Surgical steps and exposure skills of recurrent laryngeal nerve in total endoscopic thyroidectomy

Objective To investigate the surgical approach and the exposure skills of recurrent laryngeal nerve in total endoscopic thyroidectomy. Methods 213 patients underwent total endoscopic thyroidectomy from Oct 2004 to May 2016. Three hole method and via chest wall and breast pathway was used to set up a chest wall passage to neck and the operating space. We dissect thyroid according to the skills of "separate, lift, pry, pull, cut" . Recurrent laryngeal nerve was exposed on the principle of "1 mm dissection and cut" and "meticulous capsular dissection " . Results 213 thyroidectomy was performed by endoscopy. Mean operative time was (115±33.6) min, mean blood loss was (20.7±9.5)ml, RLN was not exposed in 47 cases of unilateral partial lobectomy. RLN was exposed in 166 cases of other surgical procedure. 4 cases suffered from temporary hoarseness, 8 cases had peripheral numbness of mouth and extremity.5 cases suffered from postoperative bleeding, and were cured by secondary laparoscopic surgery.Operative mortality was nil. Conclusions Total endoscopic thyroidectomy has the prominent neck cosmetic effect. According to principle of 1 mm dissection and meticulous capsular dissection, total endoscopic thyroidectomy can be performed safely. Key words: Thyroid diseases; Thyroidectomy; Recurrent laryngeal nerve