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The Modern Thyroid Operation

Explore the advanced thyroid surgical techniques offered at the Department of Otolaryngology, Kaohsiung Medical University, Taiwan. Learn about modern procedures to eradicate thyroid disease, ensure safe operations, and provide intra-operative evidence for optimal outcomes.

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The Modern Thyroid Operation

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  1. The Modern Thyroid Operation Department of Otolaryngology Kaohsiung Medical University, Taiwan Feng-Yu Chiang, MD E-mail: fychiang@kmu.edu.tw

  2. The modern thyroid operation • Eradicate thyroid disease • A safe thyroid operation • Intra-operative evidence

  3. Eradicate thyroid disease • Total lobectomy • Total thyroidectomy • Neck dissection (Central or Lateral) • Resection of upper aerodigestive tract • I-131 therapy

  4. A safe thyroid operation • Preserve RLN and EBSLN • Preserve parathyroid function

  5. Intra-operative evidence • Anatomic integrity - High-resolution photographs • Functional integrity - IONM of RLN - Intact blood supply to parathyroid

  6. Preservation of RLN

  7. Recurrent laryngeal nerve palsy • Most common and serious complication • The leading reason for medicolegal litigation

  8. Routine identification of RLN • Lower rates of RLN palsy • Gold standard of RLN treatment

  9. Intra-Operative NeuroMonitoring(IONM)

  10. Applications of IONM • Prevent RLN injury • Localize and identify RLN • Predict vocal function • Elucidate mechanism of RLN injury • Help preserve parathyroid

  11. ET tube KMU ENT

  12. 17

  13. Video of RLN approach

  14. IONM is useful and helpful for • Anatomic variants of RLN • Difficult thyroid operation

  15. Anatomic variants of RLN (Extralaryngeal branches, Non-RLN, Distorted RLN…etc) - important factors: • RLN injury • False results of IONM

  16. Extralaryngeal branches of RLN • Branch to trachea • Branch to esophagus • Branch to inferior constrictor muscle • Anterior branch • Posterior branch

  17. Bifurcated RLN

  18. Non-recurrent RLN

  19. Video of detecting Non-RLN

  20. Video of mapping Non-RLN

  21. Video of Non-RLN

  22. Difficult thyroid operation (Recurrent, substernal or large goiter , Thyroid cancer) Early localization & Definite identification An important step to prevent RLN injury

  23. Localization

  24. Reoperation

  25. Substernal or large goiter

  26. Palsy rates in 3 operation periods

  27. Preservation of EB-SLN

  28. Video of EB-SLN

  29. Preservation of parathyroid function • Preserve parathyroid with intact blood supply • Auto-transplantation for devascularized parathyroid

  30. Parathyroid with intact blood supply (1)

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