Drainage after total thyroidectomy or lobectomy for benign thyroidal disorders

Objective: This prospective randomized clinical trial was conducted to evaluate the necessity of drainage after total thyroidectomy or lobectomy for benign thyroidal disorders. Methods: A total of 116 patients who underwent total thyroidectomy or lobectomy for benign thyroidal disorders were randomly allocated to be drained or not. Operative and postoperative outcomes including operating time, postoperative pain assessed by visual analogue scale (VAS), total amount of intramuscular analgesic administration, hospital stay, complications, necessity for re-operation and satisfaction of patients were all assessed. Results: The mean operating time was similar between two groups (the drained and non-drained groups). The mean VAS score was found to be significantly low in the non-drained group patients in postoperative day (POD) 0 and POD 1. The mean amount of intramuscular analgesic requirement was significantly less in the non-drained group. One case of hematoma, two cases of seroma and three cases of transient hypoparathyroidism occurred in the non-drained group, whereas one case of hematoma, two cases of seroma, two cases of wound infections and two cases of transient hypoparathyroidism occurred in the drained group. No patient needed re-operation for any complication. The mean hospital stay was significantly shorter and the satisfaction of patients was superior in the non-drained group. Conclusion: These findings suggest that postoperative complications cannot be prevented by using drains after total thyroidectomy or lobectomy for benign thyroid disorders. Furthermore, the use of drains may increase postoperative pain and the analgesic requirement, and prolong the hospital stay. In the light of these findings, the routine use of drains might not be necessary after thyroid surgery for benign disorders.

Total thyroidectomy is safer with identification of recurrent laryngeal nerve

Objective:To investigate the effect of recurrent laryngeal nerve(RLN)identification on the complications after total thyroidectomy and lobectomy.Methods:Total 134 consecutive patients undergoing total thyroidectomy or thyroid lobectomy from January 2003 to November 2004 were investigated retrospectively.Patients were divided into two groups:RLN identified (Group A)or not(Group B).The two groups were compared for RLN injury and hypocalcaemia.Results:The numbers of patients and nerves at risk were 71 and 129 in Group A,and 63 and 121 in Group B,respectively.RLN injury in Group A(0)was sig- nificantly lower than that in Group B(57.9%)patients,75.8%nerves)for the numbers of patients(P=0.016)and nerves at risk (P=0.006).Temporary hypocalcaemia was significantly higher in Group A than in Group B(1424.1%vs 610.3%,P=0.049). Permanent complications in Group B were significantly higher than those in Group A(1320.6%vs 45.6%,P=0.009).Con- clusion:RLN injury was prevented and permanent complications were decreased by identifying the whole course and branches of the recurrent laryngeal nerve during total thyroidectomy.

Endoscopic thyroidectomy through anterior chest wall: a report of 28 cases

Objective: To retrospectively evaluate the feasibility and clinical value of endoscopic thyroidectomy through anterior chest wall. Methods: From December 2002 to May 2003, 28 patients with an average of age of 28 years old (rangeing from 20 to 45) were performed endoscopic thyroidectomy through anterior chest wall. The subcutaneous space in the anterior chest wall and the subplatysmal space in the neck were bluntly dissected through a 10-mm incision between the nipples, and CO 2 was insufflated at 6-8 mmHg to create the operative space. Three trocars were inserted in the mammary regions; and dissection of the thyroid, division of the thyroid vessels and parenchyma were performed endoscopically using an ultrasonically activated scalpel. The recurrent laryngeal nerve, the superior laryngeal nerve, and the parathyroid glands were preserved properly. Results: There were 3 mass resections, 17 subtotal lobectomies, 2 total lobectomies, 6 subtotal lobectomies plus contralateral mass resections. The mean operative time was (87.1±26.0) min; the mean blood loss during operation was (47.9±19.6) ml; and the mean postoperative hospital stay was (3.4±0.7) d. The drainage tubes were pulled out at 36-60 h postoperatively. There were no conversions to open surgery or complications. No scars can be found in the neck, and the patients were satisfied with the postoperative appearance. Conclusion: Endoscopic thyroidectomy through anterior chest wall combined with low-pressure subcutaneous CO 2 insufflation is a feasible and safe procedure. It can bring satisfactory cosmetic results. It is believed that endoscopic thyroidectomy by such approach will find a role in the future.

Evaluation of 118 Thyroid Cancer Patients Who Underwent a Re-operation after Local Resection

OBJECTIVE To evaluate the incidence of residual thyroid cancer and cervical lymph node metastasis following a previous local resection for thyroid cancer, and to discuss methods of a reoperation. METHODS From 1994-2005, 118 patients with thyroid cancer who had previously been treated with a nodule-resection or subtotal Iobectomy in other hospitals underwent a surgical re-operation. RESULTS The incidence of residual cancer at the primary site was 38.1%. The lymph node metastasis rate at the central area was 39.8%. The rate of lymph node metastasis in patients with enlarged lymph nodes in the ipsilateral internal jugular chain was 37.5%, The rate of laryngeal recurrent nerve injury was 15.2% in other hospitals while that of the second operation in our hospital was 1.6%. CONCLUSION Nodule-resection or subtotal Iobectomy alone is not indicated for patients with thyroid cancer because of the high rate of local residual cancer. It is important to be familiar with the anatomy of the laryngeal recurrent nerve for thyroid surgery. Exploration to the central area is necessary for differentiated thyroid cancer.