Monitoring of the recurrent laryngeal nerve in totally endoscopic thyroid surgery

We tested the feasibility of the sublingual transoral access for thyroid resection including the monitoring of the recurrent laryngeal nerve (RLN) in a porcine model. We performed a prospective, nonrandomized proof-of-concept experimental investigation on transoral thyroid resection in a porcine model with monitoring of the RLN. Ten endoscopic transoral thyroidectomies were performed in 10 pigs using a neuromonitoring system. First, the RLN was identified visually and then confirmed with the neuromonitoring system bilaterally. A complete transoral thyroid resection was achieved in all living pigs. The average operation time was 50 min. The neuromonitoring system permitted to prove the regular function of the RLN on both sides after the removal of the thyroid gland. The pigs were observed for another 2 h postoperatively. Consequent monitoring of the RLN in endoscopic transoral thyroid resection is possible. This system can be a helpful support to identify the nerve when the anatomic situation due to using an endoscopic access is more complicated. It proved to be a safe procedure in living pigs. Our results might be useful for using the neuromonitoring system as a standard system in endoscopic thyroid surgery for the maximal safety of the patient in these new procedures.