Surgical Innovations to Prevent Complications in Thyroid and Parathyroid Surgery

Historically, the surgical techniques for thyroidectomy remained relatively unchanged for about a century; however, in recent decades, there have been significant changes in surgical treatment methods. Because thyroid surgery has long been associated with a high risk of postoperative bleeding and hematoma, critical airway compromise can occur secondary to wound hematoma. Since the early 2000s, new hemostasis energy devices have been developed to minimize postoperative bleeding. These devices reduced wound drainage and postoperative length of stay. Voice change from laryngeal nerve injury is a major concern for thyroid surgeons. In this regard, intraoperative nerve monitoring (IONM) has been introduced to assist the surgeon in RLN identification and dissection. Although there are conflicting reports, the use of IONM may be helpful to reduce the laryngeal nerve injury. Hypocalcemia due to iatrogenic injury to parathyroid gland is another major concern of thyroid surgeons. Recent techniques such as indocyanine green angiography, and near-infrared-induced autofluorescence have been developed to facilitate identification and preservation of parathyroid glands. Reduced risk of postoperative hematoma and hypocalcemia enabled outpatient thyroidectomy. Because the conventional approach to thyroidectomy leaves long visible scar on the neck, several remote access approaches were introduced to overcome cosmetic problems and some of them have become popularized and reported excellent cosmetic outcomes and favorable oncologic results. Herein, these surgical innovations to avoid complications in thyroid and parathyroid surgery were summarized.