Carotid triangle approach to control superior thyrovascular pedicle a novel technique to avoid strap muscles cutting during thyroidectomy

ABSTRACT

Strap muscles division during thyroidectomy is a controversial issue. The role of strap muscles in voice and swallowing functions and the postoperative morbid sequelae after strap muscles cutting are all debatable. So we have been enthused to develop a surgical approach that enables us to avoid such an unnecessary invasiveness, an idea that seems to be in harmony with both surgical orthodoxy and modern surgical trends. To give a precise detailed stepwise description of such proposed procedural surgical approach and its anatomical basis with the assessment of its feasibility and safety. 30 cases 3560 years, FM [21] presenting to authors hospitals for thyroidectomy from April through October 2009; were selected for lateral approach where we approach the superior thyrovascular pedicle and the middle thyroid vein through the carotid triangle. Eligibility criteria were Huge goitres, strong taut strap muscles in males, retr opharyngyal, retro-oesophageal or large Zuckerkandl tuberculum and vascular goitres with marked adhesions. Patients with small goitres, recurrent goitres, previous neck irradiation, and malignant goitres were excluded. Intraoperative and postoperative data were gathered for procedural assessment There were no intraoperative morbidity, and the procedure succeeded in all of the study cases with no conversion to strap muscles cutting. RLN was identified in 28 pts and EBSLN in 10. Parahtyroid glands were identified in 27pts. The mean intraoperative blood loss was 70 cc, the mean operative time was 90 minutes, postoperative pain was well tolerated, mean amount of postoperative drainage was 78 cc with a mean duration of 2 days and a mean hospital stay of 3 days. there were no RLN or sympathetic nerve injury but only one developed transient EBSLN injury and 2 developed transient hypoparathyroidism. carotid triangle approach to control the superior thyrovascular pedicle enables us to avoid aggressive surgical handling of strap muscles by cutting or even excessive exhausting muscle retraction and gland manipulation with their possible morbid sequlae. It is an expeditious approach that facilitates surgery without compromising safety, we believe it to be a reasonably straightforward technique to learn and to be an appropriate addition to the armamentarium of endocrine surgeon whenever indicated