The Identification and Preservation of Parathyroid Gland during Thyroidectomy Using Carbon Nanoparticles

Abstract

Abstract Background During thyroidectomy, the parathyroid gland as well as the recurrent laryngeal nerve iatrogenic injuries are the most serious complications in goiter surgery. However, recurrent laryngeal nerve injury has been reduced to minimum as a result of meticulous surgical techniques and intraoperative nerve monitoring. Objective To determine the potential role of intraoperative CN injections for identification and preservation of parathyroid glands, thereby reducing the postoperative hypocalcaemia and whether CNs can really improve the extent of thyroidectomy and neck dissection and help identify metastatic lymph nodes. Patients and Methods We did a prospective cohort study with comparative between two groups of patients, one group established with the conventional technique of thyroidectomy while the other group established using CN injection to see which group with less post-operative hypocalcemia. A hundred patients with benign and malignant goiter disorders underwent thyroidectomy assigned into two groups: group 1 (control group) included 50 cases established with the conventional technique and group 2 (interventional group) included 50 cases operated upon with CN injection technique. Results The results showed that in group 2; 47 patients had normal Ca ++ level (94%) while 3 cases had low Ca ++ level (hypocalcemia) (6%). But in group 1; 37 patients had normal Ca ++ level (74%) while 13 cases had low Ca ++ level (hypocalcemia) (26%). The three patients in group 2 and the 13 patients in group 1 who developed hypocalcemia were managed with IV and oral supplementation of calcium and vitamin D and recovery occurred within a period of 1 week to 1 month. Conclusion CN injection technique is safe, effective, and technically feasible which helped us to keep parathyroid gland during thyroidectomy and that led us to reduce the percentage of incidence post- operative complications. Also, it helped us to identify the parathyroid gland during the surgery, the safety for thyroid surgery is based on the protection and visualization of the normal anatomy of parathyroid glands and their blood supplies according to the CNs injection technique, as verified in our research. Others see that the sooner the parathyroid glands are identified, the lower the surgeon’s level of stress. New studies with larger numbers of cases and also application of the technique by different surgeons are important to confirm the reliability and effectiveness of this technique.