Total thyroidectomy is safer with identification of recurrent laryngeal nerve

Objective： To investigate the effect of recurrent laryngeal nerve （RLN） identification on the complications after total thyroidectomy and lobectomy. Methods： Total 134 consecutive patients undergoing total thyroidectomy or thyroid lobectomy from January 2003 to November 2004 were investigated retrospectively. Patients were divided into two groups： RLN identified （Group A） or not （Group B）. The two groups were compared for RLN injury and hypocalcaemia. Results： The numbers of patients and nerves at risk were 71 and 129 in Group A, and 63 and 121 in Group B, respectively, RLN injury in Group A （0） was significantly lower than that in Group B （5 [7.9%]） patients, 7 [5.8%] nerves） for the numbers of patients （P=0.016） and nerves at risk （P=0.006）. Temporary hypocalcaemia was significantly higher in Group A than in Group B （14 [24.1%] vs 6 [ 10.3%], P=0.049）, Permanent complications in Group B were significantly higher than those in Group A （13 [20.6%] vs 4 [5.6%], P=0.009）. Conclusion： RLN injury was prevented and permanent complications were decreased by identifying the whole course and branches of the recurrent laryngeal nerve during total thyroidectomy,     

Drainage after total thyroidectomy or lobectomy for benign thyroidal disorders

Objective： This prospective randomized clinical trial was conducted to evaluate the necessity of drainage after total thyroidectomy or lobectomy for benign thyroidal disorders. Methods： A total of 116 patients who underwent total thyroidectomy or lobectomy for benign thyroidal disorders were randomly allocated to be drained or not. Operative and postoperative outcomes including operating time, postoperative pain assessed by visual analogue scale （VAS）, total amount of intramuscular analgesic administration, hospital stay, complications, necessity for re-operation and satisfaction of patients were all assessed. Results： The mean operating time was similar between two groups （the drained and non-drained groups）. The mean VAS score was found to be significantly low in the non-drained group patients in postoperative day （POD） 0 and POD 1. The mean amount of intramuscular analgesic requirement was significantly less in the non-drained group. One case of hematoma, two cases ofseroma and three cases of transient hypoparathyroidism occurred in the non-drained group, whereas one case of hematoma, two cases of seroma, two cases of wound infections and two cases of transient hypoparathyroidism occurred in the drained group. No patient needed re-operation for any complication. The mean hospital stay was significantly shorter and the satisfaction of patients was superior in the non-drained group. Conclusion： These findings suggest that postoperative complications cannot be prevented by using drains after total thyroidectomy or lobectomy for benign thyroid disorders. Furthermore, the use of drains may increase postoperative pain and the analgesic requirement, and prolong the hospital stay. In the light of these findings, the routine use of drains might not be necessary after thyroid surgery for benign disorders.