New technologies in thyroid cancer surgery.

Several new technologies have advanced the practice of thyroid surgery in recent years, with some centers implementing substantial changes in the way thyroid surgery is performed. As many thyroid cancers are diagnosed at an early stage the treatment is quite effective, and the prognosis is good for most patients with differentiated thyroid cancer. With excellent long term survival, advancements in the treatment of patients with thyroid cancers are focusing on reducing complications of surgery, improving quality-of-life and delivering care in a cost-effective way. The LigaSure electrothermal bipolar vessel sealing system and Harmonic scalpel have been designed to aid in dissection with less thermal spread than conventional electrocautery. Alternative access approaches to the thyroid allow for improved cosmetic outcomes and potentially improve the view of the surgical field. The intraoperative use of gamma-probe for the localization of metastases and sentinel lymph nodes are being increasingly reported on. Surgeon performed ultrasound is promoted for improving the detection of disease, and intraoperative nerve monitoring is now widespread, aiding in laryngeal nerve detection and protection. The assay of parathyroid hormone is also in common use for predicting patients at risk for developing postoperative hypocalcemia. This article reviews the current literature on new technologies for thyroid surgery and discusses some of the implications for the future of this field of surgery.