Integration of Non-Thermal Plasma into the Thyroidectomy Surgical Workflow: A Prospective Pilot Study on Early
César Jaramillo-Martínez1, Régulo López-Callejas2, Mario Betancourt-Ángeles1
1Instituto de Seguridad Social del Estado de México y Municipios (ISSEMYM) Medical Centre Toluca, Av. Baja velocidad 284 km. 57.5, San Jerónimo Chicahualco, Metepec 52170, Estado de México, Mexico.
Abstract:
Background: Thyroidectomy is a cornerstone treatment for thyroid pathologies but carries risks including recurrent laryngeal nerve injury, hypoparathyroidism, and cervical haematomas. Non-thermal plasma (NTP) may improve local haemostasis and tissue healing, although its safety within the cervical neurovascular axis requires human validation. Methods: This prospective, interventional, single-arm pilot study evaluated the feasibility, reproducibility and early postoperative safety of integrating atmospheric-pressure NTP (0.5 W/cm2) into the standard thyroidectomy workflow in 30 patients. Safety endpoints included the absence of thermal injury, neurovascular complications, or surgical-site morbidity. We assessed healing and aesthetic outcomes using the Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS). Results: NTP integration achieved 100% technical feasibility, without reactor failures, gas-delivery interruptions, or thermal anomalies. No major acute complications occurred, including obstructive haematomas, recurrent laryngeal nerve injuries, or severe postoperative hypocalcaemia (0/30; 0.0%). Early incisional assessments showed favourable scores (median VSS: 1.2, IQR: 1.0-2.0; median POSAS overall opinion: 1.1, IQR: 1.0-1.5), reported descriptively at the 14-day postoperative milestone. Intraoperative biophysical evaluations and postoperative clinical tracking revealed no overt thermal anomalies or deep structural alterations, supporting high biological safety. Conclusions: Integration of NTP into the endocrine neck surgery workflow demonstrates technical feasibility, logistical efficiency, and a favourable early postoperative safety profile. The intervention is associated with a favourable early incisional healing profile without compromising adjacent vital structures. These preliminary findings support NTP as a reproducible, reliable surgical adjunct and provide a robust clinical and methodological basis for endocrine surgical practice.