Lateral approach improves surgical access to the superior pole in giant endemic goiters.
Backdoor
giant endemic goiter
goiter
hypoparathyroidism
lateral approach
recurrent nerve injury
thyroidectomy
transcutaneous laryngeal ultrasound (TCLUS)
Journal
Gland surgery
ISSN: 2227-684X
Titre abrégé: Gland Surg
Pays: China (Republic : 1949- )
ID NLM: 101606638
Informations de publication
Date de publication:
Mar 2021
Mar 2021
Historique:
entrez:
12
4
2021
pubmed:
13
4
2021
medline:
13
4
2021
Statut:
ppublish
Résumé
Surgical management of mega-goiters in endemic areas with extreme iodine deficiency presents unique challenges. Based on our initial 5-year experience (2007 to 2011) operating on mega-goiters in Gitwe, Rwanda, Africa, we modified our technique to a lateral approach which affords better exposure of the superior pole vessels and other vital neurovascular structures, thereby improving safety. We describe this lateral approach technique and review outcomes compared to the standard technique. From 2007 to 2019, we have conducted 13 annual surgical missions to low resource setting in Gitwe, Rwanda. Retrospective chart review of surgeries between 2012 and 2019 was performed to study outcomes using standard approach and lateral technique during the same time period. Over a period of 8 years (2012 to 2019), out of 192 total cases, lateral approach was used in 35 patients. No patient experienced significant intra-operative blood loss requiring transfusion. One patient had a post-operative hematoma requiring surgical intervention. Vocal cord mobility testing by transcutaneous laryngeal ultrasound was implemented in 2016. Of all patients, incidence of vocal cord weakness was 8.0% (11/137 patients tested) with less than 1/3 of these symptomatic. There was no statistically significant difference in vocal cord weakness noted in the two approaches (3/23 in lateral approach and 8/114 in standard approach) by Fisher's exact test (P=0.34). Lateral approach, by affording optimal exposure of the great vessels and the laryngeal nerves, reduces the risk of bleeding and nerve injury. Furthermore, inferiorly based strap muscle flap provides excellent coverage and cosmetic outcome.
Sections du résumé
BACKGROUND
BACKGROUND
Surgical management of mega-goiters in endemic areas with extreme iodine deficiency presents unique challenges. Based on our initial 5-year experience (2007 to 2011) operating on mega-goiters in Gitwe, Rwanda, Africa, we modified our technique to a lateral approach which affords better exposure of the superior pole vessels and other vital neurovascular structures, thereby improving safety. We describe this lateral approach technique and review outcomes compared to the standard technique.
METHODS
METHODS
From 2007 to 2019, we have conducted 13 annual surgical missions to low resource setting in Gitwe, Rwanda. Retrospective chart review of surgeries between 2012 and 2019 was performed to study outcomes using standard approach and lateral technique during the same time period.
RESULTS
RESULTS
Over a period of 8 years (2012 to 2019), out of 192 total cases, lateral approach was used in 35 patients. No patient experienced significant intra-operative blood loss requiring transfusion. One patient had a post-operative hematoma requiring surgical intervention. Vocal cord mobility testing by transcutaneous laryngeal ultrasound was implemented in 2016. Of all patients, incidence of vocal cord weakness was 8.0% (11/137 patients tested) with less than 1/3 of these symptomatic. There was no statistically significant difference in vocal cord weakness noted in the two approaches (3/23 in lateral approach and 8/114 in standard approach) by Fisher's exact test (P=0.34).
CONCLUSIONS
CONCLUSIONS
Lateral approach, by affording optimal exposure of the great vessels and the laryngeal nerves, reduces the risk of bleeding and nerve injury. Furthermore, inferiorly based strap muscle flap provides excellent coverage and cosmetic outcome.
Identifiants
pubmed: 33842241
doi: 10.21037/gs-20-725
pii: gs-10-03-973
pmc: PMC8033086
doi:
Types de publication
Journal Article
Langues
eng
Pagination
973-979Informations de copyright
2021 Gland Surgery. All rights reserved.
Déclaration de conflit d'intérêts
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/gs-20-725). The authors have no conflicts of interest to declare
Références
Medicine (Baltimore). 2017 Apr;96(17):e6674
pubmed: 28445266
Int J Clin Pract. 2009 Apr;63(4):624-9
pubmed: 19335706
Gland Surg. 2020 Apr;9(2):372-379
pubmed: 32420261
JAMA Otolaryngol Head Neck Surg. 2019 Jul 25;:
pubmed: 31343681
BMC Surg. 2019 Jul 24;19(1):98
pubmed: 31340806
Arch Surg. 2005 Jan;140(1):49-53
pubmed: 15655205
World J Surg. 2008 Jul;32(7):1313-24
pubmed: 18449595
Ann Surg Oncol. 2008 Jul;15(7):2027-33
pubmed: 18459003
Surgery. 2009 Dec;146(6):1174-81
pubmed: 19958946