Identification of the external branch of the superior laryngeal nerve during minimally invasive video-assisted thyroidectomy

Rogério A Dedivitis,André V Guimarães

doi:10.1016/s1808-8694(15)31330-6

Abstract

SummaryThe minimally invasive video-assisted thyroidectomy (MIVAT) without gas infusion is considered safe and has advantages in terms of cosmetic results compared to the conventional approach. Aim: to present our findings regarding the identification of the external branch of the superior laryngeal nerve (EBSLN) during MIVAT. Study design: Transversal cohort study. Material and Method: twelve patients underwent hemithyroidectomy for thyroid nodular disease through MIVAT method. The upper pedicle of the thyroid was dissected under the magnified view at 0-degree five-millimeter endoscope in order to achieve the identification of EBSLN in all cases. Results: We identified 10 (83.3%) EBSLN out of 12 cases. The nerve ran medially to the branches of the superior thyroid artery in 8 cases (80%) and crossed anteriorly in 2 (20%). Conclusions: We identified the EBSLN in 83.3% of the cases, whose course was medial to the branches of the superior thyroid artery in 80% and crossing anteriorly in 20%. The ligation of the upper pedicle of the thyroid can be performed under direct view of the EBSLN.

Highlights

Since the first report of video-assisted endoscopic subtotal parathyroidectomy in 1996 1, a technique for the thyroid approach has been investigated 2
Invasive video-assisted thyroidectomy (MIVAT) is considered a safe procedure with esthetical advantages compared to the conventional procedure[3]
Out of 12 cases submitted to hemithyroidectomy, we identified external branch of the superior laryngeal nerve (EBSLN) in 10 cases (83.3%), and its path was medial

Summary

Introduction

Since the first report of video-assisted endoscopic subtotal parathyroidectomy in 1996 1, a technique for the thyroid approach has been investigated 2. It consists on the creation of a space using minimally invasive methods in which pre-thyroid muscles are pushed aside laterally with a retractor and there is no gas insufflation. Invasive video-assisted thyroidectomy (MIVAT) is considered a safe procedure with esthetical advantages compared to the conventional procedure[3]. The visualization of the branch is not made as a routine owing to its small diameter (0.2 millimeters) and variable course; in MIVAT the magnified vision through the optic lens allows its identification 5

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