Tension-free thyroidectomy (medial thyroidectomy)—a prospective study: surgical technique and results of 259 operations

BACKGROUND: Thyroid surgery is associated with a number of surgical complications including recurrent laryngeal nerve (RLN) injury and hypoparathyroidism. The existing methods share the same principle—the mobilization of the thyroid from the lateral side. The aim of this study was to evaluate the safety of a novel technique of thyroidectomy—tension-free thyroidectomy (TFT) based on the medial approach to the laryngeal nerves and parathyroid glands (PTGs). METHODS: The study was conducted between August 2021 and July 2022 in Saint Petersburg State University Hospital. A total of 261 patients with thyroid diseases were enrolled in the study and operated on using the TFT technique. RESULTS: The operations with the use of TFT technique were completed in all but two cases which required the conversion to the standard lateral approach. Of 259 TFT cases unilateral laryngeal paresis was registered in 6 (2.3%) cases or in 1.7% of the number of RLNs at risk. In all but one case the vocal fold function recovered in less than 6 months of the follow-up. Among 87 patients who underwent total thyroidectomy transient postoperative hypoparathyroidism was found in 10 cases (11.5%), rate of persistent hypoparathyroidism was 0%. One case of postoperative bleeding was recorded (0.4%). CONCLUSIONS: The TFT technique demonstrated high safety and several advantages over the traditional method of performing operations on the thyroid gland.