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Selective vagus-recurrent laryngeal nerve anastomosis in thyroidectomy with cancer invasion or iatrogenic transection

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Abstract

Purpose

Immediate recurrent laryngeal nerve (RLN) reconstruction at the time of thyroid cancer extirpation can provide excellent postoperative phonatory function. This study is to present our experience with the methods of RLN reconstruction, and to evaluate the role of selective vagus to RLN anastomosis (SVR) in thyroidectomy.

Methods

Respective review of RLN reconstruction in thyroid surgery from January 2004 to October 2018 was conducted in two tertiary referral academic medical centers.

Immediate RLN reconstruction was performed for primary thyroidectomy patients with intraoperative nerve tumor invasion or iatrogenic transection. Laryngofiberoscopic examination, voice evaluation of maximum phonation time, and GRBAS scale were performed preoperatively, on the second day after surgery, and monthly postoperatively for the first year.

Results

A total of 37 patients were enrolled. Twenty-nine RLNs were resected caused by tumor-associated trauma; the other nerves were inadvertently transected. Direct anastomosis (DA) was performed in eight patients, free nerve graft (FNG) was performed in four patients, ansa cervicalis to RLN anastomosis (ARA) was performed in eight patients, and SVR was performed in 17 patients. The mean periods from the reinnervation surgery of DA, SVR, ARA, and FNG to the phonation recovery were 46 ± 19 (days), 41 ± 29 (days), 83 ± 21 (days), and 137 ± 32 (days), respectively. There were improvements in the GRBAS scale of perceptual voice quality at 1 month for DA and SVR, 2months for ARA.

Conclusions

Intraoperative SVR reinnervation demonstrated voice improvement postoperatively and might be an effective treatment for thyroidectomy-related permanent unilateral vocal cord paralysis.

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Acknowledgments

The authors thank the studied patients for their willingness to cooperate with our study.

Author information

Authors and Affiliations

  1. Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, 169 Donghu Road, Wuhan, Hubei, 430071, People’s Republic of China

    Qianqian Yuan, Jinxuan Hou, Yiqin Liao, Lewei Zheng & Gaosong Wu

  2. Department of Thyroid and Breast Surgery, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, Hubei, 430030, People’s Republic of China

    Kun Wang

Authors
  1. Qianqian Yuan
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  3. Yiqin Liao
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  4. Lewei Zheng
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  5. Kun Wang
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  6. Gaosong Wu
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Contributions

Study conception and design: Gaosong Wu and Qianqian Yuan; acquisition of data: Qianqian Yuan, Yiqin Liao, and Lewei Zheng; analysis and interpretation of data: Kun Wang and Jinxuan Hou; drafting of manuscript: Qianqian Yuan; critical revision of manuscript: Gaosong Wu.

Corresponding author

Correspondence to Gaosong Wu.

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The authors declare that they have no conflict of interest.

Research involving human participants

This research was comprised of human participants and was approved by Medical Ethics Committee of Wuhan University Zhongnan Hospital. This article does not contain any studies with animals performed by any of the authors.

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

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ESM 1

After the procedure of neuroanastomosis, the reconstructive nerve was stimulated. (MP4 1694 kb).

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Yuan, Q., Hou, J., Liao, Y. et al. Selective vagus-recurrent laryngeal nerve anastomosis in thyroidectomy with cancer invasion or iatrogenic transection. Langenbecks Arch Surg 405, 461–468 (2020). https://doi.org/10.1007/s00423-020-01906-y

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