Thyroidectomy: Navigating New Technologies and Clinical Challenges

Dear Colleagues,

The landscape of thyroid surgery is undergoing a profound transformation, driven by the dual imperatives of oncological safety and the enhancement of patient quality of life. Globally, the increasing incidence of thyroid nodules and well-differentiated carcinomas, coupled with rising patient expectations regarding aesthetic outcomes and recovery times, has catalyzed a shift toward more sophisticated surgical paradigms. While conventional thyroidectomy remains a cornerstone of treatment, the integration of cutting-edge technologies—ranging from high-precision energy-based devices to robotic-assisted platforms—is redefining what is considered the "standard of care."

Despite these technological strides, significant challenges persist. The prevention of life-altering complications, such as permanent hypocalcemia and recurrent laryngeal nerve palsy, remains a primary concern for surgeons worldwide. Furthermore, the push for healthcare efficiency has made the implementation of enhanced recovery after surgery (ERAS) protocols and the exploration of non-surgical alternatives, like thermal ablation, essential topics of contemporary clinical debate. This research area is remarkably timely, as it bridges the gap between traditional surgical excellence and the digital, minimally invasive future of endocrine surgery, offering a unique opportunity to harmonize technical innovation with patient-centered outcomes.

This Special Issue aims to present and disseminate the most recent advances related to modern surgical management of thyroid diseases. We consider contributions addressing a broad range of innovative themes, including the clinical efficacy of energy-based devices, the implementation of ERAS protocols in endocrine units, and the latest strategies for the prevention of post-operative complications (hemorrhage and hypoparathyroidism).

This Special Issue also explores the ongoing shift toward treatment de-escalation, focusing on the clinical selection criteria for hemithyroidectomy and the long-term feasibility of active surveillance for low-risk microcarcinomas, reflecting the most recent international guidelines.

Furthermore, this issue focuses on the integration of intraoperative neuromonitoring (IONM), the expanding role of robotic and minimally invasive surgery, and the emerging field of thermal ablation techniques (RFA, Laser, Microwave) as alternatives to traditional resection. We welcome original research articles and reviews that provide high-quality evidence to guide both academic discourse and daily clinical practice.

Topics of interest for publication include, but are not limited to, the following:

Advanced Hemostasis: Clinical impact of new-generation energy-based devices (EBDs) on operative time and post-operative bleeding.

Functional Preservation: Updates in intraoperative neuromonitoring (IONM) for the protection of the recurrent laryngeal nerve and the external branch of the superior laryngeal nerve.

Near-Infrared Autofluorescence (NIRAF): The role of label-free imaging and indocyanine green (ICG) fluorescence in parathyroid gland identification and vascularization assessment to prevent post-operative hypocalcemia.

Metabolic Safety: Innovative strategies and technologies to predict and prevent post-thyroidectomy hypocalcemia and hypoparathyroidism.

Perioperative Optimization: Implementation and outcomes of enhanced recovery after surgery (ERAS) protocols in thyroid units.

De-escalation Strategies: Shifting the paradigm toward less invasive management, including the role of lobectomy/hemithyroidectomy for low-risk carcinomas and the implementation of active surveillance for papillary microcarcinoma.

Minimally Invasive Frontiers: Evolution of robotic-assisted, endoscopic, and remote-access thyroidectomy (e.g., TOETVA, retroauricular approach).

Non-Surgical Alternatives: The role of Thermal Ablation (Radiofrequency, Laser, and Microwave) in the management of benign nodules and microcarcinomas.

Dr. Damiano Chiari
Guest Editor

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