Recurrent laryngeal nerve injury in video-assisted thyroidectomy: Lessons learned from neuromonitoring

G. Dionigi, P. F. Alesina, M. Barczynski, L. Boni, F. Y. Chiang, H. Y. Kim, G. Materazzi, G. W. Randolph, David J Terris, C. W. Wu

Research output: Contribution to journalArticle

38 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)2601-2608
Number of pages8
JournalSurgical Endoscopy and Other Interventional Techniques
Volume26
Issue number9
DOIs
StatePublished - Sep 1 2012

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Recurrent Laryngeal Nerve Injuries
Thyroidectomy
Recurrent Laryngeal Nerve
Traction
Wounds and Injuries
Hot Temperature
Laryngeal Nerve Injuries
Thyroid Gland
Vagus Nerve Stimulation
Vocal Cord Paralysis
Hemostasis
Ligation
Dissection
Equipment and Supplies
Incidence

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 journalArticle

Dionigi, G, Alesina, PF, Barczynski, M, Boni, L, Chiang, FY, Kim, HY, Materazzi, G, Randolph, GW, Terris, DJ & Wu, CW 2012, 'Recurrent laryngeal nerve injury in video-assisted thyroidectomy: Lessons learned from neuromonitoring', Surgical Endoscopy and Other Interventional Techniques, vol. 26, no. 9, pp. 2601-2608. https://doi.org/10.1007/s00464-012-2239-y
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. / Recurrent laryngeal nerve injury in video-assisted thyroidectomy : Lessons learned from neuromonitoring. In: Surgical Endoscopy and Other Interventional Techniques. 2012 ; Vol. 26, No. 9. pp. 2601-2608.
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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.",
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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.

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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

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