Inferior-to-Superior Dissection for Recurrent Laryngeal Nerve Identification in Redo Thyroid Surgery: Enhanced Safety...

Area of Science:

• Surgical Oncology
• Endocrinology
• Otorhinolaryngology

Background:

• Recurrent laryngeal nerve (RLN) injury causing hoarseness is a significant complication of thyroid surgery.
• Identifying the RLN in redo thyroidectomies is challenging due to scarring and anatomical alterations from prior surgeries.
• The inferior-to-superior dissection technique is proposed as a solution for RLN identification in complex redo cases.

Purpose of the Study:

• To evaluate the efficacy of the inferior-to-superior dissection technique for identifying the recurrent laryngeal nerve (RLN) during redo thyroidectomies.
• To compare the safety and outcomes of this technique against the standard lateral-to-medial approach used in primary thyroidectomies.

Main Methods:

• A retrospective analysis of 40 consecutive redo thyroidectomy cases utilizing the inferior-to-superior nerve dissection technique.
• Comparison of outcomes with a cohort undergoing primary thyroidectomy using a lateral-to-medial approach.
• Assessment of recurrent laryngeal nerve paralysis rates and other postoperative complications (e.g., hypocalcemia).

Main Results:

• The permanent recurrent laryngeal nerve paralysis rate was low at 2.8% (2 out of 71 nerves at risk).
• Overall complication rates (Clavien-Dindo grade 3 or higher) were 12.5%, with transient and permanent hypocalcemia rates of 7.5% and 5%, respectively.
• No statistically significant differences in complication rates were observed when compared to primary thyroidectomies.

Conclusions:

• The inferior-to-superior nerve dissection approach is a valuable and beneficial technique for recurrent laryngeal nerve preservation in redo thyroidectomies.
• This technique offers a reliable method to prevent hoarseness and minimize surgical risks in patients undergoing repeat thyroid surgery.
• Surgeons should consider adopting the inferior-to-superior dissection technique for improved patient outcomes in redo thyroid procedures.