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Recurrent Laryngeal Nerve Morbidity: Lessons from Endoscopic via Bilateral Areola and Open Thyroidectomy Technique

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Abstract

Background and aim

Elucidating the mechanism of recurrent laryngeal nerve (RLN) injuries through intraoperative electromyographic (EMG) and laryngeal examination approaches may deepen our knowledge regarding its prevention strategies. To date, no studies have been reported on the mechanism of RLN injury caused by endoscopic thyroidectomy via bilateral areola approach (ETBAA).

Methods

Both intraoperative EMG profiles and postoperative laryngeal examination were used to investigate the mechanisms of RLN injury and compare the safety aspects between ETBAA and open thyroidectomy approach (OTA).

Results

This study examined 1420 nerves at risk. The mean follow-up period was 17 ± 4 (range 6–48) months. The incidence of vocal cord paralysis was 4.1% (59/1420). The number of cases with decreased EMG signals and vocal cord palsy was higher in ETBAA group than in OTA group (P < 0.05). The left RLNs in ETBAA group were at higher risk compared to the right nerves.

Conclusions

The results of the current study indicate that ETBAA exhibits higher risk of RLN injury. The topic includes a video.

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Funding

This study was funded by the National Nature Science Foundation of China (No. 81702651), China Postdoctoral Science Foundation (No. 2017M611313), Department of Science and Technology of Jilin Province (Nos. 20170520018JH, 20190201225JC).

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Author notes

  1. Nan Liang and Hui Sun have equal contributors.

Authors and Affiliations

  1. Division of Thyroid Surgery, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, China-Japan Union Hospital of Jilin University, 126 Xiantai Blvd, Changchun City, Jilin Province, People’s Republic of China

    Daqi Zhang, Jiao Zhang, Fang Li, Tie Wang, Hongbo Li, Nan Liang & Hui Sun

  2. Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood ‘‘G. Barresi’’, University Hospital G. Martino, University of Messina, Via C. Valeria 1, 98125, Messina, Italy

    Gianlorenzo Dionigi

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  1. Daqi Zhang
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  3. Gianlorenzo Dionigi
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  4. Fang Li
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Contributions

HS, NL and GD were involved in conception and design; HS, NL and GD contributed to administrative support; and DZ performed collection and assembly of data.

Corresponding authors

Correspondence to Nan Liang or Hui Sun.

Ethics declarations

Conflict of interest

The authors Daqi Zhang, Jiao Zhang, Gianlorenzo Dionigi, Fang Li, Tie Wang, Hongbo Li, Nan Liang and Hui Sun declare no conflict of interest. The funders had no role in (1) the design of this study; (2) the collection, analysis and interpretation of data; (3) the writing of the manuscript; or (4) the decision to submit the manuscript for publication.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Zhang, D., Zhang, J., Dionigi, G. et al. Recurrent Laryngeal Nerve Morbidity: Lessons from Endoscopic via Bilateral Areola and Open Thyroidectomy Technique. World J Surg 43, 2829–2841 (2019). https://doi.org/10.1007/s00268-019-05092-x

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