Microsurgery as a Method for Prevention of Postoperative Hypocalcemia and Laryngeal Nerves Injury in Thyroid Surgery

Introduction: Postoperative hypocalcaemia and impairment of vocal cord function due to iatrogenic injury of the parathyroid glands and laryngeal nerves are the most frequent complications in thyroid surgery. Various procedures have been introduced to prevent the glands and the nerves from lesion the incidence of these complications varies between 1.5- 22%. The aim of the study is to evaluate the role of the microsurgical technique as a method for identification of parathyroid glands, terminal branches of inferior thyroid artery and both external branch of superior laryngeal nerves /EBSLN/ and recurrent laryngeal nerve /RLN/ in the operative field. Material and methods: 224 patients underwent total thyroidectomy in the surgical clinic of University Hospital “Kaspela”, Plovdiv for the period of 2017 were analyzed. The extra capsular embrional approach was used. For the magnification a microscope was used. Postoperative levels of PTH and Ca were measured on the first postoperative day. Results: In all patients the recurrent laryngeal nerves RLN were successfully identified along their whole length from the inferior thyroid artery to their entering the laryngeal muscles. In 180 /80.30%/ patients EBSLN were seen and identified. None of the patients had temporary or permanent vocal cord palsy. In 24 /10.70%/ patients there was significant decrease of the normal levels of PTH and Ca. In another 45 /10.08%/ a mild regression was registered. All other patients were clinically and biochemically normal. Conclusion: Microsurgical technique could be very helpful for identification and preservation of both parathyroid glands and laryngeal nerves in thyroid surgery.