갑상선 부갑상선 수술에서 합병증 예방을 위한 술기의 발전

Abstract

Historically, the surgical techniques for thyroidectomy remained relatively unchanged forabout a century; however, in recent decades, there have been significant changes in surgicaltreatment methods. Because thyroid surgery has long been associated with a high risk of post-operative bleeding and hematoma, critical airway compromise can occur secondary to woundhematoma. Since the early 2000s, new hemostasis energy devices have been developed tominimize postoperative bleeding. These devices reduced wound drainage and postoperativelength of stay. Voice change from laryngeal nerve injury is a major concern for thyroid sur-geons. In this regard, intraoperative nerve monitoring (IONM) has been introduced to assistthe surgeon in RLN identification and dissection. Although there are conflicting reports, theuse of IONM may be helpful to reduce the laryngeal nerve injury. Hypocalcemia due to iatro-genic injury to parathyroid gland is another major concern of thyroid surgeons. Recent tech-niques such as indocyanine green angiography, and near-infrared-induced autofluorescencehave been developed to facilitate identification and preservation of parathyroid glands. Reducedrisk of postoperative hematoma and hypocalcemia enabled outpatient thyroidectomy. Becausethe conventional approach to thyroidectomy leaves long visible scar on the neck, several remoteaccess approaches were introduced to overcome cosmetic problems and some of them havebecome popularized and reported excellent cosmetic outcomes and favorable oncologic results. Herein, these surgical innovations to avoid complications in thyroid and parathyroid surgerywere summarized.