Temporary Recurrent Laryngeal Nerve Palsy Research Articles

Comparison of postoperative complications using Harmonic scalpel and LigaSure in thyroid surgery

Background: Thyroid surgery is the most common operation in the field of endocrine surgery. The aim of this study was to compare the use of LigaSure vessel (LS) and Harmonic scalpel (HS) in 1599 total thyroid surgeries between January 2008 and December of 2022, with regards of analysis of surgical complications, duration of hospital stay and operative surgical time.
 Methods: In this retrospective study patients have been categorized into two groups: Group A included 718 patients from January 2008 to May 2013 when LigaSure vessel was used, and the Group B included 881 patients from June 2013 to December 2022 when Harmonic scalpel was used. A summary of the total number of postoperative complications cases, surgical time and the duration of hospital stay between the two groups is presented.
 Results: There was no significant difference in the sex, age, and mean operating time between the two groups (P>0.05). Either major bleeding or wound infection occurred in 4 (0.6%) or 14 (1.9%) of the patients undergoing thyroidectomy when LS was used compared to 4 (0.5%) or 15 (1.7%) of the patients undergoing thyroid surgery when HS was used (P> 0.05 and P> 0.05, respectively). In addition, either hypoparathyroidism or temporary recurrent laryngeal nerve palsy was observed in 91 (12.7%) or 39 (5.4%) of the Group A patients compared with 98 (11.1%) or 44 (5%) of the Group B patients (P> 0.05 and P> 0.05, respectively).
 Conclusion: The current study demonstrates that thyroidectomy can be safely performed with both devices without increasing the risk of complications.

Preliminary analysis of neuroprotective effects of capillary fascia preservation recurrent laryngeal nerve anatomical method in right level Ⅵ dissection

Objective: To investigate the application and effect of capillary fascia preservation between the recurrent laryngeal nerve (RLN) and common carotid artery (fascia preservation method) in nerve protection when dissecting right level Ⅵ lymph nodes for patients with papillary thyroid carcinoma. Methods: A retrospective cohort study enrolling 195 patients with papillary thyroid carcinoma undergoing right level Ⅵ lymph node dissection in Beijing Tongren Hospital from March 2021 to August 2022 was carried out. The RLN was dissected by fascia preservation method in study group and by routine method in control group. The intraoperative electrical signal amplitude of the RLN, the number of dissected lymph nodes, and the postoperative complications were recorded and analyzed. Results: A total of 195 patients (study group: 94 cases, control group: 101 cases) were collected. There were 71 males and 124 females, with the median age of 32 (39, 51) years. In the study group, the total number of right level Ⅵ lymph nodes was significantly larger than the number of right Ⅵa level lymph nodes [8 (6, 11) vs 6 (4, 8), P<0.001]. There were no significant differences between the two groups in the number of level Ⅵa or level Ⅵb lymph nodes [Ⅵa: 6 (4, 8) vs 5 (3, 7), P=0.373; Ⅵb: 3 (1, 4) vs 2 (1, 4), P=0.337] and metastasis rate [Ⅵa: 51.1% (48/94) vs 52.5% (53/101), P=0.844; Ⅵb: 12.8% (12/94) vs 15.8% (16/101), P=0.541]. The ratio of electromyography (EMG) amplitude R2 in lower level Ⅵ and entry into larynx (grouped as>90%, 50%~90%,<50%) in the study group was significantly higher than that in the control group (P<0.001). No significant differences were detected between the two groups in temporary RLN paralysis [1.1% (1/94) vs 2.0% (2/101), P=1.000]. Conclusions: Fascia preservation method can decrease the stimulus and traction to RLN and preserve the capillary network serving RLN. It can thoroughly dissect lymph nodes and decrease the injury of RLN.

Endoscopic Thyroidectomy: A 6-Year Experience from a Tertiary Care Teaching Hospital in Western India.

Background: Minimally invasive and endoscopic surgical techniques have surpassed the conventional open thyroidectomy for the treatment of thyroid nodules. Trans-axillary, Unilateral Axillo-Breast Approach (UABA), Bilateral Axillo-Breast Approach, and Trans-Oral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) are the most common endoscopic procedures performed currently. This article highlights our experiences with UABA and TOETVA over a period of 6 years. Materials and Methods: Between January 2015 and December 2020, we retrospectively analyzed our experience in Endoscopic thyroidectomy with 119 patients using UABA (n = 72) and TOETVA (n = 47) in our tertiary care teaching hospital. Both approaches used the standard three-port technique. Real time angiography was performed intraoperatively using Indocyanine Green dye to delineate the vessels in all patients. Results: The mean operative time for UABA and TOETVA was 90 and 110 minutes, respectively. Estimated blood loss was 18 mL in the former and 20 mL in the latter. Temporary Recurrent Laryngeal Nerve palsy and Hypoparathyroidism were minimal with TOETVA (5 patients versus 4 patients and 7 patients versus 2 patients). Shorter duration of hospital stay was observed with UABA (3 days versus 5 days). Cosmetic satisfaction was better with TOETVA. Conclusion: Based on our 6-year experience, we propose "JJ Hospital Criteria," which we currently follow to decide which surgical approach will yield best results. UABA and TOETVA are safe, feasible, and give exceptional cosmetic satisfaction. Both approaches should be seen as complementary rather than competitive.

Risk of Complications in Patients Undergoing Complete Thyroidectomy. A Retrospective Study

Introduction: The main aim of this study was to determine the influence of surgery on postoperative complications in patients undergoing total thyroidectomy. Methods: Patients diagnosed with goiter and undergoing total thyroidectomy for more than ten years were retrospectively enrolled, and the main study outcomes were postoperative complications. Statistical analysis was done by chi-square and t-test with a p-value &lt;0.05 as significant. Results: A total of 116 patients with goiter were identified (mean age, 45.3 ± 8.75 years, with minimum and maximum age of 23 to 69). The most affected age with goiter resulted in 41-50 years old with 41.4% (95% CI, 37.4 to 45.8%). The majority of patients with goiter were women (85.3%), with a mean age of 47 years. After the thyroid surgery, male patients had significantly higher rates of hospital readmission than females with a risk ratio [RR] of 1.05; 95% CI [0.67–1.52], p-value = 0.02. Either hemorrhage/hematoma occurred in 4.7% and cardiopulmonary and thromboembolic events in 3.1% of the patients undergoing total thyroidectomy. In addition, either hypoparathyroidism was observed in 3.1% and temporary recurrent laryngeal nerve palsy (RLN) in 1.56%. Conclusion: The current study demonstrates that total thyroidectomy is associated with an increased rate of hemorrhagic complications. RLN palsies and hypoparathyroidism are less observed. Male patients undergoing thyroidectomy have higher rates of readmission and ICU admission. Furthermore, male patients revealed higher rates of hemorrhage and wound infection, while hypoparathyroidism or temporary recurrent laryngeal nerve palsy was more frequent among female patients.

Risk of Complications in Patients Undergoing Complete Thyroidectomy. A Retrospective Study

Introduction: The main aim of this study was to determine the influence of surgery on postoperative complications in patients undergoing total thyroidectomy. Methods: Patients diagnosed with goiter and undergoing total thyroidectomy for more than ten years were retrospectively enrolled, and the main study outcomes were postoperative complications. Statistical analysis was done by chi-square and t-test with a p-value &lt;0.05 as significant. Results A total of 116 patients with goiter were identified (mean age, 45.3 ± 8.75 years, with minimum and maximum age of 23 to 69). The most affected age with goiter resulted in 41-50 years old with 41.4% (95% CI, 37.4 to 45.8%). The majority of patients with goiter were women (85.3%), with a mean age of 47 years. After the thyroid surgery, male patients had significantly higher rates of hospital readmission than females with a risk ratio [RR] of 1.05; 95% CI [0.67–1.52], p-value = 0.02. Either hemorrhage/hematoma occurred in 4.7% and cardiopulmonary and thromboembolic events in 3.1% of the patients undergoing total thyroidectomy. In addition, either hypoparathyroidism was observed in 3.1% and temporary recurrent laryngeal nerve palsy (RLN) in 1.56%. Conclusion: The current study demonstrates that total thyroidectomy is associated with an increased rate of hemorrhagic complications. RLN palsies and hypoparathyroidism are less observed. Male patients undergoing thyroidectomy have higher rates of readmission and ICU admission. Furthermore, male patients revealed higher rates of hemorrhage and wound infection, while hypoparathyroidism or temporary recurrent laryngeal nerve palsy was more frequent among female patients.

Preliminary experience of robotic lateral neck dissection via combined axillary-retroauricular approach for N1b papillary thyroid carcinoma

Objective: To evaluate the feasibility, safety, and short-term efficacy of robotic lateral neck dissection via combined axillary-retroauricular approach for N1b papillary thyroid carcinoma (PTC). Methods: Thirty patients with cT1-2N1bM0 PTC who received robotic lateral neck dissection via combined axillary-retroauricular approach were included in the Department of Otorhinolaryngology of Sun Yat-sen Memorial Hospital from December 2016 to December 2020. There were 10 males and 20 females, with a median age of 34.5 years and a median body mass index of 25.55 kg/m2. The clinical, surgical, complications, pathology and follow-up data were analysed with SPSS 25.0 software package. Results: The median operative time of 30 patients was 255.50 min, the median operative blood loss was 69.00 ml, and the median postoperative hospital stay was 6.00 days. The incidence of postoperative temporary recurrent laryngeal nerve paralysis was 3.33% (1/30), temporary hypoparathyroidism was 16.67%(5/30), temporary accessory nerve injury was 3.33% (1/30), hematoma was 3.33% (1/30) and chylous leakage was 3.33% (1/30). The median visual analogue scale (VAS) score was 8.00, and the follow-up time was 13-38 months, with a median of 25.5 months. One case showed cervical lymph node recurrence 14 months after surgery. The most recent dynamic recurrence risk stratification showed 21 patients (70.00%) had excellent responses. Conclusions: Robotic lateral neck dissection via combined axillary-retroauricular approach for unilateral cN1b PTC is safe, feasible and aesthetic. The short-term efficacy and dynamic recurrence risk stratification results of short-term follow-up are satisfactory. It can provide a surgical option for cN1b PTC patients.

Importance of Intraoperative Neuromonitoring Parameters in Predicting Temporary Recurrent Laryngeal Nerve Palsy Following Thyroid Surgery for Malignancy.

Recurrent laryngeal nerve (RLN) palsy is one of the feared complications following thyroid surgery. Intraoperative neuromonitoring (IONM) has been used as an adjunct to reduce this complication. In the present study, we attempted to evaluate the IONM parameters such as latency, current requirement, and baseline amplitude that could predict temporary RLN palsy along with factors that could influence these parameters during thyroid surgery. This was a retrospective study of patients who underwent hemi, total, or completion thyroidectomy for cancer at our institute between June 1, 2017 to May 31, 2019 in whom IONM was used during surgery. The study consisted of 84 consecutive patients with 138 nerves at risk. The RLN palsy rate in our study was 5% (n = 7). Patients with low baseline amplitude and/or requiring higher current to maintain normal baseline amplitude were often associated with temporary RLN palsy. In the multivariate analysis, age > 40years (p = 0.001, OR = 4.14) influenced the baseline EMG amplitude the most. The intraoperative current management was influenced by advanced pT stage (p = 0.001, OR = 2.87), and structural nerve injury (p = 0.001, OR = 3.15). Patients with low baseline amplitude and/or requiring higher current to maintain normal baseline amplitude were often associated with temporary RLN palsy. Factors such as age, pT stage, and structural nerve injury influenced the IONM stimulation and recording parameters.

Thyroidectomy for the Management of Differentiated Thyroid Carcinoma and their Outcome on Early Postoperative Complications: A 6-year Single-Centre Retrospective Study.

Thyroid carcinoma (TC) accounts for one percent of all carcinomas, with a higher incidence in women. Although there is controversy on the selection of the best surgical treatment for differentiated TC, total thyroidectomy (TT) and subtotal thyroidectomy (STT) are still the two main surgical procedures. The aim of the present study was to evaluate the early complication rates of thyroidectomy in patients undergoing thyroid surgery at a tertiary hospital in Greece. A total of 306 patients with differentiated TC who underwent thyroid surgery were enrolled retrospectively. Patients were divided into two groups. Group A included 214 patients undergoing TT, whereas 92 patients (group B) underwent STT. Demographic details of patients, operating time, and early complications (hypoparathyroidism, hematoma, infection, temporary recurrent laryngeal nerve palsy) were noted. There was no significant difference in the sex, age, and mean operating time between the two groups (P=0.47, P=0.55, and P=0.09, respectively). Either hematoma or wound infection occurred in 3 (1.4%) or 4 (1.87%) of the patients undergoing TT compared to two (2.17%) or three (3.26%) of the patients undergoing STT (P=0.63 and P=0.46, respectively). In addition, either hypoparathyroidism or temporary recurrent laryngeal nerve palsy was observed in 34 (15.89%) or 13 (6.07%) of the patients undergoing TT compared with eleven (11.96%) or nine (9.78%) of the patients undergoing STT (P=0.37 and P=0.25, respectively). The current study demonstrates that total thyroidectomy can be safely performed in patients with differentiated thyroid carcinoma without increasing the risk of early complications.

Assessment of Complications following Thyroid Surgery

Background : Different diagnostic tools are available for assessment of post operative outcomes of thyroid surgery. This study was done to reach a consensus and to find out the best diagnostic tool for assessment of post operative complications of thyroid surgery.&#x0D; Materials and methods : A cross sectional study was carried out in the Medical Centre Hospital Between July 2016 to June 2017. Total 50 patients were included in the study, where post operative complications of patients were assessed, studied and enrolled. To assess the post operative outcomes of patients undergoing thyroid surgery. Data were analyzed and presented as both qualitative and quantitative data as applicable using SPSS version 20. The quantitative data were analyzed by mean, standard deviation. The qualitative data were analyzed by Mc NEMAR test (Mc NEMAR χ2 test). For all analytical test, the level of significance was set at 0.05 and p value equal or less then 0.05 was considered as significant, p value more than 0.05 was considered as not significant.&#x0D; Results : Fifty patients were selected for the study who were treated by Thyroidectomy. The mean patient's age at the time of surgery was 40.9±9.1 years ranged from 10 to 60 years. Data were collected in a prescribed data collection sheet. Then all data were compiled and analyzed. Result: 14% of the patients had complications, of them 2% had transient hypoparathyroidism, 4% had haemorrhage, 2% had temporary Recurrent Laryngeal Nerve (RLN) palsy and 2% had permanent recurrent laryngeal nerve palsy, 2% had Superior Laryngeal Nerve (SLN) palsy &amp; 2% had wound infection. Improved surgical techniques and proper management of complications reduce the postoperative morbidity and mortality of thyroid surgery.&#x0D; Conclusions: Different types of complications may occur following thyroid surgery. In spite of all measures, keen observation in postoperative period is very important to find out the complications for early intervention.&#x0D; JCMCTA 2021 ; 32 (1) : 44-47

Meta-analysis on continuous nerve monitoring in thyroidectomies.

In the last decade, the introduction of continuous intraoperative recurrent laryngeal nerve (RLN) monitoring (C-IONM) has enabled the operator to verify the functional integrity of the vagus nerve-recurrent laryngeal nerve (VN-RLN) axis in real-time. We aim to present the current evidence on C-IONM utility for thyroid surgery by conducting the first meta-analysis on this technique. A systematic review of literature was conducted by two independent reviewers via Ovid in the Medline, EMBASE, and Cochrane reviews databases. The search was limited to human subject research in peer-reviewed articles of all languages published between Jan 1946 and April 2020. Medical subject headings (MeSH) terms utilized were thyroid surgery, thyroidectomies, recurrent laryngeal nerve, vagal nerve, monitor, and stimulation. Thirty-eight papers were identified from Ovid, another six papers were identified by hand-search. A random effect meta-analysis was performed with assessment of heterogeneity using the I2 value. A total of 23 papers that investigated the use of continuous vagal nerve monitoring during thyroid surgery were identified. The proportion of nerves at risk (NAR) with temporary RLN paralysis postoperation was 2.26% (95% CI: 1.6-2.9, I2 = 37). The proportion of NAR with permanent RLN palsy postoperation was 0.05% (95% CI: 0.08-0.2, I2 = 0). In this meta-analysis, there is one case of temporary vagal nerve paralysis secondary to VN electrode dislodgement, and a case of hemodynamic instability manifested in bradycardia and hypotension in the initial phase of surgery shortly after calibration. C-IONM is a safe and effective means by which RLN paralyses in thyroid surgery can be reduced.

Trans Oral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) in Brazil: Safety and complications during learning curve.

The aim of this study was to address the first cases of TOETVA done in Brazil, by TOETVA-Bra study group, regarding safety and complications. Series of the first 93 TOETVAs cases in Brazil. All authors except LPK, AJG JOR and RPT received TOETVA training including cadaveric hands-on in Thailand or United States (Johns Hopkins Medicine) during 2017. After they came back to Brazil and started doing their first TOETVA cases in the cities of Rio de Janeiro, Sao Paulo and Chapecó they agreed to collaborate and gather data using an online spreadsheet. All patients were submitted to the technique described by Anuwong. A total of 93 patients underwent TOETVA. Most patients (58.1%) were submitted to total thyroidectomy and 59.1% had benign disease. Two patients (2.2%) needed conversion to open surgery. Five patients (9.3%) developed transient hypoparathyroidism and there were 3 (2.0%) temporary recurrent laryngeal nerve palsy. There was one (0.7%) permanent unilateral palsy. Twenty patients had some sort of complication, 16.1% were minor and 5.4% were major. A total of 73 patients (78.5%) had an uneventful recovery. The technique is reproducible with a low complication rate. While further studies are needed to confirm equivalency, early efforts suggest that TOETVA is not inferior to traditional open thyroidectomy in appropriately selected patients.

Endoscopic Left Central Lymph Node Dissection of Thyroid Cancer: Safe, Feasible, and Relatively Easy.

Purpose. The purpose of this study was to explore the feasibility of left central lymph node dissection (CLND) in endoscopic thyroidectomy via chest-breast approach (ETCB). Methods. Retrospective analysis of 57 cases of left CLND (group A) via ETCB, 35 cases of open left CLND (group B), and 90 cases of right CLND via ETCB (Group C) were performed from October 2014 to October 2019. Surgical data, complications, and follow-up data were compared among group A and group B, group A and group C, respectively. Results. There were no significant differences between group A and group B in intraoperative blood loss, tumor size, lymph node (LN) metastasis rate, dissected LN number, metastatic LN number, serum thyroglobulin (sTg), radioactive iodine uptake (RAIU), radioactive technetium uptake (RATU), radionuclide imaging of the residual area (RITRA), and radionuclide imaging of suspicious lymph node metastasis (RISLNM). There were no significant differences between group A and group C in age, operation time, intraoperative blood loss, postoperative hospital stay, tumor size, LN metastasis rate, dissected LN number, metastatic LN number, hypoparathyroidism, sTg, RAIU, RATU, RITRA, and RISLNM. There were 5 cases of temporary recurrent laryngeal nerve (RLN) palsy and 1 case of recurrence in group C. Besides, 1 case of lymphatic leakage was in group A. Conclusion. For selected cases, endoscopic left CLND is safe, feasible, efficient, and more easier than endoscopic right CLND.

Combined cervicosternotomy and cervicotomy for true retrosternal goiters: a surgical cohort study

ObjectiveIntrathoracic goiters are a heterogeneous group characterized by limited or extensive substernal extension. Whereas the former can be treated through cervicotomy, the latter sometimes requires a cervicosternotomy. Whether cervicosternotomy leads to more morbidity remains unclear.This study aimed to compare intra- and postoperative morbidity in patients treated by cervicotomy or cervicosternotomy for intrathoracic goiters and standard thyroidectomy.MethodsIn a prospectively gathered cohort undergoing thyroid surgery (2010–2019) intra- and postoperative morbidity of cervicotomy (N = 80) and cervicosternotomy (N = 15) for intrathoracic goiters was compared to each other and to a ‘standard’ thyroidectomy (N = 1500).ResultsAn intrathoracic extension prior to surgery was found in 95 (6%) of all thyroidectomies. Eighty patients (84%) were operated by cervicotomy and 15 (16%) by cervicosternotomy. The risk of temporary recurrent laryngeal nerve palsy was much higher in the cervicosternotomy group (21%) compared to cervicotomy (4%) and standard thyroidectomy (3%). The risk of temporary hypocalcemia after cervicotomy (28%) was comparable to a standard thyroidectomy (32%) but higher after cervicosternotomy (20%). No cases of permanent hypocalcemia or laryngeal nerve palsy were observed in both groups with substernal extension. The need for surgical reintervention was significantly higher in the cervicotomy group (6%) compared to cervicosternotomy (0%) and standard thyroidectomy (3%).ConclusionIn patients undergoing thyroid surgery for an intrathoracic goiter, cervicosternotomy was associated with more temporary laryngeal nerve palsy, but none of the interventions resulted in higher risks of permanent nerve damage, permanent hypocalcemia, or reintervention for bleeding. Reintervention was even more common after cervicotomy compared to cervicosternotomy.Level of evidenceIV

Neuromonitoring of recurrent laryngeal nerves in thyroid surgery comparative study of visualisation and electrophysiology methods.

Úvod: Poran&#283;ní zvratného nervu je jedna znejzáva&#382;n&#283;j&#353;ích komplikací chirurgie &#353;títné &#382;lázy, chirurgie p&#345;í&#353;títných t&#283;lísek achirurgie kr&#269;ních obratl&#367;. Vliteratu&#345;e se popisuje poran&#283;ní zevní v&#283;tve hrtanových nerv&#367; jako mén&#283; &#269;asté. Tato komplikace je natolik vá&#382;ná, &#382;e m&#367;&#382;e vést kinvalidizaci hlasových profesionál&#367; (u&#269;itel&#367;, herc&#367;, zp&#283;vák&#367;, profesionálních &#345;e&#269;ník&#367; amana&#382;er&#367;). Sou&#269;asná klinická praxe je spojena se zvý&#353;eným úsilím operopera&#269;ní ochranu funkce zvratných nerv&#367; vyu&#382;íváním elektrofyziologické monitorace funkce inervace hrtanu asou&#269;asné vizualizace zvratných nerv&#367;. Metody: Design studie je prospektivní observa&#269;ní. Ze souboru 100 po sob&#283; jdoucích operací byly chirurgy náhodn&#283; vytvo&#345;eny dv&#283; skupiny: Skupina A- spou&#382;itím neuromonitoringu (IONM) askupina B - identifikace avizualizace zvratného nervu (NLR) bez IONM. Jeden tým chirurg&#367; byl slo&#382;en zexperta (více ne&#382; 1000 provedených operací) aza&#269;ínajícího chirurga (mén&#283; ne&#382; 100 operací) adruhý ze dvou zku&#353;ených chirurg&#367; (jeden více ne&#382; 150 operací adruhý více ne&#382; 500 operací). Ka&#382;dý tým byl zapojen do operací n&#283;kolikrát vtýdnu. Porovnání bylo provedeno statistickými metodami apomocí indexu poran&#283;ní zvratného nervu (recurrent nerve injury - IRI). Cílem studie je porovnat incidenci parézy zvratných nerv&#367; p&#345;i vyu&#382;ití neuromonitorace (IONM) avyu&#382;ití peropera&#269;ní vizualizace anatomicky neporan&#283;ného nervu dv&#283;ma týmy chirurg&#367;. Výsledky: Bylo analyzováno 100 operací, respektive 50 operací ve skupin&#283; Aa50 ve skupin&#283; B. Skupina Azahrnovala 43 totálních thyreoidektomií a7 hemithyreoidektomií abyly zji&#353;t&#283;ny dv&#283; do&#269;asné jednostranné parézy. Skupina Am&#283;la IRI=1,075. Skupina B zahrnovala 48 totálních thyreoidektomií a2 hemithyreoidektomie. Vtéto skupin&#283; byly zji&#353;t&#283;na také dv&#283; jednostranné do&#269;asné parézy zvratného nervu. Skupina B m&#283;la IRI=1,02. Uvedené hodnoty IRI tak charakterizují asymetrické soubory, itato drobná asymetrie je ve výsledku hodnoty patrna. Celková incidence poran&#283;ní zvratných nerv&#367; vcelém souboru operovaných sledovaného roku, ve kterém byl výb&#283;r pacient&#367; dle metodiky této práce, byla 1,3%. Vsouboru bylo 16 do&#269;asných a4 permanentní parézy zvratného nervu ve v&#353;ech p&#345;ípadech na jedné stran&#283;. Vesledovaném období nebyla zji&#353;t&#283;na ani jediná oboustranná paréza trvalá ani do&#269;asná. Index IRI pro operace &#353;títné &#382;lázy vuvedeném období byl 2,26. Tento soubor byl srovnáván se soubory skupiny Aaskupiny B avýsledky nevykazují statisticky významné rozdíly na hladin&#283; významnosti 1% (p=0,01). Záv&#283;r: Studie neprokázala statisticky významné rozdíly incidence poran&#283;ní zvratného nervu (trvalá jednostranná paréza) vzávislosti na chirurgické technice bez vyu&#382;ití IONM asvyu&#382;itím IONM provád&#283;ných chirurgem srozdílnou zku&#353;eností vchirurgii &#353;títné &#382;lázy. Studie prokázala, &#382;e IONM m&#367;&#382;e pomoci vyrovnat handicap uza&#269;ínajících amén&#283; zku&#353;ených chirurg&#367; aomezit incidenci morbidity zvratného nervu vchirurgii &#353;títné &#382;lázy.

Safety and efficacy of microscope-assisted thyroidectomy

Introduction: Due to closely related structures like recurrent laryngeal nerve and parathyroid gland, thyroid surgery becomes challenging. Microscope assisted surgery has better visualization for dissection, and decreases the risk of injury to the nerve, parathyroid gland, and its vascular pedicle. Hence it decreases the operative complications.&#x0D; Method: This is a retrospective study of microscope-assisted thyroidectomy at Gandaki Medical College Teaching Hospital, Nepal from January 2017 to December 2019. Ethical approval was obtained from Institutional review committee. Types of surgery, postoperative hypocalcemia and recurrent laryngeal nerve function were analyzed descriptively.&#x0D; Result: Out of total 48 microscope assisted thyroidectomy, 41 were female, 42(87.5%) benign pathology, 6(12.5.%) malignant. Hemithyroidectomy was done in 40(83.4%), total thyroidectomy 4 (8.2%), total thyroidectomy with neck dissection 3(6.3%), and completion thyroidectomy with neck dissection in 1(2.1%). Among total thyroidectomies, transient hypocalcemia occurred in 2(4.2%) and temporary recurrent laryngeal nerve palsy in 1(2.1%). No complication occurred in hemithyroidectomies.&#x0D; Conclusion: Microscope-assisted thyroidectomy is a safe procedure which leads to reduced complication of hypocalcemia and recurrent never palsy.

Protection of nerve function during transoral endoscopic thyroidectomy by vestibular approach

Objective: To explore the method of functional protection in transoral endoscopic thyroidectomy by vestibular approach. Methods: Retrospective analysis was performed on the case data of 66 patients who underwent transoral endoscopic thyroidectomy by vestibular approach in the Department of Otorhinolaryngology Head and Neck Surgery of Beijing Tongren Hospital from February 2018 to February 2020. There were 11 males and 55 females aged 22-64 years, including 19 patients with benign diseases and 47 patients with malignant diseases. Important neurological functions were protected by a combination of anatomical exposure and intraoperative nerve monitoring. The clinical data and the effect of neurofunctional protection were summarized. SPSS 25.0 software was used for statistical analysis. Results: All operations were successfully completed with none transferred to open surgery. Three weeks after surgery, the numbness and tingling symptoms in the lower jaw and lower lip were basically relieved. There was no permanent mental nerve palsy, no permanent recurrent laryngeal nerve palsy but 2 cases with temporary recurrent laryngeal nerve palsy, no external branch injury of superior laryngeal nerve. There were 3 cases of temporary parathyroid gland dysfunction, 1 case of neck infection, 2 cases of subcutaneous effusion, 1 case of neck skin injury, and 2 cases of postoperative eye conjunctivitis. Conclusion: In transoral endoscopic thyroidectomy by vestibular approach, anatomical exposure can decrease mental nerve injury, and anatomical exposure combined with intraoperative nerve monitoring can protect the functions of the external branches of the superior laryngeal nerve and the recurrent laryngeal nerve.

Complications following thyroidectomy for benign thyroid diseases and their correlation with clinical, anatomical, and biochemical parameters

Background: Hypocalcemia and recurrent laryngeal nerve (RLN) palsy are common complications following thyroidectomy. The study was designed to assess the effect of preoperative clinical and biochemical features and the intraoperative anatomical features on the rate of complications following total thyroidectomy (TT) for benign thyroid disease. Materials and Methods: The prospective observational study was conducted on patients undergoing TT for benign thyroid diseases. All patients underwent complete assessment followed by the estimation of thyroid function (free T4 and thyroid-stimulating hormone). Ultrasound imaging of the neck and guided aspiration from the suspicious area for cytology were performed routinely. All patients were followed for minimum 6 months. Parameters used for the analysis included demographic features, feel of the gland, presence of adhesions to surrounding soft tissue, presence of retrosternal extension, and anatomical features of laryngeal nerves and parathyroid glands. Results: One hundred and twenty-five eligible candidates were included in the study and temporary hypocalcemia and temporary RLN palsy occurred in 48 (38%) and 9 (6.5%) patients, respectively. None of the patients had permanent complications. Failure to identify all four parathyroids was associated with a higher incidence of hypocalcemia (P Conclusion: Meticulous surgical dissection and thorough knowledge of anatomy prevent the development of both hypocalcemia and RLN palsy in TT for benign thyroid disorders.

Safety of central compartment neck dissection for transoral endoscopic thyroid surgery in papillary thyroid carcinoma.

Remote access and endoscopic thyroid surgery has been gaining popularity because it allows patients to avoid a visible scar in the neck. There is limited data on transoral endoscopic thyroidectomy when it relates to patients with papillary thyroid carcinoma. We aim to evaluate the safety of ipsilateral central compartment dissection for patients who undergo transoral thyroidectomy (thyroidectomy vestibular approach-compartment lymph node dissection). A total of 80 patients who underwent thyroidectomy vestibular approach-compartment lymph node dissection for papillary thyroid carcinoma from June 2015 to September 2016 were identified. Over the same period, a matched cohort of 80 patients who underwent open thyroidectomy with routine ipsilateral central compartment dissection was also identified (Open-compartment lymph node dissection). The two groups were analyzed in terms of patient characteristics, perioperative clinical results and post-operative outcomes. All patients were female with a mean age of 32-year. There was no difference in mean maximum tumor size and number of lymph nodes dissected. Moreover, there was no difference in average positive lymph nodes between thyroidectomy vestibular approach-compartment lymph node dissection and Open-compartment lymph node dissection (1.48 vs 1.08, P=0.647). Operative time was longer in the thyroidectomy vestibular approach-compartment lymph node dissection group (193 vs 102 min, P<0.001). Thyroidectomy specific complications were similar with rates of temporary recurrent laryngeal nerve palsy of 6.3 vs 8.8% and temporary hypocalcemia rates of 2.5 vs 5% in the thyroidectomy vestibular approach-compartment lymph node dissection and Open-compartment lymph node dissection groups, respectively. Thyroidectomy vestibular approach-compartment lymph node dissection is a feasible and safe option for select patients with papillary thyroid carcinoma who require central node dissection compared with Open-compartment lymph node dissection, and can be a viable alternative for patients wishing to avoid a visible scar.

Thyroid lobe size predicts risk of postoperative temporary recurrent laryngeal nerve paralysis.

ObjectivesIn patients who had undergone thyroidectomy in Japan for benign tumor, we determined whether thyroid lobe size correlates with temporary recurrent laryngeal nerve paralysis (T‐RLNP).MethodsWe retrospectively collected medical record data on usage of intraoperative neuromonitoring, laterality of thyroidectomy, amount of bleeding during surgery, duration of surgery, and whether the surgeon was a board certified otorhinolaryngologist as determined by the Oto‐Rhino‐Laryngological Society of Japan. Thyroid size was measured in preoperative axial computed tomography (CT) images. Receiver operating characteristic (ROC) curve analysis was used to determine the thyroid size that predicted a high risk of T‐RLNP or permanent recurrent laryngeal nerve paralysis (P‐RLNP).ResultsOf the 146 eligible patients identified, 9 (6.2%) developed T‐RLNP and 2 (1.4%) developed P‐RLNP. The amount of bleeding during thyroidectomy was significantly greater in T‐RLNP patients than in P‐RLNP patients. Thyroid sizes in CT images were significantly larger in T‐RLNP patients compared to patients who did not develop RLNP (referred to hereafter as N‐RLNP). ROC analysis revealed that 1.3% of thyroid lobes with an area of less than 1000.0 mm2, and 9.9% of thyroid lobes with an area of greater than 1000.0 mm2 were at risk for T‐RLNP.ConclusionWe presented evidence that thyroid sizes, as measured on preoperative axial CT images, were larger in T‐RLNP patients than in N‐RLNP patients. Our results indicate a connection between benign thyroid tumor stretch injuries and T‐RLNP.Level of EvidenceIV.

Changes in Tracheal Tube Cuff Pressure and Recurrent Laryngeal Nerve Conductivity During Thyroid Surgery.

The aetiology of recurrent laryngeal nerve (RLN) neurapraxia is unclear in most RLN palsies post-thyroidectomy. We hypothesised that high intralaryngeal pressures impede RLN conductivity, in turn contributing to RLN palsy. Therefore, we measured tracheal tube (TT) cuff pressure (as a surrogate for intralaryngeal pressure) and RLN conduction during ten standard manoeuvres in thyroidectomy, to assess for correlation between cuff pressure and RLN conductivity. A prospective cohort study of thyroidectomy during 2018. For each thyroid lobe, TT cuff pressure was continuously measured via an air pressure transducer. RLN conduction (amplitude and latency) was measured using continuous neuromonitoring. Changes in mean TT cuff pressure and median nerve conduction from baseline measurements were analysed using Student's t test and Wilcoxon signed-rank test. In a total of 50 RLNs, the mean baseline TT cuff pressure of 19.5 ± 8.9mmHg increased significantly to 22.0mmHg during anteromedial rotation of the thyroid (p < 0.05). RLN conduction changed during manipulation of the superior thyroid pole with shortening of latency (-0.49% from baseline, p = 0.05) and reduction in amplitude (-12.0% from baseline, p = 0.02). The timing of these deviations did not correlate with the increased TT cuff pressure. In three cases of temporary RLN palsy, the mean cumulative case TT cuff pressure was significantly higher (24.8mmHg, p = 0.02). This study demonstrates that TT cuff pressure and RLN conductivity can change significantly with manipulation of the thyroid and that high TT cuff pressures may be associated with RLN injuries.