Tension-free thyroidectomy (TFT): initial report

Area of Science:

• Endocrinology
• Surgical Oncology
• General Surgery

Background:

• Thyroidectomy safety has improved, but complications like recurrent laryngeal nerve palsy and hypoparathyroidism remain concerns.
• Minimizing these risks is crucial for patient outcomes and surgical quality.
• Advancements in surgical techniques are continuously sought to enhance safety profiles.

Purpose of the Study:

• To introduce and evaluate a new "tension-free thyroidectomy" (TFT) method.
• To assess the efficacy of TFT in reducing complication rates, specifically recurrent laryngeal nerve palsy and hypoparathyroidism.
• To present initial safety and feasibility data for TFT.

Main Methods:

• A prospective study involving 92 patients undergoing TFT between August and November 2021.
• The TFT technique involves a medial approach to the recurrent laryngeal nerve and parathyroid glands after isthmus division and dissection of Berry's ligament.
• Intraoperative neuromonitoring, translaryngeal ultrasound (TLUS), direct laryngoscopy, and postoperative biochemical monitoring were employed.

Main Results:

• No cases of recurrent laryngeal nerve palsy were observed among 127 at-risk nerves.
• One patient (1.1%) experienced transient hypoparathyroidism, resolving within two weeks with treatment.
• Mean operative times were 54 minutes for lobectomy and 99 minutes for total thyroidectomy, with no conversions to conventional methods.

Conclusions:

• Tension-free thyroidectomy (TFT) is a safe and feasible surgical approach.
• The TFT method demonstrates a potential for lower complication rates in thyroid surgery.
• Further comparative studies, including randomized trials, are warranted to validate these findings against conventional techniques.