Teaching Recurrent Laryngeal Nerve Dissection to Residents in Head and Neck Endocrine Surgery

Abstract

ABSTRACTBackgroundVarious approaches can be employed when teaching thyroidectomy. Delivery of the gland prior to complete dissection and identification of the recurrent laryngeal nerve (RLN) is sometimes utilized in the absence of laryngeal nerve monitoring (LNM), while identification and dissection of the RLN from the gland is more feasible in the presence of LNM. We hypothesized that teaching RLN dissection technique to residents as primary surgeons (using loupes and nerve monitoring) did not increase postoperative morbidity in head and neck endocrine surgery.Materials and methodsIn 101 consecutive patients who underwent thyroidectomies/parathyroidectomies, we have modified our technique to teach our residents consistent early identification of the RLN in the paratracheal region by direct visualization (loupe magnification) and nerve stimulation. All patients had preoperative fiberoptic laryngoscopy and a repeat laryngoscopy 1 week after surgery. Presence or absence of true vocal fold paralysis/paresis was documented.ResultsOne hundred and nineteen surgical procedures were available for study. One patient developed a permanent vocal fold paralysis (1/119 or 0.84%). There was another patient with a vocal fold paresis which recovered in 4 weeks (1/119 or 0.84%).ConclusionThe RLN dissection technique with early identification, dissection and preservation of the nerve using magnification combined with nerve monitoring has emerged as an important resident teaching tool. The morbidity rate is acceptable. Notably in light of the increasing rates of thyroid surgery and LNM utilization, resident physicians may benefit from exposure to this technique as a component of their training.How to cite this articleSundaram K, Aynehchi BB. Teaching Recurrent Laryngeal Nerve Dissection to Residents in Head and Neck Endocrine Surgery. Int J Head and Neck Surg 2012;3(1):5-7.