helps head and neck surgeons with recurrent laryngeal nerve (RLN) and parathyroid glands identification. This study aimed to assess the safety and efficacy of using binocular surgical loupes in thyroidectomy procedures. Material and Methods: Eighty patients with thyroid nodules who underwent thyroidectomy procedure were divided randomly into two comparable groups, group A subjected to thyroidectomy by using binocular magnification loupe, group B underwent conventional thyroidectomy without using magnification. Patients’ demographics, operation time, and postoperative morbidities were recorded. All cases had preoperative and postoperative vocal cords assessment by video laryngoscopy. Pathology, laboratory, and radiology investigations were also conducted. Results: Out of 80 patients, there were 58 females and 22 males. Benign thyroid pathology was found in 74 patients and malignant pathology in 6 patients. The mean operating time was 106 min in group A compared to 138.5 min in group B. The mean amount of intraoperative bleeding was 30 ml in group A while 50 ml in group B. There were no cases of the external branch of the superior laryngeal nerve in both groups; there was better identification in group A. There was only one patient who suffered from a temporary RLN injury in group A, while three cases of temporary and one case of permanent RLN injury were recorded in group B. Permanent hypoparathyroidism was diagnosed in only one patient in group B. Conclusion: The utilization of binocular surgical loupe magnification in thyroid surgery is considered a safe and effective maneuver that has the advantages of decreasing the overall operating time and significantly reducing postoperative complications.

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Section: Discussionmentioning

confidence: 99%

An assessment of the role of surgical loupe technique in prevention of postthyroidectomy complications: a comparative prospective study

Nagaty¹,

Shehata²,

Elkady³

et al. 2023

Annals of Medicine &Amp; Surgery

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“…In this regard, the proper identification of RLN during thyroid surgery through sufficient knowledge of the surgical anatomy and the assistance of reliable anatomical landmarks along the course of the nerve is considered of critical importance, given that it minimizes the risk of injury [ 3 5 6 7 8 ]. Hence, the direct inspection and complete exposure of RLN during thyroidectomy using crucial anatomical landmarks have become the gold standard method for the preservation of RLN and to prevent inadvertent injury to the nerve [ 2 5 6 7 9 ].…”

Section: Introductionmentioning

confidence: 99%

“…The superior parathyroid gland (SPG) has a relatively constant location and a more consistent relationship with RLN compared to the inferior parathyroid gland while sparing the parathyroid gland is a routine procedure during thyroidectomy [ 7 10 11 12 ]. However, despite these advantages, the use of SPG as a potential landmark in localizing RLN during thyroidectomy has only been addressed by a few studies [ 11 12 ].…”

Section: Introductionmentioning

confidence: 99%

The use of superior parathyroid gland as an anatomical landmark in identifying recurrent laryngeal nerve during total thyroidectomy: a prospective single-surgeon study

Gurluler

2024

Ann Surg Treat Res

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Purpose This study was performed to determine the anatomical position of recurrent laryngeal nerve (RLN) relative to superior parathyroid gland (SPG) in a consecutive total thyroidectomy series. Methods A total of 421 patients (mean age, 45.6 years; female, 76.0%) who had total thyroidectomy accompanied with intraoperative exposure of RLN in relation to SPG were included in this prospective single-surgeon thyroidectomy series study. The relation of RLN to SPG was assessed based on the measurement of the natural distance between the RLN and SPG, which was categorized as 0–5 mm, 6–10 mm, and ≥11 mm. Results Most of the thyroidectomy indications (69.1%) were related to malignant disease including papillary carcinoma in 54.9% of cases. Overall, in 90.7% of patients RLN was identified within 5 mm of the SPG, and in 65.1% of cases, it was found within 1 mm of the SPG. The RLN was found between 6 and 10 mm from the SPG in 8.5% of cases, while it was at least 11 mm away from the SPG in 0.7% of cases. Conclusion In conclusion, this prospective single-surgeon thyroidectomy series study indicates the likelihood of localizing the RLN in close proximity to SPG during total thyroidectomy operations. Hence, the SPG can be used as a landmark to identify RLN, and as part of routine parathyroid-sparing thyroidectomy, it may represent a convenient complementary approach to minimize the risk of iatrogenic injury to RLN in patients with an intact SPG.

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“…Thyroid surgery mandates the surgeons’ expertise and in-depth knowledge of the surgical anatomy and embryogenesis, due to considerable risk of complications such as injury to the recurrent laryngeal nerve (RLN), superior laryngeal nerve, or the parathyroid glands which may result in profound lifelong consequences for the patients ( 1 – 4 ).…”

Section: Introductionmentioning

confidence: 99%

“…The direct inspection and complete exposure of RLN during thyroidectomy using the crucial anatomical landmarks such as inferior thyroidal artery, the ligament of Berry, thyroid cartilage and the Zuckerkandl's tubercle (ZT), has become the gold standard method to prevent the inadvertent injury to the nerve, while the parathyroid-sparing surgery is a routinely applied procedure in thyroidectomies to prevent the postoperative hypoparathyroidism ( 3 , 4 , 10 – 14 ).…”

Section: Introductionmentioning

confidence: 99%

The use of Zuckerkandl's tubercle as an anatomical landmark in identifying recurrent laryngeal nerve and superior parathyroid gland during total thyroidectomy: a prospective single-surgeon study

Gurluler

2023

Front. Surg.

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ObjectiveTo determine the incidence and characteristics of Zuckerkandl's tubercle (ZT), and its relationship with recurrent laryngeal nerve (RLN) and the superior parathyroid gland (SPG) in the setting of total thyroidectomy.MethodsA total of 421 patients (mean (min-max) age: 45.6 (18–78) years, 76.2% were females) who had total thyroidectomy were included in this prospective single-surgeon thyroidectomy series study. Patient demographics and thyroidectomy indications (benign and malignant) were recorded in each patient. The presence, grade and laterality of ZT, and its relationship with RLN and SPG were recorded during surgery.ResultsMost of the thyroidectomy indications (69.1%) were related to a malignant disease. The ZT was unrecognizable in 41(9.7%) of 421 patients. In 380 patients with identifiable ZT, the grade 2 (46.3%) ZT was the most common finding. Majority of ZTs (92.9%) were unilaterally located (right-sided: 64.9%; left-sided: 35.1%). In majority of the cases (83.2%), the RLN was found to lie medial to ZT. Overall, SPG was identified in close proximity to ZT in 66.6% of patients (Class 2 [0.5–1 cm from ZT] in 46.6% and Class 3 [<0.5 cm from ZT] in 20.0%). SPG was more likely to be identified in close proximity to ZT when the grade of ZT was higher, which was found to be located 0.5–1 cm from the ZT in 56.9% and 42.7% of grade 2 and grade 3 ZTs, respectively, and <0.5 cm from the ZT in 46.1% of grade 3 ZTs.ConclusionIn conclusion, this prospective single-surgeon thyroidectomy series study indicates the likelihood of localizing the RLN medial to ZT, and the SPG in close proximity to ZT during total thyroidectomy operations. Hence, the ZT can be used as a reliable and constant landmark to localize both the RLN and the SPG during thyroid surgery, which enables minimizing the risk of iatrogenic injury to RLN, while ensuring a parathyroid-sparing thyroidectomy. The thyroid surgeon should have complete knowledge of thyroid gland anatomy and embryogenesis and should follow a careful and meticulous approach particularly for dissections around larger ZTs, given the increased likelihood of SPG and RLN to be in close proximity.

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Surgical tips and techniques to avoid complications of thyroid surgery

Cited by 8 publications

References 46 publications

An assessment of the role of surgical loupe technique in prevention of postthyroidectomy complications: a comparative prospective study

An assessment of the role of surgical loupe technique in prevention of postthyroidectomy complications: a comparative prospective study

The use of superior parathyroid gland as an anatomical landmark in identifying recurrent laryngeal nerve during total thyroidectomy: a prospective single-surgeon study

The use of Zuckerkandl's tubercle as an anatomical landmark in identifying recurrent laryngeal nerve and superior parathyroid gland during total thyroidectomy: a prospective single-surgeon study

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