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Technique of Thyroidectomy

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Surgery of the Thyroid and Parathyroid Glands

Abstract

Thyroidectomy is the most frequent intervention in endocrine surgery. When performed in specialized centers, the operation is safe with low morbidity and a virtually 0% mortality. Complications of thyroid surgery are directly correlated to the extent of resection and inversely proportional to the experience of the operating surgeon. Thus, the cornerstones of safe and effective thyroid surgery are an adequate training, the understanding of the anatomy and pathology, as well as a meticulous dissection technique. The dissection must be based on a sound knowledge of three-dimensional topographic anatomy, typical landmarks, and possible anatomic variations. The meticulous dissection technique is achieved by a proper exposure of all fine anatomic structures in a bloodless dry surgical field. The use of magnifying glasses (magnification 2.5–3.55×), bipolar coagulation, and fine titan clips or ligatures is highly recommended.

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References

  1. Bliss RD, Gauger PG, Delbridge LW (2000) Surgeon’s approach to the thyroid gland: surgical anatomy and the importance of technique. World J Surg 24:891–897

    Article  PubMed  CAS  Google Scholar 

  2. Runkel N, Riede E, Mann B, Buhr HJ (1998) Surgical training and vocal-cord paralysis in benign thyroid disease. Langenbecks Arch Surg 383:240–242

    Article  PubMed  CAS  Google Scholar 

  3. Lamade W, Renz K, Willeke F, Klar E, Herfarth C (1999) Effect of training on the incidence of nerve damage in thyroid surgery. Br J Surg 86:388–391

    Article  PubMed  CAS  Google Scholar 

  4. Udelsman R (2004) Experience counts. Ann Surg 240:26–27

    Article  PubMed  Google Scholar 

  5. Tysome JR, Hassan R, Davis J (2009) Standard bipolar diathermy forceps vessel ligation is safe in thyroidectomy. Eur Arch Otorhinolaryngol 266:1781–1786

    Article  PubMed  Google Scholar 

  6. Ito Y, Iwase H, Tanaka H, Yuasa H, Kureyama Y, Yamashita H et al (2001) Metachronous primary hyperparathyroidism due to a parathyroid adenoma and a subsequent carcinoma: report of a case. Surg Today 31:895–898

    Article  PubMed  CAS  Google Scholar 

  7. Hermann M, Hellebart C, Freissmuth M (2004) Neuromonitoring in thyroid surgery: prospective evaluation of intraoperative electrophysiological responses for the prediction of recurrent laryngeal nerve injury. Ann Surg 240:9–17

    Article  PubMed  Google Scholar 

  8. Zambudio AR, Rodriguez J, Riquelme J, Soria T, Canteras M, Parrilla P (2004) Prospective study of postoperative complications after total thyroidectomy for multinodular goiters by surgeons with experience in endocrine surgery. Ann Surg 240:18–25

    Article  PubMed  Google Scholar 

  9. Beldi G, Kinsbergen T, Schlumpf R (2004) Evaluation of intraoperative recurrent nerve monitoring in thyroid surgery. World J Surg 28:589–591

    Article  PubMed  Google Scholar 

  10. Dralle H, Sekulla C, Haerting J, Timmermann W et al (2004) Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery 136:1310–1322

    Article  PubMed  Google Scholar 

  11. Barczynski M, Konturek A, Cichon S (2009) Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy. Br J Surg 96:240–246

    Article  PubMed  CAS  Google Scholar 

  12. Voutilainen PE, Haglund CH (2000) Ultrasonically activated shears in thyroidectomies: a randomized trial. Ann Surg 231:322–328

    Article  PubMed  CAS  Google Scholar 

  13. Defechereux T, Rinken F, Maweja S, Hamoir E, Meurisse M (2003) Evaluation of the ultrasonic dissector in thyroid surgery. A prospective randomised study. Acta Chir Belg 103:274–277

    PubMed  Google Scholar 

  14. Hallgrimson P, Lovén L, Westerdahl J, Bergenfelz A (2008) Use of the harmonic scalpel versus conventional haemostatic techniques in patients with Grave’s disease undergoing total thyroidectomy: a prospective randomized controlled trial. Langenbecks Arch Surg 393:675–680

    Article  Google Scholar 

  15. Voutilainen PE, Haapiainen RK, Haglund CH (1998) Ultrasonically activated shears in thyroid surgery. Am J Surg 175:491–493

    Article  PubMed  CAS  Google Scholar 

  16. Siperstein AE, Berber E, Morkoyun E (2002) The use of the harmonic scalpel vs conventional knot tying for vessel ligation in thyroid surgery. Arch Surg 137:137–142

    Article  PubMed  Google Scholar 

  17. Witzel K, von Rahden BHA, Stein JH (2008) The effect of ultrasound dissection in thyroid surgery. Eur Surg Res 43:241–244

    Article  Google Scholar 

  18. Marchesi M, Biffoni M, Cresti R, Mulas MM, Turriziani V, Berni A et al (2003) Ultrasonic scalpel in thyroid surgery. Chir Ital 55:299–308

    PubMed  Google Scholar 

  19. Ortega J, Sala C, Flor B, Lledo S (2004) Efficacy and cost-effectiveness of the UltraCision harmonic scalpel in thyroid surgery: an analysis of 200 cases in a randomized trial. J Laparoendosc Adv Surg Tech A 14:9–12

    Article  PubMed  Google Scholar 

  20. Dror A, Salim M, Yoseph R (2003) Sutureless thyroidectomy using electrothermal system: a new technique. J Laryngol Otol 117:198–201

    Article  PubMed  Google Scholar 

  21. Kiriakopoulos A, Dimitrios T, Dimitrios L (2004) Use of a diathermy system in thyroid surgery. Arch Surg 139:997–1000

    Article  PubMed  Google Scholar 

  22. Alesina PF, Rolfs T, Walz MK (2010) Bipolar thermofusion vessel sealing versus conventional vessel ligation INT thyroid surgery – results from a prospective study. Langenbecks Arch Surg 395:115–119

    Article  PubMed  Google Scholar 

  23. Scerrino G, Paladino NC, Di Paola V et al (2010) Total thyroidectomy performed with the Starion vessel sealing system versus the conventional technique: a prospective randomized trial. Surg Innov 17:242–247

    Article  PubMed  Google Scholar 

  24. Manouras A, Markogiannakis H, Koutras AS, Antonakis PT et al (2008) Thyroid surgery: comparison between the electrothermal bipolar vessel sealing system, harmonic scalpel, and classic suture ligation. Am J Surg 195:48–52

    Article  PubMed  Google Scholar 

  25. Kebebew E, Clark OH (2000) Differentiated thyroid cancer: “complete” rational approach. World J Surg 24:942–951

    Article  PubMed  CAS  Google Scholar 

  26. Jarhult J, Lindestad PA, Nordenstrom J, Perbeck L (1991) Routine examination of the vocal cords before and after thyroid and parathyroid surgery. Br J Surg 78:1116–1117

    Article  PubMed  CAS  Google Scholar 

  27. Aina EN, Hisham AN (2001) External laryngeal nerve in thyroid surgery: recognition and surgical implications. Aust N Z J Surg 71:212–214

    Article  CAS  Google Scholar 

  28. Monfared A, Gorti G, Kim D (2002) Microsurgical anatomy of the laryngeal nerves as related to thyroid surgery. Laryngoscope 112:386–392

    Article  PubMed  Google Scholar 

  29. Friedman M, LoSavio P, Ibrahim H (2002) Superior laryngeal nerve identification and preservation in thyroidectomy. Arch Otolaryngol Head Neck Surg 128:296–303

    PubMed  Google Scholar 

  30. Bellantone R, Boscherini M, Lombardi CP, Bossola M, Rubino F, De Crea C et al (2001) Is the identification of the external branch of the superior laryngeal nerve mandatory in thyroid operation? Results of a prospective randomized study. Surgery 130:1055–1059

    Article  PubMed  CAS  Google Scholar 

  31. Thompson NW, Olsen WR, Hoffman GL (1973) The continuing development of the technique of thyroidectomy. Surgery 73:913–927

    PubMed  CAS  Google Scholar 

  32. Delbridge L, Reeve TS, Khadra M, Poole AG (1992) Total thyroidectomy: the technique of capsular dissection. Aust N Z J Surg 62:96–99

    Article  PubMed  CAS  Google Scholar 

  33. Mirilas P, Skandalakis JE (2003) Zuckerkandl’s tubercle: Hannibal ad Portas. J Am Coll Surg 196:796–801

    Article  PubMed  Google Scholar 

  34. Pelizzo MR, Toniato A, Gemo G (1998) Zuckerkandl’s tuberculum: an arrow pointing to the recurrent laryngeal nerve (constant anatomical landmark). J Am Coll Surg 187:333–336

    Article  PubMed  CAS  Google Scholar 

  35. Sasou S, Nakamura S, Kurihara H (1998) Suspensory ligament of berry: its relationship to recurrent laryngeal nerve and anatomic examination of 24 autopsies. Head Neck 20:695–698

    Article  PubMed  CAS  Google Scholar 

  36. Liebermann-Meffert DM, Walbrun B, Hiebert CA, Siewert JR (1999) Recurrent and superior laryngeal nerves: a new look with implications for the esophageal surgeon. Ann Thorac Surg 67:217–223

    Article  PubMed  CAS  Google Scholar 

  37. Wheeler MH (1999) Thyroid surgery and the recurrent laryngeal nerve. Br J Surg 86:291–292

    Article  PubMed  CAS  Google Scholar 

  38. Proye CA, Carnaille BM, Goropoulos A (1991) Nonrecurrent and recurrent inferior laryngeal nerve: a surgical pitfall in cervical exploration. Am J Surg 162:495–496

    Article  PubMed  CAS  Google Scholar 

  39. Chow SM, Law SC, Au SK, Mang O, Yau S, Yuen KT et al (2003) Changes in clinical presentation, management and outcome in 1348 patients with differentiated thyroid carcinoma: experience in a single institute in Hong Kong, 1960–2000. Clin Oncol (R Coll Radiol) 15:329–336

    Article  CAS  Google Scholar 

  40. Defechereux T, Albert V, Alexandre J, Bonnet P, Hamoir E, Meurisse M (2000) The inferior non-recurrent laryngeal nerve: a major surgical risk during thyroidectomy. Acta Chir Belg 100:62–67

    PubMed  CAS  Google Scholar 

  41. Wells SA Jr, Gunnells JC, Shelburne JD, Schneider AB, Sherwood LM (1975) Transplantation of the parathyroid glands in man: clinical indications and results. Surgery 78:34–44

    PubMed  Google Scholar 

  42. Schoretsanitis G, Melissas J, Sanidas E, Christodoulakis M, Vlachonikolis JG, Tsiftsis DD (1998) Does draining the neck affect morbidity following thyroid surgery? Am Surg 64:778–780

    PubMed  CAS  Google Scholar 

  43. Wihlborg O, Bergljung L, Martensson H (1988) To drain or not to drain in thyroid surgery. A controlled clinical study. Arch Surg 123:40–41

    Article  PubMed  CAS  Google Scholar 

  44. Yeh TS, Jan YY, Hsu BR, Chen KW, Chen NIE (2000) Video-assisted endoscopic thyroidectomy. Am J Surg 180:82–85

    Article  PubMed  CAS  Google Scholar 

  45. Gagner M, Inabnet WB III (2001) Endoscopic thyroidectomy for solitary thyroid nodules. Thyroid 11:161–163

    Article  PubMed  CAS  Google Scholar 

  46. Miccoli P, Bellantone R, Mourad M, Walz M, Raffaelli M, Berti P (2002) Minimally invasive video-assisted thyroidectomy: multi-institutional experience. World J Surg 26:972–975

    Article  PubMed  Google Scholar 

  47. Mourad M, Saab N, Malaise J, Ngongang C, Fournier B, Daumerie C et al (2001) Minimally invasive video-assisted approach for partial and total thyroidectomy: initial experience. Surg Endosc 15:1108–1111

    Article  PubMed  CAS  Google Scholar 

  48. Bellantone R, Lombardi CP, Bossola M, Boscherini M, De Crea C, Alesina PF et al (2002) Video-assisted vs conventional thyroid lobectomy: a randomized trial. Arch Surg 137:301–304

    Article  PubMed  Google Scholar 

  49. Miccoli P, Berti P, Materazzi G, Minuto M, Barellini L (2004) Minimally invasive video-assisted thyroidectomy: five years of experience. J Am Coll Surg 199:243–248

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, University Hospital Basel, Spitalstrasse 21, CH-4031, Basel, Switzerland

    Daniel Oertli M.D.

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  1. Daniel Oertli M.D.
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Correspondence to Daniel Oertli M.D. .

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Editors and Affiliations

  1. Chairman, Department of Surgery, University Hospital Basel, Spitalstr. 21, Basel, 4031, Switzerland

    Daniel Oertli

  2. Yale-New Haven Hospital, Department of Surgery, Yale University School of Medicine, Cedar Street 330FMB 102, New Haven, CT, 06520-8062, USA

    Robert Udelsman

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Oertli, D. (2012). Technique of Thyroidectomy. In: Oertli, D., Udelsman, R. (eds) Surgery of the Thyroid and Parathyroid Glands. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-23459-0_11

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  • DOI: https://doi.org/10.1007/978-3-642-23459-0_11

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  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-23458-3

  • Online ISBN: 978-3-642-23459-0

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