Comparison Between Two Techniques During Thyroidectomy (Conventional Dissection Technique and Injection of Methylene Blue Dye Into Inferior Thyroid Artery Technique) Regarding Recurrent Laryngeal Nerve Identification and Preservation

Ain Shams University40 enrolled

Overview

The aim of the study is to evaluate the value of injection of methylene blue dye into the inferior thyroid artery for the help of the identification and dissection of recurrent laryngeal nerve, so thyroidectomy could be done with fewer complications in comparison to conventional technique

The aim of the study is to evaluate the effectiveness of methylene blue dye injection into the inferior thyroid artery for enhancing the intraoperative visualization of the RLN during thyroidectomy. Also, this method was compared to conventional RLN identification techniques in terms of nerve identification time, blood loss, complication rates, and postoperative outcomes, while assessing the safety and feasibility of using methylene blue in thyroid surgery. The study included 40 patients with indications for thyroidectomy due to benign thyroid conditions. Patients were randomly assigned into two equal groups: * Group A: 20 patients underwent injection of methylene blue dye into the inferior thyroid artery to aid in identifying the recurrent laryngeal nerve (RLN). * Group B: 20 patients underwent conventional RLN identification during thyroidectomy.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Time Taken for Identification of Single Recurrent Laryngeal Nerve

Interventions

Methylene blue groupDRUG

After ligation of the superior pole, 0.5-1 ml of sterile methylene blue dye was injected into the inferior thyroid artery. The thyroid tissue absorbed the dye, while the RLN remained unstained, appearing as a white structure in the tracheoesophageal groove. This aided in its early and safe identification, reducing the risk of injury during dissection.

Methylene blue groupPROCEDURE

Eligibility

Sex: ALLMin age: 18 YearsMax age: 60 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * All patients who present with simple nodular goiter, solitary thyroid nodule, controlled toxic goiter and failed medical treatment with indication for thyroidectomy. * Patents undergoing primary surgery (not recurrent). * Patients who are willing to undergo surgery under general anesthesia without any preoperative complications or major diseases. * Either gender in the age group of 18-60 years Exclusion Criteria: * Previous thyroid surgery. * Malignant goiter. * Major cardiac diseases, renal diseases or patients who are unfit for surgery. * Methylene blue allergies. * Pregnancy. * Patients who refuse to participate in the study. * Presence of any preoperative cord pathology or patients with dysphonia.

Outcomes

Primary Outcomes

Easy and fast identification of recurrent laryngeal nerve

Thyroid gland absorbed the dye and got stained blue while the RLN didn't take the dye and appeared as a white structure in the tracheoesophageal groove

Time frame: Procedure (Time taken for identification of the recurrent laryngeal nerve after delivery of thyroid lobe (in minutes))

Secondary Outcomes

Lower intra-operative blood loss

Intra-operative blood loss was significantly lower in the Methylene blue group in comparison to conventional technique

Time frame: The duration of the procedure ranging from one to two hours