Narrative review of management of thyroid surgery complications

Abstract

Currently, thyroid surgery is the most common and safe operation worldwide. However, thyroidectomy is still not free from the risks of complications and death due to the anatomical structure and physiological function particularity of the thyroid gland. Postoperative complications affect the life quality and life safety of patients after surgery. The common complications include hypoparathyroidism (HP), recurrent laryngeal nerve (RLN) injury, injury to the external branch of the superior laryngeal nerve (EBSLN), postoperative bleeding (PB), thoracic duct injury, laryngeal edema, tracheospasm, tracheal injury, and esophageal injury. A severe complication, such as dyspnea, asphyxia, or thyroid crisis, might cause the death of the patient. Therefore, every thyroid surgeon's responsibility is to remain alert and aware of the occurrence of various intraoperative and postoperative complications and exercise effective prevention and treatment. This is closely related to the advancement in thyroid disease research, the increase in local anatomy knowledge, the standardization of surgical approaches, the improvement in operating skills, the application of new technologies, and the emphasis on specialty training. In addition, many complications that effect patients are much better tolerated if the patient has appropriate expectations of what the complications are and how to treat them. Open communication between surgeon and patient optimizes the potential negative effects that complications may have on patients' quality of life. This paper discusses the prevention, recognition and therapy of intraoperative and postoperative complications in thyroid surgery.

Surgical Complications in Papillary Thyroid Cancer Patients with Cervical Lymph Node Metastases

“…This can be explained by the fact that the RLN is very sensitive and vulnerable to various factors during surgery, such as excessive traction/stretching, contusion, clamping, ligation, suturing, burning, and cutting. 24 …”

The Application Value of the Central Lymph Node Metastasis Risk Assessment Model in Papillary Thyroid Microcarcinoma of Stage cN0: A Study of 828 Patients

“…CLNM will increase the risk of postoperative recurrence and affect the prognosis of patients ( 15 – 17 ). Although thyroid surgery is one of the most common and safest procedures in endocrine surgery, the risk of complications is still unavoidable on account of the unique anatomy of the thyroid gland ( 18 , 19 ). Numbness of hands and feet, difficulty in articulation, and even inability to breathe are still the major problems perplexing surgeons.…”

Preoperative ultrasound identification and localization of the inferior parathyroid glands in thyroid surgery

“…Ultrasound features of the IPGs we developed are: (1) The morphology is mostly oval, a few narrow. (2) The size is about (6-8 mm) x (4-5 mm) x (3-4 mm). (3) The overall echogenicity is higher than that of the surrounding muscle tissue and is slightly higher than that of the thyroid tissue.…”

“…Thyroid cancer is one of the most rapidly increasing malignancies in the world in recent years, and more than 90% of its pathological type is papillary carcinoma, for which surgical resection represents the most effective treatment (1). Hypoparathyroidism caused by surgical damage is one of the most common comorbidities of thyroid surgery (2,3).…”