Role of magnification and microscope in thyroid surgery safety and efficacy

Authors

  • Ravi K. S. Department of ENT, Adichunchanagiri Institute of Medical Sciences and Research Institute, B. G. Nagar, Nagamangala, Mandya, Karnataka, India
  • Kiran M. Naik Department of ENT, Adichunchanagiri Institute of Medical Sciences and Research Institute, B. G. Nagar, Nagamangala, Mandya, Karnataka, India
  • Swarna Priya M. Department of ENT, Adichunchanagiri Institute of Medical Sciences and Research Institute, B. G. Nagar, Nagamangala, Mandya, Karnataka, India
  • Abhishek M. P. Department of ENT, Adichunchanagiri Institute of Medical Sciences and Research Institute, B. G. Nagar, Nagamangala, Mandya, Karnataka, India

DOI:

https://doi.org/10.18203/issn.2454-5929.ijohns20212780

Keywords:

Microsurgery loupes magnification, Thyroid nodule, Parathyroid gland, Recurrent laryngeal nerve, Hypocalcemia, Complication

Abstract

Background: Thyroid surgery becomes challenging, due to closely related structures like recurrent laryngeal nerve and parathyroid gland. Microscope assisted surgery has better visualization for dissection, and decreases the risk of injury to the nerve, parathyroid gland, and its vascular pedicle. Hence it decreases the operative complications.

Methods: This is a retrospective study of microscope-assisted thyroidectomy at Adichunchanagiri hospital and research centre, from May 2016 to April 2020. Ethical approval was obtained from institutional review committee. Types of surgery, post-operative hypocalcemia and recurrent laryngeal nerve function were analysed descriptively.

Results: Out of total 30 microscope assisted thyroidectomy, 26 were female, 42 (87.5%) benign pathology, 6 (12.5%) malignant. Hemithyroidectomy was done in 25 (83.3%), total thyroidectomy 4 (13.3%), and completion thyroidectomy with neck dissection in 1 (3.3%). Among total thyroidectomies, transient hypocalcemia occurred in 2 (6.6%) and no temporary or permanent recurrent laryngeal nerve palsy.

Conclusions: The use of microsurgical technique and loupes magnification in thyroid surgery are safety and effective procedures that require an appropriate training in microsurgery, but may significantly reduce post-operative complications.

References

Latif S, Altaf H, Waseem S, Farooqui F, Altaf OS, Amir M. A retrospective study of complications of total thyroidectomy; is it a safe approach for benign thyroid conditions. J Pak Med Assoc. 2019;69(10):1470-3.

Chahardahmasumi E, Salehidoost R, Amini M, Aminorroaya A, Rezvanian H, Kachooei A et al. Assessment of the early and late complication after thyroidectomy. Adv Biomed Res. 2019;8:14.

Bhattacharyya N, Fried MP. Assessment of the morbidity and complications of total thyroidectomy. Arch Otolaryngol Head Neck Surg. 2002;128(4):389-92.

Lo CY, Kwok KF, Yuen PW. A prospective evaluation of RLN paralysis during thyroidectomy. Arch Surg. 2000;135:204-7.

Shaha AR, Jaffe BM. Parathyroid preservation during thyroid surgery. Am J Otolaryngol. 1998;19:113-7.

Shindo ML, Sinha UK, Rice DH. Safety of thyroidectomy in residency: a review of 186 consecutive cases. Laryngoscope.1995;105:1173-5.

Lahey FH, Hoover WB. Injuries to the recurrent laryngeal nerve in thyroid operations: their management and avoidance. Ann Surg. 1938;108(4):545-62.

Attie JN, Khafif RA. Preservation of parathyroid glands during total thyroidectomy. Improved technic utilizing microsurgery. Am J Surg. 1975;130:399-404.

Kumar A, Tyagi AK, Varshney S, Malhotra M, Priya M. Microscopic thyroidectomy: a prudent option. Indian J Otolaryngol Head Neck Surg. 2019;71(2):212-7.

D’Orazi V. Use of loupes magnification and microsurgical technique in thyroid surgery: ten years’ experience in a single center. Giornale di Chirurgia J Surg. 2016.

Seven H, Calis AB, Vural C, Turgut S. Microscopic thyroidectomy: a prospective controlled trial. Eur Arch Otorhinolaryngol. 2005;262(1):41-4.

Davidson BJ, Guardiani E, Wang A. Adopting the operating microscope in thyroid surgery: safety, efficiency, and ergonomics. Head Neck. 2010;32:154-9.

Nielsen TR, Andreassen UK, Brown CL. Microsurgical technique in thyroid surgery-a 10-year experience. J Laryngol Otol. 1998;112:556-60.

Williams SP, Wilkie MD, Tahery J. Microscope-assisted thyroidectomy: Our experience in one hundred and twenty-one consecutive cases. Clin Otolaryngol. 2014;39:289-315.

Cavallaro G, Taranto G, Chiofalo MG. Usefulness of microsurgery to isolation of recurrent laryngeal nerve and parathyroid during thyroidectomy operations. Microsurgery. 1998;18:460-1.

Doikov IY, Yovchev IP, Konsulov SS. Microsurgical technique as a method for prevention of recurrent laryngeal nerve injury in thyroid surgery. Review of seven consecutive cases. Folia Med (Plovdiv). 2001;43:5-9.

Testini M, Nacchiero M, Piccinni G. Total thyroidectomy is improved by loupe magnification. Microsurgery. 2004.24:39-42.

Pata G, Casella C, Mittempergher F. Loupe magnification reduces postoperative hypocalcemia after total thyroidectomy. Am Surg. 2010;76:1345-50.

Downloads

Published

2021-07-23

Issue

Section

Original Research Articles