Safe incorporation of new technologies in thyroid surgery

Abstract

The history of thyroid surgery starts with Billroth, Kocher and Halsted, who developed the technique for thyroidectomy between the years of 1873 and 1910. In general the essential objectives for thyroidectomy are: sparing the parathyroid glands, avoidance of injury to the laryngeal nerves, an accurate hemostasis and an excellent cosmesis. In the last 10 years, major improvements and new technologies have been proposed and applied in thyroid surgery. These include mini-invasive thyroidectomy, new devices for achieving hemostasis and dissection, regional anesthesia, intraoperative neuromonitoring, parathyroid hormone assay technology and genetic screening. This paper reviews the relevant medical literature published on the influence of these new technologies on the quality of thyroid surgery, as well as prevention of postoperative morbidity and mortality. Searches were last updated in April 2008.

Indocyanine green-enhanced fluorescence for assessing parathyroid perfusion during thyroidectomy

“…Postoperative hypocalcemia is a common complication of thyroidectomy performed by either conventional or endoscopic methods (35)(36)(37)(38)(39)(40)(41). Decreased serum calcium, secondary to hypoparathyroidism, may present clinically with muscle cramps, perioral and peripheral paresthesias, carpopedal spasm or tetany, and/or confusion.…”

“…Decreased serum calcium, secondary to hypoparathyroidism, may present clinically with muscle cramps, perioral and peripheral paresthesias, carpopedal spasm or tetany, and/or confusion. Symptomatic patients often require extended hospitalization after thyroid surgery, which increases healthcare costs (35)(36)(37)(38)(39)(40)(41). Depending on the extent of parathyroid gland damage, hypocalcemia may be transient and resolve within several few months or may be permanent.…”

“…Permanent hypocalcemia requires lifelong oral calcium and vitamin D supplementation. Although ambulatory thyroid surgery enables early discharge of patients, postoperative hypocalcemia is a particularly important consideration (35)(36)(37)(38)(39)(40)(41). In fact, some surgeons advocate indiscriminate postoperative calcium supplementation.…”

“…However, this approach has been contested. On result of the increased interest in outpatient and short-stay thyroid surgery is the improved ability of surgeons to identify patients at risk for hypocalcemia (35)(36)(37)(38)(39)(40)(41). Therefore, accurate and standardized data for thyroidectomy outcomes are essential.…”

“…For example, some studies analyze not only patients who have received total thyroidectomy, but also patients who have received less invasive procedures such as thyroid lobectomy, which has a relatively low hypocalcemia risk. Such reports can underestimate the incidence of hypocalcemia and are subject to misinterpretation (35)(36)(37)(38)(39)(40)(41).…”