Do No Harm: Trying to RFA Ablate The Whole Benign Nodule is Not The Goal.

Relieving symptoms and correcting the cosmetic problem is the goal.The treatment of a benign condition with surgery or RFA should have very low serious complications. I consider the loss of a patient’s normal voice for 6 months serious. This occurs when the operator gets too close to the recurrent nerve, and if the patient is not fully awake then they may not know about the heat damage to the nerve until the patient is more awake and can talk. The rescue technique of iced dextrose injection the area around the nerve must be done as an emergency and usually requires aborting the procedure. The voice may return rather quickly and the procedure can be resumed. Screening patients out if they are requiring sedation is an option for operators to avoid serious complications when the patient is not fully conscious.

“Our group has as our main objective of relief of symptoms and cosmetic problems. The desire to ablate as much of the nodule as possible is not out main objective. This approach leads to increase in complications. The electrode placed in a more central area of the nodule away from the recurrent nerve,vagus, carotid, and trachea will reduce the nodule enough to correct the symptoms and improve the cosmetic problem in many patients. The recent paper by a group from Texas and Utah had a higher than expected complication rate.This included a 6 month recurrent nerve palsy. This was in 50 patients.”One patient had self-limited local bleeding and another had transient voice change that recovered in 6 months.” They did not stick to just use of Lidocaine for the skin and thyroid capsule but used conscious sedation in some patients.

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