Varied Recurrent Laryngeal Nerve Course Is Associated with Increased Risk of Nerve Dysfunction During Thyroidectomy: Results of the Surgical Anatomy of the Recurrent Laryngeal Nerve in Thyroid Surgery Study, an International Multicenter Prospective Anatomic and Electrophysiologic Study of 1000 Monitored Nerves at Risk from the International Neural Monitoring Study Group

作者：Whitney Liddy, Che‐Wei Wu, Gianlorenzo Dionigi, Gianluca Donatini, Yasemin Giles Şenyürek, Dipti Kamani, Ayaka J. Iwata, Bo Wang, Okenwa C. Okose, Anthony Y. Cheung, Yoshiyuki Saito, Claudio Casella, Nurcihan Aygün, Mehmet Uludağ, Katrin Brauckhoff, Bruno Carnaille, Fatih Tunca, Marcin Barczyński, Hoon Yub Kim, Émerson Favero, Nadia Innaro, Kyriakos Vamvakidis, Jonathan W. Serpell, Romanchishen Af, Hiroshi Takami, Feng‐Yu Chiang, Rick Schneider, Henning Dralle, Jennifer J. Shin, Amr H. Abdelhamid Ahmed, Gregory W. Randolph · 发表于：Thyroid · 年份：2021 · DOI：10.1089/thy.2021.0155 · 被引用次数：57 · 研究领域：Thyroid and Parathyroid Surgery、Voice and Speech Disorders、Airway Management and Intubation Techniques

Background: The recurrent laryngeal nerve (RLN) can be injured during thyroid surgery, which can negatively affect a patient's quality of life. The impact of intraoperative anatomic variations of the RLN on nerve injury remains unclear. Objectives of this study were to (1) better understand the detailed surgical anatomic variability of the RLN with a worldwide perspective; (2) establish potential correlates between intraoperative RLN anatomy and electrophysiologic responses; and (3) use the information to minimize complications and assure accurate and safe intraoperative neuromonitoring (IONM). Methods: A large international registry database study with prospectively collected data was conducted through the International Neural Monitoring Study Group (INMSG) evaluating 1000 RLNs at risk during thyroid surgery using a specially designed online data repository. Monitored thyroid surgeries following standardized IONM guidelines were included. Cases with bulky lymphadenopathy, IONM failure, and failed RLN visualization were excluded. Systematic evaluation of the surgical anatomy of the RLN was performed using the International RLN Anatomic Classification System. In cases of loss of signal (LOS), the mechanism of neural injury was identified, and functional evaluation of the vocal cord was performed. Results: A total of 1000 nerves at risk (NARs) were evaluated from 574 patients undergoing thyroid surgery at 17 centers from 12 countries and 5 continents. A higher than expected per...