Introduction: Surgeons take in to consideration various triangles so as to ensure safe thyroidectomy with precision and minimal morbidity. These triangles and area of concern have their own advantages and disadvantages over each other. In order to have a inclusive and conclusive approach, mitigating maximum risk factors of thyroidectomy, a proposed Unified Area of Danger (UAD) provide ease and comfort to the surgeon for safe thyroidectomy. A study was carried out to assess the usefulness of the triangles described in relation to thyroidectomy.

Material and Method: It was observational study and data collected from Endocrine/ General/Onco-Surgeons/ENT surgeons. A Questionnaire was designed, which included 8 statement questions, to verify the awareness about the triangles and their utility amongst the surgeons and also the ease of understanding unified area of danger and its usefulness. Out of 80responses, responses by 65 surgeons were included in the study.

Results: Although 63 surgeons were aware of Jolls triangle and Beahrs triangle only 34 surgeons had utilised them which is 52.30%.

Out of 62 surgeons who were aware of triangle of Concern only 35 had utilised it to protect RLN and to prevent bleeding which is 53.80%.

In UAD the inferior Parathyroid glands and superior parathyroid glands were found in 67.70% and 90.80% of cases respectively and recurrent laryngeal nerve in 95.40% of cases. External branch of Superior laryngeal nerve is not found in this area.

Discussions: Surgeons are aware about the triangles. First assistants have shown less awareness about the triangles which may be termed as unsatisfactory. All the surgeons who took part in the present study understood the UAD with great ease and found it to be comprehensive or total and much easier to remember during the procedure.

Conclusion: Unified Area of Danger encompasses all the danger zones and is easier to follow during the procedure by operating surgeons and assistant  surgeon.

1. Sharma N, Chaplin JM, Watkinson CJ. Surgical Management of differentiated thyroid cancer. In: Watkinson CJ, Gilbert WR, editors. Stell and Maran’s Textbook of Head and Neck Surgery and Oncology. 5th ed. Boca Raton, FL: Taylor and Francis Group; 2012. p. 439–432.
2. Kumar P, Premkumar A. The rationale of triangles in relation to thyroid surgery: A proposed unified ‘area of danger’ for safe thyroidectomy. Indian Journal of Anatomy and Surgery of Head, Neck and Brain, April-June 2018;4(2):48-51.

Sharma Shweta