Abstract
Objective. To evaluate the clinical efficacy of laryngeal nerve (LN) monitoring (LNM) during total endoscopic thyroidectomy via breast approach, with emphasis on the identification rates for RLN and EBSLN and the incidence of RLN paralysis. Materials and Methods. This retrospective study included 280 patients who underwent endoscopic thyroidectomy with or without LNM. RLN and EBSLN were identified using endoscopic magnification in the control group, while they were localized additionally by LNM in the LNM group. Demographic parameters and surgical outcomes were analyzed by statistical methods. Patients in the control group were also stratified by the side of thyroidectomy to determine difference in left and right RLN injury rates. Results. All procedures were successfully conducted without permanent LN damage. The identification rates for RLN and EBSLN were high in the LNM group compared to those of the control group, and the risk difference (RD) of temporary RLN injury between two groups was 6.3%. The risk of damage was slightly higher for the left RLN than for the right RLN in the control group, which was performed by a right-hand surgeon. Conclusion. The joint application of LNM and endoscopic magnified view endows total endoscopic thyroidectomy with ease, safety, and efficiency.
Highlights
Thyroid surgery has long been considered an effective treatment option for malignant thyroid diseases
We evaluated the clinical efficacy of LN monitoring (LNM) during total endoscopic thyroidectomy via the breast approach and found a significant improvement in the recurrent laryngeal nerve (RLN) and external branch of the superior laryngeal nerve (EBSLN) detection rates with this modality
Intraoperative RLN identification has long been credited with the benefit of decreasing the incidence of postoperative nerve paresis
Summary
Thyroid surgery has long been considered an effective treatment option for malignant thyroid diseases. Injuries to the external branch of the superior laryngeal nerve (EBSLN) and recurrent laryngeal nerve (RLN) are still well-defined hazards in endoscopic thyroid surgery. EBSLN injury may decrease the range of vocal cord vibration frequencies, affecting the capability to generate a higher vocal register and decreasing voice projection. This nerve injury reportedly occurs in up to 58% patients during dissection or ligation of the superior thyroid pedicle [2, 3]. Several studies have reported that LN monitoring (LNM) during conventional thyroidectomy enables the reliable localization of both EBSLN and RLN, with improved neurological outcomes [5, 6]. To the best of our knowledge, the effectiveness of LNM during total endoscopic thyroidectomy
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