Tension-free thyroidectomy (TFT, medial thyroidectomy) — a prospective study: surgical technique and results of 259 operations

BACKGROUND: One of the most important tasks in thyroid surgery is to prevent the development of specific complications — laryngeal nerve dysfunction and hypoparathyroidism. A significant number of technical solutions introduced into clinical practice in recent years are aimed at solving this problem.

AIM: Тo evaluate the results of an alternative technique of thyroid surgery — medial thyroidectomy.

MATERIALS AND METHODS: 270 patients with thyroid diseases were operated on using tension free thyroidectomy technique in the volume of hemi- or thyroidectomy with or without cervical lymphadenectomy. The selection of patients was continuous. All patients underwent ultrasound or videolaryngoscopy before the operation and on the 1st postoperative day. Patients who underwent thyroidectomy underwent blood analysis for parathormone and blood analysis for ionized calcium.

RESULTS: For hemithyroidectomy the duration of surgery did not change. In the group of patients with nodes up to 30 mm the duration of surgery increased. An increase in the operation time was also noted for thyroidectomy. Unilateral laryngeal paresis was registered in 6 (2.3%) patients or 1.7% of the number of recurrent laryngeal nerves in the risk area. The risk of parathyroid gland (PTG) removal was 0.39% of the number of operations and 0.14% of the number of PTG in the risk area. Decrease in the level of parathormone in the first day after surgery was noted in 11.5% of patients. The development of postoperative hematoma was noted in 1 patient (0.39%).

CONCLUSION: The technique of thyroid surgery with medial access to the recurrent laryngeal nerve and parathyroid glands is feasible in the vast majority of patients with thyroid diseases requiring surgical treatment and shows high safety and a number of advantages over the traditional method of thyroid surgery.

1. Ching H.H. и соавт. Medial approach for the resection of goiters with suprahyoid, retropharyngeal, or substernal extension. World J Surg 2018 May;42(5):1415-1423. https://doi.org/10.1007/s00268-018-4576-z

2. Henry B.M. и соавт. The Reliability of the Tracheoesophageal Groove and the Ligament of Berry as Landmarks for Identifying the Recurrent Laryngeal Nerve: A Cadaveric Study and Meta-Analysis. Biomed Res Int 2017;2017:4357591. doi: 10.1155/2017/4357591.

3. P. V. Pradeep, B. Jayashree, and S. S. Harshita, “A closer look at laryngeal nerves during thyroid surgery: a descriptive study of 584 nerves,” Anatomy Research International, vol. 2012, Article ID 490390, 6 pages, 2012.

4. J. B. Botelho, D. M. Vieira, D. M. De Carvalho, and M. B. P. Batista, “Anatomy surgical study of relations between the recurrent laryngeal nerves and the ligament of Berry,” Revista do Colegio Brasileiro de Cirurgioes, vol. 39, no. 5, pp. 364–367, 2012.

5. Quan-Yang Duh, Orlo H. Clark, Electron Kebebew. Atlas of endocrine surgical techniques. Saunders Elsevier, 2010.

6. Uludağ M. и соавт. A Review of Methods for the Preservation of Laryngeal Nerves During Thyroidectomy. DOI: 10.14744/SEMB.2018.37928 Med Bull Sisli Etfal Hosp 2018;52(2):79–91