Disorder of mobility of vocal folds on the background of hypoparathyroidism at patient after subtotal resection of thyroid gland

Introduction: Among the specific complications of operations on the organs of the neck, the main place is occupied by a violation of the mobility of the vocal cords. Thanks to the introduction of non-invasive methods for recording a signal from the vocal folds using intraoperative neuromonitoring (IONM), it became possible to assess the preservation of the laryngeal nerves, to avoid the development of bilateral paresis of the vocal cords, by assessing the preservation of nerves during the operation. Objective: to develop a methodology for the implementation of intraoperative neuromonitoring during video endosurgical operations on thyroid gland. Materials and methods: On the basis of the surgical department No. 1 of the Central Clinical Hospital, Administrative departments of the President of the Russian Federation, Clinic of Faculty Surgery and Oncology, Saratov State Medical University V.I. Razumovsky” during May 2013-April 2020, 412 patients with various pathologies of the thyroid glands underwent videoendosurgical interventions. Results: We performed the following surgical interventions for thyroidectomy - 112, hemithyroidectomy - 145, subtotal resection - 47 cases. The volume of the thyroid gland was from 17 to 200 ml. At the same time, we try to adhere to a certain algorithm of actions, taking into account the fact that during the operation, irritation of the laryngeal nerves can cause a variety of problems that will give an incorrect answer to these reasons: anesthesiology factors, incorrect operation of the active electrode, technical errors of the operation itself. Conclusions: Intraoperative neuromonitoring for videoendoscopic interventions provides the ability to visualize all anatomical structures incomparable with open operations, reduces the risks of trauma to the laryngeal nerves, allows you to monitor the signal in real time, improves the quality of intraoperative navigation and the safety of surgical intervention.

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Assessing Quality of Life in Patients with Graves’ Disease Following Thyroidectomy

Creative Surgery and Oncology ◽

10.24060/2076-3093-2019-9-1-26-30 ◽

2019 ◽

Vol 9 (1) ◽

pp. 26-30

Author(s):

S. N. Styazhkina ◽

A. V. Ledneva ◽

E. L. Poryvaeva

Keyword(s):

Quality Of Life ◽

Hormone Replacement Therapy ◽

Surgical Treatment ◽

Thyroid Gland ◽

Replacement Therapy ◽

Hormone Replacement ◽

Subtotal Resection ◽

Graves Disease ◽

The Impact

Introduction. Graves’ disease is a disorder associated with thyroid gland producing excessive amounts of hormones which causes changes in the functional status of various organs and systems. Among thyroid disorders it takes the second place (after endemic goitre) in prevalence. Until now, there is no consensus on a single strategy for the treatment of disorders of the thyroid gland. This is why this paper aims to assess the impact of surgical treatment of Graves’ disease on patients’ quality of life and whether it would be possible to improve it by following the surgery with hormone replacement therapy.Materials and methods. This paper presents a retrospective analysis of 70 case histories of patients who received surgical treatment for diffuse toxic goitre at the BIH UR “First Republican Teaching Hospital” MH UR,Izhevsk, in the period from 2008 to 2014. Percentages of the disease by stage were as follows: stage II — 20%, stage III — 70%, stage 4 — 10%. One lobe resection was performed in 3% of patients, two lobe resection — in 1%, hemithyroidectomy — in 18±4.6%, subtotal resection — in 8%, thyroidectomy — in 70±5.5%.Results. Percentages of patients with various degrees of severity of postoperative hypothyroidism were as follows: severe — 66%, medium — 29%, light — 5%; there were no Graves’ disease recurrences. Patients’ complaints following thyroidectomy included body weight gain — 79.1±4.8%, cold in extremities — 83.3±4.4%, cardiac arrhythmia — 85.2±4.2%, oedemas — 84.3±4.3%, drowsiness, atonia — 67.1±5.6%, changes in appetite — 21±4.8%, skin pallor — 47.6±5.9%, brittle nails, hair loss — 51.2±5.9%, joint pain — 31.2±5.53%.Conclusion. Hypothyroidism always follows thyroidectomy and requires ongoing hormone replacement therapy with L-thyroxine. Th quality of life does not have to suffer if an individual dosage is established and followed on a permanent basis.

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Peculiarities of operative treatment of goiter on background of autoimmune thyroiditis

Klinicheskaia khirurgiia ◽

10.26779/2522-1396.2020.1-2.43 ◽

2020 ◽

Vol 87 (1-2) ◽

pp. 43-46

Author(s):

O. P. Kovalov ◽

O. M. Liulka ◽

V. I. Liakhovskyi ◽

I. I. Nemchenko ◽

A. V. Sydorenko

Keyword(s):

Surgical Treatment ◽

Thyroid Gland ◽

Autoimmune Thyroiditis ◽

Malignant Tumors ◽

Laboratory Data ◽

Clinical Signs ◽

Endocrine System ◽

Nodular Goiter ◽

Subtotal Resection ◽

Retrosternal Goiter

Objective. To determine the peculiarities of operative technique in surgical treatment of patients with nodular goiter on background of autoimmune thyroiditis. Materials and methods. The results of surgical treatment of nodular goiter, basing on data from surgical clinic of the Second Clinical Hospital in City of Poltava through 2003 - 2017 yrs were adduced. There were operated 549 patients, suffering nodular goiter. There were 58 (10.6%) men and 491 (89.4%) women. Unilateral nontoxic nodular goiter was observed in 187 (34.1%) patients, multinodular nontoxic – in 322 (58.7%), multinodular toxic – in 30 (5.5%), thyreotoxic adenoma – in 21 (3.8%) patients. Cervico-retrosternal goiter was in 110 (20.0%) patients. For recurrent goiter 21 (3.8%) patients were operated. Malignant tumors were revealed intraoperatively or after definite histological investigation in 22 (4/0%) patients. Of 108 patients, to whom, basing on the disease clinical signs, laboratory data and preoperative cytological investigation the diagnosis of nodular goiter on background of autoimmune thyroiditis was established, while performing of definite postoperative investigation macromicrofollicular colloidal goiter was revealed in 41 (38%), nodular goiter with the autoimmune thyroiditis – in 51 (47.2%), cancer (papillary, follicular) – in 8 (14.8%) patients. Subtotal resection of thyroid gland was performed in 8 (15.7%) patients, hemithyroidectomy - in 12 (23.5%), extrafascial thyroidectomy – in 23 (45.1%). In patients, suffering thyroidal gland cancer, extrafascial thyroidectomy was performed, while in 3 – with central lymphodissection. Intraoperatively visual macroscopic estimation of thyroid gland and obligatory suboperative cyto- and histological investigations of the specimen obtained were performed. Operative tactics was applied in accordance to actual clinical protocols for treatment of patients, suffering surgical pathology of endocrine system. Results. Some technical measures were proposed to minimize the risk of injury of anatomic structures: lower laryngeal nerve, parathyroidal glands, trachea, the neck vessels. Conclusion. Extrafascial procedure guarantees a visual control in the risk zones and radicality of operation, minimizes the specific complications rate.

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DIAGNOSTICS AND TREATMENT OF RECURRENT POSTOPERATIVE GOITER

Grekov s Bulletin of Surgery ◽

10.24884/0042-4625-2017-176-1-52-55 ◽

2017 ◽

Vol 176 (1) ◽

pp. 52-55

Author(s):

M. F. Zarivchatskiy ◽

S. A. Denisov ◽

S. A. Blinov ◽

I. N. Mugatarov ◽

N. S. Teplykh ◽

...

Keyword(s):

Thyroid Gland ◽

Medical Records ◽

Subtotal Resection ◽

Recurrent Nerve ◽

Radical Operation ◽

Laryngeal Nerves ◽

Recurrent Laryngeal Nerves ◽

Transient Hypoparathyroidism ◽

Nerve Trauma ◽

Made In

The study developed the system of therapeutic and prophylactic methods in patients with recurrent postoperative goiter. These patients (103) have been accepted and registered in the medical records since 2007. Only 48 patients underwent recurrent operation. The subtotal resection of the thyroid gland was performed on 20 patients and thyroidectomy was carried out in 28 patients. The perioperative visualization of recurrent laryngeal nerves was made in 58,3% cases. Postoperative period was complicated by unilateral recurrent nerve trauma in one patient and transient hypoparathyroidism was noted in two patients. The recurrent operative interventions must be performed in specialized centers and it should be extremely radical operation with visualization of recurrent laryngeal nerves.

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Identification and Preservation of External Branch of Superior Laryngeal Nerve in Thyroidectomy

International Journal of Phonosurgery & Laryngology ◽

10.5005/jp-journals-10023-1059 ◽

2013 ◽

Vol 3 (2) ◽

pp. 39-41 ◽

Cited By ~ 2

Author(s):

Bhagyashree D Bokare ◽

Poorva K Athavale ◽

Vipin R Ekhar ◽

Devendra Meghraj Mahore

Keyword(s):

Thyroid Gland ◽

Total Thyroidectomy ◽

Superior Laryngeal Nerve ◽

Vocal Folds ◽

Laryngeal Nerve ◽

Superior Thyroid Artery ◽

Type I ◽

Care Hospital ◽

External Branch ◽

Superior Pole

ABSTRACT The basic principle of head and neck surgery is based on the identification and preservation of important structures, rather than avoidance. This principle is also applicable to identification and preservation of external branch of the superior laryngeal nerve (EBSLN) as a standard routine in all thyroid surgeries. During thyroid surgery, the EBSLN is clearly at risk due to its close proximity to the superior thyroid artery (STA) and its branches that need to be ligated during dissection of the superior pole of the thyroid gland. Injury is detrimental to the patient by causing paralysis of the cricothyroid muscle which is the main tensor and pitch controlling mechanism of the vocal folds. Injury to the EBSLN during surgery can result in the voice changes, loss of upper range and easy fatigability of voice, the severity of which varies according to the vocal demand of the patient. Total 45 cases of thyroid swellings were treated with surgery, in the Department of ENT at a tertiary care hospital during the period from 1st October 2009 to 30th October 2010. Hemithyroidectomy was the most common operative procedure implemented in 24 patients (53.33%) in which right sided was common. Next common procedure performed was that of total thyroidectomy in 14 patients (31.11%). Four patients underwent total thyroidectomy with neck dissection. The position of EBSLN was classified according the Cernea et al classification. In our study we found the EBSLN to be type I in 46.66%, type IIa in 73.33% and type IIb in 02.22%. The anatomical landmark taken into consideration to identify EBSLN was the Joll's triangle with its relation to the superior pole of the thyroid gland and STA. How to cite this article Athavale PK, Bokare BD, Ekhar VR, Mahore DM. Identification and Preservation of External Branch of Superior Laryngeal Nerve in Thyroidectomy. Int J Phonosurg Laryngol 2013;3(2):39-41.

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USING INDOCYANIN GREEN IN ENDOSCOPIC THYROID SURGERY. OUR FIRST EXPERIENCE

Tavricheskiy Mediko-Biologicheskiy Vestnik ◽

10.37279/2070-8092-2020-23-2-20-24 ◽

2020 ◽

Vol 23 (2) ◽

pp. 20-24

Author(s):

M. E. Beloshitskiy ◽

T.A. Britvin ◽

D. Yu. Semenov

Keyword(s):

Thyroid Gland ◽

White Light ◽

Thyroid Surgery ◽

Side Wall ◽

Vocal Folds ◽

Anatomical Structure ◽

Fluorescent Imaging ◽

Surgical Interventions ◽

Endoscopic Thyroid Surgery ◽

Light Mode

One of the directions of the safety strategy in thyroid surgery is to preserve the integrity of the recurrent laryngeal nerves (RLN). In this regard, we used «Indocyanin green – Pulsion» (ICG, Germany) to improve the quality of visual control of the RLN during endoscopic operations on the thyroid gland. Goal: to evaluate the possibility of RLN visualization during endoscopic operations on the thyroid gland using fluorescent navigation with the ICG. Materials and methods. The results of 52 endoscopic hemithyroidectomies from axillary approach for various thyroid diseases were analyzed. Surgical interventions were performed using the KARL STORZ endovideosurgical stand, with the ability to work in double mode: with white light visualization and ICG-fluorescent visualization. In 14 cases, intraoperative RLN monitoring was performed using the ISIS C2 neuromonitor («Inomed», Germany), in 18 cases RLN imaging was performed in standard white light, and in another 20 cases – in ICG-fluorescence mode. Results. Endoscopic hemithyroidectomy from axillary access was performed according to the standard method in white light mode until the anatomical structure was detected based on the topographic location, diameter and color of the corresponding RLN. Then the patient received intravenous administration of the drug with a volume of 5.0 ml. The camera switched to the NIR range, effective fluorescence in the operating field area appeared after 10-15 seconds and lasted up to 15 minutes. In 9 patients, the anatomical structure detected in the standard mode did not change its whitish color when the camera was repeatedly switched to NIR mode and was regarded as RLN. In 6 patients, the anatomical structure resembling RLN, when switching the camera to NIR mode, turned bright blue or green depending on the selected spectrum, which corresponds to the blood vessel, and therefore the search for the RLN continued. In 5 patients, in the projection of the possible location of the RLN in the white light mode, several anatomical structures were simultaneously detected that run parallel to each other along the side wall of the trachea, similar in color, diameter and structure. In these observations, only the introduction of ICG to change the color when switching camera modes allowed to distinguish blood vessels from the RLN. In the postoperative period, in the group of patients who used the ICG-fluorescent RLN imaging technique, there were no violations of the mobility of the vocal folds according to the results of laryngeal endosonography. Of the 14 patients whose RLN control was performed using variable neuromonitoring, 1 observation showed transient laryngeal paresis. In the group of patients whose RLN was visualized only in the standard white light mode, persistent paresis of the vocal fold was diagnosed in 1, and transient paresis was diagnosed in 1 more patient. Conclusion: Fluorescent imaging using ICG allows differentiating vascular and neural structures, thereby evaluating the course of the RLN, and may have certain clinical prospects for thyroid endoscopic surgery.

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Paradoxical movements of the epiglottis: A rare cause of respiratory obstruction and its surgical treatment

Medicinski pregled ◽

10.2298/mpns1408252c ◽

2014 ◽

Vol 67 (7-8) ◽

pp. 252-254 ◽

Cited By ~ 1

Author(s):

Karol Canji ◽

Slobodan Mitrovic ◽

Vera Beljin

Keyword(s):

Surgical Treatment ◽

Argon Plasma ◽

Vocal Folds ◽

Subtotal Resection ◽

Physical Effort ◽

Everyday Activities ◽

Breathing Disorders ◽

Patient Reported ◽

Plasma Scalpel ◽

Endotracheal Anesthesia

Introduction. The aim of this paper was to present a rare disorder of epiglottis function as a cause of breathing disorders and a manner of dealing with this problem. Case report. A 59-yearold male patient had breathing disorders in the form of short cessations of breathing two months after a cardiac surgery. He could not tolerate even a slight physical effort. Indirect laryngoscopy and video endoscopy performed with a rigid endoscope indicated paradoxical movements of epiglottis, which closed the entrance to the larynx and caused short cessations of breathing. The patient underwent a subtotal resection of the epiglottis with an argon plasma scalpel. Directoscopy of the larynx was performed under general endotracheal anesthesia. After three weeks, the patient was without any difficulties. The check-up examination after three months showed a small remaining part of the epiglottis. There were no paradoxical movements of the vocal folds; the left vocal fold was shorter, with a loose edge, and the posterior region of the glottis tilted to the left in phonation. The patient reported no breathing disorders three months after the operation. Discussion. Airway obstruction can be reduced significantly by surgical treatment of a soft or hanging epiglottis. Subtotal resection by argon plasma scalpel resulted in termination of breathing disorders in the patient described in this paper, and it enabled him to continue his normal everyday activities. Conclusion. Paradoxical movements of the epiglottis are a rare cause of breathing disorders. Resection of the epiglottis is a method which gives good therapeutic results.

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