Complications in Patients Undergoing Thyroid Surgery

In this chapter, we discuss "complications," being defined as unfavorable and unintended outcomes of careā€”in short, adverse outcomes. Complications of thyroid surgery can be divided into general or specific complications, the latter being directly related to surgical technique, and the former being more or less independent of the surgical technical procedure itself. Examples of general complications are circulatory and respiratory problems and urinary tract infections. Specific complications include vocal cord dysfunction resulting from injury to the recurrent or external laryngeal nerves, hypoparathyroidism, bleeding, serous or lymphatic leakage, and hypoparathyroidism (origination from damage or ischemia to the parathyroid glands). The nerves at risk during thyroid operations are the external branch of the superior laryngeal nerve (EBSLN), the recurrent laryngeal nerve, and, depending on the surgical approach chosen, the various branches of the hypoglossal ansa. Other complications, such as lesions of the esophagus, thoracic duct, jugular vein, and carotid artery, are extremely rare and are likely to occur only in patients with large, invasive tumors requiring more extensive surgery. In the next sections, we deal with most general and specific complications, drawing both from literature data and from a series of 752 patients undergoing thyroid surgery at the Leiden University Medical Center (27% of them being reoperations). Attention is paid especially to the local anatomy, surgical techniques that can prevent damage to the structures at risk, and handling of complications.

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