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Identification and Protection of the Recurrent Laryngeal Nerve during Transoral Robotic Thyroidectomy
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Recurrent laryngeal nerve injury in thyroid surgery
Oman Medical Journal
|November 2, 2011
Summary
Thyroid surgery poses a risk of recurrent laryngeal nerve injury. Factors like thyroid cancer, re-operation, and total thyroidectomy significantly increase this risk, impacting vocal cord function.
Area of Science:
- Otolaryngology
- Surgical Oncology
- Endocrinology
Background:
- Iatrogenic recurrent laryngeal nerve injury (RLNI) is a significant complication of thyroid surgery, leading to vocal cord paresis or paralysis.
- The incidence of RLNI varies widely (1.5-14%), highlighting the need to identify associated risk factors.
Purpose of the Study:
- To assess the risk factors associated with recurrent laryngeal nerve injury during thyroid surgery.
Main Methods:
- Retrospective review of 340 patients undergoing thyroid surgery between 1990 and 2005.
- Evaluation of factors including lesion pathology, operation type, and intra-operative recurrent laryngeal nerve identification.
- Preoperative and postoperative indirect laryngoscopic examinations were performed for all patients.
Main Results:
- Transient vocal cord problems occurred in 3.2% of cases, with permanent palsy in 0.3%.
- Increased RLNI incidence was observed in secondary operations (21.7%), total/near-total thyroidectomies (7.2%), non-identification of the nerve (7.6%), and malignant disease (12.8%).
- No significant difference in RLNI incidence was found based on gender.
Conclusions:
- Thyroid carcinoma, re-operation for recurrent goiter, non-identification of the recurrent laryngeal nerve, and total thyroidectomy are significantly associated with an increased risk of operative RLNI.
- These findings emphasize the importance of meticulous surgical technique and careful patient selection to minimize nerve injury.
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