Comparison of Vocal Cord Function in Patients Undergoing Thyroid Surgery With and Without Microscopic Assistance

Introduction Recurrent laryngeal nerve injury is a complication of thyroid surgery that can affect vocal cord function. Microscopic magnification may improve the visualization of critical anatomical structures and facilitate precise dissections. This study aimed to compare the vocal cord function and postoperative outcomes of patients who underwent thyroid surgery with and without microscopic assistance. Materials and methods This hospital-based prospective comparative observational study included patients undergoing hemithyroidectomy or total thyroidectomy at the Department of Otorhinolaryngology. Preoperative and postoperative vocal cord function was assessed using laryngoscopy. Surgical and postoperative outcomes were compared between the groups undergoing microscope-assisted and conventional thyroidectomy. Statistical analysis was performed with p < 0.05 considered statistically significant. Results A total of 166 patients were included, comprising 76 (45.8%) and 90 (54.2%) patients in the microscope and conventional groups, respectively. Hemithyroidectomy was performed in 106 (63.9%) patients and was more frequent in microscopy (73.7% vs. 55.6%; p = 0.016). Operative time was significantly longer with microscopy for hemithyroidectomy (114.35 ± 6.7 vs. 96.0 ± 7.59 min; p < 0.001) and total thyroidectomy (130.38 ± 2.7 vs. 110.5 ± 2.64 min; p < 0.001). Transient recurrent laryngeal nerve palsy occurred in three (3.9%) versus 11 (12.2%) patients (p = 0.056), whereas hematoma was significantly lower with microscopy (1.3% vs. 8.9%; p = 0.032). In hemithyroidectomy, any recurrent laryngeal nerve palsy was significantly lower with microscopy (3.6% vs. 16.0%; OR = 0.19, 95% CI: 0.04-0.96; p = 0.046). Conclusion Microscopic thyroidectomy may improve recurrent laryngeal nerve preservation, particularly during hemithyroidectomy, although it requires a longer operative time.