A safe technique for thyroidectomy with complete nerve dissection and parathyroid preservation.

Area of Science:

• Surgical Oncology
• Endocrine Surgery
• Neurosurgery

Background:

• Recurrent laryngeal nerve (RLN) injury is a significant complication in thyroid surgery.
• Variations in RLN anatomy can increase the risk of injury.
• Minimizing injury to the RLN and external branch of the superior laryngeal nerve (EBSLN) is crucial for patient outcomes.

Purpose of the Study:

• To present a surgical technique for thyroid operations that avoids permanent recurrent laryngeal nerve injury.
• To highlight the importance of identifying anatomical variations of the RLN.
• To report a low incidence of hypoparathyroidism in a large series of thyroidectomies.

Main Methods:

• Detailed dissection and identification of the recurrent laryngeal nerve and its branches in 1,000 consecutive thyroid operations.
• Protection of the external branch of the superior laryngeal nerve through early mobilization of superior thyroid vessels.
• Extracapsular dissection technique and avoidance of ligating the inferior thyroid artery in continuity.

Main Results:

• Zero cases of permanent recurrent laryngeal nerve injury were observed.
• Sixty-five percent of cases exhibited multiple terminal branches of the RLN.
• Five cases on the right side demonstrated a nonrecurrent course of the RLN.
• A low incidence of permanent hypoparathyroidism was achieved.

Conclusions:

• Meticulous dissection and identification of the recurrent laryngeal nerve, including its variations, are essential for preventing nerve injury during thyroid surgery.
• Specific surgical techniques, such as extracapsular dissection and careful management of vascular structures, contribute to low rates of nerve injury and hypoparathyroidism.