Abstract
Abstract Background and aims. The safety of thyroid surgery in terms of recurrent laryngeal nerve palsy and hypoparathyroidism was increasing in the last decade. In this study, we present a new method of tension-free thyroidectomy (TFT), which could be used to further decrease the complication rate after thyroidectomy. Patients and Methods The procedure is based on the medial approach to the recurrent laryngeal nerve and the parathyroid glands after the division of isthmus and successive total dissection of Barry ligament. One hundred consecutive patients (128 nerves at risk) underwent "tension-free thyroidectomy" (TFT) from August to November 2021 performed by one surgeon. There were 80 females and 20 male patients (ratio 4: 1) with a mean age of ninety-two 46,4 (range from 17 to 75). Lobectomy was carried out in 74 (74%) patients, total thyroidectomy in 26 (26%). In 42 cases patients additionally underwent central or/and lateral neck dissection. Indications for surgery were papillary carcinoma (N=52), medullary cancer (N=2), follicular neoplasia - Bethesda IV group after fine-needle biopsy (N=46). Mean thyroid nodule size was 25,3 mm (ranged 7 - 120 mm). Intraoperative transient neuromonitoring was used in all the cases (5 mA), in 20 cases permanent neuromonitoring was also used. Translaryngeal untrasound or direct laryngoscopy were routinely used prior and after surgery to evaluate vocal cords mobility. Calcium and parathormone level were measured in patients after thyroidectomy on the first, 14th and 30th postoperative days. Results The mean operating time of lobectomy was 80±39 (range: 25-120), for total thyroidectomy 80 ±36 (range: 55-130). There was no conversion to the conventional lateral-to-medial approach. No fluctuation of electric activity of laryngeal nerves during surgery was revealed. Intraoperative loss of signal (LOS) due to thermal effect of electrocautery and subsequent transient unilateral laryngeal nerve palsy occurred in 3 cases (2,3% from the total number of nerves at risk). In all these patients normal vocal fold function was confirmed on the 30th day after surgery. No permanent nerve palsy cases revealed. Three patients (out of 26 in the total thyroidectomy group – 11,5%) exhibited a decrease of parathyroid hormone level on the postoperative day 1 which was resolved in two weeks under the substitution therapy with calcium and alfacalcidol. No cases of permanent hypoparathyroidism occurred. Conclusion TFT (tension-free thyroidectomy) can be considered a safe and feasible operation in patients with thyroid cancer and follicular neoplasia. Larger and comparative (randomized) studies with conventional dissection technique should be performed to investigate the hypothesis that this approach can provide a lower complication rate. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.
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