ABSTRACT
Thyroidectomy is considered a routine surgical procedure and should be associated with a low complication rate. Eighty-eight patients with bilateral benign primary thyroid disease were chosen to be subjected to bilateral total thyroidectomy. Patients were randomly divided into 2 equal groups: group I, -were subjected to the standard thyroidectomy with a lower collar incision, flap dissection, upper polar mass ligation, dissection of the inferior thyroid artery, identification of the recurrent laryngeal nerve [RLN] throughout the course to the larynx [lateral to medial dissection], inferior thyroid artery [ITA] ligation, followed by lower polar devascularization and gland excision. Group II, The procedure entailed careful capsular dissection [medial to lateral dissection] while keeping the thyroid gland under tension through medial traction. Only after the ligament of Berry's is explored, no further exploration for the RLN is attempted. The anesthesiologist checked the vocal cords soon after endotracheal extubation using the deep extubation technique. Direct laryngoscopy is preformed in the 3[rd] postoperative day or at the time a patient has hoarseness or difficulty breathing, and repeated after 6 months, Patients had their calcium level evaluated 5 hours postoperatively and the morning following the operation. Hypoparathyroidism is assigned temporary [less than 6 months] and permanent [more the 6 months] after thyroidectomy. The operative time was shorter in group I [109 +/- 24 min] than in group II [133 +/- 38 min]. The means post-excisional glandular weight was lower in group I [78.77 +/- 34.75 gm] than group II [81.35 +/- 31.76 gm]. The number of patients with postoperative cord paresis was higher in group I than in group II [2 patients in group I versus I patient in group II], the number of patients showing permanent vocal cord paresis after 6 months was higherin group I [cone patient] while no patient had permanent vocal cord paresis in group II. The whole incidence of moderate and severe hypocalcaemia was higher in group I than in group II. The procedure of capsular dissection was associated with prolonged operative time but however had a better outcome regarding hoarseness of voice and preservation of the parathyroid functions than the conventional technique