The Analysis Of Risk Factors For Hypoparathyroidism And Measures To Protect Parathyroid Glands In Da Vinci Robotic Thyroidectomy

ObjectiveTo analyze the risk factors for hypoparathyroidism caused by parathyroid injury and investigate the key techniques for preserving parathyroid in da Vinci robotic thyroidect-omy,avoiding the permanent hypoparathyroidism.MethodsTotally 195 cases of patients who underwent da Vinci robotic thyroidectomy in the General Hospital of Jinan Military Command of PLA from Jan.2014 to Jun.2016 were enrolled.On the first day after operation,the serum parathyroid hormone and calcium levels of every patients were recorded.The incidence and relevant factors of hypoparath-yroidism and hypocalcemia were evaluated,the effect of gender,age,surgical methods,central lymph node dissection and thyroid treatment(in situ reservation,autologous transplantation)on parathyroid function were observed and ways to protect the parathyroid glands were assessed.ResultsIn all the patients,40 patients were with hypoparathyroidism with the incidence of20.51%,and 46 cases were transient hypocalcemia with the incidence rate of 23.59%after the operation.There were no patients with permanent hypoparathyroidism after 3 to 30months to follow up.In robotic thyroidectomy,total thyroidectomy resulted to higher incidence of hypoparathyroidism and hypocalcemia compared with unilateral lobectomy(P=0.000 calculated by Fisher's exact probability method;?~2=11.008,P=0.001).The incidences of transient hypoparathyroidism and hypocalcemia after operation were higher in patients receiving central compartment lymph node dissection compared with patients did not(?~2=10.613,17.024;P=0.001,0.000).Compared with parathyroid left in situ,parathyroid resection with parathyroid autotransplantation were more likely to lead to hypoparathyroidism(?~2=5.518,4.900,6.121,5.504;P=0.019,0.027,0.013,0.019).Conclusion1.Of the 195 patients who underwent da Vinci robotic thyroidectomy,there were 138cases of thyroid carcinoma,including 137 cases of papillary carcinoma and 1 case of follicular carcinoma.There were 57 cases of thyroid benign disease,including 43 cases of thyroid goiter,thyroid adenoma in 10 cases,Hashimoto thyroiditis in 2 cases,1 case of hyperthyroidism and thyroid calcification nodules in 1 case.2.In da Vinci robotic thyroidectomy,total thyroidectomy and central compartment lymph node dissection and parathyroid autotransplantation were associated significantly with transient hypoparathyroidism.In da Vinci robotic thyroidectomy,it should be paid more attention to accurate identification of parathyroid by carbon nanoparticles suspen-sions,precise action in operation and protection of parathyroid glands in situ and its blood supply to prevent postoperative permanent hypoparathyroidism.