Loupe Assisted Thyroidectomy: Prevention of Complications is better than Treating Them

Abstract

Aim: Studying the value of the surgical loupe in the enhancement of performing safe thyroidectomy via dissection of the major structures which are vulnerable to injury during the operation. Subjects and methods: 150 patients with benign and malignant thyroid masses underwent near total or total thyroidectomy at Zagazig university hospitals. History taking and all necessary investigations were done. Thyroidectomy was done under the magnification of the surgical loupe and we dissected the recurrent laryngeal nerve, the external branch of superior laryngeal nerve, branches of superior thyroid artery and selectively ligating them and trace the parathyroid glands by following their minute blood vessels originating from the inferior thyroid artery. Results: Mean age of the patients was 42.5 years (range: 23-69). Female: male ratio was 19:11 (95/55). 65 patients (43.3%) had a discrete thyroid nodule and 85 patients (56.7%) had multinodular goiter. Patients were sent home in a mean of 1.6 days (1–4 days). No operative related mortality was encountered. Only three cases of transient hypocalcaemia which were resolved within three days by oral calcium supplementation and symptoms did not recur during the follow-up of these three patients. All patients were extubated without any complications. There was no any case recorded for hoarseness of voice or low pitched voice. There was only one case of secondary hemorrhage and was re-explored for control of the source (injured anterior jugular vein on the right side). Three cases developed hypertrophic scars during the follow up. Conclusion: total or near total thyroidectomy can be done with a minimal number of complications by using the surgical loupe during the dissection of the recurrent laryngeal nerve, the external branch of the superior laryngeal nerve and the parathyroid glands and their minute blood vessels.