Objective To investigate the clinical significance of visual identification and intraoperative neuromonitoring of recurrent laryngeal nerve (RLN) during thyroidectomy. Methods Totally 1 664 patients underwent thyroidectomy with RLN protection from January 2009 to December 2009 were included in this study, in which 1 447 cases were protected by visual identification only, and 217 complex thyroidectomy cases were protected by visual identification and intraoperative monitoring. Results By the “multisites, three steps” RLN exposure method, 1 417 cases （85.16%） were successfully recognized and the recognition time was (3.57±1.26) min. The recognition time in the rest 30 complex cases (2.07%) without intraoperative neuromonitoring was (17.02±5.48) min. By this method, the temporary RLN injury occurred in 23 cases (1.54%) and 15 cases (65.22%) recovered within 2 weeks. In patients undewent intraoperative neuromonitoring, the recognition rate was 100% (217/217) and recognition time was (2.18±0.67) min. The temporary RLN injury occurred in 4 cases (1.84%) and 3 cases (75.00%) recovered within 2 weeks. All temporary RLN injuries recovered within 1 month and no persistent RLN injury occurred. Conclusions Conventional visual identification can reduce the RLN injury, but not meet the needs of the RLN protection during complex thyroidectomy. The combination of visual identification and intraoperative neuromonitoring can further improve the recognition rate and shorten the recovery time of vocal cord dyskinesia.
ObjectiveTo investigate the feasibility and safety of a custom-made, needle-assisted retractor (derived from a nerve monitoring monopolar ball-tip probe) in gasless unilateral axillary approach (GUA) endoscopic thyroidectomy. MethodsA retrospective analysis was performed on the clinical data and surgical procedures of 50 consecutive patients who underwent endoscopic thyroidectomy using the needle-assisted technique via GUA at the Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University from April 2023 to December 2023. All surgical procedures were performed by a single surgeon. Surgical experiences and operative techniques were summarized. ResultsAmong the 50 patients, there were 48 females and 2 males, with an age of (35.16±7.56) years. Forty-seven patients were diagnosed with papillary thyroid carcinoma, with a tumor diameter of (0.69±0.52) cm; 3 patients were diagnosed with benign nodules, with a maximum diameter of (2.67±0.58) cm. All patients underwent unilateral thyroid lobectomy (patients with malignancy additionally underwent central neck dissection). All surgery was successfully completed without conversion to open surgery. The operative time was (156.12±34.27) min. Postoperative complications included temporary hoarseness in 2 patients, subcutaneous effusion in 2 patients, and ipsilateral upper limb numbness in 1 patient. All complications recovered within one month. ConclusionsThis study demonstrates the good feasibility and safety of needle-assisted endoscopic thyroidectomy via the GUA. Furthermore, it helps reduce the difficulty of the procedure, which provides effective support for surgeons, especially beginners, to rapidly master this technique.