Tips and tricks for a safe and effective ultrasound-guided minimally invasive treatment of thyroid nodules: a narrative technical review

Image-guided thermal ablations are nowadays increasingly used to provide a minimally invasive treatment to patients with thyroid nodules, with reported good clinical results and a low complication rate. Different ablative techniques can be applied, each with specific advantages and disadvantages according to the clinical situation. Moreover, percutaneous ablation of thyroid nodules might be complex in cases where there is limited access for image guidance or a close proximity to critical structures, which can be unintentionally injured during treatment. In the present paper we offer an overview of the most commonly used ablative techniques and of the most important manoeuvres that can be applied to enhance the safety and effectiveness of percutaneous image-guided thyroid ablations. Emphasis is given to preoperative evaluation, the different technical aspects of ablation, operating room setting, image guidance, and some tips and tricks for a safe and effective treatment are presented.