Two ways to have this surgery
The difference is whether you are asleep.
Most thyroid and parathyroid surgery is done with you fully asleep. It does not have to be.
Fully asleep
- A breathing tube and general anesthesia
- A slower, foggy day after you wake up
- More risk if you have heart or lung problems
- Nausea and grogginess are more common
- No memory of surgery
- Ability to monitor nerves with a nerve monitoring tube
Awake and comfortable
- Numbing medicine and light sedation instead
- Clear-headed right away — no fog to sleep off
- Potentially less risk from the anesthesia itself
- Home the same day for most patients, back to yourself fast
- Involved with your surgical experience
- Monitor nerves with intermittent communication during surgery
Why it matters
For many people, the anesthesia is the scary part.
Not the surgery. The idea of being fully asleep during the surgery.
That fear is fair. General anesthesia is very safe for most people. But it carries its own small risks. It means a breathing tube. It means a slow, foggy few hours after. And for some patients, it is a real concern, not just a worry.
Staying awake takes that whole layer away. Here are the people it helps most.
You are afraid of going under
If the anesthesia frightens you more than the operation, an awake option can change everything about how you feel walking in.
You have heart or lung concerns
Being put under is a bigger deal when your heart or lungs are not at their best. Numbing medicine and light sedation ask far less of your body.
You want your day back
No breathing tube and no deep sedation means no long recovery from the anesthesia. Most people are clear-headed and home the same day.
What can be done awake
More than you might think.
Awake care is not limited to simple procedures. For carefully chosen patients, all of the following can be done without general anesthesia:
Parathyroid surgery
When scans point to one overactive gland, we can often go straight to it. We remove it through a small, targeted approach, while you are awake and comfortable. Learn more about focused parathyroid surgery.
Thyroid surgery
For the correct nodule, or the correct type of thyroid problem, surgery can be done with numbing medicine and light sedation instead of full anesthesia. Whether it fits depends on the size and position of the problem.
Ablation — no cut at all
Needle treatments are almost always done awake. Radiofrequency ablation, microwave ablation, and ethanol ablation shrink certain nodules through the skin. There is no cut and no general anesthesia.
Am I a candidate?
Honestly — it depends, and we decide together.
Awake surgery is a real option. But it is not right for every patient or every problem. We will not talk you into it. We will not talk you out of it. We will tell you the truth about your case.
These are the things that tend to matter when we decide:
The size and position
Smaller and well-placed problems are the best fit. Very large glands, or hard-to-reach spots, may still need full anesthesia.
Your overall health
Sometimes staying awake is safer for you. Sometimes your health points the other way. We weigh it with care.
Your comfort with it
You have to be at ease lying still and awake. If that is not you, that is fine. It is just good to know up front.
The only way to know for sure is a conversation. Book a consultation and we will tell you plainly whether this is a safe and good choice for you.
What it is like
Step by step, start to finish.
We plan it together first
Before the day, we go over your scans. We answer every question and agree on the plan. You will know just what to expect and how to prepare.
We numb the area
On the day, we use numbing medicine so the area cannot feel pain. We add light sedation to help you relax. You stay awake, but calm and comfortable.
You are awake during the surgery
You can rest, breathe easily, and even talk with us. You should not feel pain. At most, you feel some pressure or movement. Dr. Russell does the whole operation himself.
No fog to sleep off
You were never put under, so there is nothing to wake up from. You are clear-headed right away, not groggy for hours.
Home the same day
Most patients go home the same day. You get back to yourself quickly. And you leave with Dr. Russell's own number for anything that comes up.
Why the Russell Center
Options only exist if your surgeon offers them.
Surgeons tend to recommend what they do. A team that is not set up for awake surgery will present general anesthesia as the only way.
Awake surgery takes a surgeon who works quickly and gently. It takes a team built around it. It is not something to learn on the fly. As of today, we are not aware of another practice in the country that offers thyroid and parathyroid surgery this way.
Dr. Jonathon O. Russell brought scarless remote-access thyroid surgery to the Western Hemisphere. Over the last ten years, he has done more of it than any other surgeon in the United States, by a wide margin. Surgeons travel to the Russell Center to watch him work.
We offer the full range of care. That runs from simply watching, to needle treatments, to scarless surgery. So we have no reason to push you toward one path over another. We are here to help you understand which choice is the safest and the best fit for you.
Common questions
Awake surgery, answered plainly.
Can thyroid surgery really be done without general anesthesia?
Yes, for the right patient. Using numbing medicine and light sedation, thyroid and parathyroid surgery can be done with you awake instead of fully asleep. It is not right for everyone, so the fit is decided in your consultation.
Will I feel pain during the surgery?
You should not. The numbing medicine blocks pain in the area. Most patients feel some pressure or movement, but not pain. If you ever felt discomfort, we would address it right away.
Is awake surgery safe?
For a well-chosen patient, yes — and for some people it is actually gentler than being put under, because it asks less of the heart and lungs. Safety is exactly why we choose candidates carefully rather than offering it to everyone.
Why would I want to stay awake?
Three common reasons. You may be more afraid of the anesthesia than the surgery. You may have heart or lung problems that make being put under riskier. Or you may simply want to skip the grogginess and get your day back. Staying awake helps with all three.
Who is a candidate?
It depends on the size and position of the problem, your overall health, and how comfortable you are lying still and awake. Smaller, well-placed problems are the best fit. The only way to know is a consultation, where we tell you honestly whether it is a good choice for you.
What kind of anesthesia is used instead?
Local or regional numbing medicine, which blocks pain in the surgical area, plus light sedation to help you relax. There is no breathing tube and you are not put fully under.
Will I be able to go home the same day?
Most awake patients do. Because there is no deep anesthesia to recover from, you are clear-headed soon after and can usually head home the same day.
What if I start awake but want to be asleep?
Your safety and comfort come first, always. We plan carefully so this is rare, and we talk through every option before the day. If the plan ever needs to change, we adjust — you are never trapped in a choice.
Does staying awake mean I get a smaller scar too?
They are separate choices. How much is removed and where the surgeon goes in are decided on their own. Many awake patients are also candidates for scarless surgery with no neck scar at all — we will tell you if both fit your case.
Do other surgeons offer this?
As of today, we are not aware of another practice in the country offering thyroid and parathyroid surgery without general anesthesia. It takes specific skill and a team built around it.
Find out if you can stay awake.
Tell us about your thyroid or parathyroid, and we will tell you honestly whether awake surgery is a safe and good fit for you.