Dissecting and clinical application of the external branch of the superior laryngeal nerve with endoscopic thyroidectomy <i>via</i> gasless unilateral subclavian approach_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HE Gaofei , JIANG Jinxi , CHU Junjie , LI Jianbo ,  ZHANG Deguang , LU Xiaoxiao

Department of Head and Neck surgery, Sir Run Run Shaw Hospital (SRRSH), Affiliated with the Zhejiang University School of Medicine, Hangzhou 310016, P. R. China;

Corresponding author：

ZHANG Deguang, Email: 3409086@zju.edu.cn

Keywords：

endoscopy; trans-subclavian approach; thyroidectomy; intraoperative nerve monitoring; external branch of the superior laryngeal nerve

DOI：

10.7507/1007-9424.202404085

Video：

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Objective To investigate the feasibility of dissecting the external branch of the superior laryngeal nerve using endoscopic thyroidectomy via gasless unilateral subclavian approach combined with intraoperative nerve monitoring. Methods The clinical data of 30 patients who underwent the gasless trans-subclavian approach endoscopic thyroidectomy in the Department of Head and Neck Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine from October 2023 to February 2024 were retrospectively analyzed. Results All operations were successfully completed under endoscopy approach without transfer to open surgery. A total of 29 cases of the external branch of superior laryngeal nerves were revealed in 30 cases, the rate of external branch of superior laryngeal nerve was 96.7%. The time for dissecting the external branch of the superior laryngeal nerve was 2－6 min (3.6±2.3) min. There was no obvious sound change related to the injury of the external branch of superior laryngeal nerve in postoperative patients. Conclusion For the modified endoscopic thyroidectomy via gasless unilateral subclavian approach combined with intraoperative nerve monitoring, excellent anatomical protection of the superior laryngeal nerve branches can be obtained.

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2.	中国医师协会外科医师分会甲状腺外科医师委员会, 中国研究型医院学会甲状腺疾病专业委员会. 中国甲状腺及甲状旁腺手术中神经监测指南 (2023版). 中国实用外科杂志, 2023, 43(1): 23-33.
3.	何高飞, 章德广, 高力, 等. 改良Miccoli腔镜辅助技术结合神经探测技术解剖保护喉上神经外支. 中华普通外科杂志, 2019, 34(3): 255-256.
4.	章德广, 何高飞, 李建波, 等. 改良无充气经锁骨下入路腔镜甲状腺手术治疗甲状腺乳头状癌70例疗效分析. 中国实用外科杂志, 2022, 42(6): 691-694,699.
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7.	Zhang D, Gao L, He G, et al. Predictors of graft function after parathyroid autotransplantation during thyroid surgery. Head Neck, 2018, 40(11): 2476-2481.
8.	Deniwar A, Kandil E, Randolph G. Electrophysiological neural monitoring of the laryngeal nerves in thyroid surgery: review of the current literature. Gland Surg, 2015, 4(5): 368-375.
9.	Cernea CR, Nishio S, Hojaij FC. Identification of the external branch of the superior laryngeal nerve (EBSLN) in large goiters. Am J Otolaryngol, 1995, 16(5): 307-311.
10.	Friedman M, LoSavio P, Ibrahim H. Superior laryngeal nerve identification and preservation in thyroidectomy. Arch Otolaryngol Head Neck Surg, 2002, 128(3): 296-303.
11.	邹汉青, 邢春根, 朱旬, 等. 神经监测在喉上神经外支临床解剖分型探讨中的应用. 中华普通外科杂志, 2013, 28(9): 676-678.
12.	Hurtado-Lopez LM, Pacheco-Alvarez MI, Montes-Castillo Mde L, et al. Importance of the intraoperative identification of the external branch of the superior laryngeal nerve during thyroidectomy: electromyographic evaluation. Thyroid, 2005, 15(5): 449-454.
13.	王超, 张松涛, 翟翼飞, 等. 经带状肌间入路处理甲状腺上极55例分析. 中国实用外科杂志, 2017, 37(9): 1013-1015.
14.	何高飞, 姜金汐, 褚俊杰, 等. 改良无充气经单侧锁骨下入路腔镜甲状腺全切除术治疗甲状腺乳头状癌的临床分析. 西安交通大学学报(医学版), 2024, 45(1): 80-86.
15.	章德广, 何高飞, 褚俊杰, 等. 改良无充气经锁骨下入路腔镜颈侧区淋巴结清扫术治疗甲状腺乳头状癌31例临床分析. 中华外科杂志, 2023, 61(9): 801-806.
16.	郭海巍, 徐加杰, 葛明华, 等. 无充气腋窝入路腔镜手术结合神经探测技术对甲状腺上极周围结构和功能保护的研究. 中国普外基础与临床杂志, 2023, 30(2): 142-147.
17.	郑乐葳, 袁芊芊, 廖亦秦, 等. 甲状腺术中神经监测联合“喉上神经外支分型”在喉上神经功能保护中的应用价值研究. 中华耳鼻咽喉头颈外科杂志, 2021, 56(10): 1087-1092.

1. 黄海霞, 王兴路, 唐文静, 等. 喉上神经襻的新亚型及其临床应用. 解剖学杂志, 2012, 35(5): 635-638.
2. 中国医师协会外科医师分会甲状腺外科医师委员会, 中国研究型医院学会甲状腺疾病专业委员会. 中国甲状腺及甲状旁腺手术中神经监测指南 (2023版). 中国实用外科杂志, 2023, 43(1): 23-33.
3. 何高飞, 章德广, 高力, 等. 改良Miccoli腔镜辅助技术结合神经探测技术解剖保护喉上神经外支. 中华普通外科杂志, 2019, 34(3): 255-256.
4. 章德广, 何高飞, 李建波, 等. 改良无充气经锁骨下入路腔镜甲状腺手术治疗甲状腺乳头状癌70例疗效分析. 中国实用外科杂志, 2022, 42(6): 691-694,699.
5. 孙辉, 田文. 甲状腺及甲状旁腺术中喉上神经外支保护与监测专家共识 (2017版). 中国实用外科杂志, 2017, 37(11): 1243-1249.
6. 中国医师协会外科医师分会甲状腺外科医师委员会. 甲状腺手术中甲状旁腺保护专家共识. 中国实用外科杂志, 2015, 35(7): 731-736.
7. Zhang D, Gao L, He G, et al. Predictors of graft function after parathyroid autotransplantation during thyroid surgery. Head Neck, 2018, 40(11): 2476-2481.
8. Deniwar A, Kandil E, Randolph G. Electrophysiological neural monitoring of the laryngeal nerves in thyroid surgery: review of the current literature. Gland Surg, 2015, 4(5): 368-375.
9. Cernea CR, Nishio S, Hojaij FC. Identification of the external branch of the superior laryngeal nerve (EBSLN) in large goiters. Am J Otolaryngol, 1995, 16(5): 307-311.
10. Friedman M, LoSavio P, Ibrahim H. Superior laryngeal nerve identification and preservation in thyroidectomy. Arch Otolaryngol Head Neck Surg, 2002, 128(3): 296-303.
11. 邹汉青, 邢春根, 朱旬, 等. 神经监测在喉上神经外支临床解剖分型探讨中的应用. 中华普通外科杂志, 2013, 28(9): 676-678.
12. Hurtado-Lopez LM, Pacheco-Alvarez MI, Montes-Castillo Mde L, et al. Importance of the intraoperative identification of the external branch of the superior laryngeal nerve during thyroidectomy: electromyographic evaluation. Thyroid, 2005, 15(5): 449-454.
13. 王超, 张松涛, 翟翼飞, 等. 经带状肌间入路处理甲状腺上极55例分析. 中国实用外科杂志, 2017, 37(9): 1013-1015.
14. 何高飞, 姜金汐, 褚俊杰, 等. 改良无充气经单侧锁骨下入路腔镜甲状腺全切除术治疗甲状腺乳头状癌的临床分析. 西安交通大学学报(医学版), 2024, 45(1): 80-86.
15. 章德广, 何高飞, 褚俊杰, 等. 改良无充气经锁骨下入路腔镜颈侧区淋巴结清扫术治疗甲状腺乳头状癌31例临床分析. 中华外科杂志, 2023, 61(9): 801-806.
16. 郭海巍, 徐加杰, 葛明华, 等. 无充气腋窝入路腔镜手术结合神经探测技术对甲状腺上极周围结构和功能保护的研究. 中国普外基础与临床杂志, 2023, 30(2): 142-147.
17. 郑乐葳, 袁芊芊, 廖亦秦, 等. 甲状腺术中神经监测联合“喉上神经外支分型”在喉上神经功能保护中的应用价值研究. 中华耳鼻咽喉头颈外科杂志, 2021, 56(10): 1087-1092.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

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