Bleeding
In the event of massive intraoperative bleeding (e.g., from Kocher's vein or the inferior thyroid artery), tamponade is initially performed, and continuous suction is used to attempt to identify the vessel in order to clamp and ligate it.
Note: For every thyroid surgery, it is advisable to check for hemostasis under PEEP ventilation of the patient before wound closure.
Detection of Signal Loss in IONM (Intraoperative Neuromonitoring)
If it occurs on the first side of a planned bilateral resection, it is advisable to refrain from resecting the contralateral side to avoid the risk of bilateral recurrent laryngeal nerve palsy.
Hypoperfusion or Accidental Removal of a Parathyroid Gland (PG)
Typically, autotransplantation is performed after histological confirmation of the organ in 1 mm³ cubes into a pocket of the ipsilateral sternocleidomastoid muscle (do not forget documentation!).
Prophylaxis:
In addition to the gold standard of visual identification, at least in complex cases, an additional localization method with spontaneous or induced fluorescence is recommended (autofluorescence, ICG fluorescence, PT-EYE).
A statement about the vascularization or devascularization of the parathyroid gland can only be achieved with ICG fluorescence angiography.
Tracheal Injury
Immediate suturing if possible, suture coverage with additional material (pericardium, pleura, sternocleidomastoid muscle, fleece-bound tissue adhesive), possibly stent, peri- and postoperative antibiotic therapy
Esophageal Injury
In extensive tumor or goiter surgeries, direct suture, antibiotics, drainage
Pleural Injuries/Tension Pneumothorax (in deep cervical resection)
Suture, possibly thoracic drainage