Thyroidectomy With or Without Nerve Identification: A Personal Experience and Technique

Area of Science:

• Endocrine Surgery
• Surgical Innovation
• Thyroid Gland Anatomy

Background:

• Nerve injury is a significant complication in thyroidectomies.
• Direct visualization of recurrent and external laryngeal nerves is a common surgical practice.
• The necessity of direct nerve visualization for minimizing injury risk is debated.

Purpose of the Study:

• To compare the risk of laryngeal nerve injury between thyroidectomy with and without direct nerve visualization.
• To evaluate the impact of nerve identification on surgical complication rates.

Main Methods:

• A randomized controlled trial involving 150 patients undergoing various thyroidectomies.
• Patients were divided into two groups: nerve visual identification (G1) and no nerve visualization (G2).
• Outcomes assessed included external laryngeal nerve palsy and recurrent laryngeal nerve palsy.

Main Results:

• Higher incidence of external laryngeal nerve palsy in the visualization group (5.3% vs. 2%).
• Total nerve injury rate was higher in the visualization group (10.2% vs. 5.3%), though not statistically significant (P=0.452).
• Total thyroidectomy for toxic goiter showed the highest association with transient and permanent external laryngeal nerve injury.

Conclusions:

• Meticulous dissection techniques near the thyroid capsule can reduce nerve injury risk.
• Direct visualization of nerves is not essential for achieving low complication rates in thyroid surgery.
• Experienced surgeons can achieve comparable safety outcomes through careful dissection alone.