Open Thyroidectomy Research Articles

A propensity score matching analysis of gasless endoscopic transaxillary thyroidectomy with five-settlement technique versus conventional open thyroidectomy in patients with papillary thyroid microcarcinoma.

In a previous study, we proposed a novel anatomy-based five-settlement method for transaxillary endoscopic thyroidectomy (fs-TAT) for patients with papillary thyroid carcinoma. The safety of this new method has been reported in a retrospective study of a single cohort. The safety and short-term oncological outcome of this method was confirmed by comparing it with conventional open surgery (COT) in patients with papillary thyroid microcarcinoma. The medical records of patients who underwent fs-TAT or COT by a single surgeon from February 2019 to December 2021 were reviewed retrospectively. All patients were diagnosed with papillary thyroid microcarcinoma and underwent lobectomy and ipsilateral central compartment neck dissection. Propensity score matching was used to compare the technical safety and short-term oncologic outcomes of fs-TAT and COT for the purpose of reducing potential selection bias. Reporting was consistent with the STROCSS 2021 guidelines. After propensity score matching, 460 (fs-TAT: 230; COT: 230) patients remained in the study population. There were no significant differences in sex, age, tumor size, Hashimoto's thyroiditis, or tumor multifocality between the groups. The operative time was longer [104.5 (90.3, 120.0) vs. 62.0 (52.0, 76.0), P < 0.001] and the total postoperative drainage volume [135(90, 210) vs. 75 (55, 115), P < 0.001] was greater in the fs-TAT group than in the COT group. However, intraoperative bleeding [3.0 (2.0, 5.0) vs. 5.0 (5.0, 7.5), P < 0.001] was greater, and the median number of lymph nodes yielded [5.0 (2.3, 8.0) vs. 7.0 (5.0, 11.0), P < 0.001] was greater in the COT group than in the fs-TAT group. The groups exhibited no significant difference in the rate of complications (fs-TAT: 2.2% vs. COT: 2.6%, P = 0.856), rate of positive lymph nodes (fs-TAT: 32.2% vs. COT: 36.5%, P = 0.377), length of postoperative hospital stay (3days vs. 3days, P = 0.305) or total medical costs (26,936 vs. 26,549, P = 0.144). Compared to conventional open surgery, fs-TAT offered excellent safety and acceptable short-term oncological outcomes in a selected cohort of patients with papillary thyroid microcarcinoma.

The effect of the type of thyroidectomy on the incidence of hypothyroidism

Link of Video Abstract: https://youtu.be/cKF7Miu4D9I Background: Thyroidectomy is the surgical removal of part or all of the thyroid glands. Thyroidectomy is performed to treat thyroid disease which can be in the form of enlargement of the thyroid glands and thyroid cancer. Thyroidectomy is performed to help cure the patient's disease, but after thyroidectomy, there is still the possibility of post-operative complications. One of the common complications that can occur is hypothyroidism. The type of thyroidectomy surgery that generally results in hypothyroidism is near-total or total thyroidectomy. Methods: An analytic observational study with a cross-sectional design was carried out at PKU Muhammadiyah Gamping Hospital. A total of 50 people who had thyroid problems or diseases and had undergone thyroidectomy surgery were included in the samples. The inclusion criteria for this study were patients aged 20–80 years, with hyperthyroidism or euthyroidism, both outpatients or inpatients. Patients with hypothyroidism and those with thyroid disease are excluded from this study. The research data were analyzed with the Fisher exact test. Results: Majority of the sex of subjects in this study were female. Most of the subject age groups in this study were in the 20-50 year age group. Hypothyroid complications occur in 8% of subjects. The results of bivariate analysis obtained a significant value

Safety and Efficacy of Transoral Endoscopic Thyroidectomy Vestibular Approach Versus Conventional Open Thyroidectomy: A Systematic Review and Meta-analysis.

To evaluate the safety and efficacy of the transoral endoscopic thyroidectomy vestibular approach (TOETVA) versus conventional open thyroidectomy (COT) for some thyroid diseases. Databases PubMed, Embase, and Web of Science were searched. Full-text English papers that described TOETVA and COT for people with thyroid diseases were included. Randomized, nonrandomized, controlled, and uncontrolled trials were all included. Extracted data included population characteristics and intraoperative and postoperative complications. A total of 2 randomized controlled trials and 10 retrospective studies, including 3048 patients, were included in the meta-analysis. Meta-analysis results suggested that the intraoperative conditions and postoperative complication rates did not differ significantly between the two groups. However, in the TOETVA group, there is a slightly longer operative time [weighted mean difference (WMD): 73.64; 95% CI: 49.34 to 97.94; P < 0.0001], drainage (WMD: 91.0; 95% CI: 35.52 to 146.48; P = 0.001), and hospital stay (WMD: 0.28; 95% CI: 0.18 to 0.38; P < 0.0001). For most of the benign thyroid nodules and selected patients with papillary thyroid cancer, TOETVA seems to be as feasible and safe as COT.

Profile and pattern of histology specimen of thyroidectomy patients operated in Mankweng hospital, Limpopo province, South Africa

Object of study: To evaluate the histopathologic pattern of the thyroidectomy specimen in patients with goitre who underwent thyroidectomy operation at Mankweng Hospital and to review the profile of thyroid disease in relation to the age, gender &amp; Distribution of thyroid disease which are referred to Mankweng hospital from the districts of Limpopo Province.&#x0D; The problem to be solved: The demographic profile of thyroidectomy patients in this hospital is identified. Hence outreach program can be initiated according to demographic profile.&#x0D; Main scientific results: Total of 62 patients analyzed: Male 2, female 60. Age range 15-70: District: Capricorn 23, Sekhukhune 33, Mopani 6. Histology: 62: Multinodular goitre 47, Papillary carcinoma 5: Hurtle cell carcinoma 3, colloid goitre 2, Diffuse colloid goitre 1, Cavernous haemangioma 1, follicular neoplasm 1, Hashimoto`s Thyroiditis 1, benign thyroid parenchyma with cyst 1&#x0D; The area of practical use of research results: General surgery department in Regional &amp; Tertiary hospital&#x0D; An innovative technological product: Patient demographic profile for health outreach program.&#x0D; Scope of application of an innovative technological product: General surgery department.

Prospective cohort study of parathyroid function and quality of life after total thyroidectomy for thyroid cancer: robotic surgery vs. open surgery.

To compare robot-assisted thyroidectomy (RT) and open thyroidectomy (OT) through a prospective cohort study focusing on the rate of postoperative hypoparathyroidism, efficacy, and quality of life (QoL). Hypoparathyroidism is a frequent complication after thyroidectomy. Reducing the risk of hypoparathyroidism after total thyroidectomy is a crucial and difficult task for thyroid surgeons. We prospectively enroled 306 patients with papillary thyroid carcinoma into an RT group and OT group. The former used "super-meticulous" capsular dissection) and the latter used traditional meticulous capsular dissection. Patients were evaluated by scales [Short Form (SF)-36, Visual Impairment Scale (VIS), Swallowing Impairment Scale (SIS), Neck Impairment Scale (NIS), Scar questionnaire (SCAR-Q)]. The rates of transient hypoparathyroidism, permanent hypoparathyroidism, and transient hypocalcemia after surgery in the OT group and RT group were significantly different ( P <0.001). SIS and VIS scores in the two groups were significantly different ( P <0.001). SF-36 showed significant differences ( P <0.001) in the subsections of "physiological function", "body pain", "general health", "vitality", "social function", "role emotional", and "mental health" between the two groups. SCAR-Q showed that the length and appearance of scars showed significant differences between the two groups. RT with Super-meticulous capsular dissection can protect parathyroid function and improve postoperative QoL, and could be a new option for robot-assisted surgery against thyroid cancer.

Effectiveness of the oral Clonidine as a pre-anesthetic medicine for thyroidectomy surgery; A randomized clinical trial.

Hemodynamic disturbance is a common problem in patients undergoing thyroid surgery. It may be due to episodic increases in thyroid hormones (thyroid storm) or stimulation of the carotid sinus baroreflex. The aim of the present study was to investigate effectiveness of the pre-operative oral Clonidine on reducing these hemodynamic changes during total thyroidectomy surgery. In a prospective, randomized, double-blind study, 80 patients scheduled for elective total thyroidectomy were randomized to receive either 0.2 mg Clonidine (n=40) or a matched placebo (n=40) orally sixty minutes before entering the operating room. Hemodynamic variables, the duration of surgery, estimated amount of blood loss and the dose of administered remifentanil were recorded for further analysis. Oral Clonidine was found to be significantly better in maintaining stable hemodynamics compared to the control group. Also, In the Clonidine group, the estimated amount of blood loss (110.4±10 ml vs. 182.2±11.4 mL, P=0.04), duration of the surgery (78.26±55.2 min vs. 105.16±61.75 min, P=0.027) and administered dose of remifentanil (26.67±6.6 μg vs. 216.2±14.8 μg, P=0.01) were also significantly lower than the control group. Pre-operative administration of 0.2 mg oral Clonidine in patients undergoing total thyroidectomy results in improved perioperative hemodynamic stability and reduced response to perioperative stress.

The effect of radioactive iodine therapy on anti-Müllerian hormone changes in women with thyroid cancer at reproductive age: a prospective study

BackgroundThyroid cancer is one of the common cancers that, depending on the need for treatment, patients are treated with radioactive iodine after thyroidectomy surgery. The purpose of this study is to investigate the effect of iodine therapy on the ovarian reserve of women at reproductive ages.MethodsIn this prospective study, 60 patients with thyroid cancer aged 18 to 35 who were undergoing iodine therapy for the first time in 2018–2019 were included in the study. Patients with underlying diseases and any ovarian disorders and patients who needed repeated iodine treatment were excluded from the study. Anti-Müllerian hormone (AMH) level of patients was evaluated 4 times before, 3, 6, and 12 months after iodine therapy. The significance level of the P-value study was considered less than 0.05.ResultsThe average age of the patients was 29.53 ± 4.53 years. With aging, AMH level decreases significantly. No significant correlation was observed between smoking, menarche age, and abnormal uterine bleeding with AMH level. The average AMH before, 3, 6, and 12 months after iodine therapy was 2.25 ± 0.55 ng/ml, 1.15 ± 0.35 ng/ml, 1.58 ± 0.47 ng/ml, and 1.94 ± 0.58 ng/ml, which has a significant decrease respectively 49.05%, 29.55%, and 13.58% compared to the amount before iodine therapy (P-value < 0.001).ConclusionConsidering the effect of iodine therapy on the reduction of AMH levels, it is recommended that women of reproductive age group should be evaluated prior to iodine therapy to determine their ovarian reserve level so that if their AMH level is not suitable, they may need to consult with a fertility preservation specialist.

Unnecessary thyroid surgery rate for suspicious nodule in the absence of molecular testing.

Molecular tests for suspicious thyroid nodules decrease rates of unnecessary surgeries but are not widely used due to reimbursement issues. The aim of this study was to assess the rate of unnecessary surgery performed in real-life setting for Bethesda III, IV and V nodules in the absence of molecular testing. This is a single-center retrospective study of consecutive patients undergoing fine needle aspiration cytology (FNAC) with rapid on-site evaluation between January 2017 and December 2021. Unnecessary surgery was defined as surgery performed because of Bethesda III, IV, or V results in the absence of local compressive symptoms with final benign pathology and as second surgery for completion thyroidectomy. In the 862 patients (640 females, mean age: 54.2 years), 1010 nodules (median size: 24.4 mm) underwent 1189 FNAC. Nodules were EU-TIRADS 2, 3, 4, and 5 in 3%, 34%, 42%, and 22% of cases, respectively. FNAC was Bethesda I, II, III, IV, V, and VI in 8%, 48%, 17%, 17%, 3%, and 6%, respectively. Surgery was performed in 36% of Bethesda III nodules (benign on pathology: 81%), in 74% of Bethesda IV nodules (benign on pathology: 76%) and in 97% of Bethesda V nodules (benign on pathology: 21%). Surgery was considered unnecessary in 56%, 68%, and 21% of patients with Bethesda III, IV, and V nodules, respectively. In this real data cohort surgery was unnecessary in more than half of patients with Bethesda III and IV nodules and in 21% of patients with Bethesda V nodules.

Efficacy evaluation of transaxillary non-inflatable endoscopic surgery and open neck surgery in the treatment of PTC: a single center report of 342 cases

Objective:To compare the clinical effect of transaxillary non-inflatable endoscopic surgery and traditional open thyroid surgery in the treatment of PTC. Methods:A retrospective analysis was performed on 342 patients with PTC treated in the Otorhinolaryngology Department of Qilu Hospital of Shandong University from December 2020 to December 2022. There were 73 males and 269 females, aged 16-72 years, who underwent unilateral non-inflatable transaxillary endoscopic thyroid surgery（endoscopic group） and unilateral traditional open thyroid surgery（open group）. There were 108 patients in the endoscopic group and 234 in the open group. Results:The endoscopic group was lower in age（37.1±9.4 vs 43.5±11.2） years and BMI（23.4±3.4 vs 25.7±3.8 ）kg/m² than that in the open group, and the difference was statistically significant（t was 5.53, 5.67 respectively, P<0.01）. There was no significant difference in hospitalization days between the two groups（P>0.05）. The logarithmic curve of the operation time showed a smooth downward trend, and the overall operation time of the endoscopic group was relatively consistent. There was no significant difference in intraoperative blood loss between the endoscopic group（13.3±3.2） mL and the open group（14.7±6.3） mL（P>0.05）, but the operation time（130.1±37.9） min was longer than that in the open group（57.4±13.7） min, and the difference was statistically significant（t=19.40, P<0.01）. There was no significant difference in complications such as temporary recurrent laryngeal nerve injury within 3 days after operation between the two groups（P>0.05）. The aesthetic satisfaction score of the surgical incision and the incision concealment effect score in the endoscopic group were higher than those in the open group, and the difference was statistically significant（P<0.05）. Conclusion:Compared with traditional open thyroidectomy, transaxillary non-inflatable endoscopic thyroidectomy has more advantages in the concealment and aesthetics of postoperative incision. Although the former has longer operation time and more drainage, it is still a safe and feasible surgical method with good postoperative clinical effect.

A Case of Air Embolism during Transoral Vestibular Endoscopic Thyroidectomy

Background: Carbon dioxide (CO2) embolism is a rare but potentially life-threatening complication of endoscopic surgery. While endoscopic thyroidectomy is superior to traditional open thyroidectomy in terms of cosmetic results, it may lead to venous or fatal paradoxical CO2 embolism. CO2 embolism involves the inadvertent injection of carbon dioxide into a large vein, artery, or solid organ. The clinical manifestations of CO2 embolism can vary from asymptomatic to neurological damage, cardiac failure, and even death, depending on the rate and volume of CO2 entry and the patient’s general condition. This case can enhance our understanding of CO2 embolization during endoscopic surgery. Case Presentation: This case report describes an incident in which a gas embolism occurred during endoscopic right lobe and isthmus thyroidectomy, resulting in arrhythmia and dramatic fluctuations in circulation and oxygen levels. The operation was halted, and CO2 injection was stopped. The surgical wound was covered with saline gauze, and the patient inhaled 100% pure oxygen while undergoing aggressive repeated manual pulmonary recruitment maneuvers. Additionally, vasoactive drugs such as m-hydroxyamine and ephedrine were administered to aid in treating the condition. The patient’s position was adjusted using the Durant maneuver (partial left lateral and Trendelenburg position). Following the aforementioned treatments, the patient’s ventricular arrhythmia transitioned back to a normal and regular sinus rhythm, and both circulation and oxygen levels stabilized. Conclusions: Carbon dioxide embolism is an uncommon yet potentially severe complication of laparoscopic procedures. We anticipate that this particular case will enhance our comprehension of carbon dioxide embolism during endoscopic surgery.

Intraoperative Nerve Monitoring Ought to be Used In Complementary Thyroidectomy

Background: Injuries to the recurrent inferior laryngeal nerve (RLN) remain one of the major post-operative complications after thyroid surgery. In studies, temporary RLN damage during thyroidectomy is %2-11, and the rate of permanent RLN damage is %0.6-1.6. Complementary thyroidectomies have a higher complication rate compared to the first surgical procedure. In the last two decades, intraoperative neural monitoring has become a powerful tool for risk minimization. In our study, we aimed to retrospectively examine the pa-tients who underwent complementary thyroidectomy and intraoperative nerve monitoring. Materials and Methods: Between January 2016 and February 2020, the files of 54 patients, who underwent complementary thyroidectomy and nerve monitoring in our clinic, were analyzed retrospectively.Patients who did not undergo nerve monitoring were not included in the study. The age, gender, pathology and indication, first surgery type, and the length of hospital stay of the patients, the reason for undergoing complementary thyroidectomy, and whether or not postoperative complications developed in the patients, were all recorded. Results: The mean age of the patients was 44.4 (16-82 years). The average length of hospital stay of the patients was 2.37 (1-5 days). According to the initial pathology results of the patients who underwent comp-lementary thyroidectomy, 34 had papillary thyroid cancer, 6 had follicular thyroid carcinoma or suspicion, 1 had medullary thyroid carcinoma, 1 patient had Anaplastic thyroid carcinoma suspicion and 12 patients had Multinodular Goiter recurrence. Conclusions: As a result, complementary thyroid surgery poses an important problem for surgeons. It has a high rate of complications due to the formation of scar and loss of normal tissue planes. Therefore, we think that the use of intraoperative nerve monitoring during complementary thyroidectomy surgery may be helpful in reducing the occurrence of permanent or temporary recurrent laryngeal nerve damage. Key Words: Intraoperative Nerve Monitoring Complementary Thyroidectomy, Complication

125 Central Lymph Node Dissection Increases the Rate of Postoperative Complications During Thyroidectomy Surgery - a Retrospective Observational Study

Abstract Introduction Total thyroidectomy is a commonly performed endocrine surgical procedure. Where thyroid malignancy is suspected, additional central lymph node dissection (CLND) may be performed intraoperatively leading to greater tissue dissection. The aim of this study was to assess the impact of CLND during thyroidectomy surgery on postoperative outcomes. Method This single center retrospective observational study was performed with reference to STROBE guidelines. Data from 712 patients undergoing total thyroidectomy and total thyroidectomy with CLND was collected during a 1-year period between September 2021 and September 2022. Patients were assessed by demographic data, surgical characteristics and complication rates including hypocalcemia, dysphonia and length of hospital stay. Results 567 of the patients underwent total thyroidectomy and 145 patients underwent a total thyroidectomy with central lymphadenectomy. There was no statistically significant difference in age (55 vs. 58, p = 0.768) or sex (88% vs. 86% female, p = 0.914) between the groups. Overall, there was a 14% rate of complications in thyroidectomy with CLND group and 8% rate in thyroidectomy group (p = 0.022). 4% and 7% rates of hypocalcaemia (p = 0.140), 3% and 8% rates of dysphonia (p = 0.016) were recorded in thyroidectomy with CLND and thyroidectomy alone groups, respectively. There was no significant difference in oesophageal damage or post operative bleeding rates between the groups. Conclusions Thyroidectomy with CLND compared to thyroidectomy alone is associated with increased rates of post operative complications. These findings are most likely associated with greater tissue dissection and tissue manipulation.

Transoral endoscopic and robotic thyroidectomy for thyroid cancer: the mid-term oncological outcome.

Traditional open thyroidectomy is the surgical standard for thyroid cancer; however, it inevitably leaves a visible scar on the neck and affects the patient's quality of life. Therefore, to avoid making a neck incision, the transoral endoscopic thyroidectomy vestibular approach (TOETVA) and transoral robotic thyroidectomy (TORT) have been developed recently, and the surgical outcomes of these techniques are as favorable as open surgery for benign disease. Additionally, positive short-term surgical outcomes have also been achieved in a few patients with thyroid cancer. However, no data on the mid-to-long-term recurrence and survival rates of transoral thyroidectomy in thyroid cancer are available. Therefore, in this study, we analyzed the surgical outcomes and mid-term oncological results of the TOETVA and TORT in patients with thyroid cancer. We reviewed patients who had received TOETVA or TORT between July 2017 and November 2021 and followed up on their oncological outcomes until December 2022. Perioperative surgical and mid-term oncological outcomes were analyzed. The 115 patients underwent 122 operations (57 TOETVAs and 65 TORTs), including seven complete thyroidectomies for differentiated thyroid cancer (DTC), Stage I-II, including T1-T3, N0-N1a, and initial low- to high-risk groups. There was no conversion from transoral to open surgery. TORT required a longer operating time (median [interquartile range]) than TOETVA (lobectomy: 279 [250, 318] vs. 196 [173, 253] min, p < 0.001; bilateral total thyroidectomy: 375 [309, 433] vs. 279 [238, 312] min, p < 0.001); however, no difference was found between the two groups regarding perioperative complications. Complete thyroidectomy with a second transoral approach was safe. TOETVA and TORT achieved favorable oncological outcomes with 100% survival and 98.2% acceptable response (excellent and indeterminate response) during a mean 37.88 ± 12.42months mid-term follow-up. Transoral endoscopic and robotic thyroidectomy was safe and achieved favorable mid-term oncological outcomes in a selected cohort of patients with early-stage DTC.

Endoscopic thyroidectomy using the axillo-breast approach in patients with lactating and/or large ptotic breasts

IntroductionThe purpose of this study is to evaluate the outcomes of endoscopic hemithyroidectomy (EH) performed via the modified unilateral axillo-breast approach (UABA) in patients with lactating and/or large ptotic breasts. MethodsBetween 2019 and 2021, we studied the records of twenty-three eligible female patients with lactating and/or large ptotic breasts who were presented with benign unilateral thyroid nodule (s) and who were treated by EH using modified UABA at Mansoura University Oncology Center or Meet Ghamr oncology center. The demographic data, clinicopathological parameters, operative and the esthetic outcomes were collected and analyzed. ResultsNine patients (39%) were lactating. All patients were obese (the mean BMI was 37.82 ± 4.37). All patients were having large breasts, cup C and D sizes (34% of patients & 56% of patients respectively), except for only two lactating female patients who had Cup B breasts. All patients were having ptotic breasts. The thyroid nodules greatest dimension ranged from 2.1–6 cm. All procedures were completed successfully endoscopically without any perioperative adverse events except for one case with temporary hoarseness of voice and three cases with axillary port sites cellulitis. The mean operative time was 83.26 ± 7.92 min. The patient satisfaction scores were high. ConclusionEH via modified UABA in patients with lactating and/or large ptotic breasts is safe, feasible and effective procedure without adverse events. It should be offered to this group of patients as an alternative to conventional open thyroidectomy if there is no other contraindication.

Transoral endoscopic thyroidectomy vestibular approach as a safe and feasible alternative to open thyroidectomy: a systematic review and meta-analysis.

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is a scarless alternative to open thyroidectomy (OT). This systematic review and meta-analysis aimed to synthesize evidence comparing the intraoperative and postoperative outcomes of TOETVA and OT. A systematic literature search of PubMed, Web of Science, the Cochrane Library, and Google Scholar was performed to identify studies comparing the outcomes of TOETVA and OT published before February 2023. The outcomes of interest were operative time, intraoperative blood loss, hospital stay, postoperative pain, number of central lymph nodes retrieved, number of metastatic central lymph nodes, and incidences of transient and permanent recurrent laryngeal nerve injury, transient and permanent hypocalcemia, hematoma, and infection. Thirteen studies published between 2016 and 2022, involving a total of 2889 patients (TOETVA, n =1085; OT, n =1804) were included in this systematic review and meta-analysis. Meta-analysis showed that the TOETVA group had a significantly longer overall operative time (weighted mean difference [WMD] 55.19; 95% CI, 39.15, 71.23; P <0.001), longer hospital stay (WMD, 0.27; 95% CI, 0.14, 0.39; P <0.001), and lower pain scores on postoperative day 1 (WMD, -1.41; 95% CI, -2.79, -0.03; P =0.04) than the OT group. Other intraoperative and postoperative outcomes were not significantly different between the groups. TOETVA has a similar safety profile to OT with less postoperative pain, making it an appropriate and more cosmetically appealing alternative to OT for select patients.

Trials, tribulations and the emergence of total thyroidectomy - A Sri Lankan perspective

Abstract&#x0D; The technique of thyroidectomy has emerged during the last 100 years, from a turbulent past’, due to the outstanding contributions made by many including the “Magnificent Seven” of thyroid surgery. The dissection of the gland, preservation Parathyroid function and protecting the Nerves are dealt with meticulously.&#x0D; Total thyroidectomy is associated with complications of bleeding, permanent injury to Nerves and permanent hypoparathyroidism. Many centres have reported incidence of complications around 1-3%. This is the bench mark for surgeons world over. &#x0D; Voice change is a major concern after thyroidectomy. A study has shown that RLN recovery much faster than the recovery of the EBSLN. The recovery will take up to 3 months in most patients.&#x0D; Assessment of the surgical practices related to thyroid disease in Sri Lanka has shown that the practices have changed over the last decade. More total thyroidectomies are undertaken. Younger surgeons are undertaking more total thyroidectomies.&#x0D; The quoted incidence of Incidental carcinoma is around 10-20% in the literature. In two studies done in the unit, an incidence between 8.8% and 11.38% was seen. This factor must be considered in surgical decision making for benign disease. &#x0D; Most common cause of recurrences is the enlargement of embryological remnants of the thyroid and a modern thyroid surgeon must excise the embryological remnants meticulously. &#x0D; Surgery for recurrent goitre is a difficult task. Data confirms that Lateral approach to the thyroid makes the task much easier. This must be considered a bench for Sri Lanka.&#x0D; Cosmetic issues and cost must also be considered in thyroidectomy. Data confirms that Mini incision open thyroidectomy is a safe cost effective alternative to endoscopic thyroidectomy The obituary of open total thyroidectomy shall not be written for a long time.&#x0D;

Comparison of 980-nm/1470-nm Dual-Wavelength Fiber Laser Versus Ultrasonic Scalpel Device in Open Thyroidectomy.

Background: To investigate the application value of 980-nm/1470-nm dual-wavelength fiber laser in thyroidectomy. Methods: The clinical data of 130 patients undergoing thyroid surgery from March 2017 to December 2018 were retrospectively analyzed. According to the use types of energy devices, the patients were divided into laser group and ultrasonic scalpel group, with 65 patients in each group. The baseline data, operation-related indicators, operation complications, postoperative pathological conditions, and follow-up results of the two groups were compared. Results: The operations were successfully completed in both groups. The median operative time of total thyroidectomy (TT), lobectomy+central lymph node dissection (CLND), TT+CLND in the laser group were longer than that in the harmonic scalpel group, and the difference was statistically significant (p < 0.05). The incidence of parathyroid gland congestion in the laser group (10.3%) was lower than that in the harmonic scalpel group (19.2%), and the difference was statistically significant (p < 0.05). No significant differences were found in operative type, intraoperative blood loss, postoperative drainage volume, operative complications, postoperative hospital stay, and lymph node metastasis rate between the two groups (p > 0.05). No incidence was noted of recurrence, metastasis, or death in both groups. Conclusions: The 980-nm/1470-nm dual-wavelength fiber laser had an efficacy in open thyroidectomy similar to that of the harmonic scalpel, was safe and feasible, and less damage to the parathyroid gland blood supply than a scalpel. It can be used as a new option for thyroid surgery.

Visualization of the recurrent laryngeal nerve alone versus intraoperative nerve monitoring in primary thyroidectomy: a framework approach to a missing typology.

Surgical studies evaluating a device or technology in comparison to an established surgical technique should accurately report all the important components of the surgical technique in order to reduce the risk of intervention bias. In the debate of visualization of the recurrent laryngeal nerve alone (VONA) versus intraoperative nerve monitoring (IONM) during thyroidectomy, surgical technique plays a key role in both strategies. Our aim was to investigate whether the surgical technique was considered as a risk of intervention bias by relevant meta-analyses and reviews and if steps of surgical intervention were described in their included studies. We searched PUBMED, CENTRAL-Cochrane library, PROSPERO and GOOGLE for reviews and meta-analyses focusing on the comparison of IONM to VONA in primary open thyroidectomy. Τhen, primary studies were extracted from their reference lists. We developed a typology for surgical technique applied in primary studies and a framework approach for the evaluation of this typology by the meta-analyses and reviews. Twelve meta-analyses, one review (388,252 nerves at risk), and 84 primary studies (128,720 patients) were included. Five meta-analyses considered the absence of typology regarding the surgical technique as a source of intervention bias; 48 primary studies (57.14%) provided information about at least one item of the typology components and only 1 for all of them. Surgical technique of thyroidectomy in terms of a typology is underreported in studies and undervalued by meta-analyses comparing VONA to IONM. This missing typology should be reconsidered in the comparative evaluation of these two strategies.

Total thyroidectomy: reduction in postoperative hypoparathyroidism.

Total thyroidectomy is associated with a high risk of postoperative hypoparathyroidism, mainly due to the unintended surgical damage to the parathyroid glands or their blood supply. It is possible that surgeons who also perform parathyroid surgery see lower rates of postoperative hypoparathyroidism. In a single institution, we investigated the effects of restricting total thyroidectomy operations for Graves' disease to two surgeons who performed both thyroid and parathyroid surgeries. We aimed to evaluate the rates of postoperative hypoparathyroidism in a 10-year period with primary attention toward patients with Graves' disease. Retrospective cohort study from a single institution. We defined the rate of permanent hypoparathyroidism after total thyroidectomy as the need for active vitamin D 6 months postoperatively. Between 2012 and 2016, seven surgeons performed all thyroidectomies. From January 2017, only surgeons also performing parathyroid surgery carried out thyroidectomies for Graves' disease. We performed total thyroidectomy in 543 patients. The rate of permanent hypoparathyroidism decreased from 28% in 2012-2014 to 6% in 2020-2021. For patients with Graves' disease, the rate of permanent hypoparathyroidism decreased from 36% (13 out of 36) in 2015-2016 to 2% (1 out of 56) in 2020-2021. In cancer patients, the rate of permanent hypoparathyroidism decreased from 30% (14 out of 46) in 2012-2014 to 10% (10 out of 51) in 2020-2021. Restricting thyroidectomy to surgeons who also performed parathyroid operations reduced postoperative hypoparathyroidism markedly. Accordingly, we recommend centralisation of the most difficult thyroid operations to centres and surgeons with extensive experience in parathyroid surgery. Thyroid surgery is performed by many different surgeons with marked differences in outcome. Indeed, the risk of postoperative permanent hypoparathyroidism may be very high in low-volume centres. This serious condition affects the quality of life and increases long-term morbidity and the patients develop a life-long dependency of medical treatments. We encountered a high risk of hypoparathyroidism after the operation for Graves' disease and restricted the number of surgeons to two for these operations. Further, these surgeons were experienced in both thyroid and parathyroid surgeries. We show a dramatic reduction in postoperative hypoparathyroidism after this change. Accordingly, we recommend centralisation of total thyroidectomy to surgeons with experience in both thyroid and parathyroid procedures.

Surgical profile of patients undergoing thyroid surgery and its complications at a tertiary care centre: A hospital based retrospective study

Patient related, surgeon related and thyroid gland related factors affect complication rate of surgery of thyroid gland. Hence, it is important to carry out more studies on surgical profile of patients undergoing surgery of thyroid gland and associated complications to help young surgeons understand the depth of the topic.To study surgical profile of patients undergoing thyroid surgery and its complicationsRetrospective observational analysis has been performed. Study population included all patients who had a thyroidectomy operation performed. Medical records of all patients who underwent thyroid surgery were retrospectively evaluated. A data forms were set up for the detailed collection of data on surgical techniques and their related complications. Data extraction was carried out from the patients’ medical records manually. Most commonly affected age group was 31-40 years. Females were commonly affected (93.7%). Right lobe was affected in almost half of cases. Majority i.e. 95.8% of lesions of the thyroid gland were benign in nature and only 4.2% were malignant. Most commonly performed surgical procedure was hemi-thyroidectomy in 54.1% of cases. Complication rate was only 15.6% and all complications were mild. There was no recurrent laryngeal nerve injury and No death was recorded. Most common complication was transient hypocalcemia and seroma in four cases each. Middle aged and females are commonly affected with the thyroid disease requiring surgery. Right lobe of thyroid commonly affected. Complication rate is low and all complications were mild in nature. This suggests that now a day, the thyroid surgery is not associated with mortality and severe morbidity as was the case in previous days.