Visualization and Preservation of Recurrent Laryngeal Nerve by Hydrodissection

Öz

Aim: Recurrent laryngeal nerve (RLN) injury is the most feared complication of thyroid surgery. Hydrodissection; separation of tissues by fluids is described in laparoscopic cholecystectomy, cataract surgery, carpal tunnel syndrome treatment where meticulous dissection must be carried out. In this study, we aimed to assess the incidence of RLN damage observed in our series by hydrodissection of RLN during thyroid surgery. Material and Method: Thirty four consecutive patients underwent thyroidectomy for various thyroid diseases in 24 months were included in the study. All the patients’ demographic variables (age, sex), operation type (bilateral total thyroidectomy, hemithyroidectomy (total lobectomy and isthmectomy), completion total thyroidectomy, whether central neck compartment dissection was performed), pathology reports, nerves at risk were noted retrospectively. Results: Only in one case, temporary unilateral RLN paralysis causing hoarseness was observed, after total thyroidectomy performed for voluminous toxic multinodular goitre. Conclusion: Hydrodissection is an easily applicable, non time-consuming and cheap technique. This preliminary study may be followed by further researches with larger sample sizes.

Anahtar Kelimeler

• hydrodissection
• recurrent laryngeal nerve
• thyroidectomy
• paralysis
• hoarseness

Rekürren Laringeal Sinirin Hidrodiseksiyon ile Görülmesi ve Korunması

Öz

Amaç: Rekürren Laringeal Sinir (RLS) hasarı tiroid cerrahisinin en korkulan komplikasyonudur. Laparoskopik kolesistektomi, katarakt cerrahisi, karpal tünel sendromu tedavisi gibi titiz diseksiyon yapılan durumlarda da tarif edildiği gibi hidrodiseksiyon dokuların sıvıların kullanımı ile diseke edilip, ayrıştırılmasıdır. Bu çalışmada, tiroid cerrahisi sırasında hidrodiseksiyon ile RLS’ nin görülmesi ve hasarlanma oranlarının saptanması amaçlanmıştır. Gereç ve Yöntem: Bu çalışmaya Şubat 2016- Ağustos 2017 arasında çeşitli tiroid hastalıkları nedeni ile art arda opere edilen 34 hasta dahil edilmiştir. Olguların yaş, cinsiyet gibi demografik verileri, yapılan operasyon tipleri (bilateral total tiroidektomi, hemitiroidektomi (total lobektomi ve istmektomi), tamamlayıcı tiroidektomi, santral boyun diseksiyonu yapılıp yapılmadığı), patoloji raporları, risk altındaki sinirler retrospektif olarak kayıt altına alınmıştır. Bulgular: Sadece dev toksik multinodüler guatr için total tiroidektomi yapılan bir olguda ses kısıklığına neden olan tek taraflı geçici RLS hasarı gözlendi. Sonuç: Hidrodiseksiyon kolay uygulanabilir, zaman almayan, ucuz bir tekniktir. Bu öncü çalışma daha geniş örneklemlerde yapılan çalışmalarla takip edilebilir.

Anahtar Kelimeler

• hidrodiseksiyon
• rekürren laringeal sinir
• tiroidektomi
• paralizi
• ses kısıklığı

Kaynakça

1. 1.) Rosato L, Avenia N, Bernante P, et al. Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg. 2004; 28: 271-6.
2. 2.) Joliat GR, Guarnero V, Demartines N, et al. Recurrent laryngeal nerve injury after thyroid and parathyroid surgery: Incidence and postoperative evolution assessment. Medicine (Baltimore). 2017; 96: e6674.
3. 3.) Hermann M, Alk G, Roka R, et al. Laryngeal recurrent nerve injury in surgery for benign thyroid diseases: effect of nerve dissection and impact of individual surgeon in more than 27,000 nerves at risk. Ann Surg. 2002; 235: 261-8.
4. 4.) Sinagra DL, Montesinos MR, Tacchi VA, et al. Voice changes after thyroidectomy without recurrent laryngeal nerve injury. J Am Coll Surg. 2004; 199: 556-60.
5. 5.) Schulte KM, Röher HD. Complications in the surgery of benign thyroid disease. Acta Chirurgica Austriaca. 2001; 33: 164-72.
6. 6.) Johnson A, Sprangers A, Cassidy P, et al. Design and validation of a thermoreversible material for percutaneous tissue hydrodissection. J Biomed Mater Res B Appl Biomater. 2013; 101: 1400-9.
7. 7.) Wu YT, Chen SR, Li TY, et al. Nerve hydrodissection for carpal tunnel syndrome: A prospective, randomized, double‐blind, controlled trial. Muscle Nerve. 2019; 59: 174-80.
8. 8.) Kaya B, Fersahoglu MM, Kilic F, et al. Importance of critical view of safety in laparoscopic cholecystectomy: a survey of 120 serial patients, with no incidence of complications. Ann Hepatobiliary Pancreat Surg. 2017; 21: 17-20.

9. 9.) Taş A. Minimal water-jet hydrodissection. Clin Ophthalmol. 2017; 12: 1-5.
10. 10.) Bland JDP. Hydrodissection for treatment of carpal tunnel syndrome. Muscle Nerve. 2018; 57: 4-5.
11. 11.) Li S, Chen X, Zhao J, et al. Isolated capsulorhexis flap technique in femtosecond laser-assisted cataract surgery to protect the corneal endothelial cells. J Invest Surg. 2019; 32: 35-8.
12. 12.) Agha RA, Borrelli MR, Farwana R, et al. The PROCESS 2018 statement: updating consensus preferred reporting of CasE series in surgery (PROCESS) guidelines. Int J Surg. 2018; 60: 279-82.
13. 13.) Myssiorek D. Recurrent laryngeal nerve paralysis: anatomy and etiology. Otolaryngol Clin North Am. 2004; 37: 25-44.
14. 14.) Gavilán J, Gavilán C. Recurrent laryngeal nerve: identification during thyroid and parathyroid surgery. Arch Otolaryngol Head Neck Surg. 1986; 112: 1286-8.
15. 15.) Nyeki ARN, Njock LR, Miloundja J, et al. Recurrent laryngeal nerve landmarks during thyroidectomy. Eur Ann Otorhinolaryngol Head Neck Dis. 2015; 132: 265-9.
16. 16.) Chiang FY, Lee KW, Huang YF, et al. Risk of vocal palsy after thyroidectomy with identification of the recurrent laryngeal nerve. Kaohsiung J Med Sci. 2004; 20: 431-6.
17. 17.) Sarma MK, Kakati K, Sharma K, et al. Recurrent laryngeal nerve injury (RLNI) in thyroid surgery and its prevention. Int J Res Med Sci. 2015; 3: 1632-6.
18. 18.) Kulekci M, Batıoglu-Karaaltın A, Saatci O, et al. Relationship between the branches of the recurrent laryngeal nerve and the inferior thyroid artery. Ann Otol Rhinol Laryngol. 2012; 121: 650-6.
19. 19.) Page C, Peltier J, Charlet L, et al. Superior approach to the inferior laryngeal nerve in thyroid surgery: anatomy, surgical technique and indications. Surg Radiol Anat. 2006; 28: 631-6.
20. 20.) Yang S, Zhou L, Lu Z, et al. Systematic review with meta-analysis of intraoperative neuromonitoring during thyroidectomy. Int J Surg. 2017; 39: 104-13.
21. 21.) Wang T, Kim HY, Wu CW, et al. Analyzing cost-effectiveness of neural-monitoring in recurrent laryngeal nerve recovery course in thyroid surgery. Int J Surg. 2017 ;48: 180-8.
22. 22.) Jiang Y, Gao B, Zhang X, et al. Prevention and treatment of recurrent laryngeal nerve injury in thyroid surgery. Int J Clin Exp Med. 2014; 7: 101-7.
23. 23.) Lee HS, Oh J, Kim SW, et al. Intraoperative Neuromonitoring of Recurrent Laryngeal Nerve During Thyroidectomy with Adhesive Skin Electrodes. World J Surg. 2020; 44: 148-54.
24. 24.) Isik A, Firat D, Yilmaz I, et al. A survey of current approaches to thyroid nodules and thyroid operations. Int J Surg. 2018; 54: 100-4.