Subcapsular Saline Injection during Total Thyroidectomy to Save Parathyroid Glands

Background: Hypoparathyroidism is a critical condition expressed after thyroidectomy. Subcapsular saline injection (SCASI) is a new technique that is described as preserving the parathyroid gland during an open or robotic thyroidectomy. Methods: With a prospective cohort of 40 patients divided into 20 for SCASI and 20 for Non-SCASI, PTH was assessed on days 2 and 6 months postoperative. Total and ionized calcium were assessed on day 2 and 6 months postoperative, as well. Results: Thirteen females (75%) and ten males (25%) with a mean age of 39 years were included in the study. PTH assay had a mean of 46.1 pg/dL (±18.8 SD, 95%CI= [8.7-9.1]), and the total calcium mean was 8.9mg/dL (± 0.4 SD, 95%CI=[8.7-9.1]). On day two postoperative, SCASI had no cases with transient hypo-PTH, and one case (2.5%)developed transient hypocalcemia. Non-SCASI had one case (2.5%) with transient hypo PTH, and five cases (12.5%) with transient hypo-calciemia. The SCASI group reported better operative time and pain scores compared to non-SCASI (t=-14.4, p<.001, t=-10.97, p<.001; respectively). About 7.5% of SCASI cases developed a hematoma, and 7.5% reported a surgical site infection (SSI). Conclusion: SCASI has three previously reported effects confirmed by the current study. They are i) space expander, ii) protecting pocket, iii) extractor facilitator. We, additionally, reported iv)saline compression effect, v) time preserver, vi) postoperative pain reducer.