Complication Of Thyroid Surgery Research Articles

Surgical Techniques to Avoid Complications of Thyroid Surgery

Surgical Techniques to Avoid Complications of Thyroid Surgery

Differences in surgical outcomes between cervical goiter and retrosternal goiter: an international, multicentric evaluation.

Goiter is a common problem in clinical practice, representing a large part of clinical evaluations for thyroid disease. It tends to grow slowly and progressively over several years, eventually occupying the thoracic inlet with its lower portion, defining the situation known as retrosternal goiter. Total thyroidectomy is a standardized procedure that represents the treatment of choice for all retrosternal goiters, but when is performed for such disease, a higher risk of postoperative morbidity is variously reported in the literature. The aims of our study were to compare the perioperative and postoperative outcomes in patients with cervical goiters and retrosternal goiters undergoing total thyroidectomy. In our retrospective, multicentric evaluation we included 4,467 patients, divided into two groups based on the presence of retrosternal goiter (group A) or the presence of a classical cervical goiter (group B). We found statistically significant differences in terms of transient hypoparathyroidism (19.9% in group A vs. 9.4% in group B, p < 0.001) and permanent hypoparathyroidism (3.3% in group A vs. 1.6% in group B, p = 0.035). We found no differences in terms of transient RNLI between group A and group B, while the occurrence of permanent RLNI was higher in group A compared to group B (1.4% in group A vs. 0.4% in group B, p = 0.037). Moreover, no differences in terms of unilateral RLNI were found, while bilateral RLNI rate was higher in group A compared to group B (1.1% in group A vs. 0.1% in group B, p = 0.015). Wound infection rate was higher in group A compared to group B (1.4% in group A vs. 0.2% in group B, p = 0.006). Based on our data, thyroid surgery for retrosternal goiter represents a challenging procedure even for highly experienced surgeons, with an increased rate of some classical thyroid surgery complications. Referral of these patients to a high-volume center is mandatory. Also, intraoperative nerve monitoring (IONM) usage in these patients is advisable.

Intraoperative Parathyroid Gland Identification Using Autofluorescence Imaging in Thyroid Cancer Surgery with Central Neck Dissection: Impact on Post-Operative Hypocalcemia.

Hypoparathyroidism is the most frequent complication in thyroid surgery. The aim of this study was to evaluate the impact of intraoperative parathyroid gland identification, using autofluorescence imaging, on the rate of post-operative (PO) hypoparathyroidism in thyroid cancer surgery. Patients undergoing total thyroidectomy with central neck dissection from 2018 to 2022 were included. A prospective cohort of 77 patients operated on using near-infrared autofluorescence (NIRAF+) with the Fluobeam® (Fluoptics, Grenoble, France) system was compared to a retrospective cohort of 94 patients (NIR-). The main outcomes were the rate of PO hypocalcemia, with three cutoffs: corrected calcium (Cac) < 2.10 mmol/L, <2.00 mmol/L and <1.875 mmol/L, and the rate of permanent hypoparathyroidism, at 12 months. The rate of PO Cac < 2.10 mmol/L was statistically lower in the NIRAF+ group, compared to the control group (36% and 60%, p = 0.003, respectively). No statistically significant difference was observed for the other two thresholds. There was a lower rate of permanent hypoparathyroidism in the NIRAF+ group (5% vs. 14% in the control group), although not statistically significant (p = 0.07). NIRAF is a surgically non-invasive adjunct, and can improve patients' outcomes for thyroid cancer surgery by reducing post-operative temporary hypoparathyroidism. Larger prospective studies are warranted to validate our findings.

Associated Complications and survival rate after thyroid cancer operation

Background: Thyroid cancer is a common endocrine neoplasm in all parts of the world and the commonest histologic type is PTC. The Treatment of choice for this pathology is surgery and it has associated complications commonly hypocalcaemia and RLNP with specific survival rates.&#x0D; Objective: To find out the incidence of associated complications of thyroid surgery with their survival rates.&#x0D; Patients and Methods: We analysed data from 574 patients diagnosed with TC from 2018 to 2021, using the Kaplan-Meier method and log-rank test to determine complications of thyroid surgery and overall survival.&#x0D; Results: The mean age of the patients was 41.3 (±14.1) years, there were 92(16%) patients aged &gt;55 years and 482(84%) patients ≤ 55 years old at the time of diagnosis. Females were more affected by the female: male ratio (3.9: 1); 456 cases occurred in females (79.4%) and 118 in males (20.6%). The most common modes of presentation were neck lump in 492 (85.7%) patients and tumor size ≤4 cm in 495(86.3) patients. The commonest stage at diagnosis is stage I 494(86.1%), of the cases confined to the thyroid gland. The main surgical procedure was total thyroidectomy for 470(81.9%) patients. The common complications are hypocalcemia 70(12.6%) and 46(8.3%) developed RLN damage. The mean survival time was (55.87) months (CI = 54.86-56.88 months), but varies according to age &lt; 55 years (58.02 months) and ≥ 55 years (44.426 months). Sex female has a better prognosis (56.540 months) while males (52.40 months). stage I mean survival was (58.79months) while a decrease in stage IV mean survival was (23.36 months).&#x0D; Conclusion: The incidence of complications associated with TC surgery in our study is close to what was published elsewhere in the world with slight differences in percentages of each complication. The survival rate drops within the available ranges.

HARMONIC SCALPEL COMPARED TO BIPOLAR COAGULATION FOR THYROIDECTOMY

Introduction. The basic principles of high-efficient and safe thyroid surgery were established by 1920: identification and ligation of vessels, identification and preservation of laryngeal nerves, and parathyroid glands. Bleeding remains one of the major intraoperative complications of thyroid surgery.&#x0D; The aim of this study is to evaluate the benefits of the Harmonic when compared with bipolar coagulation for open thyroidectomy.&#x0D; Materials and methods: We enrolled 85 patients who underwent total thyroidectomy for multinodular disease from 2019 till 2022 years. Patients were randomly assigned to either the group 1 (43 patients in which the operation was performed entirely using the Harmonic scalpel (HS) and no other haemostatic tool) or the group 2 (42 patients in which the operation was performed using classic technique of resorbable ligature, bipolar coagulation). The inclusion criteria were scheduled total thyroidectomy for multinodular goiter.&#x0D; Results. There were no significant differences between two groups regarding age, gender, ASA distribution, so two groups are comparable. The mean operating time in the group 1 was 62.84±0.66 (M±m) minutes, and that in the group 2 was 75.19±0.42 (M±m) minutes for thyroidectomy, and there was 19.65% (i.e. 12.35 minutes) statistically significant reduction in the operating time using the Harmonic scalpel device (p&lt;0.05). The 48 hours mean total amount of drainage was 69.05±0.88 (M±m) ml for group 1 and 81.40±0.64 (M±m) ml for group 2, which was statistically significant (p&lt;0.05). The rate of postoperative complications was comparable among the two groups (pχ2&gt;0,05).&#x0D; Conclusions. The use of Harmonic scalpel in thyroid surgery is safe and effective and is associated with a significant reduction in operative time without increasing complications rate, may also permit a better view of structures to preserve nerves, vessels of parathyroid glands and parathyroid glands when operating. Other benefits include significantly lower blood loss, efficient hemostasis and sectioning in a single instrument.

원격접근방식의 로봇 및 내시경 갑상선 절제술시 신경 감시술

Vocal fold paralysis is a dangerous complication of thyroid surgery that is often fatal. Therefore, intraoperative neuromonitoring (IONM) has recently been widely adopted and used in thyroid surgery. IONM is thought to be more helpful in identifying the recurrent laryngeal nerve (RLN) and predicting its function in a limited surgical space than conventional thyroid surgery, but there are few reports on this. Therefore, we would like to discuss IONM during robotic or endoscopic thyroidectomy.

Effect of gradual adjustment of surgical position in prevention of complications of thyroid surgery

Effect of gradual adjustment of surgical position in prevention of complications of thyroid surgery

Energy Devices in Thyroidectomy: A Safe and Effective Alternative to Conventional Methods

Objective: The most feared complications of thyroid surgery, which is one of the most performed operations of endocrine surgery, are hoarseness due to recurrent nerve damage and hematoma formation in the neck. With the advancement of technology, the use of energy devices has increased during thyroid operations. However, there are different opinions about using energy devices during thyroid operations. Our study aimed to examine the reliability of energy use in thyroid operations. Material and Methods: The data of 144 patients who underwent thyroid surgery for various reasons were reviewed retrospectively. The patients were divided into 2 groups, those who used energy devices during the operation and those who were operated with the conventional method. Demographic data of the patients, duration of operation, complication rates were evaluated comparatively. Result: The majority of patients were women. It was observed that the operation time was shorter, and the amount of bleeding was less in the group in which the energy device was used (p≤0.001). It was determined that the duration of hospital stay of the patients was significantly longer in the conventional surgery group (p≤0.001). There was no significant difference between the two groups in terms of incision lengths. Likewise, there was no difference between the two groups in terms of complication development frequency. Postoperative verbal pain score was significantly higher in the group operated on by conventional method (p≤0.001). Conclusion: Energy devices can be used safely in thyroid surgery with less hospital stay, less postoperative pain levels, better bleeding control and complication rates similar to conventional surgery.

Efficacy of four different hemostatic agents in thyroid surgery in reducing the amount of post-operative fluid collection

PurposesPostoperative bleeding remains a life-threatening complication in thyroid surgery. The aim was to assess the efficacy of four different hemostatic agents, Collagen-Fibrinogen-Thrombin Patch (CFTP) in two sizes (3 × 2.5 cm and 9.5 × 4.8 cm), polysaccharide particles (1 g) and Cellulose Gauze (2.5 × 5 cm) on postoperative drainage volume (DV) compared to a control group.MethodsWe included from October 2007 until Mai 2011, 150 patients (30 per group) for this monocentric, retrospective case-controlled study. Patients were scheduled for a hemithyroidectomy or thyroidectomy. The primary endpoint was the postoperative DV within the first 24 h, secondary the incidence of adverse events.ResultsThere were no difference in demographic parameters. The mean DV (± SD) was 51.15 (± 36.86) ml in the control, 50.65 (± 42.79) ml in small (3 × 2.5 cm), 25.38 (± 23.99) ml in large CFTP (9.5 × 4.8 cm), 53.11 (± 39.48) ml in the polysaccharide particles and 48.94 (± 30.59) ml in the cellulose gauze group. DV was significantly reduced with the large CFTP (p < 0.05) compared to all other groups. There were no adverse events.ConclusionsWe were able to demonstrate a significant reduction in the DV for the large CFTP group compared to the other collectives. Although this as being associated with not inconsiderable costs and we would only recommend its use for high-risk patients only.

Measurement of Intact Serum Parathormone and Corrected Serum Calcium after Thyroid Surgery

AbstractPostoperative hypocalcemia is an important complication of thyroid surgery. The present study was undertaken to measure the serum levels of intact parathormone (iPTH) and corrected serum calcium (CSC) in the immediate postoperative period and then sequentially till 1 month after thyroid surgery. A total of 36 patients undergoing total thyroidectomy and 44 undergoing hemithyroidectomy had measurement of the level of iPTH and CSC at 1 hour, 1 day, 1 week, and 1 month after surgery. A mean drop of 9.3% in CSC, 40% in iPTH, and 10% in ionic calcium levels was noted 1 hour after total thyroidectomy. All the patients recovered to near preoperative levels at the 1-month follow-up. Among hemithyroidectomy patients, significant postsurgery drop in levels was not observed. The importance of the study is early recognition of a hypoparathyroid state at 1 hour after surgery and institution of calcium replacement, thereby sparing the patient from unpleasant symptoms of hypocalcemia. Furthermore, patients with a drop in the iPTH levels below the defined hypoparathyroidism levels should have careful evaluation of their thyroidectomy specimen for identification and possible autotransplantation of the parathyroid gland intraoperatively or in the immediate postoperative time frame.

Unexpected mapping of recurrent laryngeal nerve by fluorescence-guided surgery using near-infrared indocyanine green angiography

Background. The recurrent laryngeal nerve (RLN) damage and parathyroid gland injury are the most severe complications of thyroid surgery. The possibility of RLN confirmation in the near-infrared spectrum after the injection of indocyanine green (ICG) was not yet been studied. Aim: to evaluate the ICG angiography for the identification of RLN during thyroid and parathyroid surgery. Materials and methods. ICG angiography of RLN was performed in 7 patients. An intraoperative neuromonitoring was applied as a method of controlling RLN. During the operation, parathyroid glands and RLN were identified by visual inspection (naked eye). To further confirm the location of the parathyroid glands by autofluorescence, an intravenous injection of ICG was performed with a concentration of 0.25 mg/kg followed by the application of the image-based system. Results. A good signal was achieved in the near-infrared spectrum from the RLN in all cases after the ICG injection. Sufficient blood perfusion of the RLN could be considered as a reasonable explanation for the exhibition of a good ICG near-infrared signal. Conclusions. ICG use might be a helpful approach for the confirmation of the RLN in addition to routine visual identification. Such function could be applied during fluorescence-guided surgery to evaluate the parathyroid gland autofluorescence. Visualization of RLN by ICG angiography is considered as an additional useful feature to prevent RLN injury.

Analysis of the Outcomes of Immediate Recurrent Laryngeal Nerve Reconstruction During Thyroid Surgery for Prevention of Vocal Fold Paralysis

Recurrent laryngeal nerve (RLN) injury and the resulting paralysis is the most common and known complicationof thyroid surgery. Several surgical techniques, such as medialization thyroplasty with or without arytenoid adduction and injection laryngoplasty, have been developed to treat RLN injury, but these procedures have specific limitations and complications. In this study, we present the outcomes for our patients who underwent immediate RLN reconstruction during thyroid surgery by analyzing both subjective and objective outcomes. A retrospective study was conducted for patients who underwent total or subtotal thyroidectomy between May 2012 and March 2020. Among them, patients who underwent immediate RLN reconstruction due to unilateral RLN injury were followed for at least 12 months. The voice perceptual evaluation, acoustic analysis, voice range profile, and Voice Handicap Index (VHI) scores were obtained preoperatively, 1 month, 6 months, and 12 months after surgery. Among the 11 patients, 6 patients (54.5%) underwent direct anastomosis, and 5 patients (45.5%) underwent nerve grafts using ansa cervicalis and great auricular nerve. The grade and breathiness in the GRBAS (grade, roughness, breathiness, asthenia, and strain) scale and jitter item showed significant improvement at 12 months postoperatively, and although not statistically significant, the rest of the items also tended to improve. The total, functional, and physical scores on VHI improved significantly at 12 months postoperatively. Moreover, when comparing the voice analysis of the direct anastomosis group and the nerve graft group, there was no significant difference between the groups in objective and subjective results. Immediate RLN reconstruction demonstrated significant voice improvement postoperatively, and reconstructing the nerve immediately and combining follow-up treatment in the event of RLN injury will greatly help patients improve their long-term voice outcomes.

EE322 Cost-Effectiveness Analysis of Intraoperative Neuromonitoring Versus Visual Identification of Recurrent Laryngeal Nerve in Total Thyroidectomy

Recurrent laryngeal nerve injury (RLNI) is one of the most serious complications of thyroid surgery. Intraoperative neural monitoring (IONM) has been widely applied and recommended to reduces RLNI by clinical guidelines in China. To evaluate the cost-effectiveness of IONM in total thyroidectomy from the Chinese societal perspective.

갑상선 수술 중 신경 손상에 대한 예방과 치료

Since most thyroid cancers are slowly growing and are not fatal, prevention of surgical complications is as important as removing the lesion. Although permanent vocal cord paralysis, a significant complication of thyroid surgery, is reported to occur in about 1-2% of cases, the actual incidence is expected to be higher for various reasons. When nerve damage occurs despite the surgeon's utmost care, appropriate measures should be taken immediately. However, even with the most aggressive approach, nerve repair (neurorraphy) rarely restores normal vocal cord movement; it is known only to maintain tension in the vocal cords to prevent atrophy. Therefore, preventing nerve damage is considered much more important. To achieve this goal, a thorough preoperative examination and understanding of the anatomical variations of the nerves around the thyroid, as well as precise and careful capsular dissection, are necessary. In this paper, the authors discuss methods for preventing and treating nerve damage during thyroid surgery.

Post-Thyroid Surgery Complications in Patients with Palpable Thyroid Gland

Objective: To determine the rate of post-thyroid surgery complications in patients with a palpable thyroid gland. Study design and setting: Cross sectional observational, Department of ENT, Jinnah Postgraduate Medical Center, Karachi. Methodology:Patients were enrolled from OPD and wards. Patients with palpable thyroid gland with plan for thyroid surgery were included. Thyroid surgery was performed by a surgeon having &gt;5 years of experience. Patients were discharged by 48–72 hours postoperatively. All patients had their vocal cords checked at the time of extubation. On the follow-up visit at day 5, final diagnosis of complications was assessed. For data analysis, SPSS v23.0 was used. Cross tabulation was done with type of surgery (lobectomy, isthmusectomy, subtotal thyroidectomy, near total thyroidectomy and total thyroidectomy) to see effect of these on outcome variables by applying chi square test. A p-value ≤0.05 was taken as significant. Results:Total 157 patients with palpable thyroid gland were selected for this study. Mean age of the patients was 39.8±12.2 years. Total 112(71.3%) were males and 45(28.7%) were females. Out of 157 patients, 14(8.9%) had hypoparathyroidism, while, 72(45.9%), 40(25.5%), 16(10.2%) and 15(9.6%) had hypothyroidism, hyperthyroidism, RLN paralysis and airway obstruction respectively. Conclusion:More extensive procedures are associated with greater number of complications in thyroid surgery. Complications of thyroid surgery can be minimized by sound knowledge of normal and pathologic anatomy and an unhurried, gentle operation technique. Keywords: Thyroidectomy, Post-thyroid Surgery Complications, Lobectomy, Isthmusectomy, Subtotal Thyroidectomy

3D printed hydrogel scaffold promotes the formation of hormone-active engineered parathyroid tissue

The parathyroid glands are localized at the back of the thyroid glands in the cervical region and are responsible for regulation of the calcium level in the blood, through specialized cells that sense Ca2+ and secrete parathyroid hormone (PTH) in response to a decline in its serum level. PTH stimulates the skeleton, kidneys and intestines and controls the level of Ca2+ through specialized activities. Iatrogenic removal of the parathyroid gland, as well as damage to its vascular integrity during cauterization are some of the common complications of thyroid surgery. Therefore, regeneration and/or replacement of malfunctioning parathyroid tissue is required. Tissue engineering is an emerging and promising field for patients with organ failure with recent pioneering clinical applications. The success of tissue engineering strategy depends on the use of proper cells, bioactive factors that stimulate the activities of these cells and scaffolds that are produced to recapitulate the tissue structure and support the function of the engineered tissues. 3D printing is a developing strategy for the production of these scaffolds by providing a delicate control over their structure and properties. In this study, human primary parathyroid cells were successfully isolated and their viability and ability to secrete PTH upon stimulation with different levels of Ca2+ were shown in vitro. These cells were then seeded onto 3D printed alginate scaffolds and 3D bioprinted within alginate bioink, and cell viability as well as the ability to secrete PTH upon stimulation were also demonstrated. Therefore, functional hormone-active parathyroid tissue substitute was engineered in vitro through 3D printed hydrogels and autologous cells.

Proving the Superiority of Intraoperative Recurrent Laryngeal Nerve Monitoring over Visualization Alone during Thyroidectomy.

Vocal fold paralysis after thyroid surgery is still a dangerous complication that significantly reduces patients' quality of life. Since the intraoperative neuromonitoring (IONM) technique has been introduced and standardized, the most frequently asked question is whether its use has significantly reduced the rate of RLN injury during thyroid surgery compared to visual identification alone (VA). The aim of this study was to attempt to prove the superiority of IONM over VA of the RLN during thyroid surgery in the prevention of vocal fold paralysis, taking into account risk factors for complications. The medical records of 711 patients (1265 recurrent laryngeal nerves at risk of injury) were analyzed retrospectively: in 257 patients/469 RLNs at risk, thyroid surgery was performed with IONM; in 454 patients/796 RLNs at risk, surgery was performed with VA. The statistical analysis showed that in the group of patients with IONM only one risk factor-the surgeon's experience-proved statistically significant (OR = 3.27; p = 0.0478) regarding the overall risk of vocal fold palsy. In the group of patients where only visualization was used, 5 of the 12 factors analyzed were statistically significant: retrosternal goiter (OR = 2.23; p = 0.041); total thyroid volume (OR = 2.30; p = 0.0284); clinical diagnosis (OR = 2.5; p = 0.0669); gender (OR = 3.08; p = 0.0054) and risk stratification (OR = 3.30; p = 0.0041). In addition, the cumulative risk, taking into account the simultaneous influence of all 12 factors, was slightly higher in the group of patients in whom only VA was used during the procedure: OR = 1.78. This value was also considerably more statistically significant (p < 0.0001) than that obtained in the group of patients in whom IONM was used: OR = 1.73; p = 0.004. Conclusions: Risk factors for complications in thyroid surgery are not significant for any increase in the rate of vocal fold paralysis as long as surgery is performed with IONM, in contrast to thyroid surgery performed only with VA, thus proving the superiority of IONM over VA for safety.

Permanent complications after thyroid surgery and effect of surgeon volume

Introduction: Thyroidectomy is a surgical method for the management of benign and malignant thyroid disease. Thyroidectomy may cause significant complications including hypocalcemia and recurrent laryngeal nerve injury. Permanent complications after thyroid surgery pose significant costs for healthcare system, as patients require lifelong alternative treatments and healthcare facilities. Objectives: The purpose of this study was to evaluate the incidence and risk factors for permanent complications following thyroidectomy. Patients and Methods: A total of 204 consecutive patients who underwent thyroid surgery between 2017 and 2018 were included in this prospective study. The patients were followed for 12 months after surgery and clinical and biochemical data were recorded. Results: The incidence of transient and permanent hypocalcemia was 46.8% and 6.38%, respectively. Transient hoarseness affected 30.3% of patients and 2.1% had recurrent laryngeal nerve paralysis as detected by video laryngoscopy 12 months after surgery. Surgeons volume was significantly related to the presence of permanent hypocalcemia (P=0.003). In comparison to high-volume-surgeons, intermediate-volume-surgeons had an odds ratio of 5.25 (P=0.042) for permanent complications. Conclusion: Hypocalcaemia remained the most common long-term complication of thyroid surgery. High volume surgeons had lower complication rates and better outcomes. In this regard, methods for improving surgical performance are worthy of investigation.

Faktori rizika za pojavu postoperativne hemoragije u hirurgiji štitaste žlezde

Post-thyroidectomy bleeding is rare but potentially life-threatening complication. The incidence of post thyroidectomy bleeding ranges from 0.43 to 4.2%. Despite developments in surgical techniques, postoperative bleeding is still the most serious complication in thyroid surgery because it represents an emergency condition, in most cases. A number of different risk factors have been reported in studies evaluating the occurrence of postoperative hematoma. Risk factors range from those related to patients' demographics, thyroid pathology, extent of resection, previous thyroid surgery, to those related to the presence of co-morbidities, or use of anticoagulant or antiplatelet medications. Postoperative hemorrhage is a rare event, therefore studying the risk factors associated with this complication is challenging. Risk factors for hematomas are still largely debatable considering that most of the studies were conducted in single centers. Early recognition and emergency intervention are essential in managing post-thyroidectomy hemorrhage. Therefore, it is especially important to identify risk factors, as well as the time frame for the occurrence of this complication.

Systematic Evaluation of Vocal Cord Function is Critical for Thyroid Cancer Patients: A Patient of Left Papillary Thyroid Carcinoma with Left Vocal Cord Paralysis

Temporary or permanent vocal cord paralysis caused by recurrent laryngeal nerve injury is one of the relatively common and serious complications of thyroid surgery. At the same time, there are many reasons for recurrent laryngeal nerve injury. Therefore, the recurrent laryngeal nerve should be paid attention to before, during and after thyroid surgery. A 51-year-old woman was diagnosed with left papillary thyroid carcinoma. Unfortunately, the patient had a history of hoarseness following a patent ductus arteriosus ligation. We operated on her for thyroid cancer. Preoperative electronic laryngoscopy revealed paralysis of the left vocal cord, and intraoperative nerve monitor showed no signal of the left vagus nerve and recurrent laryngeal nerve. There was no improvement in hoarseness symptoms during postoperative follow-up three months. There are many causes of vocal cord paralysis. In addition to the central injury, any nerve injury of vagus nerve from the brainstem nucleus suspicius to the laryngeal muscle pathway it innervates can cause vocal cord paralysis. Paying attention to the recurrent laryngeal nerve before, during and after surgery can effectively reduce the vocalization of recurrent laryngeal nerve injury.