Post-thyroidectomy neck hematoma represents a major concern for surgeons because it can result in severe and even life-threatening complications. In fact, postoperative hemorrhage may result in airway compression and respiratory distress, and therefore, effective hemostasis is an important goal in thyroid surgery. Postoperative hematoma occurs at a rate of approximately 0.1% to 1.1%. Almost all cases occur in the first 6 h after surgery and can be the result of several surgeon or patient factors. For many years the clamp-and-tie technique has been the most common way to divide the main vascular pedicles of the thyroid gland. Alternatively, bipolar electrocautery has been used for only very small vessels. Other hemostatic systems have been introduced and proved to be potentially very useful in neck surgery and, in particular, for thyroid surgery.[1] Treatment of hematomas really depends on the symptoms. Most hematomas need to be evacuated and reexplored, but only an unstable or progressively worsening hematoma in a patient requires immediate evacuation at the bedside. Reintubation in a controlled operating room environment is often possible. The most senior endoscopist should perform the intubation because significant epiglottis and arytenoid edema may be present. During surgical history, numerous technical advances have emerged in hemostasis, the suture ligatures, vessel ligating clips, electrocoagulation by mono- or bipolar instruments, and topical hemostatic agents, the use of which is mainly promoted in the last years in thyroid surgery as in other surgical disciplines.

Neck hematoma, hemostasis, thyroid surgery, treatment.

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