Microsurgical technique in thyroid surgery – a 10-year experience

Abstract

ObjectiveTo report the results of thyroid surgery in a University department of ENT – head and neck surgery, and to evaluate the benefits of the use of the surgical microscope in thyroid surgery.DesignA retrospective evaluation of the records of all patients who underwent thyroid surgery in the 10-year period 1987–1996.MethodsIn addition to standard surgical principles the Zeiss multi-discipline universal surgical microscope with a 250 mm ocular lens was used in all cases. Total thyroidectomy was performed in all malignant cases, while unilateral lobectomy plus isthmus resection was the standard procedure in benign cases.PatientsThere were 573 patients, aged 11–87 years, 444 females and 129 males. Four hundred and fifty-one had benign lesions, 122 malignant. Four hundred and eighty-nine had primary surgery, 84 underwent completion surgery or surgery for recurrent disease.ResultsPrimary thyroid gland surgery in benign/malignant disease resulted in permanent recurrent laryngeal nerve palsy in 0.6 per cent/3.5 per cent of the patients respectively, when calculated as nerves at risk (NAR). In benign recurrent or malignant completion surgery this complication rate was 4.5 per cent/2.9 per cent respectively.ConclusionThyroid surgery in our University ENT – Head and Neck Department with the use of the surgical microscope provides pleasing results, especially considering the diversity of surgeons, due to the departments' teaching responsibilities.

Use of loupes magnification and microsurgical technique in thyroid surgery: ten years experience in a single center

“…Although we did not have a control group of patient undergoing standard thyroid surgery, we are pretty confident that the use of microsurgical technique and loupes magnification could have remarkably reduced the post-operative complications, in agreement with the first observation made with the use of magnification (31) and in accordance with the few literature reported using microsurgical techniques and magnification (11)(12)(13)(14)(15)(16)(17)(18)(19)) and compared to the literature reporting the use of other surgical techniques.…”

“…In comparison, the advantages of the magnified vision are clearly evident in video-assisted surgery, and recently it has been proposed the use of three-dimensional minimally invasive video-assisted thyroidectomy for a better perception of depth and easy recognising of anatomic structures, especially concerning the upper and lower vascular pedicle, the parathyroids and the laryngeal nerves (41). To the best of our knowledge, there are only five previous studies reporting microscope-assisted thyroidectomy (4,(12)(13)(14)16). The largest study to date is a series of 573 procedures published over a decade ago by Nielsen who reported 0.6% permanent RLN injury (13).…”

“…To the best of our knowledge, there are only five previous studies reporting microscope-assisted thyroidectomy (4,(12)(13)(14)16). The largest study to date is a series of 573 procedures published over a decade ago by Nielsen who reported 0.6% permanent RLN injury (13). Other authors prospectively compared microscopic with conventional thyroidectomy and found the former to result in significantly lower rates of transient hypocalcaemia and reduced rates of RLN injury (16).…”

“…Starting from 1975, and to the best of our knowledge, only few works have been published about the use of microsurgical technique and magnification as a support to traditional thyroid surgery; interestingly, though, the results show that such treatment approach helps surgical performance and prevents complications, especially in reinterventions, thyroiditis, cancer and cervical lymphadenectomy (4,(11)(12)(13)(14)(15)(16)(17)(18)(19) …”

Use of optical magnification and microsurgical technique in general surgery

“…8,9 In the last 40 years there are only a few publications in the literature about the use of microsurgery in thyroid surgery, and all emphasize the concept that microsurgery improves surgical results especially in reinterventions and in lymphadenectomy. 8,[10][11][12][13][14][15][16][17][18] We recently published a paper in which thyroid complications are analysed from a large number of patients using microsurgical technique and optical magnification. 19 In this study we concluded that using the approach proposed can reduce the complications both with regard to hypoparathyroidism and to recurrent nerve paralysis.…”