Application of thyroidectomy by meticulous capsular dissection technique through neck incision approach in treatment of 75 patients with type <b>Ⅰ</b> substernal goiter _CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

YU Youlin ,  HU Chaohua ,  SHEN Xiongshan , HAN Yuntao , LI Weimin , SHEN Haoyuan , PENG Dongjie , XU Yuanbing

Department of General Surgery, Affiliated Xiaogan Hospital of Wuhan University of Science and Technology, Xiaogan Central Hospital, Diagnosis and Treatment Center of Thyroid and Breast Disease of Xiaogan, Xiaogan, Hubei 432000, P. R. China;

Corresponding?author：

HU Chaohua, Email: huchaohua2006@126.com; SHEN Xiongshan, Email: shenxs@medmail.com.cn

Keywords：

thyroidectomy; recurrent laryngeal nerve; superior laryngeal nerve; parathyroid gland; type Ⅰ substernal goiter; ultrasonic scalpel; bipolar coagulation forcep

DOI：

10.7507/1007-9424.201708002

Video：

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Objective To assess clinical value of thyroidectomy by meticulous capsular dissection technique through neck incision approach in treatment of 75 patients with type Ⅰ substernal goiter. Methods The clinical data of 75 patients with type Ⅰ substernal goiter in the Department of General Surgery of the Central Hospital of Xiaogan from April 2013 to April 2017 were retrospectively analyzed. These patients received the surgical resection by the meticulous capsular dissection technique with an ultrasonic scalpel and a bipolar coagulation forcep through neck incision approach. Results There were 12 Hashimoto thyroiditis, 10 thyroid adenoma, 41 nodular goiter, and 12 thyroid carcinoma in the 75 patients with type Ⅰ substernal goiter. Five cases underwent the unilateral total thyroidectomy. Fifty-eight cases underwent the bilateral total thyroidectomy. The bilateral total thyroidectomy plus central lymph node dissection were performed in the 9 patients with thyroid carcinoma, the bilateral total thyroidectomy plus central lymph node dissection plus affected ipsilateral neck lymph node dissection were performed in the 3 patients with thyroid carcinoma. The average operative time was 100 min, the average intraoperative blood loss was 50 mL, the average postoperative hospital stay was 5 d. The rate of parathyroid injury was 2.7% (2/75), the rate of hypocalcemia caused by parathyroid injury was 2.7% (2/75). There were 3 cases (4.0%) of unilateral recurrent laryngeal nerve injury, 1 case (1.3%) of the outer branch of the upper laryngeal nerve injury. There were 2 cases of tracheal partial softening in the 75 patients. None of postoperative bleeding and seroma happened. No death and the tumor recurrence and metastasis of patients happened during follow-up period. Conclusions Preliminary results in this study show that operation of meticulous capsular dissection technique with an ultrasonic scalpel and a bipolar coagulation forcep through neck incision approach in treatment of type Ⅰ substernal goiter is safe and feasible, it could effectively reduce postoperative complications of thyroidectomy, and protect parathyroid and it’s function, recurrent laryngeal nerve, and superior laryngeal nerve.

Citation： YU Youlin, HU Chaohua, SHEN Xiongshan, HAN Yuntao, LI Weimin, SHEN Haoyuan, PENG Dongjie, XU Yuanbing. Application of thyroidectomy by meticulous capsular dissection technique through neck incision approach in treatment of 75 patients with type Ⅰ substernal goiter . CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2018, 25(2): 184-190. doi: 10.7507/1007-9424.201708002 Copy

1.	趙敬柱, 于洋, 李亦工, 等. 胸骨后甲狀腺腫瘤的外科治療. 中國腫瘤臨床, 2013, 40(13): 796-798.
2.	吳躍煌, 祁永發, 唐平章, 等. 胸骨后甲狀腺腫的手術徑路. 中華耳鼻咽喉頭頸外科雜志, 2006, 41(7): 528-531.
3.	Hajhosseini B, Montazeri V, Hajhosseini L, et al. Mediastinal goiter: a comprehensive study of 60 consecutive cases with special emphasis on identifying predictors of malignancy and sternotomy. Am J Surg, 2012, 203(4): 442-447.
4.	蔣波, 彭瑤, 王浩, 等. 頸部入路切除胸骨后甲狀腺腫57例臨床分析. 中國普通外科雜志, 2017, 26(3): 347-357.
5.	Barbetakis N, Asteriou C, Paliouras D, et al. eComment. Substernal goiter. Beware of the thyroidea ima artery. Interact Cardiovasc Thorac Surg, 2014, 19(1): 143.
6.	Kilic D, Findikcioglu A, Ekici Y, et al. When is transthoracic approach indicated in retrosternal goiters? Ann Thorac Cardiovasc Surg, 2011, 17(3): 250-253.
7.	Qureishi A, Garas G, Tolley N, et al. Can pre-operative computed tomography predict the need for a thoracic approach for removal of retrosternal goitre? Int J Surg, 2013, 11(3): 203-208.
8.	McKenzie GA, Rook W. Is it possible to predict the need for sternotomy in patients undergoing thyroidectomy with retrosternal extension? Interact Cardiovasc Thorac Surg, 2014, 19(1): 139-143.
9.	Sudarshan Babu KG, Shantharam L. A study of complications of thyroidectomy. Int J Cur Res Rev, 2013, 5(17): 95-101.
10.	U P S, K B P, Karanam L. Preoperative preparation with Lugol's iodine in thyroidectomy of euthyroid patients—Is it really mandatory? —An Otorhinolaryngologist's View. J Clin Diagn Res, 2014, 8(8): KC01-KC02.
11.	Rudolph N, Dominguez C, Beaulieu A, et al. The morbidity of reoperative surgery for recurrent benign nodular goitre: impact of previous unilateral thyroid lobectomy versus subtotal thyroidectomy. J Thyroid Res, 2014, 2014: 231857.
12.	Joliat GR, Guarnero V, Demartines N, et al. Recurrent laryngeal nerve injury after thyroid and parathyroid surgery: Incidence and postoperative evolution assessment. Medicine (Baltimore), 2017, 96(17): e6674.
13.	Hayward NJ, Grodski S, Yeung M, et al. Recurrent laryngeal nerve injury in thyroid surgery: a review. ANZ J Surg, 2013, 83(1-2): 15-21.
14.	Enomoto K, Uchino S, Watanabe S, et al. Recurrent laryngeal nerve palsy during surgery for benign thyroid diseases: risk factors and outcome analysis. Surgery, 2014, 155(3): 522-528.
15.	Shi C, Tian B, Li S, et al. Enhanced identification and functional protective role of carbon nanoparticles on parathyroid in thyroid cancer surgery: A retrospective Chinese population study. Medicine (Baltimore), 2016, 95(46): e5148.
16.	龔單春, 張海東, 劉亞群, 等. 甲狀腺腺葉切除術精細化操作技術臨床結果初步報告. 中華耳鼻咽喉頭頸外科雜志, 2015, 50(1): 28-32.
17.	中國醫師協會外科醫師分會甲狀腺外科醫師委員會. 甲狀腺手術中甲狀旁腺保護專家共識. 中國實用外科雜志, 2015, 35(7): 731-736.
18.	王朝暉, 蔡永聰, 陳錦, 等. 精細化被膜解剖法在甲狀腺全切手術中的應用.中華普通外科學文獻(電子版), 2014, 8(1): 8-11.
19.	Wu G, Wang K. A novel variation of the recurrent laryngeal nerve. BMC Surg, 2017, 17(1): 66.
20.	余幼林, 胡超華, 韓運濤, 等. 甲狀腺手術中喉返神經解剖變異特征及顯露方法的再認識. 中國普通外科雜志, 2017, 26(5): 660-665.
21.	Wang K, Cai H, Kong D, et al. The identification, preservation and classification of the external branch of the superior laryngeal nerve in thyroidectomy. World J Surg, 2017, 41(10): 1521-2529.
22.	Giordano D, Valcavi R, Thompson GB, et al. Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1087 patients and review of the literature. Thyroid, 2012, 22(9): 911-917.
23.	王天笑, 于文斌, 馬驍, 等. 甲狀腺全切除術和近全切除術術后甲狀旁腺功能損傷的危險因素分析. 中華外科雜志, 2016,54(3): 206-211.
24.	Sebastian M, Rudnicki J, Jakubaszko W, et al. Clinical and biochemical factors affecting postoperative hypocalcemia after near-total thyroidectomy. Adv Clin Exp Med, 2013, 22(5): 675-682.
25.	Antakia R, Edafe O, Uttley L, et al. Effectiveness of preventative and other surgical measures on hypocalcemia following bilateral thyroid surgery: a systematic review and meta-analysis. Thyroid, 2014, 25(1): 1-12.
26.	張浩, 張挺.甲狀腺手術中能量器械對甲狀旁腺的保護與損傷. 中國普外基礎與臨床雜志, 2017, 24(10): 1183-1185.

1. 趙敬柱, 于洋, 李亦工, 等. 胸骨后甲狀腺腫瘤的外科治療. 中國腫瘤臨床, 2013, 40(13): 796-798.
2. 吳躍煌, 祁永發, 唐平章, 等. 胸骨后甲狀腺腫的手術徑路. 中華耳鼻咽喉頭頸外科雜志, 2006, 41(7): 528-531.
3. Hajhosseini B, Montazeri V, Hajhosseini L, et al. Mediastinal goiter: a comprehensive study of 60 consecutive cases with special emphasis on identifying predictors of malignancy and sternotomy. Am J Surg, 2012, 203(4): 442-447.
4. 蔣波, 彭瑤, 王浩, 等. 頸部入路切除胸骨后甲狀腺腫57例臨床分析. 中國普通外科雜志, 2017, 26(3): 347-357.
5. Barbetakis N, Asteriou C, Paliouras D, et al. eComment. Substernal goiter. Beware of the thyroidea ima artery. Interact Cardiovasc Thorac Surg, 2014, 19(1): 143.
6. Kilic D, Findikcioglu A, Ekici Y, et al. When is transthoracic approach indicated in retrosternal goiters? Ann Thorac Cardiovasc Surg, 2011, 17(3): 250-253.
7. Qureishi A, Garas G, Tolley N, et al. Can pre-operative computed tomography predict the need for a thoracic approach for removal of retrosternal goitre? Int J Surg, 2013, 11(3): 203-208.
8. McKenzie GA, Rook W. Is it possible to predict the need for sternotomy in patients undergoing thyroidectomy with retrosternal extension? Interact Cardiovasc Thorac Surg, 2014, 19(1): 139-143.
9. Sudarshan Babu KG, Shantharam L. A study of complications of thyroidectomy. Int J Cur Res Rev, 2013, 5(17): 95-101.
10. U P S, K B P, Karanam L. Preoperative preparation with Lugol's iodine in thyroidectomy of euthyroid patients—Is it really mandatory? —An Otorhinolaryngologist's View. J Clin Diagn Res, 2014, 8(8): KC01-KC02.
11. Rudolph N, Dominguez C, Beaulieu A, et al. The morbidity of reoperative surgery for recurrent benign nodular goitre: impact of previous unilateral thyroid lobectomy versus subtotal thyroidectomy. J Thyroid Res, 2014, 2014: 231857.
12. Joliat GR, Guarnero V, Demartines N, et al. Recurrent laryngeal nerve injury after thyroid and parathyroid surgery: Incidence and postoperative evolution assessment. Medicine (Baltimore), 2017, 96(17): e6674.
13. Hayward NJ, Grodski S, Yeung M, et al. Recurrent laryngeal nerve injury in thyroid surgery: a review. ANZ J Surg, 2013, 83(1-2): 15-21.
14. Enomoto K, Uchino S, Watanabe S, et al. Recurrent laryngeal nerve palsy during surgery for benign thyroid diseases: risk factors and outcome analysis. Surgery, 2014, 155(3): 522-528.
15. Shi C, Tian B, Li S, et al. Enhanced identification and functional protective role of carbon nanoparticles on parathyroid in thyroid cancer surgery: A retrospective Chinese population study. Medicine (Baltimore), 2016, 95(46): e5148.
16. 龔單春, 張海東, 劉亞群, 等. 甲狀腺腺葉切除術精細化操作技術臨床結果初步報告. 中華耳鼻咽喉頭頸外科雜志, 2015, 50(1): 28-32.
17. 中國醫師協會外科醫師分會甲狀腺外科醫師委員會. 甲狀腺手術中甲狀旁腺保護專家共識. 中國實用外科雜志, 2015, 35(7): 731-736.
18. 王朝暉, 蔡永聰, 陳錦, 等. 精細化被膜解剖法在甲狀腺全切手術中的應用.中華普通外科學文獻(電子版), 2014, 8(1): 8-11.
19. Wu G, Wang K. A novel variation of the recurrent laryngeal nerve. BMC Surg, 2017, 17(1): 66.
20. 余幼林, 胡超華, 韓運濤, 等. 甲狀腺手術中喉返神經解剖變異特征及顯露方法的再認識. 中國普通外科雜志, 2017, 26(5): 660-665.
21. Wang K, Cai H, Kong D, et al. The identification, preservation and classification of the external branch of the superior laryngeal nerve in thyroidectomy. World J Surg, 2017, 41(10): 1521-2529.
22. Giordano D, Valcavi R, Thompson GB, et al. Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1087 patients and review of the literature. Thyroid, 2012, 22(9): 911-917.
23. 王天笑, 于文斌, 馬驍, 等. 甲狀腺全切除術和近全切除術術后甲狀旁腺功能損傷的危險因素分析. 中華外科雜志, 2016,54(3): 206-211.
24. Sebastian M, Rudnicki J, Jakubaszko W, et al. Clinical and biochemical factors affecting postoperative hypocalcemia after near-total thyroidectomy. Adv Clin Exp Med, 2013, 22(5): 675-682.
25. Antakia R, Edafe O, Uttley L, et al. Effectiveness of preventative and other surgical measures on hypocalcemia following bilateral thyroid surgery: a systematic review and meta-analysis. Thyroid, 2014, 25(1): 1-12.
26. 張浩, 張挺.甲狀腺手術中能量器械對甲狀旁腺的保護與損傷. 中國普外基礎與臨床雜志, 2017, 24(10): 1183-1185.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of thyroidectomy by meticulous capsular dissection technique through neck incision approach in treatment of 75 patients with type Ⅰ substernal goiter

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