An evaluation score of the difficulty of thyroidectomy considering operating time and preservation of recurrent laryngeal nerve

Nomogram for predicting difficult transoral and submental thyroidectomy: a retrospective model development and validation study with large-scale population

OBJECTIVE

No prior studies have described or stratified the difficulty of transoral and submental thyroidectomy (TOaST). We aimed to investigate preoperative factors as indicators of difficult TOaSTs and to develop a predictive model accordingly.

METHODS

This retrospective study included 255 eligible DTC patients who underwent total thyroidectomy and central neck dissection (CND) via transoral and submental endoscopic approach between February 2021 and April 2024. These patients were randomized into training and validation groups in a 7:3 ratio. Procedures were categorized into difficult and normal TOaST based on operation time, conversion to open and intraoperative injury. Univariate and multivariate logistic regression analyses were used to assess the association between surgical difficulty and factors regarding demographics, laboratory tests and ultrasound information. A nomogram was then developed and validated internally. Surgical and oncological profiles and follow-up data were also analyzed.

RESULTS

Five independent risk factors for difficult TOaST were identified in multivariate analysis: age (OR 0.84, p < 0.001), male sex (OR 4.75, p = 0.016), thyromental distance (TMD) < 7 cm (OR 7.59, p < 0.001), presence of diffuse changes on ultrasound (OR 14.5, p < 0.001), and elevated anti-thyroid peroxidase antibody (TPO-Ab) level (OR 5.22, p = 0.005). The nomogram performed well on both the training and the validation datasets, achieving an area under curve (AUC) of 0.908 and 0.888, respectively. Calibration curves for both datasets also fit well. There was no significant difference in complication rates between the difficult and normal TOaST groups.

CONCLUSION

The developed nomogram provides a reliable, straightforward prediction of difficult TOaST, thus supporting preoperative preparation and consultation, as well as optimizing training and promotion.

Analysis of preoperative influential factors and construction of a predictive nomogram of difficult thyroidectomy

OBJECTIVE

To explore the preoperative influential factors of difficult thyroidectomy and establish a preoperative nomogram for predicting the difficulty of thyroidectomy.

METHODS

A total of 753 patients who underwent total thyroidectomy with central lymph node dissection between January 2018 and December 2021 were retrospectively enrolled in this study and randomly divided into training and validation groups at a ratio of 8:2. In both subgroups, the patients were divided into difficult thyroidectomy and nondifficult thyroidectomy groups based on the operation time. Patient age, sex, body mass index (BMI), thyroid ultrasound, thyroid function, preoperative fine needle aspiration (FNA), postoperative complications and other data were collected. Logistic regression analysis was performed to identify the predictors of difficult thyroidectomy, and a nomogram predicting surgical difficulty was created.

RESULTS

Multivariate logistic regression analysis demonstrated that male sex (OR = 2.138, 95% CI 1.055-4.336, p = 0.035), age (OR = 0.954, 95% CI 0.932-0.976, p < 0.001), BMI (OR = 1.233, 95% CI 1.106-1.375, p < 0.001), thyroid volume (OR = 1.177, 95% CI 1.104-1.254, p < 0.001) and TPO-Ab (OR = 1.001, 95% CI 1.001-1.002, p = 0.001) were independent risk factors for difficult thyroidectomy. The nomogram model incorporating the above predictors performed well in both the training and validation sets. A higher postoperative complication rate was found in the difficult thyroidectomy group than in the nondifficult thyroidectomy group.

CONCLUSION

This study identified independent risk factors for difficult thyroidectomy and created a predictive nomogram for difficult thyroidectomy. This nomogram may help to objectively and individually predict surgical difficulty before surgery and provide optimal treatment.

Selecting the Right Plane of Dissection in Thyroidectomy: Along the Recurrent Laryngeal Nerve or the Thyroid Capsule? A Retrospective Analysis

Introduction  Total thyroidectomy remains highly technical, with a significant risk of recurrent laryngeal nerve (RLN) compromise and hypoparathyroidism. After identifying RLN, at the level of the ligament of Berry, local factors may compel the surgeon to either dissect along the nerve or the thyroid capsule.

Objective  The objective of the present study is to compare these two approaches in terms of outcomes and complication rates.

Methods  This is a retrospective analysis from September, 2013 to April 2019 of 511 consecutive patients undergoing thyroidectomy. General demographics and disease parameters were recorded. At the discretion of the surgeon and according to the demands of the local operative factors, the patients either had dissection along the RLN or along the thyroid capsule. Perioperative and postoperative parameters such as blood loss, duration of surgery, hospital stay, pain scores, analgesia requirements and complications were recorded. The groups were compared with the Pearson chi-squared test or with the Fisher exact test. A p-value < 0.05 was considered statistically significant.

Results  The incidence of transient hypocalcaemia and transient RLN compromise were higher when dissection was performed along the nerve as opposed to the plane along the thyroid capsule. Other parameters including operative time, hospital stay, pain scores, analgesia requirement, wound infection, seroma, hemorrhage, and recurrence did not differ between the groups. Subgroup analysis of the patients who presented with complications showed that local factors, malignancy, and extent of surgery correlated positively with complications when dissected along the RLN.

Conclusion  Dissection along the capsule of the thyroid during thyroidectomy is a safer plane in terms of low rate of transient RLN injury and hypoparathyroidism as opposed to dissection along the nerve.

Predictive model of operative time in transoral endoscopic thyroidectomy vestibular approach

BACKGROUND

Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) has demonstrated excellent safety and is receiving wider use in North America. Understanding which factors lead to operative difficulty, as evaluated by operative time (OT), may help to improve safety and refine indications for this procedure.

METHODS

Cases of TOETVA performed at our institution were reviewed. Multivariate linear regression was performed using patient demographics, thyroid characteristics, and operative variables to predict OT.

RESULTS

A total of 207 cases were included for analysis. A multivariate linear regression model, controlling for age, sex, and BMI, was developed from 104 cases with an R² of 0.47 (p < 0.001). Cross-validation on 103 remaining cases showed root-mean-square error of 46.37. Total thyroidectomy and lobe size were the only significant predictors (p < 0.001).

CONCLUSIONS

We successfully developed a model to predict OT for TOETVA based on preoperative and operative variables. Lobe size, but not BMI, is a significant predictor of OT.