Implementing Ultrasound-Guided Microwave Ablation for Benign Thyroid Nodules in ENT Practice: Technical Considerations and Early Clinical Experience.

Background/Objectives: Ultrasound-guided microwave ablation (MWA) has emerged as an effective minimally invasive treatment for benign thyroid nodules, but practical guidance regarding implementation of the technique within otorhinolaryngology practice remains limited. This study aimed to describe the implementation of ultrasound-guided MWA for benign thyroid nodules in a tertiary ENT center, with emphasis on technical considerations, procedural safety, and early clinical outcomes. Methods: A retrospective analysis of prospectively collected data included consecutive patients seen at the ENT outpatient clinic between March 2024 and July 2025. All procedures were performed by a single ENT surgeon, and technical aspects were described. Procedural characteristics, pain, complications, nodule volume reduction, compressive symptoms, cosmetic outcomes, and thyroid function were evaluated through 3-month follow-up. Results: Twenty-five patients underwent ultrasound-guided MWA for 30 benign thyroid nodules. All procedures were successfully completed under local anesthesia. No major complications occurred; two patients developed minor, self-limiting ecchymosis. Median nodule volume decreased from 12.77 mL (IQR, 4.13-17.74) at baseline to 3.81 mL (IQR, 1.31-7.60) at 3 months, corresponding to a mean volume reduction ratio of 63.8%. Significant improvements in compressive symptoms and cosmetic scores were observed (p < 0.001). All patients remained euthyroid, with no cases of new-onset hypothyroidism. Conclusions: This early experience supports the feasibility and short-term procedural safety of ultrasound-guided MWA for selected benign thyroid nodules within an ENT setting. Careful patient selection, meticulous technique, and structured operator training appear to be key components for successful implementation. Beyond its favorable early clinical outcomes, this study provides a practical framework for centers seeking to establish thyroid MWA programs.