Background: Thyroid operations are performed by general surgeons, otolaryngologists, endocrine surgeons, and surgical oncologists. While thyroidectomy techniques are well described, differences persist among surgeons. A stepwise approach to thyroidectomy may promote standards of care and improve outcomes and training.
Methods: A total of 177 patients underwent thyroid operations in The Center for the Scientific and Clinical Research of Endocrinology, Department of Endocrine Surgery of Uzbekistan, during 2017–2018, with a stepwise technique for thyroidectomy. The series included 155 women and 12 men, with a mean age of 41.4 ± 12.8 years. Evaluations included thyroid-stimulating hormone (TSH) and free T4 levels, fine needle aspiration cytology, ultrasonography of the thyroid gland, cervical lymph nodes and adjacent structures, and vocal cord assessment. We designated five steps of thyroidectomy: (1) Medial mobilization of the gland and division of the middle thyroid vein; (2) Dissection of the anterior suspensory ligament between the superomedial lobe and cricoid/thyroid cartilage, with the division of the superior pole vessel branches, (3) Division of the branches of the inferior thyroid artery (ITA) with preservation of the recurrent laryngeal nerve (RLN) and both parathyroid glands (PTGs); (4) Division of the posterior suspensory ligament (of Berry) that connects the lobe to the cricoid cartilage and first and second tracheal rings; and (5) Central and/or lateral lymph node dissection, if indicated.
Results: A total of 134 patients (75.7%) had nodular goiter, 29 had Graves’ disease (GD) (16.4%), and 14 had thyroid carcinoma (7.9%). A total of 107 patients (60.5%) were euthyroid, 37 (20.9%) had controlled hyperthyroidism, and 33 (18.6%) had already been treated for hypothyroidism before surgery. Operations included total or near-total thyroidectomy (98, 55.4%), lobectomy (60, 33.9%), or lesser resections (19, 10.7%). There were two (1.1%) temporary and no permanent RLN palsies. Temporary hypoparathyroidism (lasting <11 days) occurred in 37 (20.9%) patients, but no patients suffered permanent hypoparathyroidism.
Conclusion: Comprehension of thyroid anatomy and systematization of technical steps may improve outcomes and enhance training in thyroid surgery.
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