Thyroid surgery complications

Thyroidectomy is a well standardized procedure. Currently mortality rate is reduced close to zero and its complications are not worrisome. Technical progress and wide attention to the cosmetic results have pushed the development of new surgical techniques, namely Minimal Invasive Video Assisted thyroidectomy (MIVAT) and transaxillary robotic thyroidectomy. MIVAT can be considered a miniaturization of traditional cervicotomic approach with a similar spectrum of complications. In the literature have been described a subcutaneous reimplant from a benign goiter. With the transaxillary approach the spectrum of complications have been broadened with tunnel associated problems and the position of the arm. One of the authors (MP) have observed a neoplastic reimplant in the tunnel. The main complications of the classic thyroidectomy are: • Acute post-operative hemorrage with compressive hematoma: this causes asphyxia, that requests emergency decompression. When bleeding is less dramatic we observe a subcutaneous hematoma, which determines a visible lump without respiratory problems • Hypocalcemia is routinely checked and can be symptomatic or a laboratory diagnosis, associated with overt symptoms or not. The asymptomatic one can be a mild form of hypoparathyroidism, deserving some forms of treatment or can reflect a low protein level: this does not deserve any treatment. • Recurrent laryngeal nerve injury can be transient or permanent, unilateral or bilateral: the last is one of the most dramatic acute event in thyroid surgery. In the recent years many surgeons have suggested the use of neuromonitoring (NIM) to reduce the incidence of nerve palsy and more to avoid bilateral palsy with a staged thyroidectomy. Other complication of thyroid surgery are: • wound problems, like seroma, infection, cutaneous sensitive neck problems and a bad scar • swallowing disorders • chilous fistula • Horner syndrome • tracheal or esophageal injury Further peculiar complications are associated to the dissection of lateral compartment of the neck.