A method to repair the recurrent laryngeal nerve during thyroidectomy.

Summary: Vocal cord palsy (VCP) is one of the most frequent complications following thyroidectomy. We evaluated the outcomes of intraoperative reconstruction of the recurrent laryngeal nerve (RLN). Of 917 patients who underwent thyroid surgery in a single high-volume general surgery ward between 2000 and 2015, 12 (1.3%) were diagnosed with RLN injury and were retrospectively categorized into 2 groups: group A (n = 5), with intraoperative evidence of iatrogenic transection or cancer invasion of the RLN, and group B (n = 7), with postoperative confirmation of VCP. In group A, immediate microsurgical primary repair of the RLN was performed. Postoperative assessment included subjective ratings (aspiration and voice quality improvement) and objective ratings (perceptual voice quality according to the grade, roughness, breathiness, asthenia and strain [GRBAS] scale, and direct laryngoscopy). In group A, roughness, breathiness and strain were significantly lower at 9 months than at 3 months (p < 0.05). Although larger, multicentre studies are needed, the results suggest potentially excellent postoperative phonatory function after immediate RLN reconstruction.

Emergency total thyroidectomy due to non traumatic disease. Experience of a surgical unit and literature review.

BACKGROUND: Acute respiratory failure due to thyroid compression or invasion of the tracheal lumen is a surgical emergency requiring urgent management. The aim of this paper is to describe a series of six patients treated successfully in the emergency setting with total thyroidectomy due to ingravescent dyspnoea and asphyxia, as well as review related data reported in literature. METHODS: During 2005-2010, of 919 patients treated by total thyroidectomy at our Academic Hospital, 6 (0.7%; 4 females and 2 men, mean age: 68.7 years, range 42-81 years) were treated in emergency. All the emergency operations were performed for life-threatening respiratory distress. The clinical picture at admission, clinical features, type of surgery, outcomes and complications are described. Mean duration of surgery was 146 minutes (range: 53-260). RESULTS: In 3/6 (50%) a manubriotomy was necessary due to the extension of the mass into the upper mediastinum. In all cases total thyroidectomy was performed. In one case (16.7%) a parathyroid gland transplantation and in another one (16.7%) a tracheotomy was necessary due to a condition of tracheomalacia. Mean post-operative hospital stay was 6.5 days (range: 2-10 days). Histology revealed malignancy in 4/6 cases (66.7%), showing 3 primitive, and 1 secondary tumors. Morbidity consisted of 1 transient recurrent laryngeal palsy, 3 transient postoperative hypoparathyroidism, and 4 pleural effusions, treated by medical therapy in 3 and by drains in one. There was no mortality. CONCLUSION: On the basis of our experience and of literature review, we strongly advocate elective surgery for patients with thyroid disease at the first signs of tracheal compression. When an acute airway distress appears, an emergency life-threatening total thyroidectomy is recommended in a high-volume centre.