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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 22  |  Issue : 1  |  Page : 13-15

A comparative study of thyroid surgery with and without a microscope


Department of ENT, GSVM Medical College, Kanpur, Uttar Pradesh, India

Date of Submission12-Aug-2019
Date of Decision06-Oct-2019
Date of Acceptance27-Oct-2019
Date of Web Publication01-Jun-2020

Correspondence Address:
Dr. Harendra Kumar Gautam
Department of ENT, GSVM Medical College, Kanpur - 208 002, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/SJOH.SJOH_10_19

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  Abstract 


Introduction: The purpose of this prospective study was to evaluate microsurgical thyroidectomy by comparing it with traditional thyroidectomy. Material and Method: Before surgery, patients were assigned either to the microscopic thyroidectomy group (MT group), with the use of the surgical microscope, or the traditional thyroidectomy group (TT group), without the use of visual magnification. Aims and Objective: Outcome measures were operative time, intraoperative bleeding, and complication rates including injury to the recurrent laryngeal nerve (RLN), the external branch of the superior laryngeal nerve (EBSLN), or the parathyroid glands. Result: Sixty patients underwent thyroid surgery (30 patients in the MT group and 30 patients in the TT group). The two groups were almost similar in age, sex, surgical procedures, and histological findings. There was no difference between the two techniques regarding the operative time and the amount of blood loss. Neither permanent nerve palsy nor persistent hypocalcemia occurred in either group. Transient nerve palsies (RLN and EBSLN) were lower in the MT group (3.3%) compared to the TT group (6.6%). Overall transient hypocalcemia was significantly lower in the MT group (3.3%) compared with the TT group (13.3%). If the population was restricted to total thyroidectomy, the rate of transient hypocalcemia was 1% in the MT group and 1% in the TT group, respectively. Conclusion: In conclusion, thyroid surgery with a microscope is significantly reduced the complication without increasing the operative time compare to without microscope.

Keywords: Hypocalcemia, microscopic, recurrent laryngeal nerve palsy, thyroid


How to cite this article:
Gautam HK, Kumar V, Maurya D. A comparative study of thyroid surgery with and without a microscope. Saudi J Otorhinolaryngol Head Neck Surg 2020;22:13-5

How to cite this URL:
Gautam HK, Kumar V, Maurya D. A comparative study of thyroid surgery with and without a microscope. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2020 [cited 2020 Jul 16];22:13-5. Available from: http://www.sjohns.org/text.asp?2020/22/1/13/285549




  Introduction Top


Thyroid surgery has been characterized in the past years by significant innovations which are well codified and standardized. Although the mortality rate is remarkably reduced (0.065%) compared to the early 1900s,[1] thyroid surgery is still not free from the risk of complications such as those related to the injury of laryngeal nerves and parathyroid glands.[2],[3] The two most common early complications of thyroid surgery are hypocalcemia (20%–30%) and recurrent laryngeal nerve (RLN) injury (5%–11%).[2] Bilateral recurrent nerve paralysis resulting in the adduction of the vocal cords is a rare life-threatening complication and requires emergency management.[2] To prevent or reduce the incidence of complication, it is of primary importance to know the anatomical knowledge of the neck as well as the application of a meticulous surgical technique.[4],[5] Thus, the rate of these complications is directly related to the extent of thyroidectomy and to a radical thyroid excision (without macroscopic thyroid residual) as well as to the surgeon's experience.[6] Microscopic-assisted thyroid surgery approach helps surgical performance and prevents complications, especially in interventions, thyroiditis, cancer, and cervical lymphadenectomy.[4] The aim of the present retrospective study was to evaluate microsurgical thyroidectomy by comparing it with traditional thyroidectomy.


  Materials and Methods Top


This was a retrospective study of 60 patients of clinically diagnosed thyroid nodules. The study was carried out at the department of ENT of a tertiary-care medical college and hospital during the period of years from March 2014 to July 2019. All patients with thyroid nodules underwent provisional diagnoses on the basis of history, physical examination of the neck, ultrasound for the thyroid gland, serum thyroid-stimulating hormone level, fine-needle aspiration cytology, and biopsy whenever it was required. Clinical information was collected on sex, age, thyroid disease, and histology. Before surgery, patients were assigned either to the microscopic thyroidectomy group (MT group), with the use of the surgical microscope, or the traditional thyroidectomy group (TT group), without the use of visual magnification. Outcome measures were operative time, intraoperative bleeding, and complication rates including injury to the RLN, the external branch of the superior laryngeal nerve (EBSLN), or the parathyroid glands.


  Results Top


This study includes 60 cases of solitary thyroid nodules, in which 30 cases were MT group and 30 cases were TT group; most of the cases were in the age group of 21–40 years. The minimum age was 11 years, and the maximum age was 60 years. Female preponderance was more than males with a ratio of 9.1:1 [Table 1]. All patients (100%) had swelling over the anterior aspect of the neck therefore presented with swelling as the chief complaint. Other complaints were dysphagia dyspnea, pain over the swelling, and hyperthyroidism. Routine thyroid function test was done in all patients, and all were found to be in the euthyroid state. Ultrasonography (USG) findings showed 15 cases of thyroid nodule, 10 cases showed colloidal cyst, and 3 cases showed multinodular goiter followed by neoplasm in 1 case. One patient had thyroiditis on USG among 30 cases of the TT group. While USG findings showed 16 cases of thyroid nodule, 9 cases showed colloidal cyst, and 3 cases showed multinodular goiter followed by neoplasm in 1 case. One patient had thyroiditis on USG among 30 cases of MT groups [Table 2]. The most common surgical procedure was hemithyroidectomy which accounts for 28 (93.34%) in TT as well as MT groups, respectively [Table 3]. Sixty patients underwent thyroid surgery (30 patients in the MT group and 30 patients in the TT group). The two groups were similar in age, sex, surgical procedures, and histological findings. There was no difference between the two techniques regarding the operative time and the amount of blood loss. Neither permanent nerve palsy nor persistent hypocalcemia occurred in either group. Transient nerve palsies (RLN and EBSLN) were lower in the MT group (3.3%) compared to the TT group (6.6%). The overall transient hypocalcemia was significantly lower in the MT group (3.3%) compared with the TT group (13.3%). All the population were restricted to total thyroidectomy; the rate of transient hypocalcemia and transient recurrent nerve palsy was 1% in the TT group and 1% in the MT group, respectively [Table 4].
Table 1: Distribution of cases according to the gender among groups

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Table 2: Distribution of various conditions by high-resolution ultrasonography findings among the groups

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Table 3: Distribution of various surgical procedure among the groups

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Table 4: Distribution of various postoperative complication among the groups

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  Discussion Top


Thyroid enlargement, whether diffuse or nodular, leads to a battery of investigations, mainly to rule out the possibility of neoplastic or no neoplastic lesions. Timely intervention in nodular lesions of thyroid can significantly reduce morbidity and mortality.[7] In the present study, the highest incidence of solitary thyroid nodule was found in the age group of 21–40 years. This result is comparable to the results obtained by Venkatachalapathy and Sreeramulu [8] the observed female-to-male ratio was 5.6:1. This female preponderance is reflected in all studies including the present. A similar observation was made by Vyas and Vijayvargiya on 100 patients with thyroid nodules where the ratio was 7:1.[9] In this study, all patients (100%) had swelling over the anterior aspect of the neck. A similar observation was done by Huque et al. on 118 patients with solitary thyroid nodules and found that thyroid swelling was the most common presentation in all cases (100%).[10] After swelling, other complaints were dyspnea (4%), dysphagia (18%), and pain over the swelling (4%). The symptoms like dyspnea and dysphagia are due to the pressure effect of thyroid swelling and usually present in malignancy, but it may be found in the very large nodule. Pain associated with nodule indicates hemorrhage into an adenoma. Routine thyroid profiles were done in each patient to find the functional status of the thyroid. In this study, all cases were in the euthyroid state. USG findings showed 15 cases of thyroid nodule, 10 cases showed colloidal cyst, and 3 cases showed multinodular goiter followed by neoplasm in 1 case. One patient had thyroiditis on USG among 30 cases of TT group. While USG findings showed 16 cases of thyroid nodule, 9 cases showed a colloidal cyst, and 3 cases showed multinodular goiter followed by neoplasm in 1 case. One patient had thyroiditis on USG among 30 cases of MT group. Walker et al. have shown that the prevalence of multinodularity in clinically solitary thyroid nodules is between 20% and 40%.[11] About 96.66% of the patients had benign lesions. Among them, 93.34% patients had colloid nodule and 3.3% had lymphocytic thyroiditis. Of the 60 patients, two had malignant lesions in the form of papillary carcinoma in both the group.

In this study, the most common procedure was hemithyroidectomy (93.34%) in both of the groups, which is almost consistent with the observation of Satihal and Palled et al. where hemithyroidectomy (84%) was the most common procedure followed by total thyroidectomy (16%).[12] There was no difference between the two techniques regarding the operative time and the amount of blood loss. Transient nerve palsies (RLN and EBSLN) were lower in the MT group (3.3%) compared to the TT group (6.6%). The overall transient hypocalcemia was significantly lower in the MT group (3.3%) compared with the TT group (13.33%). All the population were restricted to total thyroidectomy; the rate of transient hypocalcemia and transient recurrent nerve palsy was 1% in the TT group and 1% in the MT group, respectively. A similar observation was made by Seven et al.'s study that neither permanent nerve palsy nor did persistent hypocalcemia occur in either group. Transient nerve palsies (RLN and EBSLN) were lower in the MT group (1.7%) compared to the TT group (7.5%), but the difference did not reach statistical significance (P > 0.05). The overall transient hypocalcemia was significantly lower in the MT group (1.7%) compared with the TT group (12.5%, P = 0.032). If the population was restricted to total thyroidectomy, the rate of transient hypocalcemia was 4.1% in the MT group and 33.3% in the TT group, respectively [13] (P = 0.022).


  Conclusion Top


Thyroid surgery with a microscope is significantly reduced the complication without increasing the operative time compare to without a microscope.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gómez-Ramírez J, Sitges-Serra A, Moreno-Llorente P, Zambudio AR, Ortega-Serrano J, Rodríguez MT, et al. Mortality after thyroid surgery, insignificant or still an issue? Langenbecks Arch Surg 2015;400:517-22.  Back to cited text no. 1
    
2.
Christou N, Mathonnet M. Complications after total thyroidectomy. J Visc Surg 2013;150:249-56.  Back to cited text no. 2
    
3.
Selberherr A, Scheuba C, Riss P, Niederle B. Postoperative hypoparathyroidism after thyroidectomy: Efficient and cost-effective diagnosis and treatment. Surgery 2015;157:349-53.  Back to cited text no. 3
    
4.
Williams SP, Wilkie MD, Tahery J. Microscope-assisted thyroidectomy: Our experience in one hundred and twenty-one consecutive cases. Clin Otolaryngol 2014;39:307-11.  Back to cited text no. 4
    
5.
Trésallet C, Chigot JP, Menegaux F. How to prevent recurrent nerve palsy during thyroid surgery? Ann Chir 2006;131:149-53.  Back to cited text no. 5
    
6.
Hayward NJ, Grodski S, Yeung M, Johnson WR, Serpell J. Recurrent laryngeal nerve injury in thyroid surgery: A review. ANZ J Surg 2013;83:15-21.  Back to cited text no. 6
    
7.
Chandanwale S. Clinicopatholological correlation of thyroid nodules. Int J Pharm Biomed Sci 2012;3:97-102.  Back to cited text no. 7
    
8.
Venkatachalapathy TS, Sreeramulu PN. A prospective study of clinical, sonological and pathological evaluation of thyroid nodule. Thyroid Disord Ther 2012;1:2.  Back to cited text no. 8
    
9.
Vyas CS, Vijayvargiya SC. A study of thyroid swelling with clinicopathological parameters. Int J Biol Med Res 2013;4:3250-2.  Back to cited text no. 9
    
10.
Huque SN, Ali MI, Huq MM, Rumi SN, Sattar MA, Khan AM. Histopathological pattern of malignancy in solitary thyroid nodule. Bangladesh J Otorhinolaryngol 2012;18:5-10.  Back to cited text no. 10
    
11.
Walker J, Findlay D, Amar SS, Small PG, Wastie ML, Pegg CA, et al. Aprospective study of thyroid ultrasound scan in the clinically solitary thyroid nodule. Br J Radiol 1985;58:617-9.  Back to cited text no. 11
    
12.
Satihal SN, Palled ER. A study of various clinical presentation of solitary thyroid nodule at tertiary care center. Med Pulse Int Med J 2014;1:30-2.  Back to cited text no. 12
    
13.
Seven H, Calis AB, Vural C, Turgut S. Microscopic thyroidectomy: A prospective controlled trial. Eur Arch Otorhinolaryngol Head Neck 2005;262:41-4.  Back to cited text no. 13
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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