Tension-free thyroidectomy — results of the initial 77 operations

Abstract

BACKGROUND: Surgeons from all over the world make considerable efforts to reduce thyroid intraoperative complications such as recurrent laryngeal nerves trauma and parathyroid vascular supply damage.AIM: The aim of the study was improving thyroidectomy technique to reduce the rate of postoperative complications.MATERIALS AND METHODS: Inclusion criteria were primary thyroid operation in cases of papillary or medullary cancer, follicular tumours (Bethesda IV) and Grave’s disease. Thyroid volume ranged from 12–70 ml. Tension-free technique of thyroidectomy (TFT) was suggested by the authors of this study. Key points of TFT are the following: the first step is the complete dissection of Berry ligament fibers and terminal branches of lower thyroid arteries and vein. There is only lateral traction while medial traction is not applied at all. Mobilization of the upper parathyroid gland is performed at the medial thyroid surface. Thyroid lobe is extracted out of its bed beginning with the lower pole only after complete dissection of Berry’s ligament, vessels and parathyroid glands. The last step of the operation is the dissection of the upper pole thyroid vessels. The mobilized lobe is easily withdrawn downwards, that leads to space increase between external branch of the superior laryngeal nerve and the upper pole of the lobe. Transient and continuous neuromonitoring as well as optical magnification and headlamps were used during operations. Vocal cords function was controlled before and after surgery (on the first day) by means of ultrasound or endoscopic laryngoscopy. Ionized calcium and parathyroid hormone levels were checked in cases of total thyroidectomy group on the day of surgery, on the 1st and 14th postoperative days.RESULTS: 77 consecutive patients were included into the study (continuous sampling of patients). 33 hemithyroidectomies, 13 hemithyroidectomies with central ipsilateral neck dissection, 21 thyroidectomies, 8 thyroidectomies with central neck dissection, 2 thyroidectomies with central and lateral neck dissection were performed by the same surgeon. All the operations were performed by tension-free technique (TFT). There were no cases of loss of signal from the recurrent laryngeal nerves function during all the operations. One case of postoperative transient hypoparathyroidism finished with normalization of parathyroid hormone and calcium levels in 2 weeks after the operation.CONCLUSION: initial experience in TFT allows to recommend this procedure for further practicing and examination.