Abstract:

The aim of the study is to investigate the use of super-inferious nerve disection surgery in the patients with papillary carcinoma planned total thyroidectomy, along with intraoperative nerve monitoring (IONM), as well as to determine the minimum stimulation marginal values at the entrance point of the recurren laringeal nerve (RLN), the most distal of the crythyroid membrane to the laringe. Methods: In this retrospective study, 13 patients (11 women, 2 men) were studied with an average age of 53 (42-71) for the total thyroidectomy applied preoperative diagnosis of papillary thyroid carcinoma. RLN disection is performed with super-inferior technique. The super-inferred disection technique is detailed in the text. After the completion of thyroidectomy, the minimum flow sufficient to stimulate RLN at the most distal point is measured and recorded. Results: The average minimum stimulation flow value was recorded at 0.26 ± 0.07 mA on the left and 0.25 ± 0.07 mA on the right. There was no permanent or temporary RLN paralysis observed after the operation. The result: With the super-inference disection technique, RLN can be disqueated with low complication rates because it is present at a very fixed point even in the case of non-recurrenal nerve variations, but according to our experience it is essential to prevent very sensitive and careful disection complications. The use of IONM should be considered in cases where it facilitates the nerve localization.

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