Recurrent Laryngeal Nerve Morbidity: Lessons from Endoscopic via Bilateral Areola and Open Thyroidectomy Technique

World J Surg. 2019 Nov;43(11):2829-2841. doi: 10.1007/s00268-019-05092-x.


Background and aim: Elucidating the mechanism of recurrent laryngeal nerve (RLN) injuries through intraoperative electromyographic (EMG) and laryngeal examination approaches may deepen our knowledge regarding its prevention strategies. To date, no studies have been reported on the mechanism of RLN injury caused by endoscopic thyroidectomy via bilateral areola approach (ETBAA).

Methods: Both intraoperative EMG profiles and postoperative laryngeal examination were used to investigate the mechanisms of RLN injury and compare the safety aspects between ETBAA and open thyroidectomy approach (OTA).

Results: This study examined 1420 nerves at risk. The mean follow-up period was 17 ± 4 (range 6-48) months. The incidence of vocal cord paralysis was 4.1% (59/1420). The number of cases with decreased EMG signals and vocal cord palsy was higher in ETBAA group than in OTA group (P < 0.05). The left RLNs in ETBAA group were at higher risk compared to the right nerves.

Conclusions: The results of the current study indicate that ETBAA exhibits higher risk of RLN injury. The topic includes a video.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Video-Audio Media

MeSH terms

  • Adult
  • Electromyography
  • Endoscopy / adverse effects
  • Endoscopy / methods
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Nipples / surgery
  • Postoperative Period
  • Recurrent Laryngeal Nerve / physiopathology
  • Recurrent Laryngeal Nerve Injuries / etiology*
  • Recurrent Laryngeal Nerve Injuries / physiopathology
  • Recurrent Laryngeal Nerve Injuries / prevention & control
  • Thyroidectomy / adverse effects*
  • Thyroidectomy / methods*
  • Vocal Cord Paralysis / etiology*
  • Vocal Cord Paralysis / physiopathology
  • Young Adult