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<p>With thyroid disorders rising in India, thyroidectomy remains a key surgical treatment. This study compares midline and lateral approaches, addressing a critical gap in literature by evaluating both intraoperative and postoperative outcomes to improve surgical safety, efficacy, and feasibility. A prospective study was carried out on 50 patients undergoing open thyroidectomy from January 2023 to October 2024 at a tertiary hospital. Institutional ethical committee approval was obtained. Patients were divided equally into two groups: Group A (25 patients) undergoing midline approach thyroidectomy and Group B (25 patients) undergoing lateral approach thyroidectomy. Data collection included demographic details, preoperative diagnosis, intraoperative findings (identification of RLN, EBSLN, parathyroids, and operative time), and postoperative parameters (pain score, voice quality, and serum calcium status). The study aimed to compare the safety, feasibility, and efficacy of both approaches. In this study, significant findings included better parathyroid identification with the lateral approach thyroidectomy, with a mean of 3.16 parathyroids identified compared to 2.56 in the midline approach (<i>p</i> = 0.004). Postoperative pain scores were also significantly lower in the lateral approach group, with a mean VAS score difference favoring the lateral approach (<i>p</i> = 0.003). However, other outcomes did not show statistically significant differences. Operation time was slightly shorter in the lateral approach group (mean 1.84&#xa0;h vs. 2.14&#xa0;h), but this difference was not significant (<i>p</i> = 0.068). Both groups were equally effective in identifying RLN and EBSLN (<i>p</i> = 1.00), and postoperative mean serum calcium levels were comparable (<i>p</i> = 0.451). Qualitative voice changes assessed by GRBASI scores also showed no significant differences, although less incidence of voice change and hypocalcemia was noted in the lateral approach group. The lateral approach thyroidectomy demonstrates superior benefits, such as a higher rate of parathyroid identification, enhanced lymph node exploration, and improved recovery with less postoperative pain. Both approaches showed comparable outcomes in operation time, nerve identification, post operative calcium status and voice function. The lateral approach offers better surgical outcomes by minimizing complications and enhancing recovery.</p>

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A Prospective Comparative Study on Lateral Approach Versus Midline Approach in Thyroidectomy

  • 期刊论文

  • 发表日期：

    2025年10月14日

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  • Shaheen Ayesha Nasirudeen,
  • Venkatakarthikeyan Chokkalingam

摘要

With thyroid disorders rising in India, thyroidectomy remains a key surgical treatment. This study compares midline and lateral approaches, addressing a critical gap in literature by evaluating both intraoperative and postoperative outcomes to improve surgical safety, efficacy, and feasibility. A prospective study was carried out on 50 patients undergoing open thyroidectomy from January 2023 to October 2024 at a tertiary hospital. Institutional ethical committee approval was obtained. Patients were divided equally into two groups: Group A (25 patients) undergoing midline approach thyroidectomy and Group B (25 patients) undergoing lateral approach thyroidectomy. Data collection included demographic details, preoperative diagnosis, intraoperative findings (identification of RLN, EBSLN, parathyroids, and operative time), and postoperative parameters (pain score, voice quality, and serum calcium status). The study aimed to compare the safety, feasibility, and efficacy of both approaches. In this study, significant findings included better parathyroid identification with the lateral approach thyroidectomy, with a mean of 3.16 parathyroids identified compared to 2.56 in the midline approach (p = 0.004). Postoperative pain scores were also significantly lower in the lateral approach group, with a mean VAS score difference favoring the lateral approach (p = 0.003). However, other outcomes did not show statistically significant differences. Operation time was slightly shorter in the lateral approach group (mean 1.84 h vs. 2.14 h), but this difference was not significant (p = 0.068). Both groups were equally effective in identifying RLN and EBSLN (p = 1.00), and postoperative mean serum calcium levels were comparable (p = 0.451). Qualitative voice changes assessed by GRBASI scores also showed no significant differences, although less incidence of voice change and hypocalcemia was noted in the lateral approach group. The lateral approach thyroidectomy demonstrates superior benefits, such as a higher rate of parathyroid identification, enhanced lymph node exploration, and improved recovery with less postoperative pain. Both approaches showed comparable outcomes in operation time, nerve identification, post operative calcium status and voice function. The lateral approach offers better surgical outcomes by minimizing complications and enhancing recovery.