Redo Thyroidectomy Modified Technique to Eliminate Complications: A Cohort Study
Main Article Content
Keywords
Modified techniques, Recurrent goiter, Thyroid reoperation, Thyroidectomy
Abstract
Introduction
Reoperation is the most challenging task in thyroid surgery because of the high risk of complications. This study aims to demonstrate the efficacy of a modified thyroidectomy technique in decreasing associated complications to almost zero in recurrent thyroidectomy.
Methods
This single-group cohort study enrolled consecutive patients who had a recurrent thyroidectomy. The procedures were done by high-volume surgeons using a modified thyroidectomy technique, which included the following steps: 1) Preserving parathyroid glands before searching for the recurrent laryngeal nerve; 2) Expecting the recurrent laryngeal nerve in any area of the neck until it is found; 3) Initiating dissection in the suprasternal notch and moving to the tracheoesophageal groove; 4) If the nerve was not found in the suprasternal notch, the search would continue at the nerve's expected entrance to the cricoid cartilage.
Results
In total, 195 cases with redo thyroidectomy were enrolled in this study. Female patients (173, 88.7%) were predominant compared to males (22, 11.3%). The most common ultrasonographic finding was multinodular goiter in 138 cases (70.7%). Most of the cases underwent total thyroidectomy (160, 82%), and thyroid lobectomy was performed in 35 cases (18%). In all the cases that underwent total thyroidectomy, both recurrent laryngeal nerves were explored, and the concerned lateral recurrent laryngeal nerve was seen during the thyroid lobectomies. There was no injury to recurrent laryngeal nerves, and only 15% of the cases suffered from temporary hypocalcemia.
Conclusion
Recurrent thyroidectomy without significant complications is possible when conducted by high-volume surgeons, and a modified technique is used.
References
2. Bai B, Chen Z, Chen W. Risk factors and outcomes of incidental parathyroidectomy in thyroidectomy: A systematic review and meta-analysis. PLoS One. 2018;13(11):e0207088. doi:10.1371/journal.pone.0207088
3. Filho JG, Kowalski LP. Surgical complications after thyroid surgery performed in a cancer hospital. Otolaryngology—Head and Neck Surgery. 2005;132(3):490-4. doi:10.1016/j.otohns.2004.09.028
4. Menegaux F, Turpin G, Dahman M, Leenhardt L, Chadarevian R, Aurengo A, et al. Secondary thyroidectomy in patients with prior thyroid surgery for benign disease: a study of 203 cases. Surgery.1999;126(3):479-83. doi:10.1016/S0039-6060(99)70088-7
5. Reeve TS, Delbridge L, Brady P, Crummer P, Smyth C. Secondary thyroidectomy: a twenty-year experience. World journal of surgery.1988;12(4):449-52. doi:10.1007/BF01655417
6. Alqahtani SM, Almussallam B, Alatawi AS, Alsuhaimi NA, Albalawi A, Albalawi NS, et al. post-thyroidectomy complications and risk factors in Tabuk, Saudi Arabia: a retrospective cohort study. Cureus. 2020;12(10): e10852. doi:10.7759/cureus.10852
7. Alesina PF, Rolfs T, Hommeltenberg S, Hinrichs J, Meier B, Mohmand W, et al. Intraoperative neuromonitoring does not reduce the incidence of recurrent laryngeal nerve palsy in thyroid reoperations: results of a retrospective comparative analysis. World journal of surgery. 2012;36(6):1348-53. doi:10.1007/s00268-012-1548-6
8. Antakia R, Edafe O, Uttley L, Balasubramanian SP. Effectiveness of preventative and other surgical measures on hypocalcemia following bilateral thyroid surgery: a systematic review and meta-analysis. Thyroid. 2015;25(1):95-106. doi:10.1089/thy.2014.0101
9. Christou N, Mathonnet M. Complications after total thyroidectomy. Journal of visceral surgery. 2013;150(4):249-56. doi:10.1016/j.jviscsurg.2013.04.003
10. Yarbrough DE, Thompson GB, Kasperbauer JL, Harper CM, Grant CS. Intraoperative electromyographic monitoring of the recurrent laryngeal nerve in reoperative thyroid and parathyroid surgery. Surgery. 2004;136(6):1107-15. doi:10.1016/j.surg.2004.06.040
11. Aytac B, Karamercan A. Recurrent laryngeal nerve injury and preservation in thyroidectomy. Saudi medical journal. 2005;26(11):1746-9. doi:N/A
12. Elkhateeb KO, Elgohary AN, Sharaf MF. Risk of Recurrent laryngeal Nerve Injury in Complete Resection OF Recurrent Multi-nodular Goiter. Al-Azhar International Medical Journal. 2020;1(1): 69-73. doi:10.21608/aimj.2020.20772.1007
13. Gurleyik E, Cetin F, Dogan S, Yekenkurul E, Onsal U, Gursoy F, et al. Displacement of the recurrent laryngeal nerve in patients with recurrent goiter undergoing redo thyroid surgery. Journal of Thyroid Research. 2018;2018(1):1-6. doi:10.1155/2018/4763712
14. Barczyński M, Konturek A, Pragacz K, Papier A, Stopa M, Nowak W. Intraoperative nerve monitoring can reduce prevalence of recurrent laryngeal nerve injury in thyroid reoperations: results of a retrospective cohort study. World journal of surgery. 2014;38(3):599-606. doi:10.1007/s00268-013-2260-x
15. Thomusch O, Machens A, Sekulla C, Ukkat J, Lippert H, Gastinger I, et al. Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World journal of surgery. 2000;24(11):1335-41. doi:10.1007/s002680010221
16. Echternach M, Maurer C, Mencke T, Schilling M, Verse T, Richter B. Laryngeal complications after thyroidectomy: is it always the surgeon? . Archives of surgery. 2009;144(2): 149-53. doi:10.1001/archsurg.2008.530
17. Aygün N, Besler E, Yetkin G, Mihmanlı M, İşgör A, Uludağ M. Complication risk in secondary thyroid surgery. The Medical Bulletin of Sisli Etfal Hospital. 2018;52(1):19-25. doi:10.14744/SEMB.2017.87609
18. Dedivitis RA, Pfuetzenreiter EG, Nardi CE, de Barbara EC. Prospective study of clinical and laboratorial hypocalcemia after thyroid surgery. Brazilian journal of otorhinolaryngology. 2010;76(1):71-7. doi:10.1590/S1808-86942010000100012
19. Miccoli P, Frustaci G, Fosso A, Miccoli M, Materazzi G. Surgery for recurrent goiter: complication rate and role of the thyroid-stimulating hormone-suppressive therapy after the first operation. Langenbeck's archives of surgery. 2015;400(2):253-8. doi:10.1007/s00423-014-1258-7
20. Vasica G, O'Neill CJ, Sidhu SB, Sywak MS, Reeve TS, Delbridge LW. Reoperative surgery for bilateral multinodular goiter in the era of total thyroidectomy. Journal of British Surgery. 2012;99(5):688-92. doi:10.1002/bjs.8684
21. Meltzer C, Hull M, Sundang A, Adams JL. Association between annual surgeon total thyroidectomy volume and transient and permanent complications. JAMA Otolaryngology–Head & Neck Surgery. 2019;145(9):830-7. doi:10.1001/jamaoto.2019.1752
22. Dackiw AP, Rotstein LE, Clark OH. Computer-assisted evoked electromyography with stimulating surgical instruments for recurrent/external laryngeal nerve identification and preservation in thyroid and parathyroid operation. Surgery. 2002;132(6):1100-8. doi:10.1067/msy.2002.128483
23. Shindo ML, Wu JC, Park EE. Surgical anatomy of the recurrent laryngeal nerve revisited. Otolaryngology-head and neck surgery. 2005;133(4):514-9. doi:10.1016/j.otohns.2005.07.010.