Intraoperative Adjuncts in Thyroid and Parathyroid Surgery

Abstract

Extensive understanding of anatomy, pathophysiology, and refined surgical strategies and advances in technology have culminated in development of adjuncts for thyroid and parathyroid surgery. This chapter focuses on intraoperative neuromonitoring (IONM) and intraoperative parathyroid hormone (PTH) (IOPTH) assay, the two most commonly used intraoperative adjuncts for thyroid surgery and IOPTH for parathyroid surgery. IONM has been proven useful in situations like re-operative thyroid surgery, surgery for locally advanced thyroid cancer and can be useful to the occasional thyroid surgeon by helping him in avoiding the dreaded complication of recurrent laryngeal nerve (RLN) injury. There is of course a learning curve associated with mastering the technique of IONM, and modern thyroid surgeon should be aware of how to use this technology should the need arise in a particular case. Various energy devices have resulted in excellent hemostasis in thyroid surgery, and again the modern thyroid surgeon must know how to best use these energy devices to achieve bloodless thyroid surgery and at the same time avoid complications. Intraoperative detection of a viable parathyroid gland(s) by various techniques, and the use of intraoperative/early PTH can help predict hypocalcemia and aid in early discharge after thyroidectomy, as well as help start prophylactic calcium/vitamin D in those cases that are likely to develop severe hypocalcemia. IOPTH during parathyroid surgery can be helpful so long as given the confidence to the parathyroid surgeon of having cured the patient.