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Related Concept Videos

The Thyroid Gland01:23

The Thyroid Gland

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The thyroid gland is a small, butterfly-shaped gland located in the neck and covers the anterior surface of the trachea. The gland has two lateral lobes connected by a thin tissue mass called the isthmus. Internally, each lobe comprises many small spherical structures known as thyroid follicles, surrounded by a network of blood vessels.
The follicles have a central cavity lined by simple cuboidal to squamous epithelial cells called follicular cells. These cells produce the glycoprotein...
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Gasless Endoscopic Thyroidectomy via the Trans-Axillary Approach
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Tension-free thyroidectomy (TFT): initial report.

Ilya Sleptsov1, Roman Chernikov2, Alexander Pushkaruk2

  • 1Department of Endocrine Surgery, Saint Petersburg State University Hospital, Saint Petersburg, Russia. newsurgery@yandex.ru.

Updates in Surgery
|August 1, 2022
PubMed
Summary

Tension-free thyroidectomy (TFT) is a novel surgical method that significantly reduces complication rates. This technique, focusing on a medial approach, resulted in zero recurrent laryngeal nerve palsies and minimal hypoparathyroidism in a recent study.

Keywords:
ComplicationsHyporathyroidismIntraoperative neuromonitoringLoss of signalRecurrent laryngeal nerveThyroidectomy technique

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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.