Dzodic, Radan1, 2; Santrac, Nada2
1 Medical Faculty, University of Belgrade, Belgrade, Serbia
2 Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
Background: Hypoparathyroidism (HPT) is one of the most frequent and severe complications of thyroid surgery. It is caused by intraoperative damage, devascularization or accidental removal of the parathyroid glands (PTG). The incidence of postoperative HPT is directly proportional to surgery extent and surgeon’s experience [1,2].
Purpose: The authors present original technique of in situ preservation of PTGs during thyroid surgery and 40-years-experience results in postoperative HPT.
Methods: Our surgical technique focuses on meticulous capsular dissection and ligation of blood vessels close to thyroid capsule. The key step is preservation of the middle thyroid, Kocher’s, vein trunk, as well as vein branches that accompany posterior branch of superior thyroid artery and inferior thyroid artery trunk. The use of methylene blue dye for sentinel lymph nodes biopsy (SLNB) facilitates identification of PTGs during central neck dissection (CND), since PTGs are not colored in blue, unlike central lymph nodes.
Results: After 40 years of experience in thyroid surgery, and several thousands of preserved PTGs, a total prevalence of permanent HPT in the first author’s series is less than 0.5%.
Discussion & Conclusion: This original technique of venous trunk’s preservation, along with so far known surgical steps for in situ preservation of PTGs on arterial pedicle, provides good outcome for patients after total thyroidectomy, with or without CND, regarding HPT as one of the most severe complications of thyroid surgery. We find methylene blue dye useful, not only for SLNB, but also for reduction of accidental removal of PTGs.
- Giordano D, Valcavi R, Thompson GB, Pedroni C, Renna L, Gradoni P, Barbieri V. Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1087 patients and review of the literature. Thyroid 2012; 22(9): 911-917.
- Pasieka JL. The surgeon as a prognostic factor in endocrine surgical diseases. Surg Oncol Clin N Am. 2000;9(1):13-20.