Recurrent and non-recurrent laryngeal nerves visualization during thyroid surgery

RELEVANCE : thyroid surgery has always been particularly difficult. Today, surgeons are increasingly performing large-scale and complex hemi- and thyroidectomies. In cases of a malignant process, removal of the thyroid gland can be supplemented by central or lateral lymph dissection. Among the complications, damage to the recurrent laryngeal nerves occupies a special place due to its severity and potential to cause patient disability. The frequency of this complication, according to summary data, can reach up to 10%. OBJECTIVE : to develop a safe method for visualizing recurrent and non-recurrent laryngeal nerves during various thyroid surgeries. MATERIAL AND METHODS : the study analyzed treatment outcomes for 85 patients with various diseases of the thyroid gland treated at the Botkin hospital in 2024. Operations ranging from hemithyroidectomy to thyroidectomy with cervical lymphodissection were performed in the observed patients. During surgical treatment, microsurgical visualization of laryngeal nerves was performed using a method involving a virtual anatomical D-triangle to determine the search area in the paratracheal region. The D-triangle is defined as an isosceles obtuse triangle with its vertex at the laryngotracheal angle, formed by the lower border of the larynx, the lateral contour of the trachea (2 cm long), and the base connecting these lines. RESULTS : analysis showed that the required surgical outcomes were achieved in all cases without the development of laryngeal paresis or paralysis. Key findings include recurrent laryngeal nerves with normal and anomalous locations being identified. An embryonic anomaly of the right recurrent laryngeal nerve was noted in 1 (1.2%) case. Fascial fixation of the recurrent laryngeal nerve by thyroid capsule bundles was found in 4 (4.7%) cases. Extraorgan branches of the right recurrent laryngeal nerve were observed in 3 (3.5%) cases. One (1.2%) case involved a small-diameter lesion of the nerve. CONCLUSION : routine precision imaging of recurrent and non-recurrent laryngeal nerves using the proposed D-triangle method facilitates this challenging stage of thyroid surgery. The technique reduces the risk of laryngeal paresis and paralysis, ensuring safer outcomes for patients with various thyroid diseases.