Outcomes of Medial Approach Thyroidectomy Versus Lateral Approach Thyroidectomy for Retrosternal Goitre

Abstract Objective: To compare the outcomes of medial versus lateral approach thyroidectomy for retrosternal goitre in terms of the incidence of recurrent laryngeal (RLN) injury, hypocalcaemia, post operative hematoma formation and blood loss during surgery. Methodology: In this prospective comparative study, 40 patients with retrosternal goitre (RSG) were randomized into two groups. Twenty patients in group A underwent thyroidectomy via the medial approach, and 20 patients in group B underwent thyroidectomy via the lateral approach. Data was collected in tabular form and analysed using SPSS version 27. Results were considered significant when p-value ≤ 0.05 using the chi-square test and student t test. Results: Mean blood loss (105.25± 30.01 ml vs. 90±12.76 ml) and mean operating time (105.65± 11.35 min versus 90.05 ± 15.44 min) was significantly higher in medial approach thyroidectomy but incidence of unilateral transient RNL palsy (7.5% vs 2.5%,p-value 0.292), unilateral permanent RNL palsy (2.5% vs 0%, p-value 0.311), transient hypocalcaemia (10% vs.12.5%, p-value 0.705) and permanent hypocalcaemia (2.5% vs. 0%, p-value 0.311 ) was higher in lateral approach thyroidectomy than medial approach thyroidectomy respectively. Conclusion: Surgery for retrosternal goitre carries a higher risk of RLN injury and hypocalcaemia. Medial approach thyroidectomy helps in the early division of Berry's ligament and exposure of RLN and carries lower risk of RNL injury and hypocalcaemia. It may be a better alternative to lateral approach thyroidectomy for RSG. Key Words: Retrosternal goitre, thyroidectomy, palsy, hypocalcaemia