Surgical Management of Thyroid Cancer

Surgery on the thyroid gland was first performed around 500 a.d. Later, Abū al-Qāsim, a surgeon innovator also known as Albucasis, wrote a 30-volume treatise on numerous instruments he developed as well as procedures he performed. Prior to his death in 1013 a.d., he performed the first thyroid surgery that was successful. Prior to 1850, thyroid surgery was plagued with morbidity and mortality related to hemorrhage, lack of anesthesia, and infection. Two key discoveries brought surgical technique closer to avoiding this complication. Sandstrom first described the human parathyroid glands in 1880 (Rogers-Stevane and Kauffman, Otolaryngol Clin North Am 41:1059, 2008). His discovery led to the anatomical understanding of parathyroid gland blood supply in 1907 by Halstead and Evans. With the further understanding of the parathyroids’ role in calcium physiology, these discoveries led to the development of surgical techniques that spared the glands in order to maintain calcium homeostasis. Contemporary advancements continue to build on these discoveries. The advent of electrocautery followed by the ultrasonic shears encourages hemostasis and decreases operating time. Minimally invasive techniques have decreased the trauma and improved the cosmesis of the procedure. Finally, intraoperative nerve monitoring provides an additional defense against dreaded RLN injury which impact airway integrity as well as phonation. Postoperative parathyroid hormone levels help predict likelihood of postoperative hypocalcemia.