Thyroid Surgery (Updates in Surgery)

This open access book on thyroid surgery has been authored by an international team of contributors who present a comprehensive understanding of both benign and malignant thyroid disorders. It also outlines an interdisciplinary approach to their surgical management that reflects the latest changes in surgical techniques. The book reviews the most up-to-date literature available on thyroid surgery and presents it in a concise manner for use in clinical practice. For each thyroid disorder, the book covers etiology, clinical manifestations, diagnostic and localization procedures, as well as surgical and non-surgical treatment options. The operating techniques and postoperative management are explained in detail, while the benefits, risks, controversial issues, and cost-effectiveness of each approach are reviewed. To aid in the understanding of complex information, the book features drawings and photographs. Written in an easy-to-understand style, the book includes tables and diagrams that highlight best practices and current guidelines, as well as self-assessment material at the end of each section. It serves as an ideal resource for all levels of surgical experience, from a practical reference for endocrine surgeons to a perfect companion for students and residents. Foreword Foreword Preface Contents Part I: General Features and Indications for Surgery 1: History of Thyroid Surgery 1.1 Introduction 1.2 Anatomical Recognition of the Thyroid Gland 1.3 First Attempts in Thyroid Surgery 1.4 Progress in Thyroid Surgery 1.5 Billroth and Kocher 1.6 Recent Advances References 2: General Preoperative Workup, Informed Consent, Antibiotic Prophylaxis, and Anesthesia in Thyroid Surgery 2.1 General Preoperative Workup 2.1.1 History and Clinical Characteristics 2.1.2 Physical Examination 2.1.3 Laboratory Tests 2.1.4 Imaging Studies 2.2 Informed Consent 2.3 Anesthesia in Thyroid Surgery 2.4 Antibiotics in Thyroid Surgery References 3: Non-Neoplastic and Indeterminate Thyroid Lesions 3.1 Non-Neoplastic Thyroid Lesions 3.1.1 Nondiagnostic Cytology 3.1.2 Benign Cytology 3.2 Indeterminate Thyroid Lesions References 4: Suspected Malignancy and Malignant Thyroid Tumors 4.1 Introduction 4.2 Suspected Malignancy 4.3 Malignant Thyroid Tumors 4.4 Papillary Thyroid Cancer 4.5 Follicular Thyroid Cancer 4.6 Hürthle Cell Thyroid Cancer 4.7 Poorly Differentiated Thyroid Cancer 4.8 Anaplastic Thyroid Cancer 4.9 Medullary Thyroid Cancer 4.10 Treatment References 5: Retrosternal, Forgotten, and Recurrent Goiter 5.1 Retrosternal Goiter 5.2 Forgotten Goiter 5.3 Recurrent Goiter References Part II: Surgery: Cervical and Remote Approaches 6: Conventional Open Thyroidectomy 6.1 Introduction 6.2 Indications 6.3 Technical Considerations 6.3.1 Positioning 6.3.2 Surgical Technique 6.3.2.1 Incision 6.3.2.2 Exposure of the Thyroid Gland 6.3.2.3 Superior Parathyroid Glands 6.3.2.4 External Branch of the Superior Laryngeal Nerve 6.3.2.5 Superior Thyroid Artery 6.3.2.6 Middle Thyroid Vein, Isthmus Vessels 6.3.2.7 Inferior Thyroid Artery 6.3.2.8 Recurrent Laryngeal Nerve 6.3.2.9 Inferior Parathyroid Glands 6.3.2.10 Procedure Completion References 7: Minimally Invasive Video-Assisted Thyroidectomy 7.1 Introduction 7.2 Surgical Technique 7.3 Indications 7.4 Outcomes 7.4.1 Postoperative Outcome 7.4.2 Oncologic Outcome References 8: Cervical Lymphadenectomy in Papillary Thyroid Cancer 8.1 Introduction 8.2 Definitions 8.2.1 Anatomical Terminology 8.2.2 Operative Terminology 8.3 Controversies in the Management of Nodal Disease in Papillary Thyroid Cancer 8.3.1 Difficulties in Preoperative Diagnosis of Nodal Metastases in the Central Neck 8.3.2 Effect of pCND on Recurrence 8.3.3 Effect of pCND on Staging and Radioiodine Use 8.3.4 Increased Rates of Operative Complications 8.4 Salvage Treatment for Central Node Recurrence 8.5 Conclusion References 9: Robot-Assisted Transaxillary Thyroidectomy 9.1 Introduction 9.1.1 Background 9.1.2 Indications and Contraindications 9.1.3 Instruments 9.2 Surgical Procedure 9.2.1 Patient Position 9.2.2 The Remote Access: From the Axilla to the Thyroid 9.2.3 Docking Time 9.2.4 Console Time: Thyroidectomy 9.3 Controversies 9.3.1 Oncological Safety and Efficacy 9.3.2 Conventional and Unconventional Complications 9.4 Conclusion References 10: Robotic Bilateral Axillo-Breast Approach 10.1 Background 10.2 Indications and Patient Selection 10.3 Procedure 10.4 Outcomes and Cost References 11: Transoral Endoscopic Thyroidectomy Vestibular Approach: Lessons from a Five Years’ Experience 11.1 Introduction 11.2 Patients and Methods 11.3 Results 11.4 Discussion References Part III: Prevention and Management of Perioperative Complications 12: Laryngeal Nerves Monitoring in Thyroid Surgery 12.1 Introduction 12.2 Standardization of Intraoperative Neuromonitoring 12.3 Intermittent Intraoperative Neuromonitoring 12.4 NerveTrend Mode of Intermittent Intraoperative Neuromonitoring 12.5 Continuous Intraoperative Neuromonitoring 12.6 Monitoring of the External Branch of the Superior Laryngeal Nerve References 13: Autotransplantation of the Parathyroid Glands in Thyroidectomy: The Role of Autofluorescence and Indocyanine Green 13.1 Introduction 13.2 The Issue of Maintaining the Functionality of the Parathyroid Glands 13.3 Requirements for Adequate Localization of the Parathyroid Glands 13.4 Reimplantation of Parathyroid Glands References 14: Energy Devices, Hemostatic Agents, and Optical Magnification in Thyroid Surgery 14.1 Energy Devices 14.2 Hemostatic Agents 14.3 Optical Magnification References 15: Postoperative Hypoparathyroidism 15.1 Introduction 15.2 Etiology 15.3 Patient- and Disease-Related Risk Factors 15.4 Diagnosis 15.4.1 Clinical Presentation 15.4.2 Biochemical Testing 15.5 Postoperative Management of Postoperative Hypoparathyroidism 15.6 Long-Term Management and Complications of Postoperative Hypoparathyroidism 15.7 Conclusions References 16: Laryngeal Nerve Palsy 16.1 Applied Anatomy of the Laryngeal Nerves 16.2 Etiology, Prevalence and Risk Factors 16.3 Clinical Manifestations and Diagnosis 16.4 Prevention and Management 16.5 Conclusions References 17: Cervical Hematoma and Wound Complications 17.1 Introduction 17.2 Risk Factors 17.3 Recognition 17.4 Management References 18: Tracheal Injury 18.1 Traumatic Tracheal Injury 18.2 Iatrogenic Tracheal Injury 18.3 Clinical Scenario 18.3.1 Radiological Investigations 18.4 Special Clinical Conditions 18.4.1 Tracheal Injury during Thyroid Surgery 18.4.2 Thyroid Tumors Invading the Airways References Part IV: New Perspective Tools 19: Training and Learning Curves in Thyroid Surgery 19.1 Introduction 19.2 Assessment of Performance and Learning in Thyroid Surgery 19.3 Analysis Criteria 19.4 Role of Surgeon’s Experience 19.5 Role of Procedures 19.6 Conclusions References 20: The Angiogenic Microenvironment of Thyroid Cancer: An Insight into the Research of New Prognostic Markers 20.1 Introduction 20.2 The Thyroid Cancer Microenvironment and Angiogenesis 20.3 Angiogenic Mediators and their Prognostic Value References