Association between carbon dioxide insufflation in endoscopic thyroidectomy and intra-ocular pressure (IOP). Is insufflation contra-indicated in glaucoma patients?

Abstract

We have read with interest the paper by Lira RB et al. entitled ‘Transoral thyroidectomy (TOETVA): Complications, surgical time and learning curve’. We agree with the authors’ conclusions in that TOETVA has been shown to be safe and feasible in many publications. However following our own work on novel techniques in endoscopic thyroid surgery, we would like to share with you our concern regarding rises in intraocular pressure (IOP), which is a rare but serious side-effect of insufflation, especially associated with endoscopic neck surgery. Since open thyroidectomy leaves a very visible scar that is cosmetically undesirable in an important subset of the operated population, endoscopic techniques that take the incision outside the cervical region were developed. These are usually performed using laparoscopic tools but they have also been modified for robotic use. Carbon dioxide insufflation is commonly used to keep the working space open and therefore ensure the anatomy is visible. Whilst some (particularly the trans-axillary approach) have developed to eliminate gas insufflation, the majority of techniques still use this as a standard part of the procedure.