Traction Injury of Recurrent Laryngeal Nerve During Thyroidectomy

Background Loss of the neuromonitoring signal (LOS) during thyroidectomy signifies recurrent laryngeal nerve (RLN) injury, which is one of the common complications, especially by traction injury. Transient intraoperative LOS means spontaneous recovery of nerve function during surgery or within 6-mon...

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Bibliographic Details
Published in:World journal of surgery 2020-02, Vol.44 (2), p.402-407
Main Authors: Liu, Meng-Yu, Chang, Chun-Ping, Hung, Chien-Ling, Hung, Chung-Jye, Huang, Shih-Ming
Format: Article
Language:English
Subjects:
Abdominal Surgery
Cardiac Surgery
Complications
Female
General Surgery
Health risks
Humans
Injuries
Intraoperative neuromonitoring
Male
Materials recovery
Medical instruments
Medicine
Medicine & Public Health
Middle Aged
Monitoring, Intraoperative
Nerves
Original Scientific Report
Patients
Recovery time
Recurrent laryngeal nerve
Recurrent Laryngeal Nerve Injuries - etiology
Retrospective Studies
Risk analysis
Risk factors
Spontaneous recovery
Surgery
Surgical complication
Thoracic Surgery
Thyroid
Thyroid surgery
Thyroidectomy
Thyroidectomy - adverse effects
Ultrasound
Vagus nerve
Vascular Surgery
Vocal Cords - physiopathology
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Summary:Background Loss of the neuromonitoring signal (LOS) during thyroidectomy signifies recurrent laryngeal nerve (RLN) injury, which is one of the common complications, especially by traction injury. Transient intraoperative LOS means spontaneous recovery of nerve function during surgery or within 6-month post-surgery. Few articles discuss intraoperative recovery time and transient LOS, and there is no consensus on the risk factors for RLN traction injury and its recovery course; thus, we wanted to determine the maximum intraoperative recovery time. Materials and methods This retrospective study included patients who had undergone thyroidectomies at Tainan National Cheng Kung University Hospital between January 2015 and August 2018. A total of 775 patients (with 1000 nerves at risk) who underwent intermittent intraoperative neuromonitoring during thyroidectomy were included in this study. The LOS nerves were divided into 4 groups based on the LOS subtype and the intraoperative status of the recovery. The postoperative vocal cord function was determined by thyroid ultrasound and/or laryngoscope. All the patients would be followed up postoperatively in 2–3 days, 1 week, 2 weeks, and 4–6 weeks. Results LOS occurred in 67 of 775 (8.6%) patients and in 70 of 1000 nerves at risk (7.0%). There were 2 in 70 nerves (2.9%) with LOS type 1 (segmental nerve traction injury) with intraoperative recovery (Group 1), 5 (7.1%) with LOS type 1 without intraoperative recovery (Group 2), 47 (67.1%) with LOS type 2 (global injury) with intraoperative recovery (Group 3), and 16 (22.8%) with LOS type 2 without intraoperative recovery (Group 4). All LOS type 1 (segmental nerve injury) nerves had pathologic lesions near the RLN or vagus nerve, but none had invaded the nerves ( p  
ISSN:0364-2313
1432-2323
DOI:10.1007/s00268-019-05178-6