Safe thyroidectomy with intraoperative methylene blue spraying

Abstract

BackgroundWe aimed to minimalize operative complications by spraying of methylene blue stain on thyroid glands and the perithyroidal area.Material and methodsThe intra-operative methylene blue spraying technique was used prospectively on a total of 56 patients who had undergone primary (not recurrent) thyroid surgery for a variety of thyroid diseases. Bilateral total thyroidectomy was performed in all cases. After superior but before inferior pole ligation, 0.5ml of methylene blue was sprayed over the thyroid lobe and perilober area. Tissues, especially parathyroides, the recurrent laryngeal nerve, and the inferior thyroid artery, were identified and evaluated.ResultsRecurrent laryngeal nerve and arteries were not stained and thus they remained white in all cases while all other tissues were stained blue. Within three minutes parathyroid glands washed out the blue stain and the original yellow color was regained. Thyroid tissue wash-out time was not less than 15 minutes; perithyroideal muscles, tendinous and lipoid structures took no less than 25 minutes.ConclusionThe safety of intravascular methylene blue guidance on thyroid surgery is known. This research demonstrates the effectiveness of the spraying technique, a new technique which ensures not only identification of parathyroid glands within three minutes, but also identification of recurrent laryngeal nerves and inferior thyroid arteries.

Application of Nano-Carbon in Lymph Node Dissection for Thyroid Cancer and Protection of Parathyroid Glands

“…Currently, the common dyes used in China include methylene blue and patent blue. Sari et al [ 9 ] found that the parathyroid glands fade within 3 min, which is more rapid than that for thyroid tissues and lymph nodes after spraying methylene blue solution in the region around the thyroid gland. Related Chinese studies [ 10 ] have reported that methylene can be used for positioning of sentinel lymph nodes in thyroid glands, but it can stain both the parathyroid glands and lymph nodes, thus causing confusion between them and leading to mistakenly cutting parathyroid glands.…”

Recurrent laryngeal nerve identification in thyroidectomy by intra‐operative staining with methylene blue in forty‐six patients

“…In the study of Sari et al ,. MB was used to identify the RLN by applying 0.5 mL of MB (15 mL ampoule) directly without dilution over the thyroid lobe and perilobar area, including the perithyroidal muscles, tendinous and lipoid structures giving massive blue staining of all the area with sparing of the RLN and the arteries which appeared relatively white.…”

Peer Review #1 of "The sensitivity and specificity of methylene blue spray to identify the parathyroid gland during thyroidectomy (v0.2)"

“…Sari (Sari et al 2012) studied 56 patients who underwent thyroidectomy in which methylene blue spray was used to locate the parathyroid gland. They found that the parathyroid gland was able to absorb the blue staining and regain its original yellow color in three minutes, while other tissues took longer.…”