CRANIO-CAUDAL AND LATERAL APPROACH FOR RECURRENT LARYNGEAL NERVE
Recurrent Laryngeal Nerve Injuries
About this trial
This is an interventional treatment trial for Recurrent Laryngeal Nerve Injuries focused on measuring cranio-caudal approach, lateral approach, intraoperative nerve monitoring
Eligibility Criteria
Inclusion criteria:
- Multinoduler Goitre
- Thyroid papillary cancer
- Solitary thyroid nodule
Exclusion criteria:
- previous thyroid or parathyroid surgery,
- substernal goiter,
- preoperative VCP,
- evidence of lateral lymph node metastasis,
- intentional transection of the RLN due to tumor invasion,
- failure to assess RLN functioning due to equipment issues with the IONM setup,
- presurgical dissection amplitude of <500µV,
- patient's refusal to participate
Sites / Locations
- Istanbul University
Arms of the Study
Arm 1
Arm 2
Active Comparator
Active Comparator
Lateral approach
Cranio-caudal approach
Following the ligation of upper pole vessels, the thyroid lobe lobe was pulled anteromedially and the RLN was dissected within the carotid triangle at the level of inferior thyroid artery. The tissue between the carotid artery and the trachea was dissected gently parallel to the direction of the nerve until the nerve is identified visually and,or by hand held stimulation probe. After the identification of RLN, the vessels of inferior thyroid lobe was ligated. The nerve was dissected along its course to the entry point, and then the thyroid lobe was totally dissected from the trachea and the lobectomy was completed. If adverse EMG changes were encountered during lateral approach, traction was released immediately and waited for recovery.
Following the ligation of upper pole vessels, the upper pole was retracted antero-medially to expose crico-pharyngeal muscle. The RLN nerve was identified at the point of entry both visually and with hand held stimulation probe. The RLN dissection was proceeded craniocaudally by the division of the suspensory ligaments of the berry through the level of inferior thyroid artery. After the identification and visualitzation of the RLN through its whole course, the medial and inferior vessels of the thyroid gland were dissected and ligated. Then, the lobe was dissected from the trachea and lobectomy was completed.