Microscope-Assisted Thyroidectomy: A Prospective Study on Post-operative Morbidity in Eastern Nepal

Introduction: Thyroidectomy carries risks of recurrent laryngeal nerve injury, external branch of the superior laryngeal nerve injury, and hypoparathyroidism. Microscope-assisted thyroidectomy offers enhanced magnification and illumination, potentially reducing complications. Data from Eastern Nepal remain scarce. This study evaluated postoperative nerve injury and hypocalcemia following microscope-assisted thyroidectomy in Eastern Nepal. Methods: This prospective descriptive study included 74 consecutive patients undergoing microscope-assisted thyroidectomy at Birat Medical College Teaching Hospital, Eastern Nepal, between May 2024 and April 2025. Patients with prior neck surgery, irradiation, or parathyroid disorders were excluded. Intraoperative identification of nerves and parathyroid glands was performed under microscopy. Postoperative vocal cord function and serum calcium were assessed for nerve injury and hypocalcemia. Results: The cohort comprised 72 females (97.30%) and 2 males (2.70%). Procedures included right hemithyroidectomy in 38 (51.30%), total thyroidectomy in 24 (32.40%), and left hemithyroidectomy in 12 (16.20%). Benign lesions accounted for 50 (67.50%) and malignancies for 24 (32.50%). Transient unilateral vocal cord paresis occurred in 6 patients (8.10%), and permanent unilateral palsy in 2 (2.70%), no bilateral palsy was observed. All patients with an intact recurrent laryngeal nerve could produce high-pitched phonation, whereas those with unilateral palsy had mild impairment. Among total thyroidectomy patients, transient and permanent hypocalcemia occurred in 2 (8.33%) each. Conclusions: Microscope-assisted thyroidectomy was associated with low rates of nerve injury and hypocalcemia, likely due to enhanced intraoperative visualization of structures. These findings support operative magnification as an adjunct for improving surgical safety and functional outcomes.