The significance of routine exposure of recurrent laryngeal nerve in thyroidectomy
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Objective To investigate the significance of routine exposure of recurrent laryngeal nerve (RLN)in thyroidectomy.Methods The data of consecutive 232 patients with thyroidectomies during 2009-2010 were retrospectively reviewed.All operations,either lobectomy or total thyroidectomy were performed by the same surgeons.The RLN was identified routinely during the operation.Results Totally 280 RLNs were exposed in 181 thyroid lobectomies and 51 total thyroidectomies(98.9%).Ten patients experienced post-operative hoarseness(3.6%).Seven patients were diagnosed with paralysed vocal cord post-operatively,although the RLN were identified intact during the surgeries,and their voice became normal in 2 months.Another 3 patients'RLNs were transected injured and re-anastomosed during the same procedures and their voice became normal in 4 months.Conclusions Exposing the recurrent laryngeal nerve in the thyroidectomy is an effective way to prevent permanent injury to RLN.
Key words:
Thyroidectomy; Recurrent laryngeal nerve; Nerve injuryKeywords:
Vocal Cord Paralysis
Recurrent nerve
Iatrogenic injury
Objective:To study the methods of protecting recurrent laryngeal nerve(RLN) in endoscopic thyroidectomy through the upper part of sternum.Methods:The clinilical data of 46 cases underwent endoscopic thyroidectomy through the upper part of sternum was analyzed.RLN was revealed when we performed nodulectomy or partial thyroidectomy.But during subtotal and near-total thyroidectomy the RLN was always revealed.Results:Forty-five of forty-six cases were compeleted successfully with endoscopic thyroidectomy.One case was converted to open thyroidectomy because of thyroid carcinoma.No intraoperative or postoperative hemorrhage,RLN injuried and deadlimb occurred.Conclusion:In order to reduce the injury of RLN,we should select the fitting cases strictly,master the opportunity and methods of revealed RLN.
Sternum
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Objective To discuss the strategies in avoiding recurrent laryngeal nerve(RLN) injury during thyroidectomy. Methods The clinical data of 539 cases of thyroidectomies were retrospectively analyzed. Of these, 19 patients experienced RLN injury. The relationship between RLN injury occurrence and total or subtotal thyroidectomy, exposing or not the RLN were studied. The therapeutic efficacy of immediate reparation after the nerve was found cut was evaluated. Results The rate of RLN injury while routine exposition was carried out or not during total thyroidectomy was 3.5% and 19.3%, respectively. The rate of RLN injury was higher in total thyroidectomy than that in subtotal thyroidectomy. Immediate RLN reparation was an effective measure to be taken when the nerve was found cut. Conclusion Exposing the RLN routinely during total thyroidectomy is a reasonable step to be taken, it makes RLN injury be discovered immediately and reparation be done.
Subtotal thyroidectomy
Nerve Injury
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Objective To investigate the feasibility of dissection for recurrent laryngeal nerve(RLN) in endoscopic thyroidectomy via an anterior chest approach.Methods From January 2004 to March 2009,58 cases underwent endoscopic thyroidectomy for thyroid diseases via an anterior chest approach.RLN was not identified when performing nodulectomy or partial thyroidectomy,while RLN would be identified during lobectomy and near-total thyroidectomy.Results Fifty-six of the 58 cases were completed successfully with endoscopic thyroidectomy and 2 cases were converted to open thyroidectomy because of thyroid carcinoma.No intraoperative or postoperative hemorrhage,RLN injury and numbness of the limb occurred.Conclusions In order to avoid the injury to the RLN,The suitable cases should be selected appropriately,and the indication and methods of indentification of the RLN in endoscopic thyroidectomy would be mastered.
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We evaluated our surgical approach to the identification of the recurrent laryngeal nerve (RLN) under the guidance of operation microscope and RLN dissections during thyroidectomy.Twenty-three patients (20 females, 3 males; mean age 37 years) undergoing thyroidectomy were included in the study. Thirty RLN dissections were performed, being unilateral in 16 patients, and bilateral in seven patients. The recurrent laryngeal nerves were identified at the inferior thoracic inlet with the use of the operation microscope having an ocular lens of 250 mm, followed by a total dissection up to the laryngeal entrance. Endoscopic laryngeal examinations were performed for vocal cord movements one day before surgery and postoperatively on days 1, 3, and 7.No abnormal vocal cord movements were detected preoperatively. Following surgery, none of the patients developed persistent RLN paralysis. Two patients exhibited transient vocal cord paralysis (limitation in vocal cord movements). The use of the operation microscope for RLN dissections resulted in prolongation of the operation time ranging from 15 to 40 minutes for each side, which tended to decrease with enhanced experience of the surgeon.The use of the operation microscope enables safe RLN dissections during thyroidectomy operations.
Operating microscope
Vocal Cord Paralysis
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Objective To explore the clinical significance of exposure the recurrent laryngeal nerve(RLN)for preventing the RLN injury in thyroidectomy.Methods The data of 1 723 patients with thyroid diseases undergoing total or subtotal thyroidectomy from September 2006 to August 2011 were retrospectively reviewed.RLN were exposed in 914 cases,1 203 RLNs were exposed(exposed group).RLN were unexposed in 809 cases,1 013 sides were cut(unexposed group).To compare RLN injury rate after operation and recovery of vocal cord in 6 months after operation between the two groups.Results In exposed group,11 cases had RLN injury,the rate of RLN lesion was 0.91%.In unexposed group,21 cases had RLN injury,the rate of RLN lesion was 2.07%.The differences between the two groups had statistical significance(P 0.05).When six months after operation,0 case and 13 cases in exposed group and unexposed group respectively occurred permanent RLN injury,the differences between the two groups had statistical significance(P0.01).Conclusion Exposure of RLN in total and subtotal thyroidectomy can significant avoid RLN injury,especially RLN permanent injury.
Clinical Significance
Nerve Injury
Iatrogenic injury
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OBJECTIVE To explore the possibility of no recurrent laryngeal nerve injury in thyroid surgery. METHODS A total of 659 consecutive patients with thyroid disease undergoing thyroidectomy byotolaryngologists from March 2001 to March 2005 were retrospectively analyzed. The operative mode and incidence of complications, particularly postoperative RLN palsy, hypoparathyroidism and postoperative recurrence were evaluated. Routine dissection and identification of the RLN was performed during all operative procedures and parathyroid with the blood supply was preserved. RESULTS Unilateral total thyroidectomy with contralateral partial lobectomy was performed in 376 cases, unilateral total thyroidectomy with isthmectomy in 87, bilateral subtotal thyroidectomy with the remnant left at the upper pole in 76, total thyroidectomy in 73. The operations on 47 patients with substernal goiter have been successfully performed via cervical collar incision. None of our patients incurred unilateral or bilateral vocal cord paralysis and permanent hypocalcaemia. Of these patients, the incidence of temporary postoperative hypocalcemia was 1.67 %(11/659). Postoperative hemorrhage requiring reoperation occurred in 4 cases (0.60 %) and 5 patients developed wound haematomas (0.76 %).Postoperative hypothyroidism was found in 3 patients(0.45 %).The incidence of postoperative recurrence was 0.15 %(1/659). No patients had incision infection. CONCLUSION With knowledge of the anatomy of the RLN and routinely complete identification the RLN in performing capsular dissection high on the surface of the thyroid gland, RLN injury may be avoided in thyroid surgery. [
Hypocalcaemia
Hypoparathyroidism
Parathyroid gland
Vocal Cord Paralysis
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Objective To investigate the value of intraoperative neuromonitoring(IONM) for preventing recurrent laryngeal nerve(RLN) injury in thyroid surgery.Methods 1087 consecutive patients undergoing thyroid surgery at Wuhan Central Hospital from Oct 2010 to Dec 2012 were evaluated.277 cases(the study group) underwent thyroidectomy with RLN identification by naked eye plus IONM.810 cases(the control group)underwent thyroidectomy with RLN identification by naked eye only.Results In the control group,733 RLNs (90.49％,733/810)were successfully identified and 77 RLNs were failed to be identified.In the study group,all the 277 RLNs(100％,277/277)were successfully identified.28 cases had postoperative temporal RLN injury,among whom 26 cases were in the control group and 2 cases were in the study group.18 cases in the control group and 2 cases in the study group recovered in 2 weeks after surgery.The rest recovered in 2 months after surgery.RLN injury rate was significantly lower in the study group than in the control group.There was no significant difference in RLN injury for low-risk surgical patients between the 2 groups; however,the study group had advantages in RLN injury than the control group for high-risk patients.Conclusions IONM in thyroid surgery can improve the recognition rate of RLN during thyroidectomy.IONM can significantly reduce the incidence of RLN injury,especially in high-risk surgery.
Key words:
Intraoperative neuromonitoring; Recurrent laryngeal nerve; Thyroid surgery
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Objective To evaluate the effectiveness of surgical technique improvement in thyroid lobectomy for prevention of recurrent laryngeal nerve (RLN) injury. Methods The clinical data of 85 patients of thyroid disease undergoing 126 lobectomies from Jan 2010 to Jan 2011 were retrospectively analyzed.All patients undergone accurate thyroid lobectomy with accurate envelop anatomic dissection,skeletonized blood vessels. Recurrent laryngeal nerve was all dearly exposed. Results No-bleeding surgical area was achieved.The RLN was exposed.Unilateral temporary RLN injury occurred in 2 cases.The rate of RLN injury was 1.59％ (2/126). There was no bilateral and perpetual RLN injury.Conclusions Carrying through the accurate thyroid lobectomy,the incidence of RLN injury is low.
Key words:
Thyroid diseases; Thyroidectomy; Recurrent laryngeal nerve; Wounds and injury
Nerve Injury
Iatrogenic injury
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Objective To study the significance of dissection and exposure of the recurrent laryngeal nerve(RLN)in thyroid surgery.Methods The clinical data of 218 patients who had undergone operations on thyroid were retrospectively analysed.All cases were routinely operated with dissection and exposure of the recurrent laryngeal nerve.Results There were no injury cases of RLN after the operations.Conclusion The injury of nerve can be reduced with exposal the recurrent laryngeal nerve during the thyroid surgery.
Nerve Injury
Iatrogenic injury
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Objective To explore the prevention of recurrent laryngeal nerve (RLN) injury in thyroid surgery. Methods The clinical data of 816 cases underwent thyroid surgery from 1986 to 2005 were analysed. Results In subtotal and total thyroidectomy, RLN permanent injury occurred in exposure group in 1 case, and non-exposure group in 7 cases, there was significant difference between two groups. In partial thyroidectomy, RLN temporary injury occurred in exposure group in 10 cases, and non-exposure group in 2 cases, there was significant difference between two groups. Conclusion Exposure of RLN may avoid permanent injury in subtotal and total thyroidectomy, non-exposure of RLN may decrease temporary injury in partial thyroidectomy.
Nerve Injury
Subtotal thyroidectomy
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