Sanabria Alvaro, Novelli Jose Luis, Volpi Erivelto, Voogd Ana, Zund Santiago, Kowalski Luiz Paulo, Dueñas Juan Pablo
Departamento de Cirugía, Facultad de Medicina, Universidad de Antioquia, Medellín, Colombia.
CEXCA, Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellín, Colombia.
Arch Endocrinol Metab. 2025 Apr 3;69(2):e240111. doi: 10.20945/2359-4292-2024-0111.
Thyroidectomyis the most frequent endocrine surgical treatment for problems such as goiter, thyroid cancer, and Graves' disease. The global incidence of goiter ranges from 5%-20%, with a notably high frequency in less wealthy countries, and the incidence of thyroid cancer is on the rise due to the greater use of diagnostic imaging. Despite medical options, surgery remains essential. Surgical advancements such as blood vessel sealing technology, intraoperative laryngeal nerve neuromonitoring (IONM), remote access surgery, and parathyroid fluorescence have transformed thyroid surgery. Vessel sealing technologies reduce operative time and blood loss, whereas IONM preserves the laryngeal nerves. Remote access surgery, which includes a variety of techniques, produces results similar to those of open thyroidectomy with a longer operative time. Fluorescence enhances parathyroid detection and lowers the risk of temporary hypoparathyroidism. Economic studies reveal cost discrepancies, with advantages particularly visible in health care systems that depend on surgical time. While these advancements promise better patient outcomes, their accessibility and cost-effectiveness remain issues, particularly in Latin America. Recognizing these concerns, the Latin American Thyroid Society's Surgical Affairs Committee conducted an extensive review of emerging thyroid surgery technologies to guarantee their proper use in the area.
甲状腺切除术是治疗甲状腺肿、甲状腺癌和格雷夫斯病等疾病最常见的内分泌外科手术。全球甲状腺肿发病率在5%至20%之间,在较贫穷国家尤为高发,且由于诊断性影像学检查的广泛应用,甲状腺癌的发病率呈上升趋势。尽管有药物治疗选择,但手术仍然至关重要。血管封闭技术、术中喉返神经监测(IONM)、远程入路手术和甲状旁腺荧光等外科技术进步已经改变了甲状腺手术。血管封闭技术可缩短手术时间并减少失血,而IONM可保护喉返神经。包括多种技术的远程入路手术产生的结果与开放性甲状腺切除术相似,但手术时间更长。荧光增强了甲状旁腺的检测,并降低了暂时性甲状旁腺功能减退的风险。经济研究揭示了成本差异,在依赖手术时间的医疗保健系统中优势尤为明显。虽然这些进步有望带来更好的患者预后,但其可及性和成本效益仍然是问题,尤其是在拉丁美洲。认识到这些问题,拉丁美洲甲状腺协会外科事务委员会对新兴的甲状腺手术技术进行了广泛审查,以确保其在该地区的合理应用。