Recurrent Nerve Injury After Total Thyroidectomy: Risk Factor Analysis of a Targeted NSQIP Data Set

2021 ◽  
pp. 000313482110547
Author(s):  
David A. Mahvi ◽  
Lily V. Saadat ◽  
Jamie Knell ◽  
Richard D. Urman ◽  
Edward E. Whang ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Postoperative Complications ◽  
Recurrent Laryngeal Nerve ◽  
Total Thyroidectomy ◽  
Nerve Injury ◽  
Laryngeal Nerve ◽  
Recurrent Nerve ◽  
Improvement Program ◽  
Data Set ◽  
Cardiopulmonary Complications

Background Recurrent laryngeal nerve (RLN) injury is a significant complication after thyroidectomy. Understanding risk factors for RLN injury and the associated postoperative complications may help inform quality improvement initiatives. Methods The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) thyroidectomy-targeted database was utilized for patients undergoing total thyroidectomy between 2016 and 2017. Univariable and multivariable regression were used to identify factors associated with RLN injury. Results A total of 6538 patients were identified. The overall rate of RLN injury was 7.1% (467/6538). Of these, 4129 (63.1%) patients had intraoperative neuromonitoring (IONM), with an associated RLN injury rate of 6.5% (versus 8.2% without). African American and Asian race, non-elective surgery, parathyroid auto-transplantation, and lack of RLN monitoring were all significantly associated with nerve injury on multivariable analysis (P<.05). Patients with RLN injury were more likely to experience cardiopulmonary complications, re-intubation, longer length of stay, readmission, and reoperation. Patients who had IONM and sustained RLN injury remained at risk for developing significant postoperative complications, although the extent of cardiopulmonary complications was less severe in this cohort. Discussion Recurrent laryngeal nerve injury is common after thyroidectomy and is associated with significant morbidity, despite best practices. Attention to preoperative characteristics may help clinicians to further risk stratify patients prior to thyroidectomy. While IONM does not mitigate all complications, use of this technology may decrease severity of postoperative complications.

scholarly journals A current view on recurrent laryngeal nerve injury in total thyroidectomy

2021 ◽  
Vol 28 (1) ◽  
pp. 7-12
Author(s):  
Lucian ALECU ◽  
◽  
Iulian SLAVU ◽  
Adrian TULIN ◽  
Vlad BRAGA ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Total Thyroidectomy ◽  
Nerve Injury ◽  
Unintentional Injury ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Current View ◽  
Pubmed Database ◽  
Laryngeal Nerve Injury ◽  
The Moment

Introduction: Recurrent laryngeal nerve damage during total thyroidectomy was, is, and probably will be in the near future the Achilles’ heel of total thyroidectomy. Material and method: To perform the research we used the PubMed database. The questions were conceived to respect the PICOS guidelines. The PRISMA checklist was used to filter the results. The search was structured following the words: „recurrent laryngeal nerve injury” AND „total thyroidectomy”. Results: A total of 60 papers were identified. We excluded 12 papers as they were duplicates. From the 48 papers left, another 4 could not be obtained. Another 3 papers from the 44 left were excluded due to the fact they were not written in English. One paper was excluded as the subject did not follow our research purpose. 40 papers were left for analysis and discussion. Conclusion: To prevent recurrent laryngeal nerve lesions, at the moment in the literature there is no consensus. Unintentional injury to the recurrent laryngeal nerve is predictable but not an avertible situation thus bilateral lesions still represent a dramatic situation across the world for the patients and the operating surgeon.

Importance of Identifying the Course of the Recurrent Laryngeal Nerve in Total and Near-Total Thyroid Lobectomies

2005 ◽  
Vol 71 (3) ◽  
pp. 225-227
Author(s):  
Zeki Acun ◽  
Fikret Cinar ◽  
Alper Cihan ◽  
Suat Can Ulukent ◽  
Lokman Uzun ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Total Thyroidectomy ◽  
Nerve Injury ◽  
Nerve Palsy ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Thyroid Diseases ◽  
Thyroid Lobectomy ◽  
Laryngeal Nerve Injury

In our clinic, near-total thyroidectomy is the principal surgical procedure performed for benign thyroid diseases. We conducted a single-institution study on 176 consecutive patients who underwent near-total thyroidectomy due to various thyroid diseases. We compared the incidence of recurrent laryngeal nerve injury between total and near-total thyroid lobectomy sides in each patient. Our hypothesis was that the incidence of recurrent laryngeal nerve injury after total thyroid lobectomy would be similar to that of near-total thyroid lobectomy when the course of the recurrent laryngeal nerve was identified during surgery. The temporary recurrent laryngeal nerve palsy rates on the total and near-total thyroid lobectomy sides were 3.9 per cent (7 of 176 nerves) and 2.2 per cent (4 of 176 nerves), respectively. The difference was not statistically significant. Permanent recurrent laryngeal nerve palsy did not occur in any of our patients. In conclusion, the incidence of recurrent laryngeal nerve injury in total versus near-total thyroid lobectomy is not different when the course of the recurrent laryngeal nerve is identified during surgery.

scholarly journals Association of Intraoperative Neuromonitoring With Reduced Recurrent Laryngeal Nerve Injury in Patients Undergoing Total Thyroidectomy

2016 ◽  
Vol 142 (10) ◽  
pp. 994 ◽  
Author(s):  
Ioannis Vasileiadis ◽  
Theodore Karatzas ◽  
Georgios Charitoudis ◽  
Efthimios Karakostas ◽  
Sofia Tseleni-Balafouta ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Total Thyroidectomy ◽  
Nerve Injury ◽  
Recurrent Laryngeal Nerve Injury ◽  
Intraoperative Neuromonitoring ◽  
Laryngeal Nerve ◽  
Laryngeal Nerve Injury

scholarly journals Surgical Delight: Nonrecurrent Laryngeal Nerve

2015 ◽  
Vol 7 (1) ◽  
pp. 14-16
Author(s):  
Krishnan Ravikumar ◽  
Dhalapathy Sadacharan
Keyword(s):  
Case Report ◽  
Recurrent Laryngeal Nerve ◽  
Total Thyroidectomy ◽  
Postoperative Period ◽  
Anatomic Variation ◽  
Laryngeal Nerve ◽  
Recurrent Nerve ◽  
Complete Evaluation ◽  
Nonrecurrent Laryngeal Nerve ◽  
The Right

ABSTRACT Introduction A nonrecurrent course is an unusual anatomic variation of the recurrent laryngeal nerve. It is seen usually on the right side, and it is very rare on the left side. Nonrecurrent laryngeal nerve if present is mostly associated with vascular anomalies. Case report A 55-year-old female was referred to us with thyrotoxic symptoms for a period of 6 months. She was rendered euthyroid with antithyroid medications. After complete evaluation, she was posted for total thyroidectomy. Intraoperatively, right recurrent nerve could not be identified in usual position. On careful dissection, a nonrecurrent laryngeal nerve was identified. The recurrent laryngeal nerve on the left side showed normal course. The intraoperative and postoperative period were uneventful. Postoperative vocal cord status was normal. Conclusion This case was presented for its rarity and to stress the need for orderly meticulous surgical dissection. How to cite this article Ravikumar K, Sadacharan D, Suresh Rv. Surgical Delight: Nonrecurrent Laryngeal Nerve. World J Endoc Surg 2015;7(1):14-16.

scholarly journals Postoperative Complications of Thyroid Surgery: A Corroborative Study with an Overview of Evolution of Thyroid Surgery

2015 ◽  
Vol 6 (4) ◽  
pp. 149-154
Author(s):  
Chetan Bansal ◽  
Aparna Bhardwaj ◽  
Sonam Rathi ◽  
Alok Agrahari ◽  
Virendra P Singh
Keyword(s):  
Postoperative Complications ◽  
Recurrent Laryngeal Nerve ◽  
Nerve Injury ◽  
Thyroid Surgery ◽  
Complication Rate ◽  
Tertiary Care ◽  
Superior Laryngeal Nerve ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Laryngeal Nerve Injury

ABSTRACT Background To study the frequency of postoperative complications after thyroid surgery indicated for various benign and malignant lesions and to corroborate the results in relation to the extent of surgery and a clinical overview of evolution of thyroid surgery. Materials and methods An analytical study was carried out at a tertiary care center over a period of 3 years from January 2011 to December 2013. Data were collected from 80 patients who underwent thyroidectomies for various thyroid diseases at this center. Results Hemithyroidectomy, isthmusectomy, subtotal, neartotal, and total thyroidectomies were performed in 36 (45%), 6 (7.5%), 8 (10%), 10 (12.5%), and 20 (25%) cases respectively. The overall postoperative complication rate was 20%. Postoperative hypocalcemia and recurrent laryngeal nerve injury were the most common complications. Permanent hypocalcemia and permanent recurrent laryngeal nerve injury were observed in 3.75 and 2.5% of all operated cases respectively. The less common complications were wound hematoma, seroma formation, and superior laryngeal nerve injury. There was no mortality observed in our series. Conclusion The overall complication rate can be minimized by operating in a bloodless field, doing a meticulous dissection, and correctly identifying and preserving recurrent and superior laryngeal nerves along with parathyroid glands, if feasible. How to cite this article Pandey AK, Maithani T, Agrahari A, Varma A, Bansal C, Bhardwaj A, Singh VP, Rathi S. Postoperative Complications of Thyroid Surgery: A Corroborative Study with an Overview of Evolution of Thyroid Surgery. Int J Head Neck Surg 2015;6(4):149-154.

scholarly journals Identification of recurrent laryngeal nerve: a dilemma in thyroid surgery

2021 ◽  
Vol 7 (9) ◽  
pp. 1450
Author(s):  
Atishkumar B. Gujrathi ◽  
Harshada S. Kurande ◽  
Nishikant Gadpayale ◽  
Yogesh Paikrao
Keyword(s):  
Thyroid Gland ◽  
Recurrent Laryngeal Nerve ◽  
Nerve Injury ◽  
Thyroid Surgery ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Recurrent Nerve ◽  
Group A ◽  
Laryngeal Nerve Injury ◽  
Group B

<p class="abstract"><strong>Background: </strong>Surgery of the thyroid gland is one of the most common surgical procedures performed. Recurrent laryngeal nerve injury is the most dreaded complication of thyroid surgery. Hence reducing intraoperative injury is of utmost importance. Routine dissection and identification of the recurrent nerve remain controversial.</p><p class="abstract"><strong>Methods:</strong> This study consists of 70 patients who underwent thyroid surgery. This study was conducted at our institute during the period of 2 years (2018-2020). Patients were evaluated and operated. Patients with thyroid diseases and normal vocal cords were allocated to two groups randomly; in group A the nerve was identified and in group B the nerve was not identified.</p><p class="abstract">Results: Most of the patients participating in the study were in the age group of 33-42 years. Male to female disease ratio was 0.13:1. In our study out of 70 patients who underwent thyroid surgery, 18 (25.71%) patients suffered from recurrent laryngeal nerve palsy. Amongst those 18 patients, 2 palsies (5.71%) were in Group A and 16 palsies (45.71%) were in Group B. Recurrent laryngeal nerve most commonly lied posterior to the inferior thyroid artery on both right (65.38%) as well as left side (45.45%). Most commonly injured recurrent laryngeal nerve was the right sided recurrent laryngeal nerve (77.77%).</p><p class="abstract"><strong>Conclusions:</strong> Careful dissection of nerve during thyroid surgery eliminates the risk of recurrent laryngeal nerve injury. A thorough knowledge of thyroid gland, recurrent laryngeal nerve and its anatomical relations and variations is of utmost importance in preserving the recurrent laryngeal nerve in thyroid surgery.</p>

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