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Updated: Jun 18, 2026
Identification and Protection of the Recurrent Laryngeal Nerve during Transoral Robotic Thyroidectomy
Published on: October 24, 2025
Neck ultrasound for prediction of right nonrecurrent laryngeal nerve
1Department of General Surgery, Medical College, National Cheng-Kung University, National Cheng-Kung University Hospital and Dou-Liou Branch, Dou-Liou City 64043, Taiwan, Republic of China. smhuang@mail.ncku.edu.tw
Background:
Nonrecurrent laryngeal nerve (NRLN) is 1 of the important causes for nerve damage during neck surgery. The anomaly is almost associated with congenital vascular abnormally. Most neck vascular anomalies can be detected by ultrasound.
Methods:
Both 3.5-MHz and 10-MHz probe neck ultrasound scans were performed for 2330 patients undergoing thyroidectomy preoperatively. Absence of innominate artery (INA) was defined as positive with right NRLN.
Results:
Of 13 positive patients found by 10-MHz probe, 11 were also identified by 3.5-MHz probe, and proved to be with right NRLN during operation. Two false-positive patients (18%) found by 10-MHz probe were due to short INA and tortuous INA, respectively. The incidence of right NRLN was 0.47% in Chinese people. Both the sensitivity and specificity for predicting right NRLN by 3.5-MHz probe were 100%.
Conclusion:
A 3.5-MHz probe neck ultrasound scan can accurately demonstrate right NRLN. Applying this tool for neck surgery to reduce the nerve damage is highly advised.
