A method to repair the recurrent laryngeal nerve during thyroidectomy

Abstract

Vocal cord palsy (VCP) is one of the most frequent complications following thyroidectomy. We evaluated the outcomes of intraoperative reconstruction of the recurrent laryngeal nerve (RLN). Of 917 patients who underwent thyroid surgery in a single high-volume general surgery ward between 2000 and 2015, 12 (1.3%) were diagnosed with RLN injury and were retrospectively categorized into 2 groups: group A (n = 5), with intraoperative evidence of iatrogenic transection or cancer invasion of the RLN, and group B (n = 7), with postoperative confirmation of VCP. In group A, immediate microsurgical primary repair of the RLN was performed. Postoperative assessment included subjective ratings (aspiration and voice quality improvement) and objective ratings (perceptual voice quality according to the grade, roughness, breathiness, asthenia and strain [GRBAS] scale, and direct laryngoscopy). In group A, roughness, breathiness and strain were significantly lower at 9 months than at 3 months (p < 0.05). Although larger, multicentre studies are needed, the results suggest potentially excellent postoperative phonatory function after immediate RLN reconstruction.

Fig. 1

Intraoperative image of an iatrogenic lesion of the recurrent laryngeal nerve. The arrows indicate the 2 nerve stumps.

Fig. 2

(A) Section of a recurrent laryngeal nerve; the adductors fibres are shown in dark grey, and the abductors fibres, in light grey. (B) Direct microsuture of a transected recurrent laryngeal nerve. (C) Repair of the recurrent laryngeal nerve using cyanoacrylate. (D) Repair of the recurrent laryngeal nerve using the ansa cervicalis.