Protection of Laryngeal Nerve Palsy using Amniotic Membrane Shield During Thyroid Surgery

2021 ◽  
Author(s):  
Tobias - Carling
Keyword(s):  
Thyroid Surgery ◽  
Nerve Palsy ◽  
Laryngeal Nerve ◽  
Injury Rates ◽  
Lateral Node ◽  
Nerve Paralysis ◽  
Nerve Monitoring ◽  
Lateral Node Dissection ◽  
Monitoring Devices ◽  
Extensive Surgery

Abstract Recurrent laryngeal nerve (RLN) palsy, subjective voice complaints, and iatrogenic hypoparathyroidism are the main risk factors of thyroid surgery (1; 2). The rate of unintentional transient RLN injury after total thyroidectomy has been reported in up to 30% of patients, and permanent paralysis ranges between 1-5.7% (3; 4). In patients undergoing concomitant central and/or lateral node dissection, the reported incidence is even greater (5). Patients with a RLN injury typically experience dysphonia for 10-12 weeks, with approximately 8-10% having a permanent vocal dysfunction. Even in the absence of overt nerve paralysis, voice alterations can be seen in 46-84 % of post-thyroidectomy patients (6; 7). Attempts to decrease the risk of nerve injury have been limited to accurate visualization and meticulous technique, performance of less extensive surgery and/or the use of nerve monitoring devices despite that their usage has never been shown to decrease RLN injury rates (8-10).

Thyroid surgery and recurrent laryngeal nerve monitoring

2006 ◽  
Vol 120 (7) ◽  
pp. 566-569 ◽  
Author(s):  
S Bailleux ◽  
A Bozec ◽  
L Castillo ◽  
J Santini
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Thyroid Surgery ◽  
Laryngeal Nerve ◽  
Recurrent Laryngeal Nerve Paralysis ◽  
Reliable Technique ◽  
Nerve Paralysis ◽  
Nerve Monitoring ◽  
Speech Therapist ◽  
A Prospective Study ◽  
Recurrent Laryngeal Nerve Monitoring

Recurrent laryngeal nerve paralysis is a much-dreaded complication of thyroid surgery.Objective: To study the feasibility and the reliability of a recurrent laryngeal nerve monitoring technique.Materials and methods: This was a prospective study including 36 patients proposed for thyroid surgery with recurrent laryngeal nerve monitoring. They underwent post-operative fibre-optic laryngeal examination and speech therapist consultation.Results: Our technique of nerve monitoring showed a 98 per cent sensitivity and 86 per cent specificity.Conclusions: Recurrent laryngeal nerve monitoring is a feasible and reliable technique. It can be used to avoid bilateral nerve injury and to increase the surgeon's confidence but not to replace a systematic nerve identification and a careful dissection.

Recurrent laryngeal nerve palsy secondary to benign thyroid disease

1994 ◽  
Vol 108 (10) ◽  
pp. 878-880 ◽  
Author(s):  
J. E. Fenton ◽  
C. I. Timon ◽  
D. P. McShane
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Thyroid Disease ◽  
Nerve Palsy ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Laryngeal Nerve ◽  
Recurrent Laryngeal Nerve Paralysis ◽  
Recurrent Nerve ◽  
Benign Thyroid Disease ◽  
Nerve Paralysis ◽  
Benign Thyroid

Abstract: A recurrent nerve palsy occurring in the presence of a goitre is considered to be caused by thyroid malignancy until proven otherwise.Three cases are described in which benign thyroid disease resulted in recurrent laryngeal nerve paralysis. Recent haemorrhage was implicated histologically as the possible aetiology in all three cases. The importance of identifying and preserving the recurrent laryngeal nerve in the surgical management is highlighted.

scholarly journals Total Endoscopic Thyroidectomy with Intraoperative Laryngeal Nerve Monitoring

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Bin Lv ◽  
Bin Zhang ◽  
Qing-Dong Zeng
Keyword(s):  
Endoscopic Thyroidectomy ◽  
Risk Difference ◽  
Laryngeal Nerve ◽  
Control Group ◽  
Injury Rates ◽  
Nerve Monitoring ◽  
Hand Surgeon ◽  
Joint Application ◽  
Left And Right ◽  
The Right

Objective. To evaluate the clinical efficacy of laryngeal nerve (LN) monitoring (LNM) during total endoscopic thyroidectomy via breast approach, with emphasis on the identification rates for RLN and EBSLN and the incidence of RLN paralysis. Materials and Methods. This retrospective study included 280 patients who underwent endoscopic thyroidectomy with or without LNM. RLN and EBSLN were identified using endoscopic magnification in the control group, while they were localized additionally by LNM in the LNM group. Demographic parameters and surgical outcomes were analyzed by statistical methods. Patients in the control group were also stratified by the side of thyroidectomy to determine difference in left and right RLN injury rates. Results. All procedures were successfully conducted without permanent LN damage. The identification rates for RLN and EBSLN were high in the LNM group compared to those of the control group, and the risk difference (RD) of temporary RLN injury between two groups was 6.3%. The risk of damage was slightly higher for the left RLN than for the right RLN in the control group, which was performed by a right-hand surgeon. Conclusion. The joint application of LNM and endoscopic magnified view endows total endoscopic thyroidectomy with ease, safety, and efficiency.

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.

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