Identification of the recurrent laryngeal nerve during thyroidectomy can affect the complication rate


COD: 25_02_2021_2991_aop Categorie: , ,

Veli Vural, Bülent Çomçalı, Barış Saylam, Faruk Coşkun
Ann Ital Chir, 2021; 10 – Febb. 25
Online ahead of print

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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
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: Unilateral and bilateral RLN damage were detected as 4.4% and 2.2% in Group 1; and 8% and 2.67%
in Group 2, respectively. The frequency of RLN damage was similar (p=0.62). Postoperative hypocalcemia was significantly
higher in Group 1 (p=0.04); hypocalcemia was similar (p=0.149). One patient in Group 1, and 2 patients in
Group 2 had f superior laryngeal nerve (SLN) injury. Three patients from each group showed permanent hypocalcemia.
One patient in Group 1, and two in Group 2 developed permanent hoarseness.
DISCUSSION: RLN injury was similar in both groups, however, temporary hypocalcemia was more frequent in patients
undergone thyroidectomy with RLN identification at ITA level.
CONCLUSIONS: Devascularization of parathyroid glands may be accused. Future studies are needed.