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Transcutaneous laryngeal ultrasonography: a reliable, non-invasive and inexpensive preoperative method in the evaluation of vocal cords motility—a prospective multicentric analysis on a large series and a literature review

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Abstract

Thyroidectomy is a largely performed intervention and its rate has sharply increased. The most feared postoperative complication is the recurrent laryngeal nerve paralysis, which is the most frequent cause of medicolegal litigations. Therefore, surgeons have introduced the preoperative evaluation of vocal cords function through laryngoscopy. Transcutaneous laryngeal ultrasonography has been proposed as a non-invasive indirect examination of vocal cords function. The aim of this study is to assess transcutaneous laryngeal ultrasonography reliability as an alternative painless and inexpensive method in the evaluation vocal folds function in patients amenable of thyroid surgery. We conducted a prospective multicentric study on patients affected by thyroid disease referred to the thyroid surgery divisions of two tertiary hospitals. All patients preoperatively underwent transcutaneous laryngeal ultrasonography and subsequently were evaluated via laryngoscopy by a blinded otolaryngologist. The ultrasonographical and laryngoscopical findings were then compared by an external blinded investigator. Our analysis on 396 patients showed an assessability rate of 96.46%, a sensitivity of 96.8%, a specificity of 95.6%, a positive predictive value of 65.2% and a negative predictive value of 99.7% in the identification of vocal cords alterations. A concordance between transcutaneous laryngeal ultrasonography and laryngoscopy of 95.7% was reported. In 14 patients (3.54%), the investigator reported a hard visualization of vocal cords through ultrasonography. Transcutaneous laryngeal ultrasonography is a valid non-invasive and painless alternative method in the assessment of vocal cords in a selected population; moreover, it could be useful in identifying patients addressable to second-level examination.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. The datasets used and/or analyzed during the current study are available from the VII Division of General Surgery, Second University of Naples, Via Pansini 5 80131 Naples, on reasonable request.

Abbreviations

BMI:

Body mass index

TT:

Total thyroidectomy

RLN:

Recurrent laryngeal nerve

VCP:

Vocal cord paralysis

FFL:

Flexible fiberoptic laryngoscopy

ATA:

American Thyroid Association

TLUS:

Transcutaneous laryngeal ultrasonography

PPV:

Positive predictive value

NPV:

Negative predictive value

CI:

Confidence interval

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Authors and Affiliations

Authors

Contributions

All authors contributed significantly to the present research and reviewed the entire manuscript. GC: participated substantially in conception, design and execution of the study and in the analysis and interpretation of the data; also participated substantially in the drafting and editing of the manuscript. OC: participated substantially in conception, design and execution of the study and in the analysis and interpretation of the data; also participated substantially in the drafting and editing of the manuscript. RRM: participated substantially in conception, design and execution of the study and in the analysis and interpretation of the data. MDP: participated substantially in conception, design and execution of the study and in the analysis and interpretation of the data. RR: participated substantially in conception, design and execution of the study and in the analysis and interpretation of the data. GC: participated substantially in conception, design and execution of the study and in the analysis and interpretation of the data. AP: participated substantially in the drafting, revising and editing of the manuscript. LD: participated substantially in the drafting, revising and editing of the manuscript. MG: participated substantially in conception, design and execution of the study and in the analysis and interpretation of the data. GD: participated substantially in conception, design and execution of the study and in the analysis and interpretation of the data.

Corresponding author

Correspondence to Claudio Gambardella.

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The authors declare that they have no competing interests.

Research involving human participants and/or animals

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

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All patients gave written informed consent to publish.

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The ethical committee of University of Campania “Luigi Vanvitelli” approved the study protocol (Number of protocol 333/2019).

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Gambardella, C., Offi, C., Romano, R.M. et al. Transcutaneous laryngeal ultrasonography: a reliable, non-invasive and inexpensive preoperative method in the evaluation of vocal cords motility—a prospective multicentric analysis on a large series and a literature review. Updates Surg 72, 885–892 (2020). https://doi.org/10.1007/s13304-020-00728-3

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  • DOI: https://doi.org/10.1007/s13304-020-00728-3

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