title: The Reliability of the Tracheoesophageal Groove and the Ligament of Berry as Landmarks for Identifying the Recurrent Laryngeal Nerve: A Cadaveric Study and Meta-Analysis.
abstract: Purpose. The aim of this meta-analysis was to provide a comprehensive evidence-based assessment, supplemented by cadaveric dissections, of the value of using the Ligament of Berry and Tracheoesophageal Groove as anatomical landmarks for identifying the Recurrent Laryngeal Nerve.Methods. Seven major databases were searched to identify studies for inclusion. Eligibility was judged by two reviewers. Suitable studies were identified and extracted. MetaXL was used for analysis. All pooled prevalence rates were calculated using a random effects model. Heterogeneity among included studies was assessed using the Chi2test and theI2statistic.Results. Sixteen studies (n= 2,470 nerves), including original cadaveric data, were analyzed for the BL/RLN relationship. The RLN was most often located superficial to the BL with a pooled prevalence estimate of 78.2% of nerves, followed by deep to the BL in 14.8%. Twenty-three studies (n= 5,970 nerves) examined the RLN/TEG relationship. The RLN was located inside the TEG in 63.7% (95% CI: 55.3-77.7) of sides.Conclusions. Both the BL and TEG are landmarks that can help surgeons provide patients with complication-free procedures. Our analysis showed that the BL is a more consistent anatomical landmark than the TEG, but it is necessary to use both to prevent iatrogenic RLN injuries during thyroidectomies.
authors.affiliation: International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Brandon Michael
authors.identifier: 0000-0002-8047-338X
authors.initials: BM
authors.lastname: Henry
authors.affiliation: Faculty of Medicine and Surgery, University of Cagliari, Sardinia, Italy.
authors.forename: Beatrice
authors.initials: B
authors.lastname: Sanna
authors.affiliation: International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Graves
authors.affiliation: Department of Surgical Sciences, University of Cagliari, Sardinia, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Sanna
authors.affiliation: International Evidence-Based Anatomy Working Group, Krakow, Poland; Division of Medicine, Stavanger University Hospital, Stavanger, Norway.
authors.forename: Jens
authors.initials: J
authors.lastname: Vikse
authors.affiliation: Department of Medical Education, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Iwona M
authors.identifier: 0000-0003-0952-5674
authors.initials: IM
authors.lastname: Tomaszewska
authors.affiliation: Seattle Science Foundation, Seattle, WA, USA.
authors.forename: R Shane
authors.identifier: 0000-0003-1317-1047
authors.initials: RS
authors.lastname: Tubbs
authors.affiliation: International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Krzysztof A
authors.identifier: 0000-0001-5077-6948
authors.initials: KA
authors.lastname: Tomaszewski
mesh_terms: D000368:Aged; D059925:Anatomic Landmarks; D002102:Cadaver; D004947:Esophagus / Q000033:anatomy & histology; D005260:Female; D006801:Humans; D008022:Ligaments / Q000033:anatomy & histology*; D008297:Male; D012009:Recurrent Laryngeal Nerve / Q000033:anatomy & histology*; D015203:Reproducibility of Results