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Laryngeal nerve identification during thyroid surgery – feasibility of a novel approach

[L’identification du nerf laryngé pendant l’opération de la thyroïde – la faisabilité d’une nouvelle approche]

Carl L. Hillermann, FRCA^*, Joe Tarpey, FFARCSI^* and David E. Phillips, FCS

^* From the Department of Anaesthesia, and
the Department of Surgery, Warwick Hospital, Warwick, United Kingdom.

Address correspondence to: Dr. Carl L. Hillermann, Department of Anaesthesia, Faculty of Medicine, University of Natal, Private Bag 7, Congella, 4103 South Africa. Phone: +27 31 2604328/9; Email: chillermann{at}yahoo.co.uk

Purpose: Recurrent laryngeal nerve damage remains one of the most devastating complications of thyroid surgery. However, nerve identification is not always easy, and a reliable method to locate nerves intraoperatively is needed.

Methods: Thirty consecutive patients were anesthetized for elective thyroid surgery using a standard technique. Indications for surgery covered a broad spectrum of conditions. In the technique described, the airway is secured with a micro laryngeal tube, and a laryngeal mask airway is inserted through which a fibreoptic scope is inserted to view the larynx. Movement of the arytenoids in response to nerve stimulation can be viewed at any time on a television monitor. The airway is secure throughout the procedure and nerve identification is continuously available.

Results: In our study 30 patients were anesthetized and nerve stimulation used in all of them to identify both superior and recurrent laryngeal nerve. None of them developed intraoperative complications. One patient had temporary postoperative recurrent laryngeal nerve damage, which was not attributable to use of this method.

Conclusion: On the basis of our results so far, the method described is feasible and provides a safe method of nerve location during surgery. Laryngeal nerve stimulation is likely to become an integral part of thyroid surgery.

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