Optimal Thyroid Surgery
Seance of wednesday 13 september 2023 (Communications libres)
DOI number : 10.26299/fd0x-d022/emem.2023.25.04
Abstract
Objective : An uptade of thyroid surgery best practices to minimize the occurrence of postoperative complications.
Study design : Systematic Review
Materials and Methods : Review based on articles listed in Pubmed and Science Direct focusing in particular on international guidelines of specialised learned societies
Results : Since the last 30 years, Thyroid Surgery has become a real subspecialty which has benefited from some technological advances such as intraoperative neuromonitoring of the laryngeal nerves, Energy-based Vessel-sealing Devices (Ligasure® or Harmonic®), intraoperative parathyroid imaging techniques (autofluorescence, Intraoperative Indocyanine Green Angiography) or hemostatic agents (Surgicel®, Floseal®)…
Conclusion : In specialised centres, postoperative specific complications (recurrent laryngeal nerve palsy and hypoparathyroidism) rate should be inferior to 2% in total thyroidectomy for benign thyroid diseases. Complete recurrent laryngeal nerve visualisation remains the gold standard procedure to best avoid postoperative recurrent laryngeal nerve palsy. It is not essential to visualize all four parathyroid glands during thyroidectomy to reduce the incidence of postoperative hypocalcemia. A gentle capsular dissection that reflects the perithyroidal fatty tissues off the surface of the thyroid allows for preservation of the parathyroid blood supply. The major utility of intraoperative neuromonitoring of the laryngeal nerves is to avoid postoperative bilateral recurrent laryngeal nerve palsy.
Study design : Systematic Review
Materials and Methods : Review based on articles listed in Pubmed and Science Direct focusing in particular on international guidelines of specialised learned societies
Results : Since the last 30 years, Thyroid Surgery has become a real subspecialty which has benefited from some technological advances such as intraoperative neuromonitoring of the laryngeal nerves, Energy-based Vessel-sealing Devices (Ligasure® or Harmonic®), intraoperative parathyroid imaging techniques (autofluorescence, Intraoperative Indocyanine Green Angiography) or hemostatic agents (Surgicel®, Floseal®)…
Conclusion : In specialised centres, postoperative specific complications (recurrent laryngeal nerve palsy and hypoparathyroidism) rate should be inferior to 2% in total thyroidectomy for benign thyroid diseases. Complete recurrent laryngeal nerve visualisation remains the gold standard procedure to best avoid postoperative recurrent laryngeal nerve palsy. It is not essential to visualize all four parathyroid glands during thyroidectomy to reduce the incidence of postoperative hypocalcemia. A gentle capsular dissection that reflects the perithyroidal fatty tissues off the surface of the thyroid allows for preservation of the parathyroid blood supply. The major utility of intraoperative neuromonitoring of the laryngeal nerves is to avoid postoperative bilateral recurrent laryngeal nerve palsy.