Identification of recurrent laryngeal nerve during thyroidectomy decreases the risk of nerve injury (original) (raw)
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Recurrent laryngeal nerve injury in thyroid surgery: a review
ANZ Journal of Surgery, 2013
Recurrent laryngeal nerve palsy (RLNP) is an important and potentially catastrophic complication of thyroid surgery. Permanent RLNP occurs in 0.3-3% of cases, with transient palsies in 5-8%. A literature review and analysis of recent data regarding RLNP in thyroid surgery was performed, with particular focus on the identification of high-risk patients, the role of intraoperative identification and dissection of the nerve, and the role of intraoperative neuromonitoring (IONM) and optimal perioperative nerve assessment. In conjunction with the review, data from the Monash University/ Alfred Hospital Endocrine Surgery Unit between January 2007 and October 2011 were retrospectively analysed, including 3736 consecutive nerves at risk (NAR). The current literature and our data confirm that patients undergoing re-operative thyroid surgery and thyroid surgery for malignancies are at increased risk of RLNP. Intraoperative visualization and capsular dissection of the RLN remain the gold standard for intraoperative care during thyroid surgery for reducing RLNP risk. IONM should not be used as the sole mechanism for identifying and preserving the nerve, although it can be used to aid in the identification and dissection of the nerve, and may aid in nerve protection in high-risk cases including cancer surgery and re-operative surgery.
Recurrent laryngeal nerve injury (RLNI) in thyroid surgery and its prevention
International Journal of Research in Medical Sciences, 2015
Background: Vocal cord paresis or paralysis due to iatrogenic injury of the recurrent laryngeal nerve (RLNI) is one of the main problems in thyroid surgery. Although many procedures have been introduced to prevent the nerve injury, still the incidence of recurrent laryngeal nerve palsy varies between 1.5-14%. The aim of the present study is to assess the risk factors of recurrent laryngeal nerve injury during thyroid surgery. Methods: This was a prospective, observational study conducted in the
Journal of Head and Neck Surgery
RLN injury during thyroidectomy can result from transection, clamping, stretching, electrothermal injury, ligature entrapment, or ischemia [6]. Moreover, Anatomical integrity of the RLN does not indicate intact function [7]. The risk factors that increase RLN injury during thyroidectomy are primary or recurrent malignant diseases, recurrent benign diseases, thyrotoxicosis, the extent of the surgery, routine non-observance of RLN (no RLN dissection), low-volume hospital or surgeon, substernal goiter, nerve branching, aberrant course of the nerve, and presence of non-RLN [8-10]. The use of intraoperative nerve monitoring is a luxury that cannot be afforded by many centers and hence there is
Incidence of Recurrent Laryngeal Nerves Injury during Thyroid Surgery
Abstract: The technique of thyroidectomy has been in evolution for many years. It is a fundamental principle of surgery that a structure must be identified clearly during the procedure in order to prevent its damage. The objective of the study was to evaluate our routine identification of the recurrent laryngeal nerves during thyroidectomy aiming lessen the inadvertent injury of the recurrent laryngeal nerves during surgery. The study includes a convenience sample, non probability total coverage multicentre hospital based descriptive prospective study (December 2009 to May 2012) including all adult patients managed by subtotal thyroidectomy after acceptance of the pre given informed consent. All operations were undertaken by the same surgical team. Data collected using a predesigned questionnaire. Data analysis was performed using SPSS version 15.0 for Windows. The study included 82 patients (69 (84.15%) females and 13(15.85%) males), with male to female ratio of 1:5.3. Their mean a...
SiSli Etfal Hastanesi Tip Bulteni / The Medical Bulletin of Sisli Hospital, 2017
The mechanisms of recurrent laryngeal nerve injury during thyroidectomy and the impact of continuous intraoperative nerve monitoring on surgical strategy Objective: To evaluate the mechanisms of recurrent laryngeal nerve (RLN) injury during thyroidectomy and the impact of continuous intraoperative nerve monitoring (C-IONM) on surgical strategy. Material and Methods: The data of 364 consecutive patients who underwent total or hemithyroidectomy between June 2014 and January 2016 were evaluated prospectively. All patients underwent thyroidectomy by using C-IONM. The mechanisms of RLN injury and the outcomes of the patients with combined events (CE) and loss of signal (LOS) were evaluated. Results: Combined events (CE) occurred in 6 (1.6%) of these 364 patients. The reduced electromyographic (EMG) amplitude and prolonged latency recovered in all patients intraoperatively by the reversal of the medial traction maneuver. Loss of signal (LOS) occurred in 7(1.9%) patients. The mechanisms of LOS was ligation of the anterior branch of the nerve in 1 (14.3%) patient and traction in 4(57%) patients. The probable mechanism of LOS was traction or transection in 2 (28.6%) patients in whom LOS occurred during the dissection of the intrathoracic portion of large substernal goiter. Of these 7 patients, LOS recovered intraoperatively after 20 minutes of waiting in 1(14.3%) patient. In the remaining 6 (85.7%) patients, unilateral vocal cord paralysis (VCP) was verified on the postoperative laryngoscopic examination. The overall temporary and permanent unilateral VCP rates were 1.6% (n=6) and 0.8% (n=3), respectively in these 364 patients. No bilateral VCP was recorded. Continuous intraoperative nerve monitoring (C-IONM) prevented bilateral VCP in 1 (0.3%) patient. Conclusion: The major advantage of C-IONM is to alert the surgeon for imminent RLN injury. Combined event (CE) is a pathognomonic sign of impending nerve injury that may progress to LOS. This situation enables the surgeon to adverse (reverse) the surgical maneuver before permanent damage to the nerve sets in. Continuous intraoperative nerve monitoring (C-IONM) can also immediately spot RLN injury during thyroidectomy. This property of C-IONM gives the surgeon the opportunity for an early corrective action to release the affected nerve promptly. In case of permanent LOS, staged thyroidectomy could be planned to prevent bilateral VCP.
Recurrent and superior laryngeal nerve injury in thyroid surgery: literature review
International Journal Of Community Medicine And Public Health
Laryngeal nerve injury is considered one of the most common complications after thyroidectomy. It is associated with decreased quality of life because it will result in hoarseness of voice and aspiration. Identification of the risk factors and procedures to decrease the injury is crucial for handling laryngeal nerve injury. We searched the MEDLINE database using PubMed. Two independent reviewers reviewed the resulting papers and reviewed them based on our inclusion criteria. Based on the review results, the incidence of recurrent laryngeal nerve injury is higher than the external branch of the superior laryngeal nerve, but it is mainly due to under-reporting of the external branch of superior laryngeal nerve injury. Cancer surgery, surgeon experience, workload, re-operative procedures, and extent of surgery increased the incidence of the laryngeal nerve injury. Handling of these risk factors combined with visual dissection and inspection and/or intraoperative nerve monitoring decrea...
Recurrent Laryngeal Nerves Injury During Thyroid Surgery
Journal of Surgical Arts, 2014
The technique of thyroidectomy has been in evolution for many years. It is a fundamental principle of surgery that a structure must be identified clearly during the procedure to prevent its damage. To evaluate our routine identification of the recurrent laryngeal nerves (RLNs) during thyroidectomy aiming lessen the inadvertent injury of the RLN during surgery. A convenience sample, non probability total coverage multicentre Hospital based descriptive prospective study (December 2009 to May 2012) included all patients managed by subtotal thyroidectomy after acceptance the informed consent. All operations were undertaken in both hospitals by the same surgical team. Data collected using a predesigned questionnaire. All thyroidectomies were evaluated, and the various types of recurrent laryngeal nerves were recorded. Data was analyzed using SPSS version 15.0. It included 82 patients [69 (84.15%) females and 13 (15.85%) males], with male to female ratio of 1:5.3. Their mean age was 42.8 years (SD±8.4 years). All were treated by subtotal thyroidectomy. The rate of identification of the RLN was 100% for all patients. The overall frequency of RLN injury was 1.2% seen in one patient. Study proved that surgical exposure of the RLNs avoids the incidence of its damage.
Annali italiani di chirurgia, 2021
Identification of the recur-rent laryngeal nerve during thyroidectomy can affect the complication rate AIM: Identification of recurrent laryngeal nerve (RLN), performed via different techniques, decreases nerve injury during thyroidectomy. We aimed to evaluate the effect of different anatomic levels at which RLN was identified on postoperative complications. MATERIAL AND METHODS The patients underwent total thyroidectomy or lobectomy without lymph node dissection were included. Two different surgical methods were performed: thyroidectomy identifying RLN at level of inferior thyroid artery (ITA) (Group 1); at level of Berry's ligament (Group 2). Patients were evaluated with indirect laryngoscopy on 3rd postoperative day, if nerve damage was determined, at each six months. Nerve damage and postop hypocalcemia were accepted transient up to 6th month, permanent after 6th month. Total serum calcium levels were postoperatively measured on 24th and 48th hours, and then monthly. RESULTS...
World Journal of Surgical Oncology, 2013
Background: Previous thyroid or parathyroid surgery induces scarring or distorts anatomy, and increases the risk of recurrent laryngeal nerve (RLN) injury for a reoperation. The benefit of intraoperative nerve monitoring (IONM) for re-exploration (a second nerve exploration) and reoperation has not been established. Methods: Two hundred and ten patients were given a thyroid or parathyroid reoperation at our hospital between 2001 and 2010. Using IONM, we re-explored 56 patients who had been operated on before June 2007. The injury rate in these patients was compared with that of the 15 patients re-explored without IONM between 2001 and 2006. Results: Of the 70 nerves that were re-explored using IONM, only one was incidentally injured, significantly fewer than the three injured in the 15 nerves re-explored without using IONM (1.43% vs. 20%, P = 0.0164). Conclusions: IONM helped prevent RLN damage when re-exploring nerves during thyroid and parathyroid surgery. We recommend the routine use of IONM in thyroid and parathyroid reoperations.