Is the superior laryngeal nerve really safe when using harmonic focus in total thyroidectomy? A prospective randomized study

Abstract

To the best of our knowledge, this is the first study comparing conventional technique with HF in total thyroidectomy, focusing on the function of the external branch of the superior laryngeal nerve using laryngostroboscopy; results showed that HF is as safe as the conventional technique.

The Effect of Different Hemostatic Systems on the Injury of the External Branch of the Superior Laryngeal Nerve in Thyroidectomy

“…In the studies comparing vascular closure systems and conventional suture technique in the literature, complications such as postoperative hemorrhage, recurrence laryngeal nerve injury and hypoparathyroidism were evaluated in the morbidity parameters (3,4,6,7), and data on EBSLN injury were insufficient. The only study in this regard is a prospective randomized study by Arslan et al (12) that compares the harmonic scalpel with conventional suture ligation technique in thyroidectomy. Unilateral activity loss 1 (7) 0 (0) 1 (7) 0 (0) 0 (0) 0 (0) Unilateral neurogenic involvement 0 (0) 0 (0) 1 (7) 1 (7) 0 (0) 0 (0)…”

“…Among these techniques, the more invasive and time-consuming cricothyroid muscle EMG is the most accurate diagnostic method (9,20). The risk of iatrogenic partial or complete EBSLN injury varies between 0% and 6% after thyroidectomy and this rate increases up to 60% when EMG is performed (12,14,18,21).…”

“…Although there are many studies in the literature on the effect of vascular closure systems on postoperative complications in thyroid surgery, there is little data on EBSLN injury (12). Therefore, in this study, we aimed to evaluate the effect of different vascular closure systems on iatrogenic EBSLN injury in patients undergoing thyroidectomy.…”

Is cricothyroid muscle twitch predictive of the integrity of the EBSLN in Thyroid Surgery?

“…Most studies related to EBSLN have used patient self‐reports on voice changes, subjective acoustic analysis of the investigator the GRABS scale, patient‐reported questionnaires (Voice Handicap Index‐10 and SLN Impairment Index‐5), objective acoustic analysis (multidimensional voice profile, and voice range profiles), and laryngoscopic or stroboscopic evaluation of vocal folds . Although these postoperative non‐EMG methods might not yield constant, standardized and reliable findings, some researches used them as the reference methods for EBSLN integrity in the studies related to the identification methods for EBSLN . However, we had a question concerning whether CT muscle twitch inspection, well‐known as a good identification and verification method for EBSLN integrity, could be an alternative to CT muscle EMG in the fields of EBSLN or PTD research.…”

Injury of the external branch of the superior laryngeal nerve in thyroid surgery

“…et al (45) reported that the use of the harmonic scalpel was safe and did not increase de rates of EBSLN injury when postoperative laryngostroboscopy was analyzed. The authors emphasize that the device should not be applied within less than 2 mm from neural structures and should not be continuously activated for longer than 15 seconds.…”