Surgical challenges in performing thyroidectomy on huge multinodular goiters in limited resource settings. Case Series, ideal management protocols, Review of literature and pictorial presentation

Abstract Thyroidectomy is a safe procedure when performed by competent well-trained surgeon in ideal settings. However not all centers have settings that adhere to recommended standard preoperative, intraoperative, and postoperative well laid guidelines. Surgeons in such settings must improvise ingenious methods to comply to recommended guidelines. Patients in resource limited settings present late with huge benign or malignant multinodular goiters with limited preoperative investigative modalities due to financial constraints. These settings create logistical challenges for the attending surgeons in such settings. Thyroidectomy also carries a high legal ramification potential due to its high complication potential index from its anatomical proximity of potential lethal or life changing complications by iatrogenic injury to adjacent structures such as Recurrent Laryngeal Nerve, parathyroid glands, or the large caliber blood vessels. It is the authors intention to highlight these logistical challenges and not recommend or advocate the practice in such settings to be adopted as the standard of care.