Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, New South Wales, Australia.
Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.
ANZ J Surg. 2022 Jul;92(7-8):1626-1630. doi: 10.1111/ans.17783. Epub 2022 Jun 10.
In this article, we aim to describe our modern-day approach to total thyroidectomy, detailing the subtle refinements of our technique, as it has evolved over three decades and 21 000 cases. Since Delbridge's seminal paper in 2003, the major changes to our approach include a retrograde approach to the recurrent laryngeal nerve that allows dissection of the distal RLN from fascial bands within the ligament of Berry before medialisation of the thyroid lobe. Routine use of intraoperative nerve monitoring systems has increased our awareness of temporary neuropraxia, facilitated a reduction in the risk of bilateral RLN palsy and improved our identification and preservation of the external branch of the superior laryngeal nerve. The increasing use of advanced energy devices has been associated with a reduction in post-operative haematoma rates. We adopt a low threshold to parathyroid auto-transplantation, unless all glands are assessed to be clearly not at risk, and routinely supplement patients with Caltrate in the immediate post-operative period to minimize the risk of symptomatic hypocalcaemia. Ultimately, when we reflect on the subtle refinements that have contributed to improved outcomes, the fundamental principles of exposure and dissection that have evolved over decades remain the basis of our surgical approach and must continue to do so.
在本文中，我们旨在描述我们现代的甲状腺全切除术方法，详细介绍我们的技术的细微改进，因为它已经发展了三十年和 21000 例。自 2003 年 Delbridge 的开创性论文以来，我们方法的主要变化包括对喉返神经的逆行解剖，允许在甲状腺叶内移之前，从 Berry 韧带内的筋膜带解剖远端 RLN。常规使用术中神经监测系统提高了我们对暂时性神经损伤的认识，降低了双侧 RLN 麻痹的风险，并提高了我们对喉上神经外支的识别和保护。先进能量设备的使用越来越多与术后血肿发生率降低有关。我们采用低阈值甲状旁腺自体移植，除非所有腺体都被评估为明显没有风险，并且常规在术后立即补充 Caltrate 以最大程度地降低症状性低钙血症的风险。最终，当我们反思促成改善结果的细微改进时，几十年来演变的暴露和解剖的基本原则仍然是我们手术方法的基础，并且必须继续如此。
