Safe thyroidectomy with intraoperative methylene blue spraying

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.

Figure 1

Sample 1, before methylene blue sprayed.

Figure 2

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

Figure 3

Sample 2, before methylene blue sprayed.

Figure 4

Sample 2, 30 seconds after methylene blue sprayed.

Figure 5

Sample-2, five minutes after methylene blue sprayed (? parathyroid glands).