Simulation-based and structured training have transformed surgical education, providing safe environments for skill acquisition and performance assessment. However, evidence in thyroid surgery remains fragmented across modalities such as simulation, video-based learning, intraoperative neuromonitoring (IONM), and fellowship programs. This systematic review aimed to synthesize primary evidence on educational interventions in thyroid surgery and their impact on technical performance and patient outcomes. A systematic search of PubMed, Embase, Scopus, and Web of Science was conducted up to April 2025. Eligible studies included randomized trials, prospective or retrospective cohorts, and validation studies assessing simulation-based, structured, or supervised training. Two reviewers independently screened and extracted data, assessing quality using RoB 2, ROBINS-I, or CASP. Due to heterogeneity, results were summarized through a structured narrative synthesis by training modality. Ten primary studies (2011–2025) were included. Simulation and virtual-reality training improved technical performance, task completion time, and perceived realism. Supervised resident training reduced operative time after 30–50 cases, approximating senior benchmarks. Video-assisted learning decreased error rates by 49

ABSTRACT Objectives This study aims to investigate the impact of elevated preoperative thyroid autoantibodies, a proposed non‐neural contributor, on postoperative voice outcomes, specifically within a cohort of patients undergoing nerve‐preserved thyroidectomy verified by intraoperative neuromonitoring (IONM). Methods A retrospective analysis included 212 patients who underwent primary nerve‐preserved thyroidectomy with IONM‐confirmed integrity of recurrent and superior laryngeal nerves. Patients were categorized into elevated antibody (EA) and normal antibody (NA) groups according to thyroglobulin antibody (TgAb) and anti‐thyroid microsomal antibody (TMAb) levels. Objective and subjective voice analyzes (VHI, VRQoL, and IVST) were performed pre‐ and postoperatively. Results The EA group had a significantly higher proportion of bilateral surgeries, larger tumors, and heavier specimens. Several postoperative voice parameters differed significantly between the two groups, and after adjustment for patient characteristics, EA levels remained independently associated with abnormal shimmer (adjusted OR 2.33, p = 0.021) and abnormal IVST‐T (adjusted OR 2.72, p = 0.010). In the antibody‐grade analysis, a preliminary non‐linear pattern between antibody burden and postoperative voice outcomes was observed in shimmer, IVST‐T, and IVST‐S. Conclusion In this retrospective exploratory study, elevated thyroid autoantibodies were associated with poorer objective voice stability and greater subjective voice impairment following IONM‐verified nerve‐preserved thyroidectomy. With standardized IONM minimizing the influence of major neural injury, these findings highlight a potential non‐neural influence of thyroiditis on postoperative dysphonia. Shimmer and IVST are useful indicators for detecting subtle functional changes, supporting thyroid antibody status as a practical serological indicator for individualized perioperative counseling and rehabilitation. Level of Evidence Level III.

OBJECTIVE:Sudden sensorineural hearing loss (SSNHL) is a condition with largely unknown etiology, though both vascular and genetic components have been implicated. The X-ray repair cross-complementing group 1 (XRCC1) gene, involved in DNA repair and oxidative stress response, has been linked to ischemic stroke and noise-induced hearing loss. This study aimed to investigate the association between XRCC1 single nucleotide polymorphisms (SNPs) and SSNHL risk in Taiwan. DESIGN:Prospective case-control study. SETTING:Tertiary academic medical center. MATERIALS AND METHODS:A total of 276 patients with SSNHL and 293 healthy controls were enrolled. Three XRCC1 SNPs (rs1799782, rs25489, and rs25487) were genotyped using TaqMan assays. All SNPs were tested for Hardy-Weinberg equilibrium. Associations with SSNHL risk were analyzed under dominant and recessive models using multivariate logistic regression. Clinical predictors of recovery were also evaluated. RESULTS:The TT genotype of XRCC1 rs1799782 was significantly associated with increased SSNHL risk compared with the CC genotype [adjusted odds ratio (aOR)=2.005; 95% CI=1.13-3.62; P =0.0164]. This association persisted under the recessive model (TT vs. CC+CT) (aOR=1.983; 95% CI=1.15-3.49; P =0.0134). No significant associations were observed for rs25489 and rs25487. High-tone (aOR=6.42; P = 0.0043) and flat-type (aOR=4.12; P =0.0071) audiogram patterns and longer treatment delay were linked to unfavorable clinical outcomes. XRCC1 genotypes were not predictive of treatment response. CONCLUSIONS:The TT genotype of XRCC1 rs1799782 is significantly associated with increased SSNHL susceptibility in the Taiwanese population.

Background: Obtaining sufficient chondrocytes by monolayer expansion in vitro is used for articular cartilage tissue engineering. However, chondrocytes lose their chondrogenic phenotype after monolayer expansion via mitochondrial dysfunction-induced senescence. Adipose-derived stem cell mitochondrial transfer (ADSC-MT) improves senescent cell function. We hypothesise that ADSC-MT improves the chondrogenic phenotype of senescent chondrocytes. Methods: After monolayer expansion in vitro, chondrocytes were subjected to ADSC-MT. Cell senescence was evaluated via analysis of p16 and p21 expression and senescence-associated β-galactosidase (SA-β-gal) staining. The chondrogenic phenotype was evaluated by measuring collagen type II (Col-II) and collagen type I (Col-I) levels. Oxidative stress was assessed by determining the mitochondrial superoxide and 8-hydroxydeoxyguanosine (8-OHdG) levels. Mitochondrial dysfunction was assessed by determining the mitochondrial membrane potential (MMP) and PGC-1α levels. Finally, SOD-2, SIRT-1, SIRT-3, TFAM, MFN-1, MFN-2, OPA-1, PINK-1 and Parkin levels were used to assess mitochondrial quality control (MQC). Results: ADSC-MT-recipient chondrocytes exhibited alleviated senescence with decreased p16 and p21 expression and SA-β-gal staining. The increased Col-II and decreased Col-I expression indicated that the chondrogenic phenotype of the chondrocytes was restored. Decreased mitochondrial superoxide and 8-OHdG levels indicated alleviated oxidative stress. The increased MMP indicated alleviation of mitochondrial dysfunction. For MQC, SOD‑2, PGC‑1α, TFAM, SIRT-1, and SIRT-3 were upregulated, indicating that antioxidant defences and mitochondrial biogenesis in MQC were increased in ADSC‑MT–recipient chondrocytes. PINK‑1 and Parkin were downregulated, suggesting that damaged mitochondria were reduced through mitophagy. In contrast, MFN‑1, MFN‑2, and OPA‑1 were not changed, indicating that mitochondrial dynamics were not affected. Conclusions: ADSC-MT improves the chondrogenic phenotype of senescent chondrocytes by ameliorating mitochondrial dysfunction.

BACKGROUND:This study aimed to develop a connector that adapts standard endoscopic instruments into functional nerve stimulator probes. METHODS:The connector underwent engineering validation in a laboratory and preclinical testing using a porcine model. A handheld standard stimulator probe served as the control. The experimental group consisted of a long monopolar probe and two connector-adapted probes. Recurrent laryngeal nerve (RLN) and vagus nerves were stimulated to compare the efficacy and safety of the adapted probes with the standard probe. RESULTS:The connector, when coupled to endoscopic instruments, did not show a statistically significant difference in electromyographic (EMG) amplitude at 1 mA stimulation compared with the standard probe. Safety analysis showed no significant hemodynamic effects. CONCLUSION:This proof-of-concept study demonstrates that the developed connector, when paired with endoscopic instruments, enables reliable nerve identification and preservation during endoscopic thyroid surgery, with favorable efficacy and safety profiles.

Background Recurrent laryngeal nerve (RLN) palsy remains a critical complication in transoral endoscopic thyroidectomy vestibular approach (TOETVA). While intraoperative neuromonitoring (IONM) is employed, the optimal strategy for reducing vocal cord palsy (VCP) remains a topic of debate. Methods This large-scale, retrospective cohort study, based on a prospectively collected database, enrolled 2,201 TOETVA patients. We compared outcomes among three distinct groups: Non-IONM (n = 109), Peroral (PO) IONM (n = 582, Year 2016-2019), and Percutaneous (PC) IONM (n = 1,510, Year 2020-May 2025). The PO and PC groups were further analyzed according to the technique used: intermittent (I-IONM) or combined (I-IONM + continuous IONM [C-IONM]). Endpoints were the incidence of VCP and a multivariate analysis of independent risk factors for VCP. Results The 2,092 IONM patients (PO and PC) were analyzed in four subgroups: PO I-IONM (n = 481), PO Combined (I-IONM+C-IONM, n = 101), PC I-IONM (n = 1100), and PC Combined (I-IONM+C-IONM, n = 410). Among these, the percutaneous combination (PC-Combined) group had a significantly lower temporary VCP rate (0.2%) than all other groups (P < 0.05). This was attributed to higher technical success: PC-Combined IONM achieved higher rates of persistent vagus nerve stimulation (99.7% vs 94.4%), a higher detection rate of imminent RLN injury (4.4% vs 0.7%, P < 0.05), and a higher intraoperative signal recovery rate (88.9% vs 33.3%). Permanent VCP was rare (n = 2), occurring only in the PO groups. Critically, multivariate analysis confirmed that percutaneous combination IONM was an independent protective factor against VCP (OR 0.08, P = 0.02), while thyroid malignancy (OR 2.02, P = 0.02) and Graves’ disease/thyroiditis (OR 2.19, P = 0.03) were two independent risk factors. Conclusions This large-scale study confirms that the percutaneous application of combined I-IONM and C-IONM is a safe, feasible, and effective strategy for protecting the RLN in TOETVA. It is associated with reduced VCP rates and can be considered a viable option, especially for individuals with high-risk thyroid diseases.

Post-thyroidectomy dysphonia may occur even when recurrent laryngeal nerve (RLN) and external branch of the superior laryngeal nerve (EBSLN) integrity are preserved. Hemostatic materials (HMs) are widely used to enhance intraoperative hemostasis and reduce postoperative drainage; however, their use may introduce a functional trade-off between bleeding control and postoperative voice and swallowing outcomes. This study aimed to evaluate how different HMs balance hemostatic efficacy and functional preservation in nerve-preserved total thyroidectomy. This retrospective study included adult patients who underwent primary nerve-preserved total thyroidectomy with standardized intraoperative neuromonitoring (IONM). Patients were categorized into three groups according to HM use: no hemostatic material (NHM), fibrin sealant (Tisseel, TIS), and polysaccharide-based agent (4DryField PH, 4DF). Objective voice parameters and subjective voice and swallowing assessments were obtained preoperatively and at six weeks postoperatively. 175 patients were analyzed (NHM:74/TIS:30/4DF:71), with comparable demographic, surgical, and pathological characteristics among groups. TIS provided the most robust hemostatic effect, with 0

Autologous chondrocyte implantation (ACI) has long been regarded as the gold-standard chondrocyte-based therapy for articular cartilage repair. The main challenge in ACI is that chondrocytes lose their chondrogenic phenotype after monolayer expansion in vitro . The monolayer-expanded chondrocytes show dedifferentiation and senescence, hindering their ability to synthesize hyaline cartilage. Currently, there is no effective method to alleviate dedifferentiation and senescence in these monolayer-expanded chondrocytes. Adipose-derived stem cells (ADSCs) have been increasingly explored as a viable alternative cell source to chondrocytes for articular cartilage tissue engineering. Besides inducing chondrogenesis of ADSCs into chondrocyte, recent research emphasizes the positive impact of ADSC-secreted extracellular vesicles (ADSC-EVs). We demonstrate that ADSC-EVs alleviate dedifferentiation and senescence in monolayer-expanded chondrocytes, enhancing their capacity to produce hyaline cartilage. The ADSC-EVs treatment redifferentiated the monolayer-expanded chondrocytes by upregulating collagen type II (Col-II), sulfated glycosaminoglycan (sGAG), and SOX-9 expression and decreasing collagen type I (Col-I) levels. The redifferentiated chondrocytes also showed enhanced cell proliferation and reduced levels of P16 and senescence-associated β-galactosidase (SA-β-gal). Moreover, ADSC-EV treatment increased the ability of monolayer-expanded chondrocytes to synthesize hyaline cartilaginous matrices in 3D pellet culture. This effect is achieved through the suppression of interleukin-1β–induced mitogen-activated protein kinase (MAPK) signaling. Through next-generation sequencing and bioinformatic analyses, the miRNAs contained in ADSC-EVs were revealed as key candidates involved in mitigating dedifferentiation and senescence. Our findings propose a novel approach employing ADSC-EVs to restore the chondrogenic phenotype of monolayer-expanded chondrocytes, offering an alternative strategy for more effective ACI.

Background:With the development and new technological knowledge, such as surgical techniques that accompany the consolidated open surgical procedures, minimally invasive strategies have also emerged for thyroid surgery. Among these, we can cite the transoral endoscopic vestibular approach known as TOETVA. Recurrences and metastases of differentiated thyroid cancer frequently manifest in the lymph nodes, lungs, bones, and liver. Although the primary implantation of cancer cells causing these recurrences and metastases is considered an uncommon event, it can nonetheless occur in specific instances. This can be a serious complication for patients, as these recurrences and metastases can be difficult to detect and treat effectively. Early identification and appropriate management of these cases are crucial for improving patient outcomes. Case Description:We present a case of a 55-year-old male patient with recurring muscular and subcutaneous recurrence that developed five years after the initial left thyroidectomy performed via a TOETVA. The patient therefore required a second surgical procedure of completion thyroidectomy, central lymph node dissection (level 6 and 7), and removal of nodes in subcutaneous tissue and muscle. Conclusions:Tumor biology, local environment, technical issues, surgical skills, and the correct management and handling of neoplastic nodules represent crucial clinical pitfalls and important factors that can contribute to local recurrence and malignant cellular implantation following a TOETVA for thyroid surgery.

ObjectivesThis retrospective study presents an integrative transcriptomic approach for recurrent and/or metastatic head and neck squamous cell carcinoma (R/M HNSCC) by developing an immune response predictive score (IORPS) derived from tumor microenvironment (TME) transcriptomic profiles.MethodsA total of 30 R/M HNSCC patients treated with pembrolizumab or nivolumab, with available immune TME profiling data, were analyzed. IORPS was constructed based on the cumulative weighting of differentially expressed gene (DEG) expression levels. The predictive performance of conventional biomarkers, individual DEGs, and IORPS was evaluated for immunotherapy response and prognostic outcomes. The clinical relevance of IORPS was further validated using two external cohorts from the GEO database (CLB-IHN: GSE159067 and GHPS: GSE159141).ResultsBy comparing immune tumor microenvironment (TME) profiles between good and poor responders, GZMH, IFNG, and FASLG were identified as key DEGs with significantly higher expression in favorable immunotherapy responders. The IORPS, derived from transcriptomic profiling, demonstrated robust predictive accuracy for both immunotherapy response and survival outcomes in patients with R/M HNSCC.ConclusionCompared with the variable predictive performance of current biomarkers such as TPS and CPS, IORPS provides improved accuracy and reliability in identifying and stratifying patients most likely to benefit from immune checkpoint blockade therapy.

BACKGROUND:Recurrent laryngeal nerve palsy remains a critical complication in transoral endoscopic thyroidectomy vestibular approach. While intraoperative neuromonitoring is employed, the optimal strategy for reducing vocal cord palsy remains a topic of debate. METHODS:This large-scale, retrospective cohort study, based on a prospectively collected database, enrolled 2,201 patients who underwent transoral endoscopic thyroidectomy vestibular approach. We compared outcomes among 3 distinct groups: nonintraoperative neuromonitoring (n = 109), peroral intraoperative neuromonitoring (n = 582, year 2016-2019), and percutaneous intraoperative neuromonitoring (n = 1,510, year 2020-May 2025). The peroral and percutaneous groups were further analyzed according to the technique used: intermittent (intermittent intraoperative neuromonitoring) or combined (intermittent intraoperative neuromonitoring + continuous intraoperative neuromonitoring). End points were the incidence of vocal cord palsy and a multivariate analysis of independent risk factors for vocal cord palsy. RESULTS:The 2,092 intraoperative neuromonitoring patients (peroral and percutaneous) were analyzed in 4 subgroups: peroral intermittent intraoperative neuromonitoring (n = 481), peroral combined (intermittent intraoperative neuromonitoring + continuous intraoperative neuromonitoring, n = 101), percutaneous intermittent intraoperative neuromonitoring (n = 1,100), and percutaneous combined (intermittent intraoperative neuromonitoring + continuous intraoperative neuromonitoring, n = 410). Among these, the percutaneous combination (percutaneous-combined) group had a significantly lower temporary vocal cord palsy rate (0.2%) than all other groups (P < .05). This was attributed to higher technical success: percutaneous-combined intraoperative neuromonitoring achieved higher rates of persistent vagus nerve stimulation (99.7% vs 94.4%), a higher detection rate of imminent recurrent laryngeal nerve injury (4.4% vs 0.7%, P < .05), and a higher intraoperative signal recovery rate (88.9% vs 33.3%). Permanent vocal cord palsy was rare (n = 2), occurring only in the peroral groups. Critically, multivariate analysis confirmed that percutaneous combination intraoperative neuromonitoring was an independent protective factor against vocal cord palsy (odds ratio, 0.08; P = .02), whereas thyroid malignancy (odds ratio, 2.02; P = .02) and Graves disease/thyroiditis (odds ratio, 2.19; P = .03) were 2 independent risk factors. CONCLUSION:This large-scale study confirms that the percutaneous application of combined intermittent intraoperative neuromonitoring and continuous intraoperative neuromonitoring is a safe, feasible, and effective strategy for protecting the recurrent laryngeal nerve in the transoral endoscopic thyroidectomy vestibular approach. It is associated with reduced vocal cord palsy rates and can be considered a viable option, especially for individuals with high-risk thyroid diseases.

Thyroid surgery carries a risk of postoperative hematoma due to rich vascularity, commonly managed by drain placement, potentially increasing hospital stay. 4DryField PH (4DF), a powdered hemostatic material, has been widely used in surgery to improve hemostasis. This study investigates the impact of using 4DF in thyroid surgery on postoperative drainage placement. This retrospective study analyzed 208 patients undergoing neuro-monitored and Ligasure-assisted thyroidectomy. Patients were divided into non-hemostatic material and drain (NHM, n = 107), and 4DF groups (n = 101). In the 4DF group, drain placement was determined by intraoperative bloody exudate assessment approximately 30 s after 4DF application, classifying into drain (4DF + D, n = 23) and no-drain (4DF-D, n = 78) groups. Clinical characteristics, drainage volumes, and duration of drain placement were compared between groups. No significant demographic differences existed between NHM and 4DF groups. Drain placement in 22.8

In previous studies, the use of thyroid cartilage needle electrodes (TCN) was defined as an inexpensive method for intra-operative nerve monitoring (IONM) in thyroid surgery. This multi-center retrospective study aims to determine the effectiveness and reliability of TCN in thyroid surgery. Patients operated on between January 2018 and August 2023 from five centers were included in this study. Demographic data, indications, type of surgery, IONM recording system, pre–post-resection vagus nerve (V1–V2), pre–post-resection recurrent laryngeal nerve (R1-R2) amplitudes and latency values, type of loss of signal (LOS), adverse event (AE), intra-operative injury mechanism, and post-operative vocal cord examination (VCE) were evaluated. Patients with abnormal preoperative vocal cord examination were excluded. A total of 2105 patients (3772 nerves at risk) were included [1626 (77

This study introduces an innovative 3D printed dry electrode tailored for biosensing in postoperative recovery scenarios. Fabricated through a drop coating process, the electrode incorporates a novel 2D material.

Background and Objectives: Thyroid surgery with intraoperative neural monitoring (IONM) of the recurrent laryngeal nerve (RLN) requires precise anesthetic management. This narrative review compares non-selective (neostigmine) and selective (sugammadex) reversal agents for neuromuscular blockade (NMB), discussing their mechanisms of action and the challenges of achieving optimal NMB reversal without compromising surgical conditions or IONM quality. Materials and Methods: A literature search was conducted using PubMed, MEDLINE, and Google Scholar for studies published up to November 2023. Relevant case studies, clinical trials, systematic reviews, and guidelines focusing on NMB reversal in thyroid surgery with IONM were included, prioritizing investigations involving sugammadex and neostigmine. Results: Clinical evidence indicates that sugammadex (0.5–1 mg/kg) provides the rapid and reliable return of neuromuscular function, benefiting electromyography (EMG) signal quality preservation. However, overshooting the reversal can precipitate patient movement, compromising surgical precision. Neostigmine (0.03–0.04 mg/kg), while less selective, remains a cost-effective alternative, with recent studies suggesting adequate support for IONM signal integrity when carefully dosed and timed. Conclusions: This review underscores the need for balanced NMB reversal strategies tailored to intraoperative monitoring requirements in thyroidectomy. Further randomized trials and large-scale studies are needed to refine and standardize NMB reversal strategies in thyroid surgery with IONM.

OBJECTIVES:To examine (1) the relationship between anthropometric measurements and recurrent laryngeal nerve (RLN) diameter; (2) whether thin RLNs have different baseline electromyographic (EMG) characteristics; (3) if thin or branched morphology is associated with increased risk of EMG adverse events, loss of signal (LOS) or vocal cord paresis/paralysis (VCP). METHODS:In this prospective study, anthropometric data were collected, including weight, height, body mass index (BMI), neck circumference, shoulder diameter, and circumference of the right middle finger (RMF) or right ring finger (RRF). RESULTS:We enrolled 216 patients who underwent surgery from 2016 to 2020 with 307 RLNs at risk. Thin nerves were defined as those ≤ 1.5 mm in diameter. The mean RLN diameter was 2 mm; the RLN was thinner in females and in patients with BMI < 20 kg/m2, body weight < 120 kg, height < 175 cm, neck circumference < 40 cm, shoulder diameter < 50 cm, and RMF or RRF < 7.6 cm (all p < 0.05). No statistically significant differences were detected in baseline EMG characteristics between thin and thick RLNs bilaterally (except for right RLN R2 latency). We had zero cases of LOS or VCP. In all branched nerves, motor fibers resided in the anterior branch. CONCLUSION:Multiple anthropometric factors were associated with RLN diameter. Most of the studied EMG signal characteristics did not statistically differ by RLN diameter. With zero events of LOS or VCP, our study is not powered to determine if thin diameter or branching are independent risk factors for RLN injury in a high-volume endocrine surgery practice utilizing IONM.

BACKGROUND:Continuous intraoperative neuromonitoring (C-IONM) has been developed and used in open thyroidectomy to perceive imminent recurrent laryngeal nerve (RLN) injury, but has scarcely been reported in transoral endoscopic thyroidectomy vestibular approach (TOETVA) due to technical difficulty. This study aims to report the percutaneous C-IONM technology in TOETVA and compare it with the conventional peroral method to confirm its feasibility, safety, and effectiveness. METHODS:This prospective study included 102 consecutive patients who received TOETVA and standardized continuous vagal nerve (VN) stimulation via percutaneous insertion of commercially available handheld stimulation probe into the moderately dissected carotid space between carotid artery and internal jugular vein and fixed by an external fixator (PC group, n = 52 with 67 nerves at risk [NAR]) or conventional peroral DELTA electrode (DELTA group, n = 50 with 61 NAR). Demographic data, technical outcome variables, and electromyography (EMG) signals were collected and compared. RESULTS:C-IONM procedures were successfully set up in all PC group patients but failed in three DELTA group patients. Comparisons of technical characteristics show the PC group demonstrated a shorter electrode positioning time, fewer stimulator displacement events, and more stable EMG responses than the DELTA group. Four NARs (3 in PC, 1 in DELTA group) reported imminent recurrent laryngeal nerve (RLN) traction-related adverse events, all with intraoperative recovery after surgical technique modification, causing no postoperative vocal cord palsy. Severely weakened or loss of EMG signal occurred in 4 NARs (all in DELTA group), either due to stretch injury of VN (3 NAR) or traction injury of RLN (1 NAR), causing two postoperative VCP in 2 NARs. CONCLUSION:Percutaneous continuous vagal stimulation was superior to peroral vagal stimulation in a selected cohort of patients undergoing TOETVA to perceive the imminent injury of RLN to start immediate rescue.

Background/Objectives: In situ preservation is the primary strategy to preserve parathyroid gland (PG) function during thyroid surgery, while autotransplantation is used when inadvertent removal or devascularization occurs. Deciding on the optimal approach intraoperatively for exposed PGs remains challenging. This study evaluates intraoperative PG management strategies and long-term outcomes of PG function following total thyroidectomy. Methods: This retrospective study included 543 patients undergoing primary total thyroidectomy, excluding those with comorbid parathyroid disease. A stabbing test assessed the vascular supply of exposed PGs. PGs with fresh blood oozing after the test were preserved in situ; otherwise, they were autotransplanted. Intact parathyroid hormone (iPTH) and ionized calcium (iCa) were measured preoperatively and on postoperative day 1 (PO-1D), and during follow-up. Permanent hypoparathyroidism (PHPS) was defined as iPTH < 15 pg/mL, iCa < 4.2 mg/dL, or continued need for calcitriol or calcium supplementation after a postoperative period of 12 months (PO-12M). The PHPS rate was compared with the corresponding intraoperative PG status. Results: A total of 528 patients were enrolled in this study. At PO-1D, 434 patients (82.2%) had iPTH ≥ 15 pg/mL, 65 (12.3%) had iPTH between 4 and 15 pg/mL, and 29 (5.5%) had iPTH < 4 pg/mL. At PO-12M, 527 patients (99.81%) had iPTH ≥ 15 pg/mL, 1 (0.19%) had iPTH between 4 and 15 pg/mL, and none had iPTH < 4 pg/mL. Five patients (0.95%) were in PHPS after PO-12M. Among the 462 patients with at least one viable PG preserved in situ, the PHPS rate was 0.2%, compared to 6.1% (66 patients) for those without a viable PG preserved in situ (p < 0.001). Conclusions: Permanent hypoparathyroidism is rare when at least one viable PG is preserved in situ during total thyroidectomy. The stabbing test is a simple, useful, and cost-effective method to assess the vascular supply of exposed PGs, providing surgeons with essential information for intraoperative PG management.