Post thyroidectomy neck pain after endoscopic thyroidectomy : Journal of Minimal Access Surgery

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Letter to the Editor

Post thyroidectomy neck pain after endoscopic thyroidectomy

Mishra, Shalini; Gupta, Suvrat

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Journal of Minimal Access Surgery: Oct–Dec 2022 - Volume 18 - Issue 4 - p 641-642
doi: 10.4103/jmas.jmas_174_21
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Dear Sir,

We read the article entitled 'Endoscopic thyroidectomy: Which one is the better technique for the beginners?' with full interest.[1] At the outset, we want to congratulate the authors for their research. We all know that many patients complain of neck pain after thyroid surgeries. One of the postulated causes of this type of pain is prolonged hyperextension of the neck under general anaesthesia leading to compression and stretching of nerves. Therefore, this can be prevented by a vigilant anaesthesiologist and a surgeon by avoiding hyperextension and providing soft silicon support under neck. In past, some studies compared the post-operative pain in patients undergoing Robotic thyroidectomy (RT) and minimally invasive video-assisted thyroidectomy (MIVAT) and found equal or less pain, may be because both the techniques do not require much manipulation during procedures. El-Labban et al. (2009) published a randomised control trial on 76 patients and found significantly lesser early post-operative pain after MIVAT in comparison with conventional open thyroidectomy (COT).[2] Ryu et al. (2016) prospectively compared the postoperative pain after COT and trans-axillary single-incision RT in 90 patients and found similar pain.[3]

We agree that endoscopic thyroidectomy is being popularised very fast, but at the same, it is a technically challenging procedure and this is not a minimally invasive procedure at all rather it is a maximally invasive procedure with higher blood loss, increased operating time, and frequent recurrent laryngeal nerve injuries. The higher degree of hyperextension will lead to more frequent and severe post thyroidectomy neck pain. Ha et al. (2018) published a study on 254 patients undergoing RT, ET and, COT. The post thyroidectomy pain and discomfort were more common in ET and RT group tan COT.[4] We also anticipate a greater degree of hyperextension of the neck during endoscopic thyroidectomy than open conventional thyroidectomy. We often ignore the neck pain after successful endoscopic thyroidectomy because our goal of no scar in the neck is successfully achieved. We wonder if the authors have evaluated the neck pain after endoscopic thyroidectomy, if yes, we request the authors to share their experience. The neck exercises after thyroidectomy have been found to be effective in reducing post-operative pain.[56] We also want to know whether the authors have been following any post thyroidectomy neck exercises protocol in their institute.

REFERENCES

1. Kumar C, Lohani KR, Kataria K, Ranjan P, Dhar A, Srivastava A. Endoscopic thyroidectomy: Which one is the better technique for the beginners? J Minim Access Surg. 2021;17:337–41
2. El-Labban GM. Minimally invasive video-assisted thyroidectomy versus conventional thyroidectomy: A single-blinded, randomized controlled clinical trial J Minim Access Surg. 2009;5:97–102
3. Ryu HR, Lee J, Park JH, Kang SW, Jeong JJ, Hong JY, et al A comparison of postoperative pain after conventional open thyroidectomy and transaxillary single-incision robotic thyroidectomy: A prospective study Ann Surg Oncol. 2013;20:2279–84
4. Ha TK, Kim DW, Park HK, Shin GW, Heo YJ, Baek JW, et al Comparison of postoperative neck pain and discomfort, swallowing difficulty, and voice change after conventional open, endoscopic, and robotic thyroidectomy: A single-center cohort study Front Endocrinol (Lausanne). 2018;9:416
5. Takamura Y, Miyauchi A, Tomoda C, Uruno T, Ito Y, Miya A, et al Stretching exercises to reduce symptoms of postoperative neck discomfort after thyroid surgery: Prospective randomized study World J Surg. 2005;29:775–9
6. Ayhan H, Tastan S, Iyigün E, Oztürk E, Yildiz R, Görgülü S. The effectiveness of neck stretching exercises following total thyroidectomy on reducing neck pain and disability: A randomized controlled trial Worldviews Evid Based Nurs. 2016;13:224–31
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