The lateral "backdoor" approach to open thyroid surgery: A comparative study

The traditionally taught technique for conventional open thyroidectomy is via a midline splitting of the strap muscles following a skin crease neck incision - midline approach (MA). The lateral "backdoor" approach (LA) uses the same central neck incision but approaches the thyroid gland between the anterior border of sternocleidomastoid (SCM) and strap muscles. This technique is usually reserved for re-do thyroid surgery. We compared the results of the two approaches in patients undergoing conventional thyroidectomy for the first time.

A case-control study was performed on 90 patients undergoing conventional open thyroidectomy from 2012 to 2014. The first 45 patients underwent MA and subsequent 45 patients underwent LA. All patients were given 10 ml of 1% Marcaine infiltration into the neck incision before closure. Basic demographic data, operative time, incision length, weight of gland, need for transection of strap muscles and complications were recorded. Revision thyroid surgery and minimally invasive thyroid operations were excluded.

The demographics, operative timing, gland weight and incisional length showed no significant difference. Post-operative pain was significantly lower in the LA group. 5 patients (11%) in MA group needed horizontal transection of strap muscles to extract large goitres compared to 1 patient (2.2%) in the LA group. No major complications occurred in either group.

The LA method is as safe as the midline technique with comparable operative time and significantly lower pain scores. It avoids midline separation and suturing of strap muscles and reduces the need for strap muscle transection to removal large goitres.