Capsular dissection technique for reducing recurrent laryngeal neuropraxia and temporary hypoparathyroidism after thyroidectomy: a single center experience

Abstract

Background: Recurrent laryngeal nerve injury and hypoparathyroidism are two of the much discussed major complications of thyroid surgery. It has been classically described by the majority of textbooks to meticulously dissect out the course of the recurrent laryngeal nerve to avoid its injury. However, the argument remains that this dissection might devascularise the nerve and the parathyroids, leading to recurrent laryngeal neuropraxia and temporary hypocalcemia. Hence some authors have recommended adopting a capsular dissection technique in order to avoid these complications.

Methods: This retrospective descriptive study analysed the outcome in a large series of patients who underwent total thyroidectomy by capsular dissection technique, over a 5 year period in a tertiary care center.

Results: As per this study, the incidence of permanent nerve damage was zero whereas the incidence of temporary neuropraxia was found to be around 0.5%. The incidence of temporary and permanent hypocalcemia was found to be around 0.7% and 0.2% respectively. These complications were found more in obese patients and those with malignancies.

Conclusions: Taking account of the very low incidence of nerve and parathyroid injury in this series, the authors suggest that meticulous capsular dissection is superior to dissection of the entire nerve in avoiding transcient nerve damage as well as temporary hypocalcemia. However it is stated that a deliberate search for the nerve is definitely indicated in cases where there is likely to be distorted anatomy, as in infiltrating malignancies and recurrent thyroidectomies.