Two Useful Adjuncts to Thyroid Oncological Surgery: The Ansa To Recurrent Nerve Anastomosis and Mediastinoscopy Approach to Metastatic Disease

  • Background: Extrathyroidal spread with invasion of the recurrent laryngeal nerve and metastatic disease to the mediastinum are two manifestations of aggressive papillary thyroid cancer. These videos outline useful surgical adjuncts to the management of recurrent laryngeal nerve sacrifice from invasive disease and mediastinal lymphadenopathy without the need for sternotomy. Methods: Video was created using iPhone 6 and edited in iMovie in a patient undergoing total thyroidectomy, bilateral central neck dissection, and left lateral neck dissection for papillary thyroid cancer with a known preoperative left vocal cord immobility. The ansa cervicalis was identified and preserved, rotated deep to the sternohyoid muscle, and anastomosed to the cut end of the recurrent laryngeal nerve using 9-0 nylon sutures. A second patient with a remote history of total thyroidectomy and mediastinal disease was filmed using a mediastinoscope to extirpate adenopathy after lateral neck dissection and revision central neck dissection. Results: Successful anastomosis of the distal stump of the left recurrent laryngeal nerve to the ansa cervicalis was performed on the first patient, with resultant improved tone of the vocal cord and improved phonation. Extirpation of mediastinal lymphadenopathy was successfully executed using mediastinoscopy without need for sternotomy. Discussion & Conclusions: Use of the ansa cervicalis is a viable option in cases of recurrent laryngeal nerve sacrifice for known invasive disease. The ansa is readily available for anastomosis with both lateral neck dissection and through a central incision for thyroidectomy only. Use of mediastinoscopy can obviate the need for sternotomy for mediastinal metastasis.


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