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In some cases, with the right choice of patients, surgical removal of the thyroid gland or part of it can be safely performed using local anesthesia—with advantages over doing the operation under general anesthesia, a new study indicates.
Thyroidectomy, as the procedure is called, may necessary if someone has cancer or other diseases of the thyroid.
"It is fairly uncommon for surgeons to perform thyroidectomy using local anesthesia,” lead author Dr. Kathryn Spanknebel, from Columbia University in New York, told Reuters Health.
“I was at an international surgical meeting recently,” she said, “and they asked the audience how many people performed thyroid surgery using local anesthesia, and not very many people raised their hands.”
As to why the local operation, which was introduced more than a decade ago, has not become popular, Spanknebel said that surgeons may find it more difficult and labor-intensive than thyroidectomy under general anesthesia.
“Quite frankly, it is easier to do thyroid surgery with patients asleep—you can just focus on the operation. When the patient is awake, it becomes a very patient-centric environment, which means more work for the surgeon and for anesthesia.”
The present study, which is reported in the Journal of the American College of Surgeons for September, involved 1025 consecutive patients who underwent thyroidectomy under local anesthesia over a 16-year period.
Overall, just 3 percent of the operations had to be switched to general anesthesia.
Over time, there was a significant increase in the use of local-anesthesia thyroid surgery for high-risk, older, and more obese patients as well as for more extensive goiter operations and bilateral operations.
Although potentially more labor intensive, Spanknebel believes that the local procedure offers one distinct advantage over the conventional procedure: immediate vocal feedback.
“With the patient awake, they can talk, or even sing, during the operation to let us know the status of the vocal cord nerves,” she explained. “We think this is the best means of voice monitoring, better than nerve monitoring, which can be done under general anesthesia, but may miss damage that actually changes the voice.”
SOURCE: Journal of the American College of Surgeons, September 2005.
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