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Energy Devices in Minimally Invasive Thyroidectomy

  • Pier Francesco Alesina
  • Martin K. Walz
Chapter

Abstract

An accurate haemostasis is essential during any surgical procedure. This problem is well known for thyroid surgery since over one century when Billroth, considered one of the best surgeons in Europe, reported a mortality of 40% on a series of 20 patients in 1869. Few decades later, in the hands of Theodor Kocher, thyroidectomy developed into a safe operation with a mortality rate of 0.5% by 1898 (Richard 1990). The key for these extraordinary results was the technique he introduced which first ligated the major arteries and veins followed by identifying and isolating the recurrent laryngeal nerve (Kocher 1883). Since that time, suture ligation has continued to be the gold standard of obtaining haemostasis. The introduction of the minimally invasive thyroid surgery poses the problem to break this 100-year-old rule. The impossibility to ligate is obvious for the purely endoscopic operations such as the endoscopic neck, thoracic and axillary approach (Henry and Segab 2006; Strik et al. 2007; Kang et al. 2009), but also the video-assisted operation due to the limited working space permits conventional ligatures only after the extraction of the thyroid lobe through the skin incision (Miccoli et al. 2006). Many instruments are now available for this use and have been demonstrated to be at least as safe as the knot-and-tie technique.

Keywords

Recurrent Laryngeal Nerve Thyroid Surgery Energy Device Cosmetic Satisfaction Axillary Approach 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Clinic for Surgery and Centre of Minimal Invasive Surgery, Kliniken Essen-MitteAcademic Hospital of the University of Duisburg-EssenEssenGermany

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