Complications in Thyroid Surgery
Thyroid surgery is the surgery of parathyroid glands and recurrent laryngeal nerves. Surgeon is the most important prognostic factor for the complication rate. Possible complications of thyroid surgery are numerous, including bleeding, infection, hypopara
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Radan Dzodic, Nada Santrac, Ivan Markovic, Marko Buta, and Merima Goran
Introduction William Stewart Halsted said: “The extirpation of the thyroid gland for goiter typifies, perhaps, better than any operation, the supreme triumph of the surgeon’s art” [1]. From ancient times, attempts to treat goiter were recorded; however they were rare and related to large goiters with threat to suffocation [2]. The first typical partial thyroidectomy was successfully performed in 1791 by French surgeon Pierre Joseph Desault [3]. However, number of lethal outcomes after thyroid surgery led many great surgeons of that time, such as Robert Liston and Samuel Gross, to think that thyroid surgery is not justified in any case [2]. The great breakthrough in thyroid surgery happened in the second half of the nineteenth century. There were three important events that changed the course of surgery drastically: introduction of general anesthesia in 1846 by Boston dentist William Morton [4], Lister’s discovery of antisepsis in 1867 [5], and develop-
R. Dzodic (*) · N. Santrac · I. Markovic · M. Buta · M. Goran Faculty of Medicine, Department of Surgery, University of Belgrade, Belgrade, Serbia Department of Endocrine and Head and Neck Surgery, Surgical Oncology Clinic, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
ment of hemostatic forceps in European clinics (around 1870) [2]. The central role among thyroid surgery giants remains reserved for Swiss surgeon Emil Theodor Kocher (1841–1917), acclaimed as the father of thyroid surgery. He was the first “high-volume” endocrine surgeon who showed that surgical training and meticulous technique reduce complications in thyroid surgery. By the end of his life, he managed to reduce perioperative mortality rate during thyroid operations from 40 to 0.5% after over 5000 operations [2]. He is acclaimed not only for mastering the surgical technique, but also for his contributions in physiology and pathology of thyroid gland, for which he was awarded with the Nobel Prize in 1909 [2].
Background From the very beginnings of thyroid surgery to modern times, the significance of a surgeon remains of the same importance. Surgeon is thought to be an important prognostic factor, not only for the outcome and survival, but also for the complications rate [6]. However, regardless of the improvements in surgical technique and technical support, complications still occur. Thyroid surgery is the surgery of parathyroid glands and recurrent laryngeal nerves. Injuries to these structures are severe. Other major complications include bleeding, infection, superior laryn-
© Springer Science+Business Media Singapore 2018 R. Parameswaran, A. Agarwal (eds.), Evidence-Based Endocrine Surgery, https://doi.org/10.1007/978-981-10-1124-5_16
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geal nerve injury, thoracic duct injury, as well as injury of the lateral neck nerves, arteries, and veins. Some minor complications include pain, paresthesia, neck and shoulder stiffness, seroma, poor scaring, granuloma, sinus (fistula), and wound dehisce
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