Non-recurrent inferior laryngeal nerve identification during robotic thyroidectomy

Area of Science:

• Anatomy
• Surgical Innovation
• Endocrinology

Background:

• The non-recurrent inferior laryngeal nerve (NRLN) is a rare anatomical variation where the nerve branches directly from the vagus nerve in the neck, bypassing the typical thoracic course.
• This anomaly increases the risk of iatrogenic injury during neck surgeries, particularly thyroidectomy.
• Early identification and understanding of surgical landmarks are crucial for preventing nerve damage.

Observation:

• A case involving a 38-year-old woman with suspected papillary microcarcinoma is presented.
• Pre-operative computed tomography revealed a right aberrant subclavian artery, suggesting a potential right NRLN.
• Robotic thyroidectomy facilitated detailed dissection along the thyroid capsule.

Findings:

• The robotic endoscope provided crucial three-dimensional, high-magnification views.
• These enhanced visualization capabilities enabled the precise identification of the right NRLN's laryngeal entrance point.
• This constant anatomical landmark was successfully recognized during the procedure.

Implications:

• Robotic thyroidectomy, combined with detailed pre-operative radiological assessment, offers a safe approach for managing patients with NRLN.
• Enhanced visualization and anatomical knowledge are key to preserving the NRLN during surgery.
• This technique can improve patient outcomes by minimizing the risk of vocal cord dysfunction after thyroidectomy.