[Approach to the recurrent laryngeal nerve in thyroid surgery].

Objectives: We evaluated our surgical approach to the identification of the recurrent laryngeal nerve (RLN) under the guidance of operation microscope and RLN dissections during thyroidectomy.

Patients And Methods: Twenty-three patients (20 females, 3 males; mean age 37 years) undergoing thyroidectomy were included in the study. Thirty RLN dissections were performed, being unilateral in 16 patients, and bilateral in seven patients. The recurrent laryngeal nerves were identified at the inferior thoracic inlet with the use of the operation microscope having an ocular lens of 250 mm, followed by a total dissection up to the laryngeal entrance. Endoscopic laryngeal examinations were performed for vocal cord movements one day before surgery and postoperatively on days 1, 3, and 7.

Results: No abnormal vocal cord movements were detected preoperatively. Following surgery, none of the patients developed persistent RLN paralysis. Two patients exhibited transient vocal cord paralysis (limitation in vocal cord movements). The use of the operation microscope for RLN dissections resulted in prolongation of the operation time ranging from 15 to 40 minutes for each side, which tended to decrease with enhanced experience of the surgeon.

Conclusion: The use of the operation microscope enables safe RLN dissections during thyroidectomy operations.