Visual identification of the recurrent laryngeal nerve during thyroidectomy

Abstract

INTRODUCTION: Injuries to the recurrent laryngeal nerve (RLN) are always a possible complication of thyroidectomy, in spite of various technical proposals aimed at reducing these risks. The aim of this study is the description of the technical methods used by us for identification.

MATERIALS AND METHODS: Onehundred seventyfive patients underwent thyroidectomy with a technique consisting in a systematic search of the RLN in the tracheoesophageal groove where it crosses the ITA avoiding ligatures, sections or electro-coagulation before making a definite identification of the nerve which then takes place and is then safeguarded until laryngeal insertion.

RESULTS: In 95.4% of the cases total thyroidectomy was performed and in 4.6% of the cases a hemi-thyroidectomy, with a total of 342 identifications of the RLN. In two cases (1.14%) the laryngeal nerve was non-recurrent. There was no operative mortality. There were no bilateral lesions of the RLN, while unilateral lesions occurred in 2.8% of cases (5/175) of which 3 (1.7%) with temporary vocal deficit.

DISCUSSION: We examined the different methods used to facilitate the identification of the nerve including: palpatory method, peri-tracheal excision, use of loupe magnification, intraoperative nerve monitoring (IONM). None of the procedures examined showed a genuine reduction to the risk of injury. The authors emphasize that the visual identification, using the methods they described, allows the visualization and preservation of the nerve for the majority of the cases.

CONCLUSION: Taking into consideration that the various methods of preservation of the RLN have not significantly reduced the risk of injury, the visual identification with specific measures has made it possible to limit the damage to a very low number of cases.