Researchers reported their novel technique of tension-free thyroidectomy is a safe method of surgery with notably positive surgical outcomes. Their study was published in Updates in Surgery.
Thyroidectomy is indicated in patients with medullary thyroid carcinoma, papillary carcinoma, multinodular toxic goiter, and follicular neoplasia. It is a risky procedure that can lead to a number of complications, including transient or permanent damage to the laryngeal nerve and postoperative bleeding.
Surgeons go to great lengths to avoid these complications because they can impair recovery. To accomplish this, they typically practice vigilance during surgery to avoid damaging vulnerable anatomical areas. Studies demonstrate that surgeons who are more experienced tend to make fewer intraoperative mistakes.
“In this study, we present a new method of tension-free thyroidectomy, which could be used to decrease the complication rate through its changing of a standard technique of the conventional operation,” the authors of the study wrote.
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Over 4 months in 2021, 92 patients underwent tension-free thyroidectomy at Saint Petersburg State University Hospital in Russia. All operations were performed by a single surgeon. Total thyroidectomy was performed in 23.9% of patients, while lobectomy was performed in 43.5% of patients.
To evaluate vocal cord mobility, translaryngeal ultrasound was carried out prior to surgery and on the first postoperative day. If visualization was poor, direct laryngoscopy was performed. The patients’ calcium and parathyroid hormone levels were measured prior to surgery, as well as on the first postoperative day in patients who underwent a total thyroidectomy.
The results demonstrated that tension-free thyroidectomy achieved the preservation of the superior laryngeal nerve, which was made possible by the traction of the thyroid lobe downwards. This allows the surgeon to separate branches of the upper thyroid vessel, which are in close anatomical proximity to thyroid tissue.
“Such traction does not damage the laryngeal nerve because there is generally no tight connection between the nerve and the vessels,” the authors of the study wrote.
Another advantage of tension-free thyroidectomy is that it can facilitate a bloodless operative field. This is because the inferior thyroid artery is separated at the start of surgery when all the thyroid veins are still functioning. In addition, important anatomical structures, such as the parathyroid glands, are separated from the thyroid tissue before the lobe is exposed above skin level, preserving their function.
“Our novel technique of tension-free thyroidectomy is a feasible and safe method with excellent initial surgical outcomes,” the authors of the study wrote. “We suggest that the application of tension-free thyroid surgery could decrease the complication rate in patients with thyroid pathologies.”
Sleptsov I, Chernikov R, Pushkaruk A, et al. Tension-free thyroidectomy (TFT): initial report. Updates Surg. Published online August 1, 2022. doi:10.1007/s13304-022-01338-x