Surgery of the Thyroid and Parathyroid Glands E-Book

Gregory W. Randolph

• Publisher: Elsevier
• Year: 2020
• ISBN:
  9780323661287
• Edition: 3
• Topic: Medicine
• Subtopic: Surgery & Surgical Medicine

Bringing together more than over 120 expert contributors from otolaryngology, general surgery, endocrinology, and pathology, Surgery of the Thyroid and Parathyroid Glands, 3rd Edition, presents an interdisciplinary approach to surgical management and treatment of benign and malignant disease. This renowned text/atlas is an ideal resource at all levels of surgical experience: for residents and junior surgeons, it clearly provides all relevant anatomy, surgical procedures, and workup; for experienced surgeons, it details the management of difficult cases, including revision surgery. Highly illustrated and accompanied by dozens of videos, this edition brings you up to date with the full continuum of care in thyroid and parathyroid surgery.

• Easy-to-follow, templated chapters cover preoperative evaluation, surgical anatomy, intraoperative techniques, and postoperative management, for a full range of disorders of the thyroid and parathyroid glands.
• More than 30 procedural videos walk you step by step through minimally invasive thyroid surgery, surgical anatomy and monitoring of the recurrent laryngeal nerve, surgery for locally advanced thyroid cancer and nodal disease, and more; plus 23 chapter guide videos from the authors with Surgical Text Video Editor-in-Chief Gregory W. Randolph, Jr.
• Coverage of cutting-edge topics includes recurrent laryngeal nerve monitoring, minimally invasive surgery and the role of PET in staging and surgical planning.
• Expert guidance on thyroid cancer, including multiple chapters on PTC, MTC and HCC, ATC and NIFTP.
• New chapters cover medical oncology and TKI therapy.
• Extensive coverage of key topics such as FNA mutational analysis, transoral and minimally invasive surgery, recurrent laryngeal nerve monitoring, management of RLN paralysis, all aspects of parathyroid disease, ethics, malpractice, and more.

Section 1

Introduction

Introduction

1

History of Thyroid and Parathyroid Surgery

Cristian M. Slough; Whitney Liddy; Jennifer Brooks; Edwin L. Kaplan; Mijenko Bura; Anatoly F. Romanchishen; Kristina Vabalayte; Gregory W. Randolph

“Only the man who is familiar with the art and science of the past is competent to aid in its progress in the future.”

—T. Billroth, 1862¹

The history of thyroid surgery closely parallels the evolution of modern surgical techniques and the synthesis of our understanding of anatomy, physiology, endocrinology, and pathology. The evolution of thyroid surgical techniques has been convoluted. Even when thyroid and parathyroid disorders were first recognized as discrete entities, they were misunderstood. Initially, Graves’ disease was considered to represent a cardiac illness; hypothyroidism, a neurologic and dermatologic disorder; and hyperparathyroidism, a primary bone disorder. One of the first thyroid procedures in the 1600s resulted in the imprisonment of the surgeon.² Fortunately, the anatomist and physiologist embraced the initial morbid surgical misadventures, ultimately rendering the applied art of thyroid surgery a safe and even triumphant treatment form. As Halsted has written, “The extirpation of the thyroid gland for goiter typifies perhaps better than any other operation the supreme triumph of the surgeon’s art.”³ The surgical story begins with the treatment of iodine deficiency.

The early years

Goiter has been recognized as a discrete disease entity since the earliest recorded history. The first mention of goiters in China occurs as early as 2700 b.c. Although goiter has been endemic in several parts of the world throughout history, it was not until 500 a.d. that Abdul Kasan Kelebis Abis, in Baghdad, performed the first recorded goiter excision. The patient survived despite massive postoperative bleeding. Other early remedies included the application of toad’s blood to the neck and stroking of the thyroid gland with a cadaverous hand.

In Europe, Abu al-Qasim is credited with performing and describing the technique of goiter excision where the patient just avoids exsanguination, as recorded in his surgical tome, Al-Tasrif, in 952 a.d. Early developments in thyroid surgery came from the school of Salerno, Italy, in the 12th and 13th centuries (Figure 1.1). The typical operation involved insertion of two heated iron setons at right angles into the offending mass. These were then manipulated at the skin surface twice a day until they pierced the flesh. In cases in which arterial supply of the goiter was thought not to be excessive, the surface of the goiter was cut, the tumorous tissue was grasped with a hook, and the skin was dissected away from it. Once exposed, the section of encapsulated goiter would be removed with a finger. Pedunculated goiters would be ligated en masse with a bootlace and removed.⁴ During such procedures, patients were tied down to a table and held firmly. Although these procedures sometimes reduced goiter size, patients often died from sepsis or hemorrhage.⁴

Fig. 1.1 The assistant holds the patient as the surgeon cuts scrofula (goiter) from the patient’s neck. Rogerius Salernitanus (Ruggero Frugardo): Chirurgia (1180). (From Ignjatović M: The thyroid gland in works of famous old anatomists and great artists. Langenbecks Arch Surg. 2010;395[7]:973–985.)

The anatomy of the normal thyroid gland was not generally understood until the Renaissance, with the work of Leonardo da Vinci (Figure 1.2). He drew the thyroid as two globular glands, which he speculated filled up empty spaces in the neck (Figure 1.3).⁵ Others pondered the function of the thyroid gland, speculating that its role was to lubricate the neck or make it more aesthetically pleasing. Caleb Hillier Parry of Bath, England, recognizing the thyroid gland’s vascularity, considered the gland a blood buffer to protect the brain from sudden increases in blood flow from the heart.⁶ In Roman times, increased neck girth was believed to herald the onset of puberty.⁷ Bartholomaeus Eustachius of Rome in the 16th century characterized the gland as “glandulam thyroideam” with two lobes connected via an isthmus.⁴ The term thyroid gland (glandulae thyreoidea) is attributed to Thomas Wharton (described in his work Adenographia, 1646), who gave it this name either because of the gland’s own shield-like shape (thyreos: Greek “shield”) or because of the shape of the thyroid cartilage, with which it is closely associated.⁸

Fig. 1.2 Leonardo da Vinci: “The Madonna of the Carnation” or “Madonna with a Rose” ca. 1478. Madonna with the goiter. (From Ignjatović M: The thyroid gland in works of famous old anatomists and great artists. Langenbecks Arch Surg. 2010;395[7]:973–985.)

Fig. 1.3 The first illustration of a thyroid is attributed to Leonardo da Vinci in 1503. (From O’Malley CD, de CM Saunders JB: Leonardo on the Human Body. New York: Dover Publications; 1983:169.)

In 1646 Wilhelm Fabricius reported the first thyroidectomy performed using scalpels. However, the patient, a 10-year-old girl, died and the surgeon was imprisoned.² In 1791 Pierre Joseph Desault performed a successful partial thyroidectomy in Paris.² Guillaume Dupuytren followed in Desault’s footsteps and in 1808 performed the first “total” thyroidectomy. Unfortunately, despite little intraoperative blood loss, the patient died of “shock.”² The most successful thyroid surgeon of that time was Johann Hedenus, a German surgeon from Dresden. By 1821 he had reported on the successful removal of six large obstructing goiters. His remarkable series of successes would not be equaled for nearly 40 years.⁵ In the 1850s a variety of incisions—longitudinal, oblique, and occasionally Y-shaped—were performed for thyroidectomy. Collar incisions had been introduced by Jules Boeckel of Strasbourg in 1880.² After skin incisions, most surgeons at this time performed blunt dissection. Bleeding was generally inadequately controlled. Bloodletting was performed for postoperative complications, despite perioperative blood loss. Typically, wounds were left open and dead spaces were either packed or left to fill with blood.⁴

The progress of early thyroid surgery is intertwined with initial advances in our understanding of thyroid endocrinology. It had been known empirically for some time that seaweed kelp and marsh seawater reduced goiter size. In 1811 Bernard Courtois discovered iodine in burned seaweed.⁵ By 1820 Johann Straub and Francois Coindet, both Swiss, systematically studied the use of iodine to treat goiter. Coindet went on to recommend the use of iodine preoperatively to reduce the size and vascularity of goiters and consequently to lessen operative risks.⁴ The use of iodine preparations became widespread. Considered miracle drugs, iodine medication...