Nonrecurrent Laryngeal Nerve Identification and Preservation during Transoral Robotic Thyroidectomy
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The nonrecurrent laryngeal nerve (NRLN), a rare, anatomic variation of the recurrent laryngeal nerve, is associated with increased injury risk during thyroid surgery. Here, we report a 44-year-old female presenting with right NRLN, receiving transoral robotic thyroidectomy with intraoperative neuromonitoring (IONM). Ultrasonogram of the patient's thyroid gland revealed a solitary nodule, with fine-needle aspiration cytology, indicating papillary carcinoma. Preoperative computed tomography scan revealed an aberrant right subclavian artery arising from the distal aortic arch, suggesting right NRLN. During transoral robotic hemi-thyroidectomy, IONM identified a NRLN emanating from the right vagus nerve and entering the larynx. The post-operative period was uneventful, and laryngoscopic examination demonstrated normal vocal cord movement with no changes observed in patient voice. This is the first report of transoral robotic thyroidectomy in a patient with NRLN. During transoral thyroidectomy, the right NRLN was easily identified and its integrity was preserved utilizing IONM.
Abstract
The nonrecurrent laryngeal nerve (NRLN), a rare, anatomic variation of the recurrent laryngeal nerve, is associated with increased injury risk during thyroid surgery. Here, we report a 44-year-old female presenting with right NRLN, receiving transoral robotic thyroidectomy with intraoperative neuromonitoring (IONM). Ultrasonogram of the patient's thyroid gland revealed a solitary nodule, with fine-needle aspiration cytology, indicating papillary carcinoma. Preoperative computed tomography scan revealed an aberrant right subclavian artery arising from the distal aortic arch, suggesting right NRLN. During transoral robotic hemi-thyroidectomy, IONM identified a NRLN emanating from the right vagus nerve and entering the larynx. The post-operative period was uneventful, and laryngoscopic examination demonstrated normal vocal cord movement with no changes observed in patient voice. This is the first report of transoral robotic thyroidectomy in a patient with NRLN. During transoral thyroidectomy, the right NRLN was easily identified and its integrity was preserved utilizing IONM.
참고문헌 (10)
- Timmermann W, "Effectiveness and results of intraoperative neuromonitoring in thyroid surgery. Statement of the interdisciplinary study group on intraoperative neuromonitoring of thyroid surgery", Chirurg, 75, pp.916~922 (2004)
- Barczynski M, "Randomized controlled trial of visualization versus neuromonitoring of the external branch of the superior laryngeal nerve during thyroidectomy", World J Surg, 36, pp.1340~1347 (2012)
- Lee HY, "Robotic transoral periosteal thyroidectomy (TOPOT): experience in two cadavers", J Laparoendosc Adv Surg Tech A, 25, pp.139~142 (2015)
- Benhidjeb T, "Natural orifice surgery on thyroid gland: totally transoral video-assisted thyroidectomy (TOVAT): report of first experimental results of a new surgical method", Surg Endosc, 23, pp.1119~1120 (2009)
- Anuwong A, "Transoral endoscopic thyroidectomy vestibular approach: a series of the first 60 human cases", World J Surg, 40, pp.491~497 (2016)
- Lee HY, "Transoral periosteal thyroidectomy: cadaver to human", Surg Endosc, 29, pp.898~904 (2015)
- Avisse C, "Right nonrecurrent inferior laryngeal nerve and arteria lusoria: the diagnostic and therapeutic implications of an anatomic anomaly. Review of 17 cases", Surg Radiol Anat, 20, pp.227~232 (1998)
- Defechereux T, "The inferior non recurrent laryngeal nerve: a major surgical risk during thyroidectomy", Acta Chir Belg, 100, pp.62~67 (2000)
- Attmann T, "Two-stage surgical and endovascular treatment of an aneurysmal aberrant right subclavian (Lusoria) artery", Eur J Cardiothorac Surg, 27, pp.1125~1127 (2005)
- Toniato A, "Identification of the nonrecurrent laryngeal nerve during thyroid surgery: 20-year experience", World J Surg, 28, pp.659~661 (2004)