Effects of Intraoperative Neural Tunnel in Protecting Recurrent Laryngeal Nerve: Experiences in Open, Trans Breast, and Transoral Endoscopic Thyroidectomy.

Xing Yu,Yujun Li,Yuancong Jiang,Yong Wang,Ping Wang,Chang Liu,Qionghua He,Zhaodi Liu

doi:10.3389/fonc.2022.779621

Abstract

BackgroundEnergy-based devices (EBDs) increase the risks of thermal nerve injuries. This study aimed to introduce a surgical strategy of intraoperative neural tunnel protecting (INTP) for evaluating the effect in reducing the incidence of recurrent laryngeal nerve (RLN) damage in open, trans breast, and transoral endoscopic thyroidectomy.MethodsINTP strategy was introduced: a tunnel was established and protected by endoscopic gauze along the direction of the nerve. A total of 165, 94, and 200 patients with papillary thyroid carcinoma (PTC) were to use INTP in respectively open, trans breast, and transoral endoscopic thyroidectomy as the INTP group. Additionally, 150, 95, and 225 patients who received the same methods without INTP were enrolled in the control group. Ipsilateral thyroidectomy or total thyroidectomy, and central compartment dissection were performed on the enrolled patients.ResultsClinicopathologic characteristics, surgical outcomes, and surgical complications were similar between the INTP group and the control group in open, trans breast, and transoral endoscopic thyroidectomy. The incidences of electromyography (EMG) changes in the INTP group were lower as compared to the control group in trans breast endoscopic thyroidectomy (p < 0.05). The incidence of postoperative hoarse in the INTP group was lower as compared to the control group in open and transoral endoscopic thyroidectomy (p < 0.05). Postoperative calcium levels (p < 0.01) were significantly higher, and the white blood cells (p < 0.05) and C-reactive protein levels (p < 0.01) were significantly decreased in the INTP group compared with the control group in transoral endoscopic thyroidectomy.ConclusionsThis was the first instance of the INTP strategy being introduced and was found to be an effective method for protecting the RLN in open, trans breast, and transoral endoscopic thyroidectomy. Additionally, INTP helped protect other important tissues such as the parathyroid glands in transoral endoscopic thyroidectomy as well as in reducing postoperative inflammatory responses.

Highlights

Paralysis of the vocal cord (VC) is one of the most frequent and serious complications following thyroidectomy surgeries [1]
The patients’ age, sex ratio, and body mass index (BMI) were similar in the intraoperative neural tunnel protecting (INTP) and control groups in open, trans breast, and transoral endoscopic thyroidectomy
We introduced a new strategy of INTP in the current study, which was found to be useful in protecting the recurrent laryngeal nerve (RLN) in open, trans breast, and transoral endoscopic thyroidectomy

Summary

Introduction

Paralysis of the vocal cord (VC) is one of the most frequent and serious complications following thyroidectomy surgeries [1]. We introduced a new strategy of intraoperative neural tunnel protecting (INTP) for evaluating the effects of INTP in reducing the incidences of RLN damages in open, trans breast, and transoral endoscopic thyroidectomy. Step 5: Gauze provided a separation barrier between thermal liquid–gas and the RLN when the HS was used to dissect non-neural tissues adjacent to the nerve. The meaning of INTP is a tunnel that was established along the direction of the nerve and protected by endoscopic gauze. This study aimed to introduce a surgical strategy of intraoperative neural tunnel protecting (INTP) for evaluating the effect in reducing the incidence of recurrent laryngeal nerve (RLN) damage in open, trans breast, and transoral endoscopic thyroidectomy

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Discussion

Conclusion