Risk facrors and protection of parathyroid in Da Vinci robotic thyroidectomy

Abstract

Objective To analyze the risk factors responsible for hypoparathyroidism and investigate the technique for preserving parathyroid in Da Vinci robotic thyroidectomy, avoiding the permanent hypoparathyroidism. Methods Totally 190 cases of patients performed da vinci robotic thyroidectomy were reviewed retrospectively from Jan. 2014 to May. 2016 in the General Hospital of Jinan Military Command of PLA.The incidence and relevant factors of hypoparathyroidism and hypocalcemia were evaluated, and ways to protect the parathyroid glands were assessed. Results In all the patients, 39 patients were hypoparathyroidism with the incidence rate of 20.53%, and 45 cases were transient hypocalcemia with the incidence rate of 23.68%. Permanent hypoparathyroidism did not happen. In robotic thyroidectomy, compared with unilateral lobectomy, total thyroidectomy resulted in higher incidence of hypoparathyroidism and hypocalcemia (χ2=14.789, 11.604; P=0.000, 0.001). The comparison between patients receiving central compartment lymph node dissection or not had the same result (χ2=11.200, 17.771; P=0.001, 0.000). Compared with parathyroid left in situ, parathyroid resection with parathyroid autotransplantation more likely to lead to hypoparathyroidism (χ2=5.536, 4.851, 6.140, 5.453; P=0.019, 0.028, 0.013, 0.020). Conclusions In da vinci robotic thyroidectomy, total thyroidectomy, central compartment lymph node dissection and parathyroid excision with parathyroid autotransplantation are associated with transient hypoparathyroidism significantly. In da vinci robotic thyroidectomy, it should be paid more attention to accurate identification of parathyroid, precise action in operation and protection of parathyroid glands and its blood supply to prevent postoperative permanent hypoparathyroidism. Key words: Robotic surgical procedures; Thyroidectomy; Hypoparathyroidism; Hypocalcemia; Complications