Severity of Recurrent Laryngeal Nerve Injuries in Thyroid Surgery

Dionigi, Gianlorenzo; Wu, Che‐Wei; Kim, Hoon Yub; Rausei, Stefano; Boni, Luigi

doi:10.1007/s00268-016-3415-3

Cited by 118 publications

(151 citation statements)

References 26 publications

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“…Complete recovery from VCP was documented in 91% of RLN injuries (28). The severity of thermal injuries by EBD was worst than traction injury (28).…”

Section: The Severity Of Thermal Injury By Ebd In the Clinical Practicementioning

confidence: 92%

“…RLN thermal injury was quite frequent (28). The distribution of RLN injuries types, in order of frequency, was traction (71%), thermal from EBD (17%), compression (4.2%), clamping (3.4%), ligature entrapment (1.6%), suction (1.4%), and nerve transection (1.4%).…”

Section: The Severity Of Thermal Injury By Ebd In the Clinical Practicementioning

confidence: 99%

“…One study, first, attempts to classify RLN injuries and rank them by severity (28). The study was a prospective clinical study that analyzed 281 RLN injuries in which a true loss of signal was identified by IONM, and VCP was confirmed by a postoperative laryngoscope.…”

Section: The Severity Of Thermal Injury By Ebd In the Clinical Practicementioning

confidence: 99%

“…A porcine model of traction lesion showed only distorted outer nerve structure, whereas the thermal lesion by EBD showed severe damage in the inner endoneurium (28).…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, different RLN injuries types were experimentally induced in a porcine model to compare morphological change (28). A porcine model of traction lesion showed only distorted outer nerve structure, whereas the thermal lesion by EBD showed severe damage in the inner endoneurium (28).…”

Section: Introductionmentioning

confidence: 99%

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Safety of energy based devices for hemostasis in thyroid surgery

Dionigi¹,

Wu²,

Kim³

et al. 2016

Gland Surg.

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Energy based devices (EBD) have been developed, implemented and increasingly applied in thyroid surgery because they can provide a combined dissection and haemostatic effect. In particular, advantages of EBD have been described in terms of efficacious haemostasis, reduction of procedureassociated time, reduced incision length, less operative blood loss and transfusion need, decreased postoperative drain, pain and hospital stay. In addition, EBD are essential for endoscopic procedures. On the contrary, a potential drawback is the increased health care costs. This paper reviews relevant medical literature published on the safety of new devices for achieving hemostasis and dissection around the recurrent laryngeal nerve (RLN).

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“…Complete recovery from VCP was documented in 91% of RLN injuries (28). The severity of thermal injuries by EBD was worst than traction injury (28).…”

Section: The Severity Of Thermal Injury By Ebd In the Clinical Practicementioning

confidence: 92%

Section: The Severity Of Thermal Injury By Ebd In the Clinical Practicementioning

confidence: 99%

Section: The Severity Of Thermal Injury By Ebd In the Clinical Practicementioning

confidence: 99%

“…A porcine model of traction lesion showed only distorted outer nerve structure, whereas the thermal lesion by EBD showed severe damage in the inner endoneurium (28).…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Safety of energy based devices for hemostasis in thyroid surgery

Dionigi¹,

Wu²,

Kim³

et al. 2016

Gland Surg.

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Outcomes of Immediate Total Thyroidectomy in First-Side Loss of Neuromonitoring Signal

Ramesh,

Van Den Berg,

Sheahan

2024

JAMA Otolaryngol Head Neck Surg

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ImportanceUse of intraoperative neuromonitoring (IONM) during thyroidectomy can nearly eliminate the risk of postoperative bilateral vocal cord palsy (VCP) by indicating staged surgery in cases of loss of signal (LOS) on the first side of planned total thyroidectomy. However, aborting planned total thyroidectomy may lead to persistence of symptoms, delay in adjuvant treatment, and patient inconvenience and distress. There are few data to guide a selective approach to total thyroidectomy in patients with first-side LOS.ObjectiveTo investigate outcomes of immediate bilateral surgery in patients undergoing total thyroidectomy with first-side LOS.Design, Setting, and ParticipantsThis cohort study was a retrospective review of outcomes for patients undergoing thyroidectomy between January 2016 and July 2023 at an academic tertiary referral center for thyroid surgery. Consecutive patients scheduled for total thyroidectomy using IONM were included. Exclusion criteria were preoperative VCP, deliberate sacrifice of recurrent laryngeal nerve (RLN), inadvertent RLN resection, and surgery performed without IONM.ExposuresTotal thyroidectomy performed using IONM.Main Outcome MeasuresVocal mobility on first postoperative day as assessed by flexible laryngoscopy; secondary outcome measures included subjective voice assessment, other postoperative complications, and long-term vocal mobility.ResultsAmong 400 patients undergoing planned total thyroidectomy (mean age, 50.5 years [range, 4-88 years]; 318 female [79.5%]), 51 (12.8%) had first-side LOS, of whom 37 (9.3%) had persistent LOS. Twenty-nine patients (56% of procedures with first-side LOS, including 18 with persistent LOS) proceeded to immediate total thyroidectomy. Postoperatively, 16 patients (55% of patients undergoing total thyroidectomy following first-side LOS, including 14 of 18 with persistent LOS) had impaired vocal mobility. One patient had bilateral VCP that did not require tracheostomy, and 2 had postoperative hypoparathyroidism. Of those whose surgery was aborted after first-side LOS, 8 of 22 (36%) underwent completion thyroidectomy at a later stage. In those undergoing completion thyroidectomy, 2 of 8 (25%) had temporary VCP after the second surgery, 2 (25%) had permanent hypoparathyroidism, and 1 (12.5%) developed inoperable cancer. Postoperative VCP was fully reversible in all but 1 patient.Conclusion and RelevanceAmong patients planned for total thyroidectomy who develop first-side LOS, immediate total thyroidectomy may be considered among those who have pressing reasons for same, and where surgical difficulties might be anticipated in a secondary surgery.

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Surgical management of the recurrent laryngeal nerve in thyroidectomy: American Head and Neck Society Consensus Statement

et al. 2018

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"I have noticed in operations of this kind, which I have seen performed by others upon the living, and in a number of excisions, which I have myself performed on the dead body, that most of the difficulty in the separation of the tumor has occurred in the region of these ligaments…. This difficulty, I believe, to be a very frequent source of that accident, which so commonly occurs in removal of goiter, I mean division of the recurrent laryngeal nerve." Sir James Berry (1887).

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Severity of Recurrent Laryngeal Nerve Injuries in Thyroid Surgery

Cited by 118 publications

References 26 publications

Safety of energy based devices for hemostasis in thyroid surgery

Safety of energy based devices for hemostasis in thyroid surgery

Outcomes of Immediate Total Thyroidectomy in First-Side Loss of Neuromonitoring Signal

Surgical management of the recurrent laryngeal nerve in thyroidectomy: American Head and Neck Society Consensus Statement

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