Immediate Ansa cervicalis-to-recurrent laryngeal nerve low-tension anastomosis: A new technique for phonation recovery and bilateral anastomoses to avoid tracheotomy

Shuai Dong; Feng Zhu; Jun Pan; Xue-Yu Zhou; Xiao-Long Du; Xiao-Jun Xie; Yi-Jun Wu

doi:10.1016/j.amjoto.2024.104358

Immediate Ansa cervicalis-to-recurrent laryngeal nerve low-tension anastomosis: A new technique for phonation recovery and bilateral anastomoses to avoid tracheotomy

Am J Otolaryngol. 2024 Apr 28;45(5):104358. doi: 10.1016/j.amjoto.2024.104358. Online ahead of print.

Authors

Shuai Dong¹, Feng Zhu², Jun Pan², Xue-Yu Zhou², Xiao-Long Du², Xiao-Jun Xie³, Yi-Jun Wu⁴

Affiliations

¹ Department of Thyroid Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China. Electronic address: donshai@zju.edu.cn.
² Department of Thyroid Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
³ Department of Thyroid Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China. Electronic address: xxj701023@zju.edu.cn.
⁴ Department of Thyroid Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China. Electronic address: wuwu5929@zju.edu.cn.

PMID: 38754262
DOI: 10.1016/j.amjoto.2024.104358

Abstract

Objective: This case series study investigated the outcomes of an innovative approach, ansa cervicalis nerve (ACN)-to-recurrent laryngeal nerve (RLN) low-tension anastomosis.

Methods: Patients who received laryngeal nerve anastomosis between May 2015 and September 2021 at the facility were enrolled. The inclusion criteria were patients with RLN dissection and anastomosis immediately during thyroid surgery. Exclusion criteria were cases with anastomosis other than cervical loop-RLN anastomosis or pronunciation recovery time > 6 months. Patients admitted before January 2020 were assigned to group A which underwent the conventional tension-free anastomosis, and patients admitted after January 2020 were group B and underwent the innovative low-tension anastomosis (Dong's method).

Results: A total of 13 patients were included, 11 patients received unilateral surgery, and 2 underwent bilateral surgery. For patients who underwent unilateral anastomosis, group B had a significantly higher percentage of normal pronunciation via GRBAS scale (83.3 % vs. 0 %, p = 0.015) and voice handicap index (66.7 % vs. 0 %, p = 0.002), and shorter recovery time in pronunciation (median: 1-day vs. 4 months, p = 0.001) than those in group A after surgery.

Conclusions: ACNs-to-RLN low-tension anastomosis with a laryngeal segment ≤1 cm (Dong's method) significantly improves postoperative pronunciation and recovery time. The results provide clinicians with a new strategy for ACN -to-RLN anastomosis during thyroid surgery.

Keywords: Anastomosis; Ansa cervicalis nerve (ACN); Recurrent laryngeal nerve (RLN); Thyroid surgery; Tracheotomy.