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Total thyroidectomy by loupe magnification: a comparative study

Totale Schilddrüsenresektion mit Lupenvergrößerung: eine Vergleichsstudie

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Zusammenfassung

GRUNDLAGEN: Die Entfernung der gesamten Schilddrüse ist in der Therapie bei gutartigen und bösartigen Erkrankungen der Schilddrüse etabliert, ist aber potentiell mit erhöhten postoperativen Komplikationen assoziiert. Es geht vor allem um die Schonung der Nervus laryngeus recurrens und der Nebenschilddrüsen. Die Autoren überlegten, ob die Lupenvergrößerung dazu beitragen kann, die angeführten Komplikationen zu vermeiden. METHODIK: Die totale Thyreoidektomie wurde mit (Gruppe A) und ohne (Gruppe B) Lupenvergrößerung durchgeführt. Stimmbandfunktion und Kalziumspiegel wurden postoperativ untersucht. ERGEBNISSE: Die Lupenvergrößerung verbessert die Identifizierung und Schonung des Nervus laryngeus recurrens und der Nebenschilddrüsen. SCHLUSSFOLGERUNGEN: Lupenvergrößerung bei Entfernung der gesamten Schilddrüse ist machbar, verbessert das Ergebnis und sollte von erfahrenen Chirurgen durchgeführt werden.

Summary

BACKGROUND: Total thyroidectomy has been accepted as current surgical therapy for benign and malignant thyroidal disorders but extensive resection might increase the risk of postoperative complications. Intensive effort should be spent to prevent recurrent laryngeal nerve injury and hypoparathyroidism, because they can be avoided with appropriate surgical technique during total thyroidectomy. The authors proposed that the use of a loupe for operative field magnification could improve the outcome of total thyroidectomy as regard to identification of both the recurrent laryngeal nerves and the parathyroids. METHODS: Patients were subjected to total thyroidectomy with loupe magnification in group A and without loupe in group B. The status of vocal cords of all patients was checked postoperatively by laryngoscope. Serum calcium concentration immediately postoperatively and during follow-up was checked. RESULTS: Loupe magnification helps identification of external branch of superior laryngeal nerve and parathyroid preservation. CONCLUSIONS: Total thyroidectomy by loupe magnification is feasible, improves the outcome, and should be done by experienced surgeon.

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References

  • Veyseller B, Aksoy F, Demirhan H, Yıldırım YS, Ertaş B, Açıkalın RM, Kumral TL, Bayraktar GI. Total thyroidectomy in benign thyroid diseases. Kulak Burun Bogaz Ihtis Derg 2009;19:299–303

    PubMed  Google Scholar 

  • Thomusch O, Dralle H. Endokrine Chirurgie und Evidenz-basierte Medizin. Der Chirurg 2000;71:635–45

    Article  CAS  Google Scholar 

  • Hisham AN, Lukman MR. Recurrent laryngeal nerve in thyroid surgery: a critical appraisal. Aust NZ J Surg 2002;72:887–9

    Article  Google Scholar 

  • Bron LP, O'Brien CJ. Total thyroidectomy for clinically benign disease of the thyroid gland. Br J Surg 2004;91:569–74

    Article  PubMed  CAS  Google Scholar 

  • Rosato L, Avenia N, Bernante P, De Palma M, Gulino G, Nasi PG, Pelizzo MR, Pezzullo L. Complications of thyroid surgery: analysis of a multicentric study on 14934 patients operated on in Italy over 5 years. World J Surg 2004;28:271–6

    Article  PubMed  Google Scholar 

  • Thomusch O, Sekulla C, Dralle H. Is primary total thyroidectomy justified in benign multinodular goiter? Results of a prospective quality assurance study of 45 hospitals offering different levels of care. Der Chirurg 2003;74:437–43

    Article  CAS  Google Scholar 

  • Dralle H; Chirurgische Arbeitsgemeinschaft Endokrinologie (CAEK) der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV) und für die Deutsche Gesellschaft für Chirurgie (DGCH). Identification of the recurrent laryngeal nerve and parathyroids in thyroid surgery. Chirurg 2008;32:1358–66

    CAS  Google Scholar 

  • Hermann M, Hellebart C, Freissmuth M. Neuromonitoring in thyroid surgery: prospective evaluation of intraoperative electrophysiological responses for the prediction of recurrent laryngeal nerve injury. Ann Surg 2004;240:9–17

    Article  PubMed  Google Scholar 

  • Barczyński M, Cichoń S, Konturek A, Cichoń W. Applicability of intraoperative parathyroid hormone assay during total thyroidectomy as a guide for the surgeon to selective parathyroid tissue autotransplantation. World J Surg 2008;32:822–8

    Article  PubMed  Google Scholar 

  • Efremidou EI, Papageorgiou MS, Liratzopoulos N, Manolas KJ The efficacy and safety of total thyroidectomy in the management of benign thyroid disease: a review of 932 cases. Can J Surg 2009,52:39–44

    PubMed  Google Scholar 

  • Friedman M, LoSavio P, Ibrahim H. Superior laryngeal nerve identification and preservation in thyroidectomy. Arch Otolaryngol Head Neck Surg 2002;128:296–303

    PubMed  Google Scholar 

  • Tezelman S, Borucu I, Senyurek Giles Y, Tunca F, Terzioglu T. The change in surgical practice from subtotal to near-total or total thyroidectomy in the treatment of patients with benign multinodular goiter. World J Surg 2009;33:400–5

    Article  PubMed  Google Scholar 

  • Müller PE, Kabus S, Robens E, Spelsberg F. Indications, risks, and acceptance of total thyroidectomy for multinodular benign goiter. Surg Today 2001;31:958–62

    Article  PubMed  Google Scholar 

  • Reeve TS, Delbridge L, Brady P, Crummer P, Smyth C. Secondary thyroidectomy: a twenty-year experience. World J Surg 1988;12:449–53

    Article  PubMed  CAS  Google Scholar 

  • Khadra M, Delbridge L, Reeve TS, Poole AG, Crummer P. Total thyroidectomy: its role in the management of thyroid disease. Aust N Z J Surg 1992;62:91–5

    Article  PubMed  CAS  Google Scholar 

  • Gough IR. Total thyroidectomy: indications, technique and training. Aust N Z J Surg 1992;62:87–9

    Article  PubMed  CAS  Google Scholar 

  • Cappellani A, Di Vita M, Zanghì A, Lo Menzo E, Cavallaro A, Alfano G, Giuffrida D. The recurrent goiter: prevention and management. Ann Ital Chir 2008;79:247–53

    PubMed  Google Scholar 

  • Thomusch O, Sekulla C, Dralle H. Is primary total thyroidectomy justified in benign multinodular goiter? Results of a prospective quality assurance study of 45 hospitals offering different levels of care. Der Chirurg 2003;74:437–43

    Article  CAS  Google Scholar 

  • Testini M, Nacchiero M, Piccinni G, Portincasa P, Di Venere B, Lissidini G, Bonomo GM. Total thyroidectomy is improved by loupe magnification. Microsurgery 2004;24:39–42

    Article  PubMed  Google Scholar 

  • Loch-Wilkinson TJ, Stalberg PL, Sidhu SB, Sywak MS, Wilkinson JF, Delbridge LW. Nerve stimulation in thyroid surgery: is it really useful? Aust NZ J Surg 2007;77:377–80

    Article  Google Scholar 

  • Canbaz H, Dirlik M, Colak T, Ocal K, Akca T, Bilgin O, Tasdelen B, Aydin S. Total thyroidectomy is safer with identification of recurrent laryngeal nerve. J Zhejiang Univ Sci B 2008;9:482–8

    Article  PubMed  Google Scholar 

  • Miller MC, Spiegel JR. Identification and monitoring of the recurrent laryngeal nerve during thyroidectomy. Surg Oncol Clin N Am 2008;17:121–44, viii–ix

    Article  PubMed  Google Scholar 

  • Hemmerling TM, Schmidt J, Bosert C, Jacobi KE, Klein P. ?Intraoperative monitoring of the recurrent laryngeal nerve in 151 consecutive patients undergoing thyroid surgery. Anesth Analg 2001;93:396–9

    Article  PubMed  CAS  Google Scholar 

  • Riju R, Jadhav S, Kanthaswamy R, Jacob P, Nair CG. Is total thyroidectomy justified in multinodular goitre. J Indian Med Assoc 2009;107:223–5

    PubMed  CAS  Google Scholar 

  • Delbridge L, Guinea AI, Reeve TS. Total thyroidectomy for bilateral benign multinodular goiter: effect of changing practice. Arch Surg 1999;134:1389–93

    Article  PubMed  CAS  Google Scholar 

  • Rathi PK, Shaikh AR, Shaikh GA. Dentification of recurrent laryngeal nerve during thyroidectomy decreases the risk of nerve injury. Pak J Med Sci 2010;26:148–51

    Google Scholar 

  • Pagedar NA, Freeman JL. Identification of the external branch of the superior laryngeal nerve during thyroidectomy. Arch Otolaryngol Head Neck Surg 2009;135:360–2

    Article  PubMed  Google Scholar 

  • Kochilas X, Bibas A, Xenellis J, Anagnostopoulou S. Surgical anatomy of the external branch of the superior laryngeal nerve and its clinical significance in head and neck surgery. Clin Anat 2008;21:99–105

    Article  PubMed  Google Scholar 

  • Inabnet WB, Murry T, Dhiman S, Aviv J, Lifante JC. Neuromonitoring of the external branch of the superior laryngeal nerve during minimally invasive thyroid surgery under local anesthesia: a prospective study of 10 patients. Laryngoscope 2009;119:597–601

    Article  PubMed  Google Scholar 

  • Dionigi G, Bacuzzi A, Boni L, Rovera F, Dionigi R. What is the learning curve for intraoperative neuromonitoring in thyroid surgery? Int J Surg 2008;6(Suppl. 1):S7–12

    Article  PubMed  Google Scholar 

  • Morton RP, Whitfield P, Al-Ali S. Anatomical and surgical considerations of the external branch of the superior laryngeal nerve: a systematic review. Clin Otolaryngol 2006;31:368–74

    Article  PubMed  CAS  Google Scholar 

  • Mishra AK, Temadari H, Singh N, Mishra SK, Agarwal A. The external laryngeal nerve in thyroid surgery: the 'no more neglected' nerve. Indian J Med Sci 2007;61:3–8

    Article  PubMed  Google Scholar 

  • Hurtado-Lopez LM, Pacheco-Alvarez MI, Montes-Castillo Mde L, Zaldivar-Ramirez FR. Importance of the intraoperative identification of the external branch of the superior laryngeal nerve during thyroidectomy: electromyographic evaluation. Thyroid 2005;15:449–54

    Article  PubMed  Google Scholar 

  • Loch-Wilkinson TJ, Stalberg PL, Sidhu SB, Sywak MS, Wilkinson JF, Delbridge LW. Nerve stimulation in thyroid surgery: is it really useful? Aust NZ J Surg 2007;77:377–80

    Article  Google Scholar 

  • Barczyński M, Cichoń S, Konturek A, Cichoń W. Applicability of intraoperative parathyroid hormone assay during total thyroidectomy as a guide for the surgeon to selective parathyroid tissue autotransplantation. World J Surg 2008;32:822–8

    Article  PubMed  Google Scholar 

  • Han N, Bumpous JM, Goldstein RE, Fleming MM, Flynn MB. Intra-operative parathyroid identification using methylene blue in parathyroid surgery. Am Surg 2007;73:820–3

    PubMed  Google Scholar 

  • Testini M, Gurrado A, Lissidini G, Nacchiero M. Hypoparathyroidism after total thyroidectomy. Minerva Chir 2007;62:409–15

    PubMed  CAS  Google Scholar 

  • Farahat FY, Hegazy NI, Saber A. Post-thyroidectomy complications: a surgical malpractice. Zag U Med J 2005;18(4):458–65

    Google Scholar 

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Authors and Affiliations

  1. Department of General Surgery, Port-Fouad General Hospital, Port-Fouad, Port-Said, Egypt

    A. Saber

  2. Faculty of Medicine, Department of Otorhinolarygology, Suez Canal University, Ismailia, Egypt

    M. Rifaat

  3. Faculty of Medicine, Department of Surgery, Suez Canal University, Ismailia, Egypt

    G. M. Ellabban & M. A. Gad

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  1. A. Saber
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  2. M. Rifaat
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  3. G. M. Ellabban
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  4. M. A. Gad
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Correspondence to A. Saber.

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Saber, A., Rifaat, M., Ellabban, G. et al. Total thyroidectomy by loupe magnification: a comparative study. Eur Surg 43, 49–54 (2011). https://doi.org/10.1007/s10353-011-0591-0

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  • DOI: https://doi.org/10.1007/s10353-011-0591-0

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