September 27, 2005

Thyroid surgery with local anesthesia possible

By Anthony J. Brown, MD

NEW YORK (Reuters Health) - 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

"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

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.