Thyroidectomy in Australia 2022: lessons from 21,000 consecutive cases.

Area of Science:

• Surgery
• Endocrinology
• Otolaryngology

Background:

• Total thyroidectomy is a common endocrine surgical procedure.
• Refinements in surgical technique are crucial for improving patient outcomes and reducing complications.
• Decades of surgical experience provide valuable insights into technique evolution.

Purpose of the Study:

• To describe an evolved, modern approach to total thyroidectomy.
• To highlight key technical refinements over three decades.
• To discuss the impact of these refinements on surgical outcomes.

Main Methods:

• Description of surgical technique evolution over 30 years and 21,000 cases.
• Emphasis on retrograde recurrent laryngeal nerve dissection.
• Integration of intraoperative nerve monitoring and advanced energy devices.
• Standardized approach to parathyroid management and postoperative calcium supplementation.

Main Results:

• Improved identification and preservation of the recurrent laryngeal nerve (RLN).
• Reduced risk of temporary RLN neuropraxia and bilateral RLN palsy.
• Enhanced identification and preservation of the external branch of the superior laryngeal nerve.
• Decreased rates of postoperative hematoma with advanced energy devices.
• Minimized symptomatic hypocalcemia through parathyroid auto-transplantation and supplementation.

Conclusions:

• Subtle technical refinements, particularly retrograde RLN dissection and nerve monitoring, have improved total thyroidectomy outcomes.
• Advanced energy devices contribute to reduced postoperative hematoma.
• Careful parathyroid management and postoperative supplementation effectively mitigate hypocalcemia.
• Fundamental principles of surgical exposure and dissection remain paramount for successful total thyroidectomy.