Tension-free thyroidectomy with medial access to the recurrent largeal nerves and thyroid vessels: methodology, results of application, advantages and disadvantages

Abstract

BACKGROUND: Despite technical improvements in surgical equipment, a significant number of studies report a high incidence of recurrent laryngeal nerve paresis and hypoparathyroidism. In order to reduce specific complications, we have proposed an alternative method of performing thyroidectomy — tension-free thyroidectomy (TFT) with medial access to the recurrent laryngeal nerve (RLN) and parathyroid glands.AIM: Assessing the effectiveness and safety of the TFT method.MATERIALS AND METHODS: The study included patients who were treated at the Saint Petersburg State University Hospital in the period from 2020 to 2024. The study is prospective, non-randomized. Patients were recruited using the continuous sampling method. The criterion for inclusion in the study was the patient’s consent to the proposed surgical method, age over 18 years, and the absence of previous operations on the thyroid gland. Exclusion criteria included laryngeal paralysis identified before surgery and previous operations on the thyroid gland. The primary control point is the development of laryngeal paralysis. Secondary control points are the development of persistent hypoparathyroidism, the development of transient hypoparathyroidism and hypocalcemia, the duration of surgery.RESULTS: The study included 792 patients who underwent tension-free thyroidectomy/hemithyroidectomy using a medial approach to the recurrent laryngeal nerve and parathyroid glands. Indications for surgery were thyroid cancer (454 patients; 57.3%), follicular tumor of the thyroid gland (262; 33.1%), Graves’ disease (44; 5.6%), nodular toxic goiter (20; 2.5 %), nodular nontoxic goiter with compression of the neck organs (11; 1.4%), intrathyroid adenoma of the parathyroid gland (1; 0.1%). Postoperative hematoma developed in 2 patients (0.3%). Unilateral laryngeal paresis was noted in 16 patients (1.6% of the number of nerves at risk). Permanent laryngeal paresis was noted in 2 patients (0.2% of the number of nerves in the risk zone); all other cases of laryngeal paresis were transient. Hypoparathyroidism was diagnosed in 17 cases (7.7% of the number of thyroidectomies), of which in 7 cases after thyroidectomy with central cervical lymph node dissection (7.1% of the number of thyroidectomies with central cervical lymph node dissection). In 16 (7.2%) cases, hypoparathyroidism was transient in nature, in 1 case (0.5%) it was permanent.CONCLUSION: The technique of tension-free thyroidectomy allows for a low level of postoperative complications, such as hypoparathyroidism and dysfunction of the recurrent laryngeal nerves. The TFT technique can be recommended for wide clinical use.