The Role of Ultrasound in Transoral Endocrine Surgery

Abstract

Preoperative planning for the safe and successful surgical removal of cervical endocrine organs, e.g., thyroidectomy, with or without lymph node dissection, and parathyroidectomy, requires a thorough knowledge of the specific anatomic and pathologic features that characterize the tissue to be resected. Preoperative neck imaging is an important means of assessing these variables, and such imaging therefore plays a critical role in the selection of the operative approach for thyroid and parathyroid surgery. This is particularly relevant when considering a transoral thyroidectomy or parathyroidectomy, as this approach remains novel, with many surgeons currently in the learning phase for this technique. Among the various imaging modalities available for preoperative planning, ultrasound is generally considered the most useful, and all patients for whom thyroidectomy and/or parathyroidectomy is being considered should undergo preoperative ultrasonography. Critical information provided by neck ultrasound includes physical characterization of the relevant anatomy (e.g., size and position), assessment of the potential for associated inflammation, as well as estimation of attendant primary and nodal metastatic malignancy risk. Further, neck ultrasound is inexpensive, is safe, and is widely available. In this chapter, we review the specific anatomic and pathologic variables assessed during preoperative neck ultrasound for thyroid and parathyroid disease and discuss the impact of ultrasound findings on operative approach selection in each case.