Microscopic Thyroidectomy: A Prudent Option

  • Amit KumarEmail author
  • Amit Kumar Tyagi
  • Saurabh Varshney
  • Manu Malhotra
  • Madhu Priya
Original Article


Microscopic Thyroidectomy is not a new surgical technique but it is not explored much. The routine use of microscope in thyroid surgery can reduce the rate of nerve palsy and hypocalcemia. Nine cases were done exclusively with the microscope only and postoperative nerve palsy and hypocalcemia were noted. We have also discussed about optimum working distances and magnification for critical structures during thyroid surgery. No patient has any nerve palsy while one patient reported transient hypocalcemia. Recurrent laryngeal nerve could be identified at 2 × but optimal magnification for dissection of nerve should be 4 ×. We find this technique easy to adopt and critical structures can be identified and preserved easily with microscopic thyroidectomy then conventional and loupe technique. It is better to have standardized and optimum working distance and magnification during different steps of surgery. It is great teaching tool in view of its better illumination and magnification.


Thyroid gland Thyroidectomy 



This research received no specific Grant from any funding agency, commercial or not-for-profit sectors.

Compliance with Ethical Standards

Conflict of interest

Authors declares that they have no conflict of interest.

Ethical Approval

It is approved by Institutional Ethics Committee of AIIMS Rishikesh. (AIIMS/IEC/18/344).


  1. 1.
    Lahey FH, Hoover WB (1938) Injuries to the recurrent laryngeal nerve in thyroid operations: their management and avoidance. Ann Surg 108(4):545–562CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    D’Orazi V (2016) Use of loupes magnification and microsurgical technique in thyroid surgery: ten years experience in a single center. Giornale di Chirurgia J Surg.
  3. 3.
    Kim MJ, Nam K-H, Lee SG, Choi JB, Kim TH, Lee CR et al (2018) Yonsei experience of 5000 gasless transaxillary robotic thyroidectomies. World J Surg 42(2):393–401CrossRefPubMedGoogle Scholar
  4. 4.
    Cho J, Lee D, Baek J, Lee J, Park Y, Sung K (2017) Single-incision endoscopic thyroidectomy by the axillary approach with gas inflation for the benign thyroid tumor: retrospective analysis for a single surgeon’s experience. Surg Endosc 31(1):437–444CrossRefPubMedGoogle Scholar
  5. 5.
    Gupta AK, Kumar A, Singh A, Subash A (2018) Robot assisted trans axillary thyroidectomy: a subcontinent experience. Indian J Otolaryngol Head Neck Surg.
  6. 6.
    Beneragama T, Serpell JW (2006) Extralaryngeal bifurcation of the recurrent laryngeal nerve: a common variation. ANZ J Surg 76(10):928–931CrossRefPubMedGoogle Scholar
  7. 7.
    Davidson BJ, Guardiani E, Wang A (2009) Adopting the operating microscope in thyroid surgery: safety, efficiency, and ergonomics. Head Neck 32(2):154–159Google Scholar
  8. 8.
    Yalcxin B (2006) Anatomic configurations of the recurrent laryngeal nerve and inferior thyroid artery. Surgery 139(2):181–187CrossRefGoogle Scholar
  9. 9.
    Abboud B, Sargi Z, Akkam M, Sleilaty F (2002) Risk factors for postthyroidectomy hypocalcemia. J Am Coll Surg 195(4):456–461CrossRefPubMedGoogle Scholar
  10. 10.
    Halperin I, Nubiola A, Vendrell J, Vilardell E (1989) Late-onset hypocalcemia appearing years after thyroid surgery. J Endocrinol Investig 12(6):419–420CrossRefGoogle Scholar
  11. 11.
    Badash I, Gould DJ, Patel KM (2018) Supermicrosurgery: history, applications, training and the future. Front Surg.
  12. 12.
    Nielsen TR, Andreassen UK, Brown CL, Balle VH, Thomsen J (2018) Microsurgical technique in thyroid surgery—a 10-year experience. J Laryngol Otol.

Copyright information

© Association of Otolaryngologists of India 2018

Authors and Affiliations

  1. 1.Department of Otolaryngology and Head-Neck SurgeryAIIMSRishikeshIndia

Personalised recommendations