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Identification and Protection of the Recurrent Laryngeal Nerve during Transoral Robotic Thyroidectomy
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Recurrent laryngeal nerve monitoring during thyroidectomy and parathyroidectomy in children
1Otolaryngology-head and Neck Surgery Department, Hôpital Robert Debré, 48 Bd Sérurier, 75019, Paris, France.
Insights
Recurrent laryngeal nerve (RLN) monitoring during pediatric thyroid and parathyroid surgery is crucial. A double-needle electrode through the cricothyroid ligament offers a reliable, complication-free method for RLN monitoring in children.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Nerve Monitoring
Background:
- Recurrent laryngeal nerve (RLN) injury is a common complication of thyroid and parathyroid (TP) surgery.
- RLN monitoring in pediatric patients undergoing TP surgery is not extensively studied.
Purpose of the Study:
- To evaluate the reliability, feasibility, and benefits of RLN monitoring during TP surgery in children.
- To compare different RLN monitoring techniques in a pediatric population.
Main Methods:
- A retrospective analysis of 53 TP surgeries on 47 pediatric patients (6 months to 18 years) from January 2009 to March 2018.
- Patients were divided into three groups: no monitoring, endotracheal tube monitoring, and double-needle electrode monitoring via cricothyroid ligament.
- Assessed complication rates, sensitivity, specificity, and predictive values for each monitoring method.
Main Results:
- The double-needle electrode group showed higher sensitivity (67%) and specificity (100%) compared to the endotracheal tube group (33% and 97%).
- Positive predictive value was 100% for the double-needle electrode and 50% for the tube method.
- No complications were reported with the double-needle electrode insertion, though some patients required smaller orotracheal tubes than the available monitoring tubes.
Conclusions:
- RLN monitoring using a double-needle electrode inserted through the cricothyroid ligament is a reliable and safe method for pediatric TP surgery.
- This technique is feasible across all pediatric age groups and offers significant benefits for nerve protection.
Objective:
Injury of the recurrent laryngeal nerve (RLN) is the most frequent complication of thyroid and parathyroid (TP) surgery. Monitoring of the RLN in children is not widely studied as this is not a common disease in the pediatric population. The aim of our study was to evaluate the reliability, feasibility and benefits of RLN monitoring during TP surgery in children.
Methods:
We analyzed all children who underwent TP surgery in our department between January 2009 and March 2018. Patients were classified into three groups: without monitoring (group 1), monitoring with an endotracheal tube (group 2) and monitoring with a double-needle electrode placed through the cricothyroid ligament (group 3).
Results:
We performed 53 surgeries (77 RLNs at risk) on 47 patients aged between 6 months and 18 years. Fourteen RLNs were in group 1, 47 in group 2 and 16 in group 3. We found one transient lesion of the RLN in group 1, three in group 2 and two in group 3. Seven patients in group 3 could not undergo monitoring with the tube because they need an orotracheal tube smaller than the smallest monitoring tube size available. The sensitivity and specificity values of the monitoring methods were 33% and 97% in group 2 and 67% and 100% in group 3, respectively. The positive and negative predictive values were 50% and 95% in group 2 and 100% and 92% in group 3, respectively. No complications arose during insertion of the electrode through the cricothyroid ligament.
Conclusion:
Monitoring of the RLN with a double-needle electrode inserted through the cricothyroid ligament is a reliable method with no associated complication, which is achievable at any age.
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