Case SeriesModified thyroidectomy: 4 techniques to prevent recurrent laryngeal nerve injury and postoperative hypocalcaemiaSalih, Abdulwahid M. MDa,b; Baba, Hiwa O. MDb,c; Ahmed, Mohsin M. MDd; Kakamad, Fahmi H. PhDa,b,c,; Hassan, Hunar A. BScb,c; Hassan, Marwan N. MDb,c; Abdulla, Berwn A. BScb,c; Muhialdeen, Aso S. MDb,c; Mohammed, Shvan H. BScc Author Information aCollege of Medicine, University of Sulaimani bSmart Health Tower cKscien Organization dDepartment of Surgery, Teaching Hospital, Ministry of Health, Sulaimani, Kurdistan, Iraq Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. This manuscript has been peer reviewed. Published online 18 May 2022 *Corresponding author. Address: Doctor City, Building 11, Apartment 50, Sulaimani 0064, Iraq. Tel: +009647717267454; fax: N/A. E-mail address: [email protected] (F.H. Kakamad). This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0/ IJS: Short Reports: April/June 2022 - Volume 7 - Issue 2 - p e45 doi: 10.1097/SR9.0000000000000045 Buy Metrics Abstract Objective: To share 4 techniques that decrease the rate of postoperative hypocalcaemia and save recurrent laryngeal nerve with a good cosmetic outcome. Method: The research included all consecutive patients of thyroidectomy (hemi and total thyroidectomy) during 4-year practice. The techniques included (1) elevation of a circular flap after 4 cm collar incision. (2) Ligation of the pedicles (middle first-vein, inferior last-artery). (3) Sharp dissection of the parathyroid glands. (4) Sharp and blunt dissection and exposing the nerve in all of the patients. Result: The total numbers of patients were 2399. At least 1 symptom of hyperthyroidism was found in 1271 patients (53%). The main indication for operation was multinodular goiter and compression symptoms in 1331 (55.5%) patients, followed by thyrotoxicosis in 598 (25%) patients and malignancy in 402 (16.8%) patients. The most common operations were total thyroidectomy in 1880 (78.4%) patients, followed by thyroid lobectomy in 495 (20.6%) patients and completion thyroidectomy in 24 (1%) patients. Among all patients, 4 (0.16%) patients developed permanent voice change. Seven (0.3%) patients developed permanent hypocalcemia. Conclusion: This study offers a set of surgical techniques that reduced the risks of complications of thyroidectomy to a minimal range. Copyright © 2022 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of IJS Publishing Group Ltd.