Jiyang Li, Chen Liu, Hongqing Xi, Bo Wei, Lin Chen, Zhi Qiao. Chinese PLA General Hospital
Brackground: Bilateral axillo-breast approach has the cosmetic superiority of various techniques for endoscopic thyroidectomy. Nevertheless, inadequate exposure of surgical field may increase the risk of recurrent laryngeal nerve injury. Vocal cord palsy occurs in 12% of patients with papillary thyroid carcinoma after endoscopic thyroidectomy. In recent years, intraoperative nerve monitoring (IONM) has been introduced into thyroidectomy procedures. This study investigated the risk of postoperative vocal cord palsy with or without the use of intermittent IONM in endoscopic thyroidectomy.
Methods: The prospective cohort consisted of 50 patients undergoing endoscopic thyroidectomy for papillary microcarcinoma from January 2015 to December 2017. IONM was used in 26 operations (52%), which is named IONM group; the other 24 patients not using IONM were included in the NO-IONM group. Transient hoarseness was diagnosed within 6 weeks after surgery. Permanent palsy of the recurrent laryngeal nerve was defined as that persisting after 6 months. The latest follow-up date was June 30, 2018. Patient demographics, clinicopathologic characteristics and surgical-related parameters were analyzed. Univariable and multivariable logistic regression analyses were used to examine risk factors for vocal cord palsy.
Results: No significant differences in demographic or clinicopathologic characteristics were noted between the groups. The number of retrieved ipsilateral lymph nodes was larger in the IONM group compared with the NO-IONM group (4.3 vs 2.1 P = 0.030). Mean operation time was shorter for the IONM group compared with the NO-IONM group (118 vs. 149 min, respectively), but this did not reach statistical significance (P = 0.125). Estimated blood loss, drain maintenance, drain amount and hospitalization length were similar between the two groups. Transient hoarseness occurred in 3 patients (6%) of the NO-IONM group and 1 patient (2%) of the IONM group. Permanent vocal cord palsy occurred in 2 patient (4%) of the NO-IONM group. Other postoperative complications included 2 cases of postoperative bleeding, 1 case of skin bruising on the chest wall, and 5 cases of transient hypocalcemia. In the multivariable analysis, the use of IONM was associated with a decreased risk of transient hoarseness (95% OR 0.91, 0.64 to 1.47), but decreased risk of permanent vocal cord palsy (95% OR: 0.59, 0.21 to 0.98).
Conclusion: With satisfactory cosmetic results, endoscopic thyroidectomy via bilateral axillo-breast approach with IONM reduced the risk of permanent vocal cord palsy in patients with papillary thyroid carcinoma. This technical combination might gain wider acceptance in the near future.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94444
Program Number: P625
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster