Romanchishen, Anatoly1; Vabalayte, Kristina1; Romanchishen Filipp1
1 Saint-Petersburg State Pediatric Medical University, Department of Hospital Surgery. Saint-Petersburg Center of Endocrine Surgery, Oncology. Saint-Petersburg, Russia
Introduction: The steady using of intraoperative visualization and monitoring of the recurrent laryngeal and spinal accessory nerves (IORLNM) now its routine procedure and is becoming standard practice for the protection of that nerves in 21st century. The possible reasons for laryngeal muscles paresis and paralysis after thyroid and parathyroid surgery could be: the cancer invasion before the operations; RLN surgical liberation from the tumors and scars; accidental damage of RLN; an unexpected postoperative that complication in cases with apparent macroscopically intact RLN.
Material and methods: During 1974 – 2015 in Saint Petersburg Center of Endocrine Surgery and Oncology (Russia) among 29325 operated on Thyroid were 1481 benign recurrent goiters (BRG) and 443 TC relapses (TCR) patients. Lasts made 1.5% of 29325 all thyroid and 10.7% – of 4353 TC patients. Among them were 14 children. Here represented comparative estimations of the RLNs damages dynamics before regular visualization (1974-1991) – 368 BRG patients and after permanent RLN dissection (1992 – 2015) – 1113 cases. Since 2001 we have performed IORLNM and SAN in 53% of our Thyroid patients.
Results: During the first period of our practice the unilateral damage of RLN in BRG and curable TCR made 7.6%, bilateral – 1.63%. During the second period it decreased to 0.5% and 0.34% respectively. The difference is statistically signifikant.
Conclusion: Statedly using of the RLN and SAN visualization and IONM has improved efficiency and reliability of the surgical treatment of adults and children with BRG recurrent goiter and TCR.