Recurrent laryngeal nerve, phonation and voice preservation--energy devices in thyroid surgery--a note of caution.

摘要: Reservations [1] about energized dissection (ED) in thyroidectomies (EDIT) and ED-induced iatrogenic catastrophes laparoscopy exhort us to forsake adventurism, with technology un-benchmarked against standards of patient safety [2]. Surgeons embody Plato’s “techne iatrike”, Aristotle’s desire for dexterity, artist’s sensibilities, remembering the as a double-edged sword, giving accolade criticism equally The advocates EDIT, reporting higher rate insult recurrent laryngeal nerve (RLN), confess essentiality meticulous surgical technique await prospective randomized control trails (RCT), knowledge thyroid specific heat dispersion sink engineered ED. Even RCTs cannot negate basics precision hemostasis [3]. A few minutes gain should not be traded off quadrupled complications. Redundancy assistance is made virtue violating team-based “systems approach”, sounding contemptuous towards training. train heterogeneous fiscal atmospheres universal concerns ethics safety. Time advantage remains unsupported by hepatectomy experiences where collateral damageinduced biliary sealing virtue, but structures around bartered collaterals damage. “Patient-reported outcomes” are proper “study end points” this era informed patients, “technological toy”-wielding surgeon, altered “phonation frequency range”, vocal flitter reported preserved RLN indicate invisible during dissection. Involuntary spread energy ED insults cold sharp dissection, something regaining respect even laparoscopic surgery [4]. History study evolution hemostasis. Advocacy pioneers whose names live on hemostats that we use, i.e., Schiebervorrichtung Fricke, Kocher, Halsted, Mayo, Crile, Lahey. Hemostatic techniques surgeries an index skills. It might surprise hemostatic forceps were developed replace cautery. Halsted castigated Cushing (co-inventor Bovie) saying “The only weapon which unconscious can immediately retaliate upon incompetent surgeon hemorrhage”. benchmark evolved despite from Berry calling thyroidectomy “worse than useless” Gross “No honest sensible it seems me, would engage it”. Invisible thermal goes undetected because electromyography exclude such insult. There more vulnerable structures, parathyroid vasculature Amalita Galli Curci. environmental compromise too To submit all patients has small benefit group yet complications measurable larger madness [5]. Langenbecks Arch Surg (2009) 394:911–912 DOI 10.1007/s00423-009-0504-x