Redo thyroidectomy: A modified technique to eliminate complications

Abstract

Introduction: Reoperation is the most challenging task in thyroid surgery because of the high risk of complications. This study aims to demonstrate the efficacy of a modified thyroidectomy technique in decreasing associated complications to almost zero in recurrent thyroidectomy. Methods: This single-group cohort study enrolled consecutive patients who had a recurrent thyroidectomy. The patients were examined for vocal cord motility preoperatively. The procedures were done by high-volume surgeons using a modified thyroidectomy technique, which included the following steps:1) Finding and preserving parathyroid glands before searching for the recurrent laryngeal nerve; 2) Expecting the recurrent laryngeal nerve in any area of the neck until it is found; 3) Starting the dissection in the suprasternal notch to find the recurrent laryngeal nerve in the tracheoesophageal groove; 4) If the nerve was not found in the suprasternal notch, the search would continue at the nerve's expected entrance to the cricoid cartilage. Results: In total, 195 cases with redo thyroidectomy were enrolled in this study. Female patients (173, 88.7%) were predominant compared to males (22, 11.3%). The most common ultrasonographic finding was multinodular goiter in 138 cases (70.7%). Most of the cases underwent total thyroidectomy (160, 82%), and thyroid lobectomy was performed in 35 cases (18%). In all the cases that underwent total thyroidectomy, both recurrent laryngeal nerves were explored, and the concerned lateral recurrent laryngeal nerve was seen during the thyroid lobectomies. There was no injury to recurrent laryngeal nerves, and only 15% of the cases suffered from temporary hypocalcemia. Conclusion: Recurrent thyroidectomy without significant complications is possible when conducted by high-volume surgeons, and a modified technique is used.