Effects of Intraoperative Neural Tunnel in Protecting Recurrent Laryngeal Nerve: Experiences in Open, Trans Breast, and Transoral Endoscopic Thyroidectomy

Xing, Yu; Li, Yujun; Liu, Chang; Jiang, Yiqun; Liu, Zhao‐Di; He, Qionghua; Wang, Yong; Wang, Ping

doi:10.3389/fonc.2022.779621

Cited by 5 publications

(6 citation statements)

References 23 publications

(28 reference statements)

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“… 9 IONM allows easier identification, dissection, and preservation of the RLN during ET‐BA. 6 , 10 , 11 However, our study confirmed that RLN injury can still occur, even when using IONM. Separation, transection, and thermal RLN injuries were most common.…”

Section: Discussionsupporting

confidence: 65%

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Mechanisms of recurrent laryngeal nerve injury in endoscopic thyroidectomy for papillary thyroid carcinoma: A large data from China

Teng

Ding

et al. 2023

Laryngoscope Investig Oto

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Purpose To investigate the mechanisms of recurrent laryngeal nerve (RLN) injury during endoscopic thyroidectomy via breast approach (ET‐BA) in patients with papillary thyroid carcinoma (PTC). Methods The records of 416 PTC patients who underwent ET‐BA with intraoperative neural monitoring (IONM) from May 2015 to May 2021 in Beijing Friendship Hospital affiliated to Capital Medical University were retrospectively analyzed. Results All patients were women. Mean age was 37.80 (7.87) years. The ET‐BA was performed in 416 patients. Overall incidence of RLN injury was 4.3% (18 patients). Injury was transient in 13 patients (3.1%) and permanent in five (1.2%). Macroscopic physical changes were apparent in the injured nerve in five patients (27.8%) and postoperative hoarseness or cough after drinking water were present in 11 (61.1%). Two RLN injuries occurred during nerve identification at the RLN laryngeal entry point into the surgical field, 15 during early nerve dissection somewhere between the first 0.5 and 2 cm of the nerve's course through the surgical field, and one occurred distal to 2 cm. The percentage of patients with separation, transection, traction and thermal mechanisms of injury was 27.8%, 22.2%, 22.2%, and 16.7%, respectively. The mechanism of injury was unknown in 11.1%. Conclusions RLN injury may still occur during ET‐BA despite endoscopic magnification and early nerve identification even when IONM is used. Separation, transection, and traction injuries were the most frequent causes of injury.

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Section: Discussionsupporting

confidence: 65%

“…Surgeons who perform ET must be able to identify, dissect, and expose the RLN using endoscopic instruments and view 9 . IONM allows easier identification, dissection, and preservation of the RLN during ET‐BA 6,10,11 . However, our study confirmed that RLN injury can still occur, even when using IONM.…”

Section: Discussionmentioning

confidence: 50%

Mechanisms of recurrent laryngeal nerve injury in endoscopic thyroidectomy for papillary thyroid carcinoma: A large data from China

Teng

Ding

et al. 2023

Laryngoscope Investig Oto

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“…Protection of the RLN and parathyroid gland is particularly important in thyroid surgery, as this directly affects the patient’s quality of life 32 . In this study, there was no statistically significant difference in the incidence of injury to the RLN and parathyroid gland between the two groups.…”

Section: Discussionmentioning

confidence: 45%

“…Protection of the RLN and parathyroid gland is particularly important in thyroid surgery, as this directly affects the patient's quality of life. 32 In this study, there was no statistically significant difference in the incidence of injury to the RLN and parathyroid gland between the two groups. Apart from the operator's familiarity with the anatomic location, the magnifying effect of the endoscope also helped the surgeon better identify the RLN and parathyroid gland, thus providing better protection.…”

Section: Discussionmentioning

confidence: 49%

Safety and Efficacy of Transoral Endoscopic Thyroidectomy Vestibular Approach Versus Conventional Open Thyroidectomy: A Systematic Review and Meta-analysis

Huo,

Ou,

Guo

et al. 2023

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Objective: To evaluate the safety and efficacy of the transoral endoscopic thyroidectomy vestibular approach (TOETVA) versus conventional open thyroidectomy (COT) for some thyroid diseases. Materials and Methods: Databases PubMed, Embase, and Web of Science were searched. Full-text English papers that described TOETVA and COT for people with thyroid diseases were included. Randomized, nonrandomized, controlled, and uncontrolled trials were all included. Extracted data included population characteristics and intraoperative and postoperative complications. Results: A total of 2 randomized controlled trials and 10 retrospective studies, including 3048 patients, were included in the meta-analysis. Meta-analysis results suggested that the intraoperative conditions and postoperative complication rates did not differ significantly between the two groups. However, in the TOETVA group, there is a slightly longer operative time [weighted mean difference (WMD): 73.64; 95% CI: 49.34 to 97.94; P < 0.0001], drainage (WMD: 91.0; 95% CI: 35.52 to 146.48; P = 0.001), and hospital stay (WMD: 0.28; 95% CI: 0.18 to 0.38; P < 0.0001). Conclusion: For most of the benign thyroid nodules and selected patients with papillary thyroid cancer, TOETVA seems to be as feasible and safe as COT.

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“…The Thyroid Cancer-Specific Quality of Life Questionnaire (THYCA-QOL) has highlighted concerns with scarring, and a history of minimally invasive thyroid surgery was found to be associated with better thyroid cancer-specific QOL (3). In the pursuit of improved cosmetic outcomes, various endoscopic thyroid surgery approaches have been introduced, with the bilateral areolar approach showing promise and being particularly recommended for lymph node dissection (4)(5)(6).…”

Section: Introductionmentioning

confidence: 99%

Feasibility and safety of modified en-bloc resection in endoscopic thyroid surgery via bilateral areolar approach – long-term institutional analysis ten years after surgery

Xie,

Ma,

et al. 2024

Front. Endocrinol.

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PurposeThis study aimed to introduce a new modified en-bloc resection method and evaluate its feasibility and safety in endoscopic thyroid surgery via bilateral areolar approach (BAA).MethodsPapillary thyroid carcinoma (PTC) patients who underwent lobectomy and ipsilateral central node dissection (CND) via the BAA approach were retrospectively reviewed. Their clinical characteristics and outcomes were evaluated, including operative duration, lymph node yield (LNY), surgical complications, recurrence rate, and metastasis rate, over a ten-year follow-up period. Simultaneous lobectomy and CND were performed in the modified en-bloc group, whereas lobectomy was performed first, followed by CND in the conventional group.ResultsThe study included 108 patients in the modified en-bloc group and 213 in the conventional group. There were no significant differences in gender, age, tumor locations, tumor dominant nodule size, or the incidence of concomitant Hashimoto thyroiditis when comparing clinicopathologic characteristics. The comparison of operative duration (P = 0.14), blood loss (P = 0.13), postoperative hospital stay (P = 0.58), incidence of transient vocal cord paralysis (P = 0.90) and hypocalcemia (P = 0.60) did not show any differences. The mean LNY achieved in the central compartment of the modified en-bloc group (7.5 ± 4.5) was significantly higher than that in the conventional group (5.6 ± 3.6). Two patients in the modified en-bloc group and two in the conventional group experienced metastasis after surgery during the ten-year follow-up (1.8% vs. 0.9%, P = 0.60). The learning curve analysis showed a significant decrease in operative duration after the 25-35th cases for modified en-bloc resection.ConclusionsThe modified en-bloc resection method in endoscopic thyroid surgery via BAA is a technically feasible and safe procedure with excellent cosmetic outcomes for selective PTC patients.

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Effects of Intraoperative Neural Tunnel in Protecting Recurrent Laryngeal Nerve: Experiences in Open, Trans Breast, and Transoral Endoscopic Thyroidectomy

Cited by 5 publications

References 23 publications

Mechanisms of recurrent laryngeal nerve injury in endoscopic thyroidectomy for papillary thyroid carcinoma: A large data from China

Mechanisms of recurrent laryngeal nerve injury in endoscopic thyroidectomy for papillary thyroid carcinoma: A large data from China

Safety and Efficacy of Transoral Endoscopic Thyroidectomy Vestibular Approach Versus Conventional Open Thyroidectomy: A Systematic Review and Meta-analysis

Feasibility and safety of modified en-bloc resection in endoscopic thyroid surgery via bilateral areolar approach – long-term institutional analysis ten years after surgery

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