Minilaparoscopy-Assisted Hemithyroidectomy via Bilateral Breast Approach in Nonrecurrent Laryngeal Nerve Patient with Intraoperative Neuromonitoring

Abstract

Introduction: Minilaparoscopy-assisted hemithyroidectomy via bilateral breast approach is a technique for thyroidectomy in patients with thyroid disease. This technique can promote the effect of cosmetology in thyroid surgery. In this video, we present the preoperative identity for nonrecurrent laryngeal nerve (NRLN) and identify the NRLN with intraoperative neuromonitoring (IONM). Materials and Methods: In January 2015, we operated a 36-year-old female patient. The patient underwent fine-needle aspiration cytology and right papillary thyroid carcinoma was diagnosed. After CT scanning and ultrasonic inspection preoperatively, we found that she has an aberrant right subclavian artery with the NRLN. So, we decided to use the IONM. The clinical staging is cT1aN0M0 stage I. According to the Chinese thyroid nodule and thyroid cancer guideline,1 we decided to perform hemithyroidectomy and central neck dissection via bilateral breast approach. The operation room setup and the steps to create the operation space were described in the video in the article entitled Minilaparoscopy-Assisted Hemithyroidectomy and Central Neck Dissection (Level VI) Using Bilateral Breast Approach.2 So, the approach starts with the creation of the operation space, then indent the NRLN with IONM before ligating the superior thyroid artery. Then, identify the external branch of superior laryngeal nerve with IONM. While removing the thyroid gland, the dissection continues with central neck dissection (Level IV). Finally, we present the NRLN and parathyroids after dissection and the autotransplantation of the inferior parathyroid. Results: The patient operated with this technique was hospitalized for 3 days without any postoperative complication. IONM is time-saving and safety approach for patients with NRLN. Conclusions: Minilaparoscopy-assisted hemithyroidectomy via bilateral breast approach can bring better cosmetic result and minimal invasion for youth patients. Also, IONM can save the time to identify the NRLN. Acknowledgments: This video is funded by the clinical major departments' construction Project by the Ministry of Health. The clinical major department's construction Project by Fujian Provincial and Young and middle-aged backbone training project in the health system of Fujian province (Grant No. 2013-ZQN-ZD-13). No competing financial interests exist. Runtime of video: 9 mins 32 secs