Recurrent laryngeal nerve injury (RLNI) in total thyroidectomy with intraoperative nerve monitoring (IONM) and harmonic sealing instrument: A retrospective analysis and treatment results

INTRODUCTION: The aim of the current study was to reveal the incidence of RLNI in our patients with total thyroidectomy and to evaluate their clinical outcomes.
METHODS: Charts of 260 patients who underwent total thyroidectomy between 2014 and 2018 were interrogated retrospectively. Standard IONM and harmonic seal were used in all. Patients with suspect of RLNI were further evaluated. Demographics, etiologic disease and the overall treatment results were presented.
RESULTS: A total of 12 patients with RLNI (4.6 %) were presented. Nine (75 %) were women and 3 (25 %) were men. Mean age was 51 years (range, 32-67). RLNI was unilateral in 8 patients (3 %; 50 % in right RLN and 50 % in left RLN) and bilateral in four (1.5 %). All were started corticosteroid and follow-up period was 26 months (range, 9-52). Mean hospital stay was 4 days (range, 2-14). Histopathological evaluations revealed papillary carcinoma (n=7, 58 %), multinodular goitre with thyroiditis (n=4, 34 %) and multinodular goitre with parathyroid adenoma (n=1, 8 %). In a patient with bilateral RLNI (0.3 %), tracheostomy was done on postoperative day 2, and closed on postoperative month 4. Thyroplasty and suture lateralization were applied to other bilateral RLNI cases. In 5 patients with unilateral RLNI and one with bilateral palsy, vocal cords became normal in first 6 months (transient palsy, 2.3
DISCUSSION AND CONCLUSION: Careful surgical dissection with harmonic and IONM employed in total thyroidectomy are both reliable methods. In case of inevitable RLNI, a close follow-up and cooperation are mandatory to have optimal results.