Mechanisms of recurrent laryngeal nerve injury in endoscopic thyroidectomy for papillary thyroid carcinoma: A large data from China.

Abstract

Purpose:

To investigate the mechanisms of recurrent laryngeal nerve (RLN) injury during endoscopic thyroidectomy via breast approach (ET-BA) in patients with papillary thyroid carcinoma (PTC).

Methods:

The records of 416 PTC patients who underwent ET-BA with intraoperative neural monitoring (IONM) from May 2015 to May 2021 in Beijing Friendship Hospital affiliated to Capital Medical University were retrospectively analyzed.

Results:

All patients were women. Mean age was 37.80 (7.87) years. The ET-BA was performed in 416 patients. Overall incidence of RLN injury was 4.3% (18 patients). Injury was transient in 13 patients (3.1%) and permanent in five (1.2%). Macroscopic physical changes were apparent in the injured nerve in five patients (27.8%) and postoperative hoarseness or cough after drinking water were present in 11 (61.1%). Two RLN injuries occurred during nerve identification at the RLN laryngeal entry point into the surgical field, 15 during early nerve dissection somewhere between the first 0.5 and 2 cm of the nerve's course through the surgical field, and one occurred distal to 2 cm. The percentage of patients with separation, transection, traction and thermal mechanisms of injury was 27.8%, 22.2%, 22.2%, and 16.7%, respectively. The mechanism of injury was unknown in 11.1%.

Conclusions:

RLN injury may still occur during ET-BA despite endoscopic magnification and early nerve identification even when IONM is used. Separation, transection, and traction injuries were the most frequent causes of injury.

• Authors: Wei Xu, Changsheng Teng, Guoqian Ding, Ning Zhao
• Journal: Laryngoscope investigative otolaryngology (Laryngoscope Investig Otolaryngol) Vol. 8 Issue 2 Pg. 604-609 (Apr 2023) ISSN: 2378-8038 [Print] United States
• PMID: 37090890 (Publication Type: Journal Article)
• Copyright: © 2023 The Authors. Laryngoscope Investigative Otolaryngology published by Wiley Periodicals LLC on behalf of The Triological Society.