1 Jul 2017Article
In situ preservation of the partathyroid glands in total thyroidectomy: a propensity score matched analysis
Vincenzo Ambrogi 1Erina Alushi 2Antonio Montemurro 3Arvin Dibra 4Mario Stefani 2Filadelfo Coniglione 2Francesco Rulli 2
Affiliations
Article Info
1 Department of Thoracic Surgery, University “Tor Vergata”, Rome, Italy
2 Department of Surgical Sciences, Catholic University “Our Lady of Good Council”, Tirana, Albania
3 Private endocrinology, Rome, Italy
4 Faculty of Medicine and Surgery, Catholic University “Our Lady of Good Council”, Tirana, Albania
Ann. Ital. Chir., 2017, 88(4), 288-294;
Published: 1 Jul 2017
Copyright © 2017 Annali Italiani di Chirurgia
This work is licensed under a Creative Commons Attribution 4.0 International License.
Abstract
AIM: Severe hypocalcemia due to parathyroid gland damage may be a serious complication after thyroidectomy. In order to save parathyroid integrity we developed a no-touch parathyroid (NTP) thyroidectomy technique. METHODS: We performed a total extracapsular thyroidectomy with NTP technique in consecutive 50 cases of benign goiter between July 2014 and June 2015. Parathyroid glands were firstly indentified, then they were separated from the thyroid avoiding manipulation or trauma and preserving their vascularization. Traditional scissors were preferentially used for dissection around the glands. Patients operated with NTP technique were matched by a propensity score to a control group. RESULTS: NTP was feasible in all foreseen patients except one. Propensity score selected a group of 23 patients/group for matching. No mortality has been observed in either group. Operative time were comparable between groups. Blood loss were significantly less abundant in the NTP group. No laryngeal permanent paralysis was experienced. Hospital stay was shorter yet not significantly in NTP group. Neither hypocalcemic crisis nor permanent hypoparathyroidism were described in either group. Serum calcium levels (NTP Vs control) were significantly higher in NTP group at day 1 (p=0.03) and day 2 (p=0.002), respectively. Similarly, intact parathormone dosages were significantly higher at day 1 (p=0.004) and day 7 (p=0.001), respectively. CONCLUSIONS: We conclude that NTP thyroidectomy is a feasible in the majority of the patientsand, allows a significant reduction of blood loss without prolonging the operative time. After the procedureboth values of calcemia and intact parathormonewere stable and no hypocalcemic crisis was experienced.
Keywords
- Parathyroid
- Hypoparathyroidism
- Hypocalcemia
- Total thyroidectomy