The efficacy and safety of tension-free thyroidectomy in the clinical work of the Endocrine Surgery Department Pavlov State Medical University, pilot study

BACKGROUND: Despite the intensive development of safe thyroid surgery technologies, it has not yet been possible to achieve a significant reduction in the level of specific complications. One of the possible reasons is the method of the conventional surgical operation especially possible traction during thyroid tissue rotation on the way to n.reccurence. In 2022, group of authors led by I.V. Sleptsov proposed a new technique for Tention-Free Thyroidectomy (TFT), which demonstrated a significant reduction in the level of specific complications.

AIM: To conduct a pilot study to assess the reproducibility, efficacy and safety of TFT in the work of the endocrine surgery department of Pavlov First St. Petersburg State Medical University.

MATERIALS AND METHODS: The study was conducted at the Department of Endocrine Surgery in the period from January to April 2022. Patients with surgical thyroid disease underwent a new proposed TFT intervention. The method is fully consistent with the author’s description in patent No. 2772015, and the surgeons performing the new surgical technique underwent an internship with the authors of TFT before the initiation of the study. The study is prospective, non-randomized, uncontrolled. Persistent laryngeal dysfunction and persistent hypoparathyroidism were considered the primary endpoint. Secondary endpoints were transient vocal cord paresis, hypocalcemia and hypoparathyroidism.

RESULTS: The study included 20 people. The indications for surgery were endocrinological and oncological. The number of performed hemithyroidectomies were 15, thyroidectomy (TE) — 5 (one with central lymph node dissection), the volume of the thyroid gland varied from 4 cm³ to 280 cm³ . None of the patients reached the primary endpoint. There were no permanent dysfunction of the larynx in our study. Only in one patient in the postoperative period, a violation of the mobility of the vocal fold was revealed, however, during follow up on the 30th day of the postoperative period the mobility of the vocal fold was restored (confirmed by direct laryngoscopy). Hypoparathyroidism and hypocalcemia were not detected. However, it is necessary to mention the number of TE was too small.

CONCLUSION: Thus, the new proposed TFT method is fully reproducible in the work of a specialized department of endocrine surgery. The method has demonstrated high rates of efficiency and safety in real clinical practice. However, further studies with a higher evidence base are required.

1. Khirurgiia endokrinnoi sistemy. Ed. by OV Nikolaev. Moscow: Biblioteka prakticheskogo vracha; 1952. 250 p. (In Russ.)

2. Siperstein A. Endocrine surgery: Great accomplishments, future challenges. Surgery. 2022;171(1):1-5. doi: https://doi.org/10.1016/j.surg.2021.07.008

3. Joliat G-R, Guarnero V, Demartines N, et al. Recurrent laryngeal nerve injury after thyroid and parathyroid surgery. Medicine (Baltimore). 2017;96(17):e6674. doi: https://doi.org/10.1097/MD.0000000000006674

4. Biswas SS, Hossain MM, Mahbub S, Razib SF. Routine Exposure Versus Non-Exposure of Recurrent Laryngeal Nerve during Thyroid Surgery: Our Experience of 300 Cases. Mymensingh Med J. 2022;31(1):154-160

5. Kartal K, Aygun N, Celayir MF, et al. Intraoperative Neuromonitoring in Thyroid Surgery: An Efficient Tool to Avoid Bilateral Vocal Cord Palsy. Ear, Nose Throat J. 2021;100(5):694S-699S. doi: https://doi.org/10.1177/0145561320906325

6. Ku D, Hui M, Cheung P, et al. Meta‐analysis on continuous nerve monitoring in thyroidectomies. Head Neck. 2021;43(12):3966-3978. doi: https://doi.org/10.1002/hed.26828

7. Ahn SV, Lee J-H, Bove-Fenderson EA, et al. Incidence of Hypoparathyroidism After Thyroid Cancer Surgery in South Korea, 2007-2016. JAMA. 2019;322(24):2441. doi: https://doi.org/10.1001/jama.2019.19641. Erratum in: JAMA. 2021;325(4):402. doi: https://doi.org/10.1001/jama.2020.26894

8. Demarchi MS, Seeliger B, Lifante J-C, et al. Fluorescence ImageGuided Surgery for Thyroid Cancer: Utility for Preventing Hypoparathyroidism. Cancers (Basel). 2021;13(15):3792. doi: https://doi.org/10.3390/cancers13153792

9. van Beek D-J, Almquist M, Bergenfelz AO, et al. Complications after medullary thyroid carcinoma surgery: multicentre study of the SQRTPA and EUROCRINE ® databases. Br J Surg. 2021;108(6):691-701. doi: https://doi.org/10.1093/bjs/znaa195

10. Edafe O, Antakia R, Laskar N, Uttley L, Balasubramanian SP. Systematic review and meta-analysis of predictors of postthyroidectomy hypocalcaemia. Br J Surg. 2014;101(4):307-320. doi: https://doi.org/10.1002/bjs.9384

11. Chahardahmasumi E, Salehidoost R, Amini M, et al. Assessment of the Early and Late Complication after Thyroidectomy. Adv Biomed Res. 2019;8(1):14. doi: https://doi.org/10.4103/abr.abr_3_19

12. Demarchi MS, Karenovics W, Bédat B, Triponez F. Intraoperative Autofluorescence and Indocyanine Green Angiography for the Detection and Preservation of Parathyroid Glands. J Clin Med. 2020;9(3):830. doi: https://doi.org/10.3390/jcm9030830

13. Roman BR, Randolph GW, Kamani D. Conventional Thyroidectomy in the Treatment of Primary Thyroid Cancer. Endocrinol Metab Clin North Am. 2019;48(1):125-141. doi: https://doi.org/10.1016/j.ecl.2018.11.003

14. Sleptsov IV, Chernikov RA, Sablin IV, et al. Tension-free thyroidectomy — results of the initial 77 operations. Endocrine Surgery. 2022;15(2):13-21. (In Russ.) doi: https://doi.org/10.14341/serg12718

15. Sasou S, Nakamura S, Kurihara H. Suspensory ligament of Berry: Its relationship to recurrent laryngeal nerve and anatomic examination of 24 autopsies. Head Neck. 1998;20(8):695-698. doi: https://doi.org/10.1002/(SICI)1097-0347(199812)20:83.0.CO;2-3

16. Leow CK, Webb AJ. The lateral thyroid ligament of Berry. Int Surg. 1998;83(1):75-78.