Is craniocaudal dissection of recurrent laryngeal nerve safer than lateral approach: a prospective randomized study comparing both techniques by using continuous intraoperative nerve monitoring

Yalin Iscan; Nurcihan Aygun; Ismail Cem Sormaz; Fatih Tunca; Mehmet Uludag; Yasemin Giles Senyurek

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자료유형: 학술저널

저자정보: Yalin Iscan (Istanbul University) Nurcihan Aygun (University of Health Sciences Turkey) Ismail Cem Sormaz (Istanbul University) Fatih Tunca (Istanbul University) Mehmet Uludag (University of Health Sciences Turkey) Yasemin Giles Senyurek (Istanbul University)

저널정보: 대한외과학회 Annals of Surgical Treatment and Research Annals of Surgical Treatment and Research Vol.103 No.4

발행연도: 2022.10

수록면: 205 - 216 (12page)

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Purpose: This study was performed to compare the real-time electromyographic (EMG) changes and the rate of recurrent laryngeal nerve (RLN) injury in craniocaudal and lateral approaches for RLN during thyroidectomy.
Methods: One hundred twelve and 86 patients were prospectively randomized to receive lateral (group 1) or craniocaudal (group 2) approach to RLN, respectively, under continuous intraoperative nerve monitoring.
Results: Loss of signal (LOS) occurred in 7 (2.0%) of 356 nerves at risk (NAR). LOS was significantly associated with repeated adverse EMG changes and presence of RLN entrapment at the ligament of Berry (LOB), which was accompanied by other clinicopathological or anatomical features, such as tubercle of Zuckerkandl (TZ), extralaryngeal branching, hyperthyroidism, autoimmune thyroid disease (ATD), or thyroid lobe volume of >29 cm3 (P = 0.001 and P = 0.030, respectively). The rate of repeated adverse EMG changes and LOS in the NARs with LOB entrapment accompanied by other clinicopathological and anatomical features was higher in group 1 vs. group 2 (11.1% vs. 2.2%, respectively and 9.7% vs. 0%, respectively; P = 0.070). The total rate of vocal cord palsy (VCP) was significantly higher in group 1 than in group 2 (P = 0.005). The rate of permanent VCP showed no significant difference between the 2 groups.
Conclusion: The craniocaudal approach to the RLN is safer than the lateral approach in the RLNs with entrapment at the LOB accompanied by other features, such as TZ, extralaryngeal branching, hyperthyroidism, ATD, or high thyroid lobe volume.

#Intraoperative nerve monitoring #Loss of signal #Nerve dissection #Recurrent laryngeal nerve #Thyroidectomy

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