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

Abstract 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. 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. 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. 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. 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. 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. 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. 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.