Is there a role for routine laryngoscopy before and after parathyroid surgery?

Area of Science:

• Endocrine Surgery
• Otolaryngology
• Surgical Complications

Background:

• Recurrent laryngeal nerve (RLN) palsy is a significant complication of parathyroid surgery, leading to morbidity and litigation.
• Peri-operative laryngoscopy aids in identifying and managing vocal cord palsy.
• The routine use of laryngoscopy in asymptomatic patients undergoing parathyroid surgery remains controversial due to low incidence, cost, and patient inconvenience.

Purpose of the Study:

• To evaluate the necessity and yield of routine peri-operative laryngoscopy in patients undergoing parathyroid surgery for primary hyperparathyroidism (PHPT).

Main Methods:

• A 3-year prospective study included patients undergoing parathyroid surgery for PHPT (excluding re-do or concurrent thyroidectomy).
• Data collected included voice outcomes, pre- and post-operative laryngoscopy results, and associated costs.
• Statistical analysis was performed on the collected data.

Main Results:

• Vocal cord palsy incidence was 0.5% pre-operatively and 1.7% post-operatively among 189 patients.
• Only one patient had pre-operative palsy (asymptomatic), and three had post-operative palsy (two temporary/symptomatic, one asymptomatic).
• The cost per laryngoscopy was £127.00, totaling £46,736.00 for the cohort.

Conclusions:

• The low incidence of vocal cord palsy does not support routine laryngoscopy for all patients undergoing parathyroid surgery for PHPT.
• Laryngoscopy should be reserved for patients with voice changes or those undergoing re-operative or concomitant thyroid surgery.