Haemostatic technology and nerve monitoring in thyroidectomy
THE CONTEXT
New devices support haemostasis and nerve assessment during thyroid surgery, although benefits and adoption vary.
Haemostasis
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Haemorrhage is the major immediate risk after thyroidectomy, making meticulous haemostasis essential.
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Conventional methods use artery forceps, ligatures and sutures. Ultrasonic shears, enhanced bipolar diathermy and harmonic vessel sealing devices are increasingly used and may help in complex procedures.
Intermittent nerve monitoring
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Monitoring of the recurrent laryngeal nerve and vagus nerve uses electrodes on the endotracheal tube between the vocal cords to detect movements during nerve stimulation.
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Advocates find monitoring particularly useful during recurrent operations, where scar tissue makes nerve identification difficult. Some also report reduced operating time and value for training.
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During bilateral thyroid surgery, recognition of unilateral palsy may help prevent bilateral palsy requiring tracheostomy.
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Objections include a lack of evidence for improved outcomes and the expense of the machine and electrodes.
Continuous nerve monitoring
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Intermittent monitoring identifies an already damaged nerve; continuous monitoring theoretically identifies threatened function, such as during excessive traction.
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Continuous monitoring requires an electrode on the vagus nerve and has not gained widespread acceptance.