title: A standard approach to expose the recurrent laryngeal nerve during endoscopic thyroidectomy.
abstract: OBJECTIVE
  Exposing the recurrent laryngeal nerve (RLN) during all types of thyroid surgery is essential to protect this nerve. Endoscopic thyroidectomy (ET) has gained acceptance from both patients and physicians, in part due to the cosmetic benefits. Therefore, the avoidance of intraoperative RLN impairment during ET is of critical significance. We have developed a standard approach to expose the RLN during ET that prevents RNL impairment.
  
  
  METHODS
  ET was performed in 120 consecutive patients with thyroid disease. In order to develop a standard procedure that protects the RLN, several steps that differed from the traditional open procedure were introduced. First, the thyroid gland was freed from the isthmus instead of the superior pole. Then, the inferior pole of the thyroid gland was meticulously freed, and the lateral side of the thyroid gland was freed followed by the superior pole. At this point, the RLN was easily visualized in the tracheoesophageal groove. The thyroidectomy was then performed simultaneously with exposure of the RLN from the inferior to superior aspects. All RLNs were exposed when hemithyroidectomies, subtotal thyroidectomies, or total thyroidectomies were performed. The operative time and parathyroid hormone (PTH) and calcium levels were recorded prospectively and analyzed.
  
  
  RESULTS
  Using this method, all RLNs were easily exposed within 15 minutes. Only one case of transient RLN palsy occurred due to accidental contact of the harmonic scalpel to the nerve. Postoperative hypocalcemia occurred in 23 cases (19.2%), and the PTH level decreased significantly in 33 cases (27.5%). The PTH levels returned to normal within 3 months.
  
  
  CONCLUSIONS
  Use of the described approach to expose and protect the RLN when performing ET is safe and feasible.
authors.affiliation: Department of General Surgery, Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Shi
authors.initials: S
authors.lastname: Chang
authors.forename: Hui-Huan
authors.initials: HH
authors.lastname: Tang
authors.forename: Cun-Chuan
authors.initials: CC
authors.lastname: Wang
authors.forename: Le-Du
authors.initials: LD
authors.lastname: Zhou
authors.forename: Jin-Dong
authors.initials: JD
authors.lastname: Li
authors.forename: Yun
authors.initials: Y
authors.lastname: Huang
authors.forename: Qing-Jun
authors.initials: QJ
authors.lastname: Zeng
authors.forename: Zhi-Ming
authors.initials: ZM
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D002118:Calcium / Q000097:blood; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D012009:Recurrent Laryngeal Nerve / Q000601:surgery*; D013959:Thyroid Diseases / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000209:etiology / Q000517:prevention & control
chemical_list: D010281:Parathyroid Hormone; D002118:Calcium