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Updated: Jun 11, 2026

Identification and Protection of the Recurrent Laryngeal Nerve during Transoral Robotic Thyroidectomy

Identification and Protection of the Recurrent Laryngeal Nerve during Transoral Robotic Thyroidectomy

Published on: October 24, 2025

Postoperative drainage in head and neck surgery.

Ida Amir¹, Pradeep Morar, Antonio Belloso

¹ENT Department, Royal Blackburn Hospital, Blackburn BB2 3HH, UK. ida_lailaa@hotmail.com

Annals of the Royal College of Surgeons of England

|July 10, 2010

Summary

Monitoring surgical drain output every 8 hours allows for earlier removal in head and neck surgery patients. This practice safely discharges more patients sooner, improving care and hospital resource use.

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Last Updated: Jun 11, 2026

Identification and Protection of the Recurrent Laryngeal Nerve during Transoral Robotic Thyroidectomy

Identification and Protection of the Recurrent Laryngeal Nerve during Transoral Robotic Thyroidectomy

Published on: October 24, 2025

Area of Science:

Surgical Oncology
Otolaryngology
Hospital Administration

Background:

Length of hospital stay after head and neck surgery is significantly impacted by surgical drain use.
Current practices for surgical drain removal are not well-defined, often relying on 24-hour drainage volume thresholds.
This study investigates a novel approach to surgical drain management to optimize patient discharge and resource allocation.

Purpose of the Study:

To evaluate the efficacy of 8-hourly drainage rate monitoring for surgical drains in head and neck surgery patients.
To determine if shorter interval drainage measurement can decrease the time to drain removal.
To assess the impact of earlier drain removal on patient length of stay and hospital resource utilization.

Main Methods:

A 6-month prospective observational study was conducted on patients undergoing head and neck surgery without neck dissection.
Patients with closed suction drains had drainage rates measured at 8-hourly intervals.
Surgical drains were removed when the drainage rate was less than or equal to 1 ml/h over an 8-hour period.

Main Results:

The highest drainage rates were observed in the first 8 postoperative hours, with significant decreases thereafter.
Using the new criteria (≤ 1 ml/h over 8 hours), 51% of drains were removed by 16 hours post-operation, and 86% by 24 hours.
This contrasts with the previous method (≤ 25 ml/24h), where only 20.9% of patients could potentially be discharged the day after surgery.

Conclusions:

Eight-hourly drainage rate monitoring facilitates safe, earlier discharge for a significant number of head and neck surgery patients (65% more discharged on the day after surgery).
This optimized drain management improves patient care and enhances the efficient use of hospital resources.
The study highlights positive economic implications for the department through improved patient flow and resource management.