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Nonneural Complications of Thyroid and Parathyroid Surgery

Introduction Thyroid and parathyroid operations rank among the most common procedures performed by endocrine surgeons and are generally considered low-risk procedures. Yet, complications occur even when surgery is performed by experienced surgeons. Endocrine neck surgery mandates adherence to certain core principles of surgery, such as absolute hemostasis, distinct identification and preservation of the relevant surrounding tissue, clear illumination and visualization of the operative field, and staying…

Management of Recurrent Laryngeal Nerve Paralysis

Video 43.1 Vocal Fold Augmentation Using Transcricothyroid Membrane Submucosal Approach. Introduction Alteration in the function of the recurrent laryngeal nerve (RLN) is an unfortunate and sometimes unavoidable consequence of thyroid surgery. It may result from errors in surgical technique or judgment or from the disease process itself. Injury to the RLN may yield vocal fold hypomobility or frank immobility. Preoperative counseling on the risks of transient…

Pathophysiology of Recurrent Laryngeal Nerve Injury

Introduction Laryngeal nerve injury is a serious complication of thyroid surgery. Unilateral injury impairs the voice and, occasionally, swallowing. Bilateral injury can result in life-threatening airway obstruction. Symptoms vary greatly over time and between patients, depending on the site and severity of the lesion and the biology of the healing process. This chapter deals with the pathophysiology of recurrent laryngeal nerve (RLN) injury and the biology…

Surgical Pathology of the Thyroid Gland

Introduction Most surgical thyroid disease involves lesions that produce thyroid enlargement—sometimes diffuse but usually nodular. This chapter will discuss lesions of the thyroid that produce nodules. We will describe and discuss the pathologic features of these lesions as well as their differential diagnosis and prognostic features. All neoplasms that arise from thyroid epithelial cells can have some functional capacities. They may respond to thyroid-stimulating hormone (TSH)…

Incisions in Thyroid and Parathyroid Surgery

Video 40.1 Introduction to Chapter 40, Incisions in Thyroid and Parathyroid Surgery. Introduction Among endocrine surgeries, thyroidectomy remains a demanding procedure because of the specific patient population, the decreasing surgical morbidity, and increasing patient expectations. Patients now seek safe surgery with preservation of the laryngeal nerves and parathyroid glands, but increasingly, they also express interest in a better cosmetic outcome. Thyroid surgical diseases disproportionately affect females…

Lateral Neck Dissection: Indications and Technique

Video 39.1 Lateral Neck Dissection for Differentiated Thyroid Cancer. The incidence of thyroid cancer has been increasing over the past few decades, and although the majority of cases are localized to the thyroid, the number of patients with lateral neck disease at first presentation has increased. Although there is an abundance of literature on the patterns of metastasis for thyroid carcinoma, there remains some controversy surrounding…

Central Neck Dissection: Indications and Technique

Video 38.1 Introduction to Chapter 38, Central Neck Dissection: Indications and Technique. Video 38.2 Central Compartment Dissection. Introduction Central lymph node metastasis is very common in differentiated thyroid cancers, especially in papillary thyroid carcinomas (PTCs). Although therapeutic central neck dissection for cN1a is widely accepted, there continues to be ongoing debate regarding the role of elective/prophylactic central compartment dissection for cN0 necks. In a 2016 meta-analysis…

Surgery for Locally Advanced Thyroid Cancer: Larynx, Tracheal Invasion, and Esophageal

Video 37.1 Tracheal Resection for Locally Advanced Carcinoma of the Thyroid Gland. Invasive thyroid cancer is defined as a disease that extends outside of the thyroid gland or outside the capsule of metastatic nodes to involve adjacent structures. Several decades ago, the problem of invasive disease was more prevalent, as patients tended to seek medical care later in the course of their illnesses—when symptoms brought them…

Surgical Anatomy and Monitoring of the Recurrent Laryngeal Nerve

Video 36.1 Introduction to Chapter 36, Surgical Anatomy and Monitoring of the Recurrent Laryngeal Nerve. Video 36.2 Recurrent Laryngeal Nerve Monitoring. Video 36.3 Continuous Vagal Nerve Monitoring. Introduction Galen, in the second century, discovered and named the recurrent laryngeal nerve (RLN). He found that vagal sectioning in a pig resulted in aphonia. Until this time, speech was thought to be controlled by the heart. In the…

Surgical Anatomy and Monitoring of the Superior Laryngeal Nerve

Video 35.1 Introduction to [CR] , Surgical Anatomy and Monitoring of the Superior Laryngeal Nerve. Video 35.2 Superior Laryngeal Nerve Anatomy and Monitoring. Video 35.3 Stimulation of the Right-Sided External Branch of the Superior Laryngeal Nerve During Thyroidectomy. The technical aspects of operations on the thyroid gland have changed very little since the original papers by Kocher. Usually, the complication rate of thyroidectomy is very low…

Minimally Invasive Video-Assisted Thyroidectomy

Video 34.1 Minimally Invasive Video-Assisted Thyroidectomy. This chapter contains additional online-only content, including exclusive video, available on expertconsult.com . Introduction The conventional surgery for neck endocrine diseases is generally performed using traditional Kocher incision, which is characterized by a standard skin incision and results in a visible, large scar on the neck (see Chapter 31 , Principles in Thyroid Surgery). For minimally invasive neck endocrine surgery,…

Transoral Thyroidectomy

Video 33.1 Introduction to [CR] , Transoral Thyroidectomy. Video 33.2 Transoral Endoscopic Thyroidectomy Vestibular Approach. History of Transoral Thyroidectomy Since Kocher introduced the modern era of thyroid surgery well over a century ago, the surgical approach has remained virtually unchanged: a lower midneck transverse incision. With improved instrumentation, lighting, and safer operating conditions over the decades, the size of the incision has decreased, but a resultant…

Robotic and Extracervical Approaches to the Thyroid and Parathyroid Glands

Video 32.1 Transaxillary Robotic Thyroidectomy Video 32.2 Postauricular Robotic Thyroidectomy Introduction Advances in surgical technology have enabled surgeons to develop multiple minimally invasive and remote access approaches to the thyroid gland. In the early 2000s, Miccoli introduced the minimally invasive endoscopic thyroidectomy (MIVAT) using a small cervical incision, which initially gained significant interest in the United States. Following that, remote-access approaches were attempted using endoscopes through…

Principles in Thyroid Surgery

Video 31.1 Basic Thyroid Surgical Maneuvers. Video 31.2 Advanced Thyroid Cancer Surgery. Video 31.3 Total Thyroidectomy: Autofluorescence and Parathyroid Angiography. Introduction There are a number of chapters in this text devoted to specific thyroid surgical approaches, ranging from minimally invasive to extracervical, robotic, and transoral approaches (see Chapter 32 , Robotic and Extra Cervical Approaches to the Thyroid and Parathyroid Glands, Chapter 33 , Transoral thyroidectomy,…

Familial Nonmedullary Thyroid Cancer

Introduction In 1955, Robinson and Orr published the first report of isolated familial papillary thyroid cancer affecting 24-year-old identical twins. Twenty years later, Nĕmec and colleagues described differentiated thyroid cancer without environmental exposures in a mother and son. Since that time, numerous reports have been published describing families with thyroid cancer of follicular cell origin without other familial syndromes. Population-based studies have established that individuals with…

Pediatric Thyroid Cancer

Video 29.1 Introduction to Chapter 29, Pediatric Thyroid Cancer. Introduction Much like many childhood diseases, there are major differences in the diagnosis and management of pediatric patients with thyroid cancers compared with adults. This chapter highlights some of those differences and reviews the current approach to the etiology, diagnosis, and treatment of pediatric thyroid cancer. Thyroid cancer accounts for approximately 1% to 3% of all childhood…

Anaplastic Thyroid Cancer and Primary Thyroid Lymphoma

Introduction Thyroid cancer incidence is rising rapidly, mostly due to increasing rates of incidentally detected papillary microcarcinoma. Anaplastic thyroid cancer (ATC), however, is a rare form of undifferentiated thyroid carcinoma. Even though the incidence for differentiated thyroid cancer (DTC) is increasing, the incidence for ATC has largely been similar over the years. Overall mortality from DTC is low at ~ 3%, but ATC disproportionately accounts for…

Syndromic Medullary Thyroid Cancer: MEN 2A and MEN 2B

Introduction As early as the beginning of the 20th century, medullary thyroid carcinoma (MTC) was noted as a distinct disease entity within the broad spectrum of malignant thyroid tumors. By the first half of the century, the peculiar tumor biology of the sporadic type had been described as “small tumors with early lymphatic and hematogenous spread,” whereas multicentric MTC had become the hallmark of familial tumors.…

Sporadic Medullary Thyroid Carcinoma

Video 26.1 Introduction to Chapter 26, Sporadic Medullary Thyroid Carcinoma. Introduction Medullary thyroid carcinoma (MTC) comprises 1% to 2% of all new cases of thyroid cancer in the United States, a number that is significantly smaller than historically documented, due to the increasing incidence of papillary thyroid cancer. MTC occurs as two distinct clinical entities, hereditary (25%) and sporadic (75%). Although these entities share the same…

Hürthle Cell Tumors of the Thyroid

Video 25.1 Introduction to Chapter 25, Hürthle Cell Tumors of the Thyroid. Introduction Hürthle cell carcinoma (HCC) of the thyroid gland is an uncommon tumor, accounting for 3% to 10% of all thyroid cancers, and therefore few institutions have significant experience with this condition. Because of its rarity, the natural history and optimal management of patients with HCC remain a subject of much debate. The clinical…