avoiding complications in thyroid surgery...
TRANSCRIPT
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AVOIDING COMPLICATIONS
IN THYROID SURGERY
2013
Panelists: Gaurav Agarwal, MD. India
Dan Fliss, MD. Israel
Steven Libutti, MD. USA
Ralph Tufano, MD. USA
Moderator: Jesus E. Medina, MD. USA
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52 y.o. man,
Had an uneventful right thyroid lobectomy 5 days prior for a 5 cm. “follicular lesion”, which proved to be a follicular adenoma.
He presents now with a soft fluid collection under the incision that was aspirated yielding 9 ccs. of serous-sanguineous fluid
Prevention of Seroma
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57 y.o. female,
Had a right lateral tongue T1 N0 SCCa for which she underwent partial glossectomy on 6/06/2012.
US of neck: incidental left thyroid nodule, 2.2 cm.
FNA: Indeterminate
1/16/13: Left thyroid lobectomy, 3 cm incision
Prevention of Hematoma
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57 y.o. female,
While being discharged from the recovery room she developed sudden swelling under the incision, which rapidly became tense as she began to experience difficulty breathing.
Prevention of Hematoma
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Case Presentation: 64 y.o woman reportedly had a 3 cm rubbery mass in the inferior pole of the right lobe, which was diagnosed as papillary carcinoma on FNA. She was undergoing a total thyroidectomy for a papillary carcinoma of the thyroid. No nerve monitoring device in place During surgery, two firm nodes were noted in the right paratracheal area; the largest one, about 1.5 cm in diameter.
Prevention of Recurrent Laryngeal Nerve Injury
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Case Presentation:
In the course of the paratracheal dissection, the surgeon realized that the recurrent laryngeal nerve had been divided between clips, “thinking it was a vein” about 5 mm above the level of the innominate artery. He calls in consultation from the OR.
Prevention of Recurrent Laryngeal Nerve Injury
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Case Presentation: A 42 y. female present to the ER, about 72 hours after undergoing a total thyroidectomy, with overt symptoms and signs of hypocalcemia. The operating surgeon states that 2 parathyroids were visualized and appeared viable at the end of the procedure. Ionized Ca: 20 hrs. after surgery: 1.12 (N:1.10–1.35 mmol/L)
Prevention of hypoparathyroidism/hypocalcemia
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Case Presentation: A 45 yo BF patient, who is known to have had a goiter for several years, is referred for surgery because she has developed progressively “noisier” breathing and SOB
Prevention of Airway Problems
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Prevention of Airway Problems
On examination she is no distress but her breathing is “noisy” on deep inspiration, no frank stridor. Has a large goiter palpable on the right side , which extends substernally. Moves up with deglutition. VC motility is normal
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Prevention of Infection
Case 1a: On 3/7/13 she underwent total thyroidectomy and was discharged in 48 hours. She returned on 3/21/13 with a history of increasing pain, swelling in the neck and fever. On exam: Temp: 39.5 C. No respiratory distress. Erythema and edema of the skin of the neck and upper chest, no crepitance. WBC 19,500.