Safe total thyroidectomy by using intraoperative methylene blue spray

Abstract

Background Intraoperative localization and preservation of recurrent laryngeal nerve (RLN) and parathyroid glands improve outcomes following thyroid surgery. This can be facilitated by methylene blue. Aim the aim was to evaluate the value of spraying methylene blue dye during thyroidectomy for the help of the identification and dissection of RLN. Patients and methods A total of 34 patients with benign goiter disorders were included in this prospective observational study. During the surgery, after ligation of the superior pole of the thyroid and before ligation of inferior pole, 1 ml (10 mg) of 1% methylene blue solution was sprayed over the thyroid bed and perithyroidal tissue. Identification and safe dissection of the thyroid gland from the RLN and parathyroid glands were done without injuring these structures. Results RLN remained white, whereas thyroid and parathyroid glands were stained blue. The parathyroid glands washed out the stain within 5 min and were visible in its normal yellow color in all cases. Conclusion Spraying of methylene blue dye during thyroidectomy is a safe and effective method for identification and avoiding injury to RLN and parathyroid glands during thyroid surgeries.