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Endoscopic thyroidectomy versus traditional open thyroidectomy for identification of the external branch of the superior laryngeal nerve

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Abstract

Aim

To explore the anatomical features of the external branch of the superior laryngeal nerve (EBSLN) and determine an effective approach for its preservation during endoscopic thyroidectomy (ET).

Methods

From January 2017 to December 2018, a total of 405 consecutive patients with thyroid disease were retrospectively analyzed. These patients were divided into the ET group and the open thyroidectomy (OT) group according to the surgical approaches. There were 195 cases in the ET group including 43 males and 152 females, and 210 cases in the OT group including 65 males and 145 females. The dissection process of EBSLN, detection rate, distribution of identification methods of the EBSLN and rate of voice change were recorded.

Results

There were 205 EBSLNs detected under direct vision in ET group for a detection rate of 88.0%, while 158 EBSLNs were detected under direct vision in OT group for a detection rate of 58.1%. But with the assistant of intraoperative neuromonitoring (IONM), the number of EBSLNs detected visually reached up to 220 in ET group and 226 in OT group, respectively, for a visual detection rate of 94.4% and 83.1%, respectively. There were significant difference in the rate of direct visual identification, total visual identification with IONM. Stratified risk estimation indicated that the tumor size and location were risk factors for the direct visual dissection of EBSLN. Stratified analysis by tumor size indicated that when tumor diameter was ≤ 4 cm, the incidence of vocal cord fatigue and total vocal changes in ET group was significantly lower than that in OT group.

Conclusions

Recognition and exposure of the EBSLN can be facilitated by the magnification and focusing function of high-definition endoscopy and the advantage of a 30° variable angle. Full exposure of the sternothyroid-laryngeal triangle and fine dissection along the superior thyroid vessels is beneficial for recognizing the EBSLN.

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Acknowledgments

The work was supported by the Research project of Putian University (Grant No. 2017049).

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Authors and Affiliations

  1. Department of Thyroid Surgery, The Affiliated Hospital of Putian University, Fujian, 351100, China

    Guo-liang Zhang, Guo-lie Zhang, Yuan-mei Lin, Bing Li, Jian Gao & Yi-jun Chen

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  1. Guo-liang Zhang
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  2. Guo-lie Zhang
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  3. Yuan-mei Lin
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  4. Bing Li
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  5. Jian Gao
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Correspondence to Guo-lie Zhang.

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All the authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria, educational grants, participation in speakers’ bureaus, membership, employment, consultancies, stock ownership, or other equity interest, and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript. Guo-liang Zhang, Guo-lie Zhang, Yuan-mei Lin, Bing Li, Jian Gao, and Yi-jun Chen have no conflicts of interest or financial ties to disclose.

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Zhang, Gl., Zhang, Gl., Lin, Ym. et al. Endoscopic thyroidectomy versus traditional open thyroidectomy for identification of the external branch of the superior laryngeal nerve. Surg Endosc 35, 2831–2837 (2021). https://doi.org/10.1007/s00464-020-07718-x

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  • DOI: https://doi.org/10.1007/s00464-020-07718-x

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