Author(s)
Carolyn A DeBiase MD
Merry E Sebelik MD
Srinivasa R Chandra MD
Jagdish K Dhingra MD
Affiliation(s)
Albany Medical College;
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to describe the lateral approach and its utility in resecting mega goiters.
Objectives: Iodine deficiency is one of the most common micronutrient deficiencies globally, affecting one-third of the world population. Goiter can be endemic in these geographical areas. Low resource areas of the world carry a large burden of the disease. Limited access to healthcare results in mega goiters and present a surgical challenge due to significant risk of neurovascular injury. These risks are higher in patients with large superior pole extension.
Study Design: Retrospective review of thyroidectomies performed in low resource setting in Rwanda.
Methods: We describe our technique of "lateral approach" to safely resect enormous goiters with superior pole involvement and analyze outcomes between 2012 and 2019. Intraoperative and postoperative blood loss was recorded. Preoperative and postoperative vocal fold mobility was checked by handheld ultrasound starting in 2016.
Results: Over a period of 8 years, a total of 192 thyroidectomies (partial and subtotal) were performed. Lateral approach was used in 35 mega goiters with significant superior extension. No patient experienced significant intraoperative blood loss requiring transfusion. One patient had a postoperative hematoma requiring return to the operating room. 9/113 patients (7.9%) had a vocal cord paresis by laryngeal ultrasound, symptomatic in 3 patients.
Conclusions: Lateral approach results in early identification of the great vessels and laryngeal nerves, thereby reducing the risk of neurovascular injury. Moreover, this technique may reduce risk of neuropraxia due to rotational stretch. Divided infrahyoid musculature can be easily reapproximated as a muscle flap affording protection and preventing tethering of the skin and resulting in excellent cosmetic outcome.