Endocrine Abstracts

Background and aims: The safety of thyroid surgery in terms of recurrent laryngeal nerve palsy and hypoparathyroidism was increasing in the last decade. In this study, we present a new method of tension-free thyroidectomy (TFT), which could be used to further decrease the complication rate after thyroidectomy.

Patients and Methods: TFT is based on the medial approach to the recurrent laryngeal nerve (RLN) and the parathyroid glands after the division of isthmus and successive total dissection of Berry’s ligament with full mobilization of the RLN and the parathyroid glands before the thyroid is pilled out from the neck. One hundred twenty consecutive patients (163 nerves at risk) underwent “tension-free thyroidectomy” (TFT) from August to November 2021 performed by one surgeon. There were 96 females and 24 male patients (ratio 4:1) with a mean age of ninety-two 46,3 (range from 17 to 75). Lobectomy was carried out in 93 (77,5%) patients, total thyroidectomy in 35 (22,5%). In 42 cases patients additionally underwent central or/and lateral neck dissection. Indications for surgery were papillary carcinoma (n=53), medullary cancer (n=2), follicular neoplasia - Bethesda IV group after fine-needle biopsy (n=49), Graves disease (n=12), multinodular toxic goiter (n=3), multinodular euthyroid goiter (n=1). Mean thyroid nodule size was 25,4 mm (ranged 7 - 120 mm). Intraoperative neuromonitoring was used in all the cases (5 mA). Translaryngeal untrasound or direct laryngoscopy were used prior and after surgery to evaluate vocal cords mobility. Calcium and parathormone levels were measured in patients after thyroidectomy on the first, 14^th and 30^thpostoperative days.

Results: No fluctuation of electric activity of laryngeal nerves during surgery was revealed. Intraoperative loss of signal (LOS) due to thermal effect of electrocautery and subsequent transient unilateral RLN palsy occurred in 4 cases (2,5% from the total number of nerves at risk). In all these patients normal vocal fold function was confirmed on the 30-45^th days after surgery. No permanent nerve palsy cases revealed. Four patients (out of 35 in the total thyroidectomy group – 11,4%) exhibited a decrease of parathyroid hormone level on the postoperative day 1 which was resolved at day 30^th under the substitution therapy with calcium and alfacalcidol. No cases of permanent hypoparathyroidism occurred.

Conclusion: TFT can be considered a safe and feasible operation. Larger and comparative (randomized) studies with conventional dissection technique should be performed to investigate the hypothesis that this approach can provide a lower complication rate.