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Head and Neck Surgery

(305) Medial Approach Thyroidectomy for Obese Patients

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time

    Presenting Author(s)

  • SM

    Spencer Muscelli, BS

    University of Nevada School of Medicine (Kirk Kerkorian SOM At UNLV), USA

    • Co-Author(s)

  • NL

    Nathan J. Lloyd, MD

    Resident
    University of Nevada School of Medicine (Kirk Kerkorian SOM At UNLV)
    Henderson, Nevada, United States

  • AC

    Adrianna Castellanos, BS

    University of Nevada School of Medicine (Kirk Kerkorian SOM At UNLV), USA

  • Emily Sagalow, MD

    Resident
    University of Nevada School of Medicine (Kirk Kerkorian SOM At UNLV)
    Las Vegas, Nevada, United States

    • Senior Author(s)

  • RW

    Robert C. Wang, MD

    Chair, Department of Otolaryngology-Head & Neck Surgery
    University of Nevada School of Medicine (Kirk Kerkorian SOM At UNLV)
    Las Vegas, Nevada, United States

Disclosure(s):
Emily Sagalow, MD: No relevant relationships to disclose.
Robert C. Wang, MD: No relevant relationships to disclose.


Introduction: Operative time and recurrent nerve palsy in thyroidectomy are increased with increasing BMI. This study aims to determine if the medial approach provides improved surgical outcomes for the obese population.

Methods: Data was collected from all cases of total and hemithyroidectomy exclusively using a medial approach performed by a single surgeon at our institution from July 2018 to January 2022. The technique emphasizes superficial dissection and keeping deep dissection to a minimum that is advantageous particularly in obese subjects. The relation between patient size and the risk of recurrent laryngeal nerve (RLN) palsy, hypoparathyroidism and surgical duration were statistically analyzed.

Results: The primary outcomes for this study were operative time, postoperative RLN injury, and postoperative hypoparathyroidism. The primary outcomes were compared between two groups based on patient BMI (BMI >25 and BMI < 25), and subgroup analysis was performed by type of thyroidectomy (total vs hemi) and complexity of procedure (additional dissection vs no additional dissection). Analyses were performed using Fisher's Exact Test and Welch Two Sample t-test in Rstudio v2022.02.2 with a significance level set at 0.05.
In this series, we evaluated a total of 274 patients (145 total thyroidectomy, 14 completion, 115 hemithyroidectomy). Of these, 24.1% (N=66) had a BMI < 25 and 75.2% (N=206) had a BMI >25. Two patients were excluded from analysis due to incomplete data. Across all patients, mean operative time was 136 minutes in the BMI < 25 group and 147 minutes in the BMI>25 group. No significant difference in operative time was found between the groups (p < 0.05). Total rates of postoperative hypoparathyroidism were 5.3% (N=2) in the BMI < 25 group and 5.8% (N=7) in the BMI>25 group, while rates of postoperative RLN injury were 3.1% (N=2) and 5.6% (N=11), respectively. No significant difference in rate of hypoparathyroidism or RLN injury was found between groups.

Conclusions: The medial approach to thyroidectomy equalizes operative time between normal and obese patients, without increasing RLN palsy or hypoparathyroidism.