Injury to the recurrent laryngeal nerve is one of the serious complications of thyroid surgery, which can lead to hoarseness, choking and coughing, and in severe cases, death by asphyxiation. In particular, the incidence of laryngeal nerve injury is significantly higher in complex thyroid surgery. Xiaohui Wang, Department of General Surgery, Xuanwu Hospital, Capital Medical University
For example.
1. thyroid cancer with multiple metastases in the cervical lymph nodes
2. those with recurrent thyroid cancer requiring secondary surgery
3. huge thyroid tumors requiring bilateral total thyroidectomy.
4. some primary care hospitals with benign thyroid gland pathology in the first operation, but with postoperative conventional paraffin pathology of thyroid carcinoma, who need a second operation due to insufficient scope of the first operation.
5. Patients whose recurrent laryngeal nerve has been severed, compressed or ligated by the previous surgery.
In these cases, especially in the second or multiple operations, the anatomical changes, tissue adhesions and unclear structures can easily lead to injury of the recurrent laryngeal nerve. In Europe and the United States, the laryngeal nerve monitor is routinely used in complex thyroid surgery. Real-time monitoring of the laryngeal nerve during surgery can quickly clarify the location and course of the nerve, which is highly sensitive and can reduce laryngeal nerve injury, shorten surgery time, reduce surgical trauma and bleeding, and facilitate rapid postoperative recovery.
The Department of General Surgery of Xuanwu Hospital has recently introduced a world’s most advanced NIM – Neuro3.0 intraoperative nerve monitor. This instrument is capable of providing precise nerve navigation for complex thyroid surgery. We have performed more than 30 complex thyroid surgeries with this technology, most of which are secondary surgeries for thyroid cancer and thyroid gland. The operating time is significantly shortened and the surgical trauma is significantly reduced. It not only confirms the anatomical integrity of the recurrent laryngeal nerve, but also ensures the functional integrity of the recurrent nerve. This technique is currently carried out in only a few large tertiary hospitals in China. The successful implementation of this technology in our department has brought us in line with the high level of international thyroid surgery, enriched the treatment means of thyroid surgery in our hospital, and greatly enhanced the reputation of our department and even Xuanwu Hospital in the field of thyroid surgery in China.