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[Identification of the recurrent nerve in thyroid surgery. Technical note]

C Spinelli1, P Berti, P Miccoli

  • 1Instituto di Clinica Chirurgica, Università degli Studi di Pisa.

Minerva Chirurgica
|January 1, 1995
PubMed
Summary

Recurrent laryngeal nerve injury during thyroidectomy is often caused by stretching or compression, not complete severance. Careful surgical technique minimizes but cannot entirely prevent these nerve injuries.

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Area of Science:

  • Otorhinolaryngology
  • Surgical Anatomy
  • Neurosurgery

Context:

  • Thyroidectomy is a common surgical procedure for various thyroid diseases.
  • Recurrent laryngeal nerve (RLN) injury is a significant complication of thyroid surgery, potentially leading to vocal cord dysfunction.
  • Identifying and preserving the RLN is crucial during thyroidectomy.

Purpose:

  • To analyze the causes of recurrent laryngeal nerve injury during thyroidectomy.
  • To evaluate the incidence and mechanisms of RLN injury in a large series of thyroid surgeries.
  • To identify surgical techniques and anatomical factors contributing to RLN injury.

Summary:

  • This study reviewed 1800 thyroidectomies, identifying the recurrent laryngeal nerve in all cases.
  • RLN injury was analyzed, with findings suggesting stretching, compression, or ischemia as common causes, rather than complete nerve section.

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  • Surgical errors such as vessel ligation before nerve identification, improper hemostasis, excessive nerve traction, or dissection-induced ischemia were implicated.

    • Impact:

    • Highlights that recurrent laryngeal nerve injury is not solely due to nerve sectioning during thyroidectomy.
    • Emphasizes the importance of meticulous surgical technique and anatomical awareness to minimize nerve damage.
    • Provides insights for improving surgical strategies to reduce the incidence of vocal cord paralysis post-thyroidectomy.