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 nilateral subclavian approach endoscopic thyroidectomy in the Department of Head and Neck Surgery, Sir Run Run Shaw Hospital, Affiliated with the 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 revealed rate 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 external branch of the superior laryngeal nerve can be obtained.

Citation： HE Gaofei, JIANG Jinxi, CHU Junjie, LI Jianbo, ZHANG Deguang, LU Xiaoxiao. Dissecting and clinical application of the external branch of the superior laryngeal nerve with endoscopic thyroidectomy via gasless unilateral subclavian approach. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(11): 1376-1379. doi: 10.7507/1007-9424.202404085 Copy

1.	黃海霞, 王興路, 唐文靜, 等. 喉上神經襻的新亞型及其臨床應用. 解剖學雜志, 2012, 35(5): 635-638.
2.	中國醫師協會外科醫師分會甲狀腺外科醫師委員會, 中國研究型醫院學會甲狀腺疾病專業委員會. 中國甲狀腺及甲狀旁腺手術中神經監測指南 (2023版). 中國實用外科雜志, 2023, 43(1): 23-33.
3.	何高飛, 章德廣, 高力, 等. 改良Miccoli腔鏡輔助技術結合神經探測技術解剖保護喉上神經外支. 中華普通外科雜志, 2019, 34(3): 255-256.
4.	章德廣, 何高飛, 李建波, 等. 改良無充氣經鎖骨下入路腔鏡甲狀腺手術治療甲狀腺乳頭狀癌70例療效分析. 中國實用外科雜志, 2022, 42(6): 691-694, 699.
5.	孫輝, 田文. 甲狀腺及甲狀旁腺術中喉上神經外支保護與監測專家共識 (2017版). 中國實用外科雜志, 2017, 37(11): 1243-1249.
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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.	鄒漢青, 邢春根, 朱旬, 等. 神經監測在喉上神經外支臨床解剖分型探討中的應用. 中華普通外科雜志, 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, 張松濤, 翟翼飛, 等. 經帶狀肌間入路處理甲狀腺上極55例分析. 中國實用外科雜志, 2017, 37(9): 1013-1015.
14.	何高飛, 姜金汐, 褚俊杰, 等. 改良無充氣經單側鎖骨下入路腔鏡甲狀腺全切除術治療甲狀腺乳頭狀癌的臨床分析. 西安交通大學學報(醫學版), 2024, 45(1): 80-86.
15.	章德廣, 何高飛, 褚俊杰, 等. 改良無充氣經鎖骨下入路腔鏡頸側區淋巴結清掃術治療甲狀腺乳頭狀癌31例臨床分析. 中華外科雜志, 2023, 61(9): 801-806.
16.	郭海巍, 徐加杰, 葛明華, 等. 無充氣腋窩入路腔鏡手術結合神經探測技術對甲狀腺上極周圍結構和功能保護的研究. 中國普外基礎與臨床雜志, 2023, 30(2): 142-147.
17.	鄭樂葳, 袁芊芊, 廖亦秦, 等. 甲狀腺術中神經監測聯合“喉上神經外支分型”在喉上神經功能保護中的應用價值研究. 中華耳鼻咽喉頭頸外科雜志, 2021, 56(10): 1087-1092.

1. 黃海霞, 王興路, 唐文靜, 等. 喉上神經襻的新亞型及其臨床應用. 解剖學雜志, 2012, 35(5): 635-638.
2. 中國醫師協會外科醫師分會甲狀腺外科醫師委員會, 中國研究型醫院學會甲狀腺疾病專業委員會. 中國甲狀腺及甲狀旁腺手術中神經監測指南 (2023版). 中國實用外科雜志, 2023, 43(1): 23-33.
3. 何高飛, 章德廣, 高力, 等. 改良Miccoli腔鏡輔助技術結合神經探測技術解剖保護喉上神經外支. 中華普通外科雜志, 2019, 34(3): 255-256.
4. 章德廣, 何高飛, 李建波, 等. 改良無充氣經鎖骨下入路腔鏡甲狀腺手術治療甲狀腺乳頭狀癌70例療效分析. 中國實用外科雜志, 2022, 42(6): 691-694, 699.
5. 孫輝, 田文. 甲狀腺及甲狀旁腺術中喉上神經外支保護與監測專家共識 (2017版). 中國實用外科雜志, 2017, 37(11): 1243-1249.
6. 中國醫師協會外科醫師分會甲狀腺外科醫師委員會. 甲狀腺手術中甲狀旁腺保護專家共識. 中國實用外科雜志, 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. 鄒漢青, 邢春根, 朱旬, 等. 神經監測在喉上神經外支臨床解剖分型探討中的應用. 中華普通外科雜志, 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, 張松濤, 翟翼飛, 等. 經帶狀肌間入路處理甲狀腺上極55例分析. 中國實用外科雜志, 2017, 37(9): 1013-1015.
14. 何高飛, 姜金汐, 褚俊杰, 等. 改良無充氣經單側鎖骨下入路腔鏡甲狀腺全切除術治療甲狀腺乳頭狀癌的臨床分析. 西安交通大學學報(醫學版), 2024, 45(1): 80-86.
15. 章德廣, 何高飛, 褚俊杰, 等. 改良無充氣經鎖骨下入路腔鏡頸側區淋巴結清掃術治療甲狀腺乳頭狀癌31例臨床分析. 中華外科雜志, 2023, 61(9): 801-806.
16. 郭海巍, 徐加杰, 葛明華, 等. 無充氣腋窩入路腔鏡手術結合神經探測技術對甲狀腺上極周圍結構和功能保護的研究. 中國普外基礎與臨床雜志, 2023, 30(2): 142-147.
17. 鄭樂葳, 袁芊芊, 廖亦秦, 等. 甲狀腺術中神經監測聯合“喉上神經外支分型”在喉上神經功能保護中的應用價值研究. 中華耳鼻咽喉頭頸外科雜志, 2021, 56(10): 1087-1092.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Dissecting and clinical application of the external branch of the superior laryngeal nerve with endoscopic thyroidectomy via gasless unilateral subclavian approach

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