Using methylene blue spray intraoperatively to perform safe thyroidectomy

Abstract

BackgroundRecurrent laryngeal nerve (RLN) injury and hypoparathyroidism are serious complications following thyroidectomy. Minimizing these complications is important to avoid a destructive life-long handicap.AimOur goal was to decrease the incidence of intraoperative mishaps by spraying methylene blue dye on thyroid tissue and the tissues nearby.Patients and methodsThis is a prospective study that included 90 patients who underwent primary thyroid surgery for various thyroid diseases, with total thyroidectomy done in all. The patients were divided into two groups: methylene blue group included 45 patients who underwent surgery using methylene blue technique, and conventional group included 45 patients who underwent surgery using the conventional technique. Spraying of 0.5 ml of methylene blue stain (normal saline) (2 : 8) following superior pole ligation was done. Thyroid tissue of a lobe and perilobar area were exposed to the methylene blue dye spraying, with identification and evaluation of the RLN and parathyroid tissues.ResultsRLN and inferior thyroid artery stayed white in color in every case, but other tissues have been stained by blue color, with different times of fading out. Parathyroid glands stained for 3 min before fading out. Time for wash-out of thyroid gland was 15 min, whereas fading out time for other tissues, such as perithyroid tissues, tendinous, and lipoid structures was ∼25 min.ConclusionThis research aims to show the efficacy of methylene blue spraying as a safe procedure for identification of different important structures in close relation with the operative field such as RLN and parathyroid glands intraoperatively to do safe thyroidectomy.