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Using Intra-Operative Laryngeal Ultrasonography as a Real-Time Tool in Assessing Vocal Cord Function During Radiofrequency Ablation of the Thyroid Gland

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Abstract

Background

Inadvertent injury of the recurrent laryngeal nerve can occur during radiofrequency ablation (RFA) of thyroid nodules. Methods to avoid permanent injury have not been described. Laryngeal ultrasonography (LUSG) can assess the function of vocal cords (VCs) in real time. The present study aimed to evaluate the feasibility and accuracy of LUSG in assessing real-time VC function during RFA of benign thyroid nodules.

Methods

Consecutive patients undergoing RFA for benign thyroid nodules under local anesthesia were included. Spontaneous VC movements were checked with intra-operative LUSG (iLUSG) following each transverse ablation plane. In case of reduced VC movement, the ablation was stopped immediately. Post-ablation VC function was rechecked by LUSG on day-0 and flexible laryngoscopy (FL) on day-7. A concordance with day-0 LUSG or day-7 FL was a “true positive” or “true negative” depending on the presence or absence of VC palsy (VCP). Accuracy was calculated as the sum of all true positives and negatives divided by total nerves-at-risk.

Results

Of 65 eligible patients, 56 (86.2%) were females. Twelve (18.5%) patients had bilateral lobe RFA, while 53 (81.5%) had unilateral RFA. The total number of nerves-at-risk was 77. Three unilateral VCPs (3.9%) were initially detected on iLUSG and confirmed by day-0 LUSG. All recovered fully within one week. The overall accuracy of iLUSG was 100%.

Conclusion

iLUSG is a highly accurate method that permits real-time feedback on the function of the VCs during RFA procedure. Real-time detection of VCP may prevent permanent injury. Methodological routine use of iLUSG is recommended during thyroid RFA.

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Data availability

Datasets generated during and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Division of Endocrine Surgery, Department of Surgery, the University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, SAR, China

    Matrix Man Him Fung & Brian Hung Hin Lang

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  1. Matrix Man Him Fung
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  2. Brian Hung Hin Lang
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Contributions

MMHF wrote the manuscript, researched the data and performed statistical analyses. BL critically reviewed and edited the manuscript. BL initiated and supervised the study, is the guarantor of this work, has full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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Correspondence to Brian Hung Hin Lang.

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Fung, M.M.H., Lang, B.H.H. Using Intra-Operative Laryngeal Ultrasonography as a Real-Time Tool in Assessing Vocal Cord Function During Radiofrequency Ablation of the Thyroid Gland. World J Surg 46, 2206–2211 (2022). https://doi.org/10.1007/s00268-022-06596-9

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  • DOI: https://doi.org/10.1007/s00268-022-06596-9

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