DIFFERENT SURGICAL TECHNIQUES FOR PRESERVATION OF RECURRENT LARYNGEAL NERVE DURING THYROIDECTOMY

Background: The most significant risk that associated with thyroid surgery, is the occurrence of recurrent laryngeal
nerve palsy. If this condition affects both sides of the larynx, it leads to laryngeal diplegia, resulting in severe
respiratory complications. Aim: To evaluate the surgical techniques used to preserve recurrent laryngeal nerves during thyroidectomy safely.
Methods: This cross-sectional study was conducted in the general surgery department of Beni-Suef University
Hospital and Fayoum General Hospital. We included 60 patients who were indicated for thyroidectomy. According
to the approach of RLN identification, the included patients were divided into four groups: lateral (n = 15), inferior (n
= 15), superior (n = 15), and medial (n = 15).
Result: The operative time of the inferior approach was the lowest operative Time 41.4 ± 10.7, compared with the
lateral approach 46.3 ± 9.9, the superior approach 55.6 ± 11.1, and the medial approach 67.7 ± 4.8. Inferior, superior,
and medial approaches were not associated with cases of paralyzed VC. The lateral approach group showed two cases
with paralyzed VC (11.8%). The lateral approach group showed a statistically significant number of cases with
hoarseness of voice (17.6%), while the other approaches showed no cases with hoarseness of voice (0%) (p = 0.042).
Conclusion: Our study highlights that identifying the RLN superiorly near its constant point of entry into the larynx
is an effective and safe technique to reduce the risk of RLN injury, nerve exposure, and low risk of hypocalcemia.
The lateral approach requires expertise and wide exposure to minimize RLN injury risk. The inferior approach poses
a lower RLN injury risk but raises concerns about parathyroid gland devascularization. The medial approach is helpful in local infiltrative malignancy and offers safer dissection for the parathyroid gland and ITA.