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Assessment of Utility of Staining in the Intraoperative Localization of Parathyroid Glands

100%
Głyda M.
Polish Journal of Surgery
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2010
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vol. 82
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issue 2
77-87
EN
Identifying the primary and secondary hyperparathyroidism is a recommendation for the surgical treatment. To streamline the surgical treatment there are applied before- and intra-operative methods of location of parathyroid glands.The aim of the study was to assess an effectiveness and benefits of intra-operative colouring of parathyroid glands with methylene blue.Material and methods. In the Department of General and Endocrinological Surgery, Medical University in Poznań in the years 2000-2005 116 patients with hyperparathyroidism (61 with primary and 55 secondary hyperparathyroidism) were operated. At 82 patients a method of indicating patathyroid glands with methylene blue was applied. At all patients there were assesed a duration of the operation, the number of prepared parathyroid glands, and the number of the histopatological tests necessary for their identification, as well as procedures during which thyroid gland were additionally operated. There were compared methods of before- and intra-operative location of the glands.Results. After a statistical analysis of gathered material there was stated characteristic statistically difference of shortening the duration of operation in the group with colouring in comparison to the group without colouring. There were also reduced amount of intra-operative tests needed for identification of removed glands. The method is considered as significantly streamlining the operation. Limitation of the duration of the treatment reduced the perioperative injury, shortened the period of the hospitalization, and consequently reduced costs of the treatment. Colouring method showed itself to be the most effective method of the location of parathyroid glands. The majority of preoperative methods concerns only ectopic glands.Conclusions. Colouring with methylene blue is a method facilitating identifications of parathyroid glands in the operative field, shortening the duration of the treatment and at the same time safe, cheap and readily available.
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Local Anesthesia in Thyroid Surgery - Own Experience and Literature Review

33%
Banasiewicz T., Meissner W., Pyda P., Wierzbicki T., Biczysko M., Głyda M., Iwanik K., Drews M.
Polish Journal of Surgery
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2011
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vol. 83
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issue 5
264-270
EN
The local anesthesia in thyroid surgery is rarely used, only in selected patients. Majority of centers performing thyroid surgery with local anesthesia have possibility to convert to the general anesthesia.The aim of the study was to present our experiences with partial thyroidectomy under local anesthesia performed in 49 consecutive subjects in the Central African Republic (bilateral subtotal strumectomy, total resection of the one lobe, subtotal resection of the one lobe).Material and methods. All admitted patients with clinically significant goiter were accepted for surgical treatment. For infiltration anesthesia 1% lignocaine was used. Because of the shortage of medical resources, potential conversion to the general anesthesia was impossible. Before the operation patients had received an oral sedation and antibiotic. In 16 patients general anesthesia was used, in other 33 it was impossible.Results. Subtotal bilateral thyroidectomy was performed in 37 patients, 12 patients underwent lobectomy or partial lobectomy of the affected portion of the gland. There were no intraoperative and postoperative complications noticed in the reported group, including complications related to laryngeal nerve injury. The mean duration of the procedure was 127 minutes and mean medical follow-up was 3 days. General condition of all patients on the day of discharge from hospital was good.Conclusions. Surgery for goiter under local anesthesia may be a safe alternative where general anesthesia is not available or contraindicated for medical reasons. The infiltration anesthesia is simple to perform and reduces the number of complications potentially occurred at the C2-C4 neck plexus block.
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