title: Does extensive dissection of recurrent laryngeal nerve during thyroid operation increase the risk of nerve injury? Evidence from the application of intraoperative neuromonitoring.
abstract: OBJECTIVE
  Extensive dissection of recurrent laryngeal nerve (RLN) is inevitable in some complicated thyroid operations. The study aimed to determine whether extensive dissection of RLN increases the risk of nerve injury.
  
  
  METHODS
  Three hundred thirty-one patients (506 nerves at risk) who underwent thyroid operations with intraoperative neuromonitoring were included. The study chiefly focused on the 101 RLNs on which extensive nerve dissection from the thoracic inlet to the entry of larynx was performed and for which the nerve exposure was longer than 5 cm. Electromyographic (EMG) signals were obtained from the RLN and vagus nerve before and after complete RLN dissection, and these were defined as R(1), V(1) and R(2), V(2) signals, respectively. The RLN palsy rates and the change of EMG signals were evaluated and analyzed.
  
  
  RESULTS
  Among 101 nerves with extensive dissection, 13 nerves were due to the operation for recurrent goiter; 41 nerves, for large goiter with substernal extension; and 47 nerves, for thyroid cancer with paratracheal nodal metastasis. No permanent palsy occurred, but 2 nerves experienced loss of EMG signal after complete RLN dissection from a large recurrent goiter and developed temporary palsy. The palsy rates were 2% (2/101) in the extensive dissection group and 2.5% (10/405) in the nonextensive dissection group (P = .77). Among 99 nerves with normal vocal function after operation, none experienced weakened signal after complete RLN dissection, and the mean amplitudes of R(2) and V(2) signals were not significantly different from those of R(1) and V(1) signals (R(2) vs R(1); 1038 vs 1030 μV; P = .74; V(2) vs V(1); 824 vs 816 μV; P = .75).
  
  
  CONCLUSIONS
  The results of this study suggest that careful surgical dissection is well tolerated by the RLN.
authors.affiliation: Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan.
authors.forename: Feng-Yu
authors.initials: FY
authors.lastname: Chiang
authors.forename: I-Cheng
authors.initials: IC
authors.lastname: Lu
authors.forename: Cheng-Jing
authors.initials: CJ
authors.lastname: Tsai
authors.forename: Pi-Jung
authors.initials: PJ
authors.lastname: Hsiao
authors.forename: Chia-Cjen
authors.initials: CC
authors.lastname: Hsu
authors.forename: Che-Wei
authors.initials: CW
authors.lastname: Wu
mesh_terms: D000328:Adult; D000368:Aged; D004210:Dissection / Q000009:adverse effects / Q000379:methods; D004576:Electromyography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006042:Goiter / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D012008:Recurrence; D012009:Recurrent Laryngeal Nerve / Q000473:pathology / Q000601:surgery*; D012016:Reference Values; D012086:Reoperation / Q000379:methods; D018570:Risk Assessment; D013965:Thyroidectomy / Q000009:adverse effects* / Q000379:methods; D020196:Trauma, Nervous System / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000209:etiology / Q000517:prevention & control*