Abstract
Introduction: The objective of the study was to assess the mechanism of recurrent laryngeal nerve (RLN) injury during video-assisted thyroidectomy (VAT). Methods: The study examined 201 nerves at risk (NAR). VAT with laryngeal neuromonitoring (LNM) was outlined according to this scheme: (a) preparation of the operative space; (b) vagal nerve stimulation (V1); (c) ligature of the superior thyroid vessels; (d) visualization, stimulation (R1), and dissection of the RLN; (e) extraction of the lobe; (f) resection of the thyroid lobe; (g) final hemostasis; (h) verification of the electrical integrity of the RLN (V2, R2). The site, cause, and circumstance of nerve injury were elucidated with the application of LNM. Laryngeal nerve injuries were classified into type 1 injury (segmental) and 2 (diffuse). Results: Fourteen nerves (6.9 %) experienced loss of R2 and V2 signals. 80 percent of lesions occurred in the distal 1 cm of the course of the RLN. The incidence of type 1 and 2 injuries was 71 and 29 % respectively. The mechanisms of injury were traction (70 %) and thermal (30 %). Traction lesions were created during the extraction of the lobe from the mini-incision [point (e)]. Thermal injury occurred during energy-based device use in (f) and (g) circumstances. Conclusions: RLN palsy still occurs with routine endoscopic identification of the nerve, even combined with LNM. LNM has the advantage of elucidating the mechanism of RLN injury. Traction and thermal RLN injuries are the most frequent lesions in VAT.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 2601-2608 |
| Number of pages | 8 |
| Journal | Surgical Endoscopy and Other Interventional Techniques |
| Volume | 26 |
| Issue number | 9 |
| DOIs | |
| State | Published - Sep 1 2012 |
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Keywords
- Morbidity
- Neuromonitoring
- Recurrent laryngeal nerve
- VAT
- Video-assisted thyroidectomy
ASJC Scopus subject areas
- Surgery
Cite this
Recurrent laryngeal nerve injury in video-assisted thyroidectomy : Lessons learned from neuromonitoring. / Dionigi, G.; Alesina, P. F.; Barczynski, M.; Boni, L.; Chiang, F. Y.; Kim, H. Y.; Materazzi, G.; Randolph, G. W.; Terris, David J; Wu, C. W.
In: Surgical Endoscopy and Other Interventional Techniques, Vol. 26, No. 9, 01.09.2012, p. 2601-2608.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Recurrent laryngeal nerve injury in video-assisted thyroidectomy
T2 - Lessons learned from neuromonitoring
AU - Dionigi, G.
AU - Alesina, P. F.
AU - Barczynski, M.
AU - Boni, L.
AU - Chiang, F. Y.
AU - Kim, H. Y.
AU - Materazzi, G.
AU - Randolph, G. W.
AU - Terris, David J
AU - Wu, C. W.
PY - 2012/9/1
Y1 - 2012/9/1
N2 - Introduction: The objective of the study was to assess the mechanism of recurrent laryngeal nerve (RLN) injury during video-assisted thyroidectomy (VAT). Methods: The study examined 201 nerves at risk (NAR). VAT with laryngeal neuromonitoring (LNM) was outlined according to this scheme: (a) preparation of the operative space; (b) vagal nerve stimulation (V1); (c) ligature of the superior thyroid vessels; (d) visualization, stimulation (R1), and dissection of the RLN; (e) extraction of the lobe; (f) resection of the thyroid lobe; (g) final hemostasis; (h) verification of the electrical integrity of the RLN (V2, R2). The site, cause, and circumstance of nerve injury were elucidated with the application of LNM. Laryngeal nerve injuries were classified into type 1 injury (segmental) and 2 (diffuse). Results: Fourteen nerves (6.9 %) experienced loss of R2 and V2 signals. 80 percent of lesions occurred in the distal 1 cm of the course of the RLN. The incidence of type 1 and 2 injuries was 71 and 29 % respectively. The mechanisms of injury were traction (70 %) and thermal (30 %). Traction lesions were created during the extraction of the lobe from the mini-incision [point (e)]. Thermal injury occurred during energy-based device use in (f) and (g) circumstances. Conclusions: RLN palsy still occurs with routine endoscopic identification of the nerve, even combined with LNM. LNM has the advantage of elucidating the mechanism of RLN injury. Traction and thermal RLN injuries are the most frequent lesions in VAT.
AB - Introduction: The objective of the study was to assess the mechanism of recurrent laryngeal nerve (RLN) injury during video-assisted thyroidectomy (VAT). Methods: The study examined 201 nerves at risk (NAR). VAT with laryngeal neuromonitoring (LNM) was outlined according to this scheme: (a) preparation of the operative space; (b) vagal nerve stimulation (V1); (c) ligature of the superior thyroid vessels; (d) visualization, stimulation (R1), and dissection of the RLN; (e) extraction of the lobe; (f) resection of the thyroid lobe; (g) final hemostasis; (h) verification of the electrical integrity of the RLN (V2, R2). The site, cause, and circumstance of nerve injury were elucidated with the application of LNM. Laryngeal nerve injuries were classified into type 1 injury (segmental) and 2 (diffuse). Results: Fourteen nerves (6.9 %) experienced loss of R2 and V2 signals. 80 percent of lesions occurred in the distal 1 cm of the course of the RLN. The incidence of type 1 and 2 injuries was 71 and 29 % respectively. The mechanisms of injury were traction (70 %) and thermal (30 %). Traction lesions were created during the extraction of the lobe from the mini-incision [point (e)]. Thermal injury occurred during energy-based device use in (f) and (g) circumstances. Conclusions: RLN palsy still occurs with routine endoscopic identification of the nerve, even combined with LNM. LNM has the advantage of elucidating the mechanism of RLN injury. Traction and thermal RLN injuries are the most frequent lesions in VAT.
KW - Morbidity
KW - Neuromonitoring
KW - Recurrent laryngeal nerve
KW - VAT
KW - Video-assisted thyroidectomy
UR - http://www.scopus.com/inward/record.url?scp=84866127768&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84866127768&partnerID=8YFLogxK
U2 - 10.1007/s00464-012-2239-y
DO - 10.1007/s00464-012-2239-y
M3 - Article
VL - 26
SP - 2601
EP - 2608
JO - Surgical Endoscopy and Other Interventional Techniques
JF - Surgical Endoscopy and Other Interventional Techniques
SN - 0930-2794
IS - 9
ER -