Recurrent Laryngeal Nerve Morbidity: Lessons from Endoscopic via Bilateral Areola and Open Thyroidectomy Technique

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Background and aim

Elucidating the mechanism of recurrent laryngeal nerve (RLN) injuries through intraoperative electromyographic (EMG) and laryngeal examination approaches may deepen our knowledge regarding its prevention strategies. To date, no studies have been reported on the mechanism of RLN injury caused by endoscopic thyroidectomy via bilateral areola approach (ETBAA).


Both intraoperative EMG profiles and postoperative laryngeal examination were used to investigate the mechanisms of RLN injury and compare the safety aspects between ETBAA and open thyroidectomy approach (OTA).


This study examined 1420 nerves at risk. The mean follow-up period was 17 ± 4 (range 6–48) months. The incidence of vocal cord paralysis was 4.1% (59/1420). The number of cases with decreased EMG signals and vocal cord palsy was higher in ETBAA group than in OTA group (P < 0.05). The left RLNs in ETBAA group were at higher risk compared to the right nerves.


The results of the current study indicate that ETBAA exhibits higher risk of RLN injury. The topic includes a video.

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Author information

HS, NL and GD were involved in conception and design; HS, NL and GD contributed to administrative support; and DZ performed collection and assembly of data.

Correspondence to Nan Liang or Hui Sun.

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Conflict of interest

The authors Daqi Zhang, Jiao Zhang, Gianlorenzo Dionigi, Fang Li, Tie Wang, Hongbo Li, Nan Liang and Hui Sun declare no conflict of interest. The funders had no role in (1) the design of this study; (2) the collection, analysis and interpretation of data; (3) the writing of the manuscript; or (4) the decision to submit the manuscript for publication.

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Zhang, D., Zhang, J., Dionigi, G. et al. Recurrent Laryngeal Nerve Morbidity: Lessons from Endoscopic via Bilateral Areola and Open Thyroidectomy Technique. World J Surg 43, 2829–2841 (2019) doi:10.1007/s00268-019-05092-x

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