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. 2023 Sep;67(9):791-795.
doi: 10.4103/ija.ija_316_23. Epub 2023 Sep 6.

A single-arm, prospective study comparing translaryngeal ultrasonography with direct visualisation by flexible laryngoscopy for vocal cord assessment in patients undergoing oesophagectomy or mediastinoscopy

Madhavi Shetmahajan  1 , M Vignesh  1   2 , Vijaya Patil  1 , Swapnil Yeshwant Parab  1 , Priya Ranganathan  1
Affiliations

A single-arm, prospective study comparing translaryngeal ultrasonography with direct visualisation by flexible laryngoscopy for vocal cord assessment in patients undergoing oesophagectomy or mediastinoscopy

Madhavi Shetmahajan et al. Indian J Anaesth. 2023 Sep.

Abstract

Background and aims: Translaryngeal ultrasonography (TLUSG) for diagnosis of vocal cord palsy, a relatively new, safe and noninvasive bedside technique with minimal risk of respiratory infection transmission, has been effective in patients with thyroid disease. We studied its use as an alternative method to visual inspection by flexible laryngoscopy (FL) for vocal cord assessment in patients undergoing thoracic surgeries.

Methods: After Institutional Ethics Committee approval and trial registration, in this single-arm, prospective study, the vocal cord function of 110 patients who underwent either total oesophagectomy or mediastinoscopy was assessed immediately after extubation by both FL and TLUSG. A follow-up assessment was done by laryngoscopy using Hopkin's endoscope (HL) and a repeat TLUSG. The primary outcome was the concordance between direct visualisation (FL or HL) and TLUSG.

Results: Vocal cords were successfully visualised by TLUSG in 90% of male and all female patients. Findings of FL and TLUSG done at the first assessment matched in 89 (86.4%) out of 103 patients, and the degree of concordance was 0.69 (95% confidence interval [CI] =0.52-0.83). At the second assessment, HL and TLUSG findings matched in 83 (94.3%) out of 88 patients, and the degree of concordance was 0.89 (95% CI = 0.77-0.98).

Conclusion: TLUSG is an effective noninvasive alternative to direct visualisation for vocal cord assessment in both male and female patients undergoing thoracic surgery.

Keywords: Mediastinoscopy; flexible laryngoscopy; oesophagectomy; translaryngeal ultrasonography; ultrasonography; vocal cord assessment; vocal cord palsy.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Study schema. FL = flexible laryngoscopy, HL = laryngoscopic examination with Hopkins endoscope, POD = postoperative day, TLUSG = translaryngeal ultrasonography, VC = vocal cord
See this image and copyright information in PMC

References

    1. Scholtemeijer MG, Seesing MFJ, Brenkman HJF, Janssen LM, van Hillegersberg R, Ruurda JP. Recurrent laryngeal nerve injury after esophagectomy for oesophagal cancer: Incidence, management, and impact on short- and long-term outcomes. J Thorac Dis. 2017;9:S868–78. - PMC - PubMed
    1. Koyanagi K, Igaki H, Iwabu J, Ochiai H, Tachimori Y. Recurrent laryngeal nerve paralysis after esophagectomy: Respiratory complications and role of nerve reconstruction. Tohoku J Exp Med. 2015;237:1–8. - PubMed
    1. Fourdrain A, De Dominicis F, Iquille J, Lafitte S, Merlusca G, Witte Pfister A, et al. The usefulness of a routine endoscopic assessment of laryngeal lesions after lung cancer surgery. Respirology. 2018;23:107–10. - PubMed
    1. Sano Y, Shigematsu H, Okazaki M, Sakao N, Mori Y, Yukumi S, et al. Hoarseness after radical surgery with systematic lymph node dissection for primary lung cancer. Eur J Cardiothorac Surg. 2019;55:280–5. - PubMed
    1. Kim DH, Lee J, Seo Y, Kim SW, Hwang SH. Perioperative transcutaneous laryngeal ultrasonography to assess vocal cord function in thyroid surgery. Am J Surg. 2022;223:893–9. - PubMed

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