Endocrine Abstracts

Introduction: Thyroidectomy can performed by open or wide array of endoscopic techniques. Lack of uniform consensus on specific indications for each technique leads to confusion on ideal thyroidectomy technique. In this context, we analysed our experience with specific emphasis on deducing an algorithm on ideal technique for a given patient.

Material and methods: This is a retrospective study conducted at a tertiary care endocrine surgery department in South India over a period of 10 years from July 2009 to June 2019. Data on our thyroidectomy techniques was analysed with the specific emphasis on choice of technique based on disease related, non disease related and patient choice factors. We categorized all the clinico-investigative, logistic and patient factors influencing the choice of thyroidectomy technique in to four types A, B, C and D. Type A included disease related factors; Type B included logistics related factors; Type C factors based on comorbidities; Type D based on patient and their family. Finally, an algorithm to select an ideal technique of thyroidectomy for a given patient was developed based on the results.

Results: Open thyroidectomy was performed in 1794/2075 (86.5 %) cases. Endoscopic thyroidectomy was employed in 281 subjects. Type A to C factors, bifurcated the choice of technique to OT and ET without the need for Type D factors. Type D factors primarily dictated the choice amongst the available ET techniques. Further, DI, II and VII factors converted some of the ET feasible subjects to OT. DIII, IV, V, VI factors dictated the choice of a particular ET technique.

Conclusions: 1) The ideal technique of thyroidectomy for a given patient depended on logistics, expertise and patient choice rather than disease (goiter) related factors and 2) Our proposed algorithm appears to guide in making decision on the ideal choice of thyroidectomy technique. Key words: Thyroidectomy; Endoscopy; Algorithm; Surgery; Technique)