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

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Technical refinements to the minithyrotomy procedure.

McLean Gunderson¹, Ben Bauer¹, Rachel C Glab¹

¹Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.

Journal of Voice : Official Journal of the Voice Foundation

|February 6, 2014

Summary

This study refined the minithyrotomy (MT) procedure and composite thyroid ala perichondrium flap (CTAP) techniques for voice restoration. Improvements in surgical methods and instrumentation demonstrated successful in vivo application for better vocal fold reconstruction.

Keywords:

CTAP Minithyrotomy Reinke's space Vocal fold augmentation

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Area of Science:

Laryngeal surgery
Voice restoration techniques
Surgical innovation

Background:

The minithyrotomy (MT) procedure, introduced in 1999, has seen limited adoption for voice restoration due to implant and technical challenges.
The composite thyroid ala perichondrium flap (CTAP) was introduced in 2011 to address implant needs but persisted with technical difficulties, including limited surgical access and potential CTAP pedicle constriction.

Purpose of the Study:

To address and overcome the technical challenges associated with the minithyrotomy (MT) procedure and composite thyroid ala perichondrium flap (CTAP) reconstruction for voice restoration.
To develop and refine surgical instrumentation and affixation techniques for improved outcomes in MT and CTAP procedures.

Main Methods:

Experimental study utilizing both cadaveric and in vivo canine models.
Refinement of CTAP modification, MT technique, specialized instrumentation, and implant affixation procedures.
In vivo application of refined techniques in canine subjects, followed by laryngeal harvest and histologic analysis.

Main Results:

Successful in vivo application of refined CTAP modification, MT technique, instrumentation, and CTAP affixation procedures.
The refinements proved effective in the canine model, mirroring positive outcomes from preliminary cadaveric trials.
Demonstrated feasibility of improved surgical access, pedicle management, and implant stability.

Conclusions:

The proposed refinements enhance the outcomes of CTAP reconstruction within the MT approach and are applicable to other MT techniques.
Continued development of specialized instrumentation and improved CTAP affixation methods are crucial for wider adoption.
Further advancements are expected to facilitate more reliable implementation of the MT procedure by a broader range of laryngeal surgeons.