Abstract
Introduction Total thyroidectomy remains highly technical, with a significant risk of recurrent
laryngeal nerve (RLN) compromise and hypoparathyroidism. After identifying RLN, at
the level of the ligament of Berry, local factors may compel the surgeon to either
dissect along the nerve or the thyroid capsule.
Objective The objective of the present study is to compare these two approaches in terms of
outcomes and complication rates.
Methods This is a retrospective analysis from September, 2013 to April 2019 of 511 consecutive
patients undergoing thyroidectomy. General demographics and disease parameters were
recorded. At the discretion of the surgeon and according to the demands of the local
operative factors, the patients either had dissection along the RLN or along the thyroid
capsule. Perioperative and postoperative parameters such as blood loss, duration of
surgery, hospital stay, pain scores, analgesia requirements and complications were
recorded. The groups were compared with the Pearson chi-squared test or with the Fisher
exact test. A p-value < 0.05 was considered statistically significant.
Results The incidence of transient hypocalcaemia and transient RLN compromise were higher
when dissection was performed along the nerve as opposed to the plane along the thyroid
capsule. Other parameters including operative time, hospital stay, pain scores, analgesia
requirement, wound infection, seroma, hemorrhage, and recurrence did not differ between
the groups. Subgroup analysis of the patients who presented with complications showed
that local factors, malignancy, and extent of surgery correlated positively with complications
when dissected along the RLN.
Conclusion Dissection along the capsule of the thyroid during thyroidectomy is a safer plane
in terms of low rate of transient RLN injury and hypoparathyroidism as opposed to
dissection along the nerve.
Keywords
dissection - thyroidectomy - plane of dissection - recurrent laryngeal nerve injury
- hypoparathyroidism
