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Identification and Protection of the Recurrent Laryngeal Nerve during Transoral Robotic Thyroidectomy
Published on: October 24, 2025
The importance of pyramidal lobe in thyroid surgery
G Geraci1, F Pisello, F Li Volsi
1Università degli Studi di Palermo, Sezione di Chirurgia Generale ad Indirizzo Toracico.
Il Giornale Di Chirurgia
|December 11, 2008
Summary
The pyramidal lobe (PL), an embryological remnant, occurs intraoperatively in 12% of thyroidectomies. Careful surgical identification and removal are crucial to prevent incomplete resection and potential cancer recurrence.
Area of Science:
- Endocrinology
- Surgical Anatomy
- Embryology
Background:
- The pyramidal lobe (PL) is an embryological remnant of the thyro-glossal duct with a variable incidence (15-75%).
- Limited data exist on its intraoperative characteristics, size, and surgical implications.
Purpose of the Study:
- To determine the intraoperative frequency, anatomical location, and surgical management of the pyramidal lobe.
- To assess the diagnostic accuracy of preoperative imaging for PL detection.
Main Methods:
- A retrospective analysis of 604 total thyroidectomies performed between 1999 and 2007.
- Intraoperative identification and documentation of PL presence, location, and association with other structures.
- Preoperative ultrasonography (US) and Tc-99m pertechnetate scintigraphy were reviewed for PL detection rates and false-positive/negative findings.
Main Results:
- The intraoperative incidence of PL was 12%, more common in males (57%).
- PL most frequently originated from the left isthmus (96%) and was associated with the delphian lymph node in 25% of cases.
- Preoperative imaging identified PL in only about 50% of cases, with low specificity.
- No PL exceeded 2 cm; operative time was unaffected, and no incomplete resections were recorded.
Conclusions:
- The pyramidal lobe (PL) is a common finding during thyroidectomy, with an intraoperative incidence of 12%.
- Preoperative diagnosis of PL is challenging, with imaging modalities showing limited accuracy.
- Thorough intraoperative exploration is essential to identify and manage the PL, preventing incomplete thyroidectomy and potential complications like cancer recurrence.
