The role of LigaSure™ and Harmonic Scalpel in the preservation of recurrent laryngeal nerve during thyroidectomy

2021 ◽  
Author(s):  
E Spartalis ◽  
A Giannakodimos ◽  
I Giannakodimos ◽  
A Ziogou ◽  
T Papasilekas ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Retrospective Studies ◽  
Harmonic Scalpel ◽  
Laryngeal Nerve ◽  
Permanent Damage ◽  
Vessel Sealing ◽  
Significant Difference ◽  
Significant Superiority

INTRODUCTION Transient or permanent damage to the recurrent laryngeal nerve (RLN) during thyroidectomy is of paramount importance for patient quality of life. The aim of this study is to systematically review the literature concerning the role of the most popular energy-based vessel-sealing devices (LigaSure™ (LS) and Harmonic Scalpel (HS)) in preservation of the RLN during thyroidectomy. The safety and inferiority or superiority of LS and HS compared with conventional haemostatic techniques are highlighted. METHODS A systematic search of the literature was performed. Clinical trials, prospective and retrospective studies that significantly compared the use of LS and HS with conventional haemostasis regarding the postoperative incidence of RLN palsy were included. FINDINGS The search resulted in 43 studies, including 17,953 patients treated using energy-based devices or conventional haemostatic methods. Concerning the incidence of RLN palsy, 40 studies showed no significant difference between the energy-based device and conventional groups, whereas two studies demonstrated a significant superiority in performance for LS and HS compared with conventional haemostasis. Only one study exhibited significant inferiority of LS and HS compared with conventional methods. No statistical relationship was observed between energy-based devices and conventional techniques regarding permanent damage to the RLN. CONCLUSION The performance of both LS and HS shows no inferiority compared with conventional haemostatic techniques, regarding damage to the laryngeal nerve. Further well-designed studies are needed to investigate their potential benefit in preservation of the RLN.

Evaluating the safety of the Harmonic Scalpel around the recurrent laryngeal nerve

2010 ◽  
Vol 80 (11) ◽  
pp. 822-826 ◽  
Author(s):  
Hang Jiang ◽  
Hongliang Shen ◽  
Daozhen Jiang ◽  
Xiangmin Zheng ◽  
Wei Zhang ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Harmonic Scalpel ◽  
Laryngeal Nerve

Total thyroidectomy for safe and definitive management of Graves' disease

2013 ◽  
Vol 127 (7) ◽  
pp. 681-684 ◽  
Author(s):  
A Prasai ◽  
P A Nix ◽  
M Aye ◽  
S Atkin ◽  
R J England
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Total Thyroidectomy ◽  
Nerve Palsy ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Laryngeal Nerve ◽  
Definitive Treatment ◽  
Royal Infirmary ◽  
Graves Disease ◽  
Laryngeal Nerve Palsy

AbstractBackground:The role of total thyroidectomy in the management of patients with Graves' disease remains controversial. However, there is increasing evidence to support the role of the procedure as a safe and definitive treatment for Graves' disease.Method:Patients were identified from a prospective thyroid database of the multidisciplinary thyroid clinic at Hull Royal Infirmary. All case notes were independently reviewed to confirm the data held on the database.Results:Over a 7-year period, the senior author has performed 206 total thyroidectomies for Graves' disease. The incidence of temporary recurrent laryngeal nerve palsy and hypoparathyroidism was 3.4 per cent and 24 per cent respectively. There was one case of permanent unilateral recurrent laryngeal nerve palsy, and 3.9 per cent of patients developed permanent hypoparathyroidism. There has been no relapse of thyrotoxicosis.Conclusion:In the context of a multidisciplinary thyroid clinic, total thyroidectomy should be offered as a safe and effective first-line treatment option for Graves' disease.

RA07.05: DIAGNOSTIC VALUE OF INTRAOPERATIVE ULTRASONOGRAPHY IN ASSESSING THORACIC RECURRENT LARYNGEAL NERVE LYMPH NODES IN PATIENTS WITH ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 35-35
Author(s):  
Hong Yang
Keyword(s):  
Esophageal Cancer ◽  
Recurrent Laryngeal Nerve ◽  
Predictive Value ◽  
Conflicts Of Interest ◽  
Nodal Metastasis ◽  
Laryngeal Nerve ◽  
Intraoperative Ultrasonography ◽  
Nodal Metastases ◽  
Thoracic Esophageal Cancer ◽  
Significant Difference

Abstract Background To evaluate the ability of intraoperative ultrasonography (IU) to detect recurrent laryngeal nerve (RLN) nodal metastases in esophageal cancer patients. Methods Sixty patients with esophageal cancer underwent IU, computed tomography (CT), and endoscopic ultrasonography (EUS) to assess for RLN nodal metastasis. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were compared. Results The sensitivities of IU, CT, and EUS in diagnosing right RLN nodal metastases were 71.4%, 14.3%, and 30.0%, respectively, and a significant difference among these three examinations was observed (c2 = 10.077, P = .006). The specificities of IU, CT, and EUS for diagnosing right RLN nodal metastasis were 67.4%, 97.8%, and 95.0%, respectively, and a significant difference was observed (c2 = 21.725, P < .001). No significant differences in either PPV or NPV were observed when diagnosing right RLN nodal metastases. For diagnosis of left RLN lymph nodal metastases, the sensitivities of IU, CT, and EUS were 91.7%, 16.7%, and 40.0% respectively. There was a significant difference among these diagnostic sensitivities (c2 = 14.067, P = .001). The specificities of IU, CT, and EUS for diagnosis of left RLN nodal metastases were 79.2%, 100%, and 82.5%, respectively and a significant difference was observed (c2 = 10.819, P = .004). No significant differences were observed in PPV or NPV for these examinations when diagnosing left RLN nodal metastases. Conclusion Intraoperative ultrasonography showed superior sensitivity compared with preoperative CT or EUS in detecting RLN lymph node metastasis in patients with thoracic esophageal cancer. Disclosure All authors have declared no conflicts of interest.

scholarly journals Energy Based Vessel Sealing Devices in Thyroid Surgery: A Systematic Review to Clarify the Relationship with Recurrent Laryngeal Nerve Injuries

Medicina ◽  
2020 ◽  
Vol 56 (12) ◽  
pp. 651
Author(s):  
Mario Pacilli ◽  
Nicola Tartaglia ◽  
Alberto Gerundo ◽  
Giovanna Pavone ◽  
Alberto Fersini ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Thyroid Surgery ◽  
Current Knowledge ◽  
Operating Time ◽  
Laryngeal Nerve ◽  
Injury Rates ◽  
Operative Outcomes ◽  
Vessel Sealing ◽  
Number Of Patients ◽  
Efficient Alternative

Background and objectives: The principal complications associated with thyroid surgery consist in postoperative recurrent laryngeal nerve (RLN) palsy, hypoparathyroidism, intra-operative and post-operative hemorrhage. In this paper, structured as a literature review, we describe the current knowledge and the technical improvements currently employed in the field of thyroid surgery, focusing on the contribution of energy based devices in relation with the reduction of the operating time and the odds of possible complication. Materials and methods: a relevant systematic literature search on Pubmed was carried out including works from 2004 through 2019, selecting studies providing information on the energy based devices employed in surgeries and statistic data concerning RNL (transient and permanent) injury and operative time. Results: Nineteen studies were reviewed, dealing with 4468 patients in total. The operative variables considered in this study are: employed device, number of patients, pathological conditions affecting the patients, surgical treatment, RNL injury percentage and the operating time, offering an insight on different patient conditions and their relative operative outcomes. A total of 1843 patients, accounting to the 41.2% of the total pool, underwent the traditional technique operation, while 2605 patients (58.3%) were treated employing the energy based devices techniques. Thyroidectomy performed by approaches different from traditional (for example robotic, MIVAT (Mini Invasive Video Assisted thyroidectomy)) were excluded from this study. Conclusions: The energy-based vessel sealing devices in study, represent a safe and efficient alternative to the traditional clamp-and-tie hand technique in the thyroidal surgery scenario, granting a reduction in operating time while not increasing RNL injury rates. According to this information, a preference for energy based devices techniques might be expressed, furthermore, a progressively higher usage rate for these devices is expected in the near future.

scholarly journals Arthroscopic Debridement and Autologous Micronized Adipose Tissue Injection in the Treatment of Advanced-Stage Posttraumatic Osteoarthritis of the Ankle

Cartilage ◽  
2020 ◽  
pp. 194760352094636
Author(s):  
Yoshiharu Shimozono ◽  
John F. Dankert ◽  
John G. Kennedy
Keyword(s):  
Adipose Tissue ◽  
Advanced Stage ◽  
Arthroscopic Debridement ◽  
Posttraumatic Osteoarthritis ◽  
Significant Difference ◽  
The Mean ◽  
Grade 3

Objective To evaluate the effect of intra-articular injection of autologous micronized adipose tissue (MAT) with ankle arthroscopic debridement in patients with advanced-stage posttraumatic osteoarthritis (PTOA) of ankle. Design A retrospective cohort study investigating patients treated with arthroscopic debridement and autologous MAT injection for ankle PTOA was performed. Patients with Kellgren-Lawrence (KL) grade 3 to 4 were included. Visual analogue scale (VAS), Foot and Ankle Outcome Scores (FAOS), and patient satisfaction were evaluated. Results A total of 19 patients (19 ankles) were included (KL grade 3, 8 patients; grade 4, 11 patients). At a mean follow-up time of 14.3 months (range, 7-23 months), the mean FAOS subscales for pain and quality of life significantly increased from 48.8 and 20.1 preoperatively to 61.1 and 30.1 ( P = 0.029 and 0.048, respectively). The mean VAS score significantly improved from 6.1 to 3.8 (P = 0.003) at final follow-up. A total of 10.5% (2/19) of patients were very satisfied, 31.6% (6/19) satisfied, 26.3% (5/19) neutral, 21.1% (4/19) unsatisfied, and 10.5% (2/19) very unsatisfied with their outcomes. The overall FAOS score demonstrated a significant difference in pre- to postoperative change with 14.8 for KL grade 3 and 5.9 for KL grade 4 ( P = 0.048). Conclusions Autologous MAT injection is a safe and potentially beneficial procedure for advanced-stage ankle PTOA as an adjunct to arthroscopic debridement, although more than one-third of patients were unsatisfied with the procedure. This procedure may be more beneficial for KL grade 3 patients than grade 4 patients. However, future investigations are necessary to define the role of MAT for ankle PTOA.

An anatomical study of the myelination of human laryngeal nerves

2011 ◽  
Vol 125 (12) ◽  
pp. 1263-1267 ◽  
Author(s):  
J C Fleming ◽  
N Gibbins ◽  
P J Ingram ◽  
M Harries
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Cross Sections ◽  
Recovery Of Function ◽  
Superior Laryngeal Nerve ◽  
Anatomical Study ◽  
Laryngeal Nerve ◽  
Clinical Consequence ◽  
Laryngeal Nerves ◽  
Significant Difference ◽  
Myelinated Fibres

AbstractObjective:To determine the differences in myelination between the human recurrent laryngeal nerve and superior laryngeal nerve.Methods:Fifteen confirmed laryngeal nerve specimens were harvested from five cadavers. Cross-sections were examined under a photomicroscope and morphometric analysis performed.Results:There was a significantly greater number of myelinated fibres than unmyelinated fibres, in both the recurrent laryngeal nerve (p = 0.018) and the superior laryngeal nerve (p = 0.012). There was a significantly greater number of myelinated fibres in the superior laryngeal nerve, compared with the recurrent laryngeal nerve (p = 0.028). However, there was no significant difference in the number of unmyelinated fibres, comparing the two nerves (p = 0.116).Conclusion:These findings support those of previous studies, and provide further evidence against the historical plexus theory of laryngeal nerve morphology. The differences in the degree of myelination, both within and between the human laryngeal nerves, may have clinical consequence regarding recovery of function following nerve injury.

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