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Safe thyroidectomy with intraoperative methylene blue spraying.

Sari S, Aysan E, Muslumanoglu M, Ersoy YE, Bektasoglu H, Yardimci E - Thyroid Res (2012)

Bottom Line: Recurrent laryngeal nerve and arteries were not stained and thus they remained white in all cases while all other tissues were stained blue.Within three minutes parathyroid glands washed out the blue stain and the original yellow color was regained.This research demonstrates the effectiveness of the spraying technique, a new technique which ensures not only identification of parathyroid glands within three minutes, but also identification of recurrent laryngeal nerves and inferior thyroid arteries.

View Article: PubMed Central - HTML - PubMed

Affiliation: Deparment General Surgery, Bezmialem Vakif University, Faculty of Medicine, Vatan Caddesi, Fatih, Istanbul, Turkey. dr@webcerrah.com.

ABSTRACT

Background: We aimed to minimalize operative complications by spraying of methylene blue stain on thyroid glands and the perithyroidal area.

Material and methods: The intra-operative methylene blue spraying technique was used prospectively on a total of 56 patients who had undergone primary (not recurrent) thyroid surgery for a variety of thyroid diseases. Bilateral total thyroidectomy was performed in all cases. After superior but before inferior pole ligation, 0.5ml of methylene blue was sprayed over the thyroid lobe and perilober area. Tissues, especially parathyroides, the recurrent laryngeal nerve, and the inferior thyroid artery, were identified and evaluated.

Results: Recurrent laryngeal nerve and arteries were not stained and thus they remained white in all cases while all other tissues were stained blue. Within three minutes parathyroid glands washed out the blue stain and the original yellow color was regained. Thyroid tissue wash-out time was not less than 15 minutes; perithyroideal muscles, tendinous and lipoid structures took no less than 25 minutes.

Conclusion: The safety of intravascular methylene blue guidance on thyroid surgery is known. This research demonstrates the effectiveness of the spraying technique, a new technique which ensures not only identification of parathyroid glands within three minutes, but also identification of recurrent laryngeal nerves and inferior thyroid arteries.

No MeSH data available.


Related in: MedlinePlus

Sample 1, seconds after methylene blue sprayed (↓ Recurrent laryngeal nerve).
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Figure 2: Sample 1, seconds after methylene blue sprayed (↓ Recurrent laryngeal nerve).

Mentions: The arteries and recurrent laryngeal nerves were not stained and therefore they remained white at all times (Figures 1,2). Within three minutes, the parathyroid glands had washed out the blue stain so that the tissues were again their original yellow color (Figures 3,4,5). Wash-out time for thyroid tissue was not less than 15 minutes and not less than 25 minutes for perithyroideal muscles, tendinous, and lipoid structures. Staining and wash-out times of non-nodular thyroid lobes were diffuse in all cases. On the other hand, staining patterns of nodular thyroid lobes were not diffuse, but wash-out time was not shorter than 15 minutes. Patients were discharged in a mean of 1.2 days (1–3 days) with no major complications.


Safe thyroidectomy with intraoperative methylene blue spraying.

Sari S, Aysan E, Muslumanoglu M, Ersoy YE, Bektasoglu H, Yardimci E - Thyroid Res (2012)

Sample 1, seconds after methylene blue sprayed (↓ Recurrent laryngeal nerve).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3539958&req=5

Figure 2: Sample 1, seconds after methylene blue sprayed (↓ Recurrent laryngeal nerve).
Mentions: The arteries and recurrent laryngeal nerves were not stained and therefore they remained white at all times (Figures 1,2). Within three minutes, the parathyroid glands had washed out the blue stain so that the tissues were again their original yellow color (Figures 3,4,5). Wash-out time for thyroid tissue was not less than 15 minutes and not less than 25 minutes for perithyroideal muscles, tendinous, and lipoid structures. Staining and wash-out times of non-nodular thyroid lobes were diffuse in all cases. On the other hand, staining patterns of nodular thyroid lobes were not diffuse, but wash-out time was not shorter than 15 minutes. Patients were discharged in a mean of 1.2 days (1–3 days) with no major complications.

Bottom Line: Recurrent laryngeal nerve and arteries were not stained and thus they remained white in all cases while all other tissues were stained blue.Within three minutes parathyroid glands washed out the blue stain and the original yellow color was regained.This research demonstrates the effectiveness of the spraying technique, a new technique which ensures not only identification of parathyroid glands within three minutes, but also identification of recurrent laryngeal nerves and inferior thyroid arteries.

View Article: PubMed Central - HTML - PubMed

Affiliation: Deparment General Surgery, Bezmialem Vakif University, Faculty of Medicine, Vatan Caddesi, Fatih, Istanbul, Turkey. dr@webcerrah.com.

ABSTRACT

Background: We aimed to minimalize operative complications by spraying of methylene blue stain on thyroid glands and the perithyroidal area.

Material and methods: The intra-operative methylene blue spraying technique was used prospectively on a total of 56 patients who had undergone primary (not recurrent) thyroid surgery for a variety of thyroid diseases. Bilateral total thyroidectomy was performed in all cases. After superior but before inferior pole ligation, 0.5ml of methylene blue was sprayed over the thyroid lobe and perilober area. Tissues, especially parathyroides, the recurrent laryngeal nerve, and the inferior thyroid artery, were identified and evaluated.

Results: Recurrent laryngeal nerve and arteries were not stained and thus they remained white in all cases while all other tissues were stained blue. Within three minutes parathyroid glands washed out the blue stain and the original yellow color was regained. Thyroid tissue wash-out time was not less than 15 minutes; perithyroideal muscles, tendinous and lipoid structures took no less than 25 minutes.

Conclusion: The safety of intravascular methylene blue guidance on thyroid surgery is known. This research demonstrates the effectiveness of the spraying technique, a new technique which ensures not only identification of parathyroid glands within three minutes, but also identification of recurrent laryngeal nerves and inferior thyroid arteries.

No MeSH data available.


Related in: MedlinePlus