scholarly journals The experience of access application to recurrent laryngeal nerve and parathyroid glands as the way of the postoperative complications prevention in case of video-assisted surgery

2014 ◽  
Vol 95 (2) ◽  
pp. 282-284
Author(s):  
L E Slavin ◽  
A N Chugunov ◽  
M M Khasanshin
Keyword(s):  
Thyroid Gland ◽  
Recurrent Laryngeal Nerve ◽  
Ultrasound Examination ◽  
Laryngeal Nerve ◽  
Reference Points ◽  
Parathyroid Glands ◽  
Anatomical Structures ◽  
Video Assisted ◽  
Surgical Access ◽  
Skin Section

Aim. To justify the application of surgical access to thyroid and parathyroid glands by means of videoendoscopic equipment. Methods. 14 video-assisted surgeries on thyroid and parathyroid glands were performed during the period of 2011-2014 using low-invasive midline cervical access by means of videoendoscopic equipment. Results. The surgery was carried out with a skin access of less than 3 cm, the section was made 1.5-2 cm above than jugular notch. Tissue dissection was performed by means of «channel» formation with mobilization of tissues while looking for recurrent laryngeal nerve and parathyroid glands up to allocation of the superior pole of a thyroid gland lobe under the laparoscopic control. In case of parathyroidectomy due to adenoma special attention was paid to presurgical topical diagnostics which included neck organs ultrasound examination with the use of expert class equipment as well as thyroid and parathyroid glands scintigraphy. Intrasurgical ultrasound examination of the area of surgery to specify the pathologically changed parathyroid gland location was performed in some cases. Jugular notch of sternum, lower pole of thyroid gland, lateral surface of trachea, tracheo-oesophageal groove, and inferior thyroid artery were used as reference points for identification of recurrent laryngeal nerve and parathyroid glands while using video equipment. As a rule, the recurrent laryngeal nerve was located behind and below the parathyroid glands. The distance from a skin section to a recurrent laryngeal nerve and lower parathyroid glands was 3.6 and 3.1 cm respectively. Conclusion. Use of video endoscopic equipment allows to reduce traumatic surgeries on neck organs and promotes the better visualization of anatomical structures in an area of surgery.

scholarly journals Tubercle of Zuckerkandl

2015 ◽  
Vol 7 (2) ◽  
pp. 33-35
Author(s):  
Naval Bansal ◽  
Navneet Tripathi ◽  
Ashwini Reddy
Keyword(s):  
Thyroid Gland ◽  
Recurrent Laryngeal Nerve ◽  
Thyroid Surgery ◽  
Laryngeal Nerve ◽  
Parathyroid Glands ◽  
Anatomic Variations ◽  
Intimate Knowledge ◽  
Endocrine Surgeon

ABSTRACT Endocrine Surgeon must have intimate knowledge about all anatomic variations of thyroid gland for performing safe thyroid surgery. Tubercle of Zuckerkandl is a posterior extrusion of the lateral thyroid lobes and it is a pointer to the recurrent laryngeal nerve and inferior parathyroid glands. We have discussed pertinent issues regarding tubercle of Zuckerkandl in this mini review. How to cite this article Mayilvaganan S, Bansal N, Tripathi N, Reddy A, Agarwal A. Tubercle of Zuckerkandl. World J Endoc Surg 2015;7(2):33-35.

scholarly journals Comparative analysis of conventional and video-assisted surgeries on thyroid and parathyroid glands

2015 ◽  
Vol 96 (3) ◽  
pp. 307-310
Author(s):  
M M Khasanshin
Keyword(s):  
Comparative Analysis ◽  
Thyroid Gland ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Parathyroid Glands ◽  
Conventional Surgery ◽  
Anatomical Structures ◽  
Tertiary Hyperparathyroidism ◽  
Video Assisted ◽  
Selection Of

Aim. A comparative analysis of conventional and video-assisted operations effectiveness.Methods. The study included 80 patients were operated from 2010 to 2015 for thyroid and parathyroid glands diseases. The first (main) group included 35 patients who underwent video-assisted surgery. The second group (comparison group) included 45 patients who were operated conventionally. Surgery for thyroid gland diseases included hemithyroidectomy, for diseases of the parathyroid glands - parathyroidectomy in patients with tertiary hyperparathyroidism and adenoma resection in patients with primary hyperparathyroidism.Results. In video-assisted hemithyroidectomy, mean surgery duration was 42.2±3.6 min, compared to 34.4±2.8 min (p=0.086) in conventional method. Recurrent laryngeal nerve and parathyroid glands were identified in 73% of cases at conventional surgery, compared to 96% at video-assisted hemithyroidectomy (p=0.012). At video-assisted surgeries, no phonation disorders were recorded, while at conventional surgeries they were diagnosed in 7 patients (14.0%, p=0.041). Transient hypocalcemia according to the results of laboratory tests was observed in 1 (3.3%) patients after video-assisted and in 3 (6.0%) patients after conventional surgery (p=0.998). The average length of hospital stay after conventional surgery was 8.1±1.8 days, and after video-assisted surgery - 2.6±1.6 days (p=0.040). Postoperative scar size in the group of video-assisted surgery not exceeded 3 cm, in the group of conventional surgery - up to 7 cm.Conclusion. With proper selection of patients, particularly with parathyroid gland diseases, are video-assisted surgery might be a method of choice. Using video-assisted surgery in treating patients with thyroid gland diseases allows to identify anatomical structures of the neck in detail.

scholarly journals Equine Carcinoma Hemithyroidectomy

2021 ◽  
Vol 49 ◽  
Author(s):  
Alessandra Mayer Coelho ◽  
Brenda Valeria dos Santos Oliveira ◽  
Diana Villa Verde Salazar ◽  
Karin Elisabeth Rodrigues Borba ◽  
Lais Maria Gomes ◽  
...  
Keyword(s):  
Weight Loss ◽  
Weight Gain ◽  
Thyroid Gland ◽  
Thyroid Carcinoma ◽  
Ultrasound Examination ◽  
Histopathological Examination ◽  
Thyroid Tissue ◽  
Parathyroid Glands ◽  
Common Finding ◽  
Significant Weight Loss

Background: In horses, the thyroid gland is located slightly caudal to the larynx and dorsolaterally between the third and sixth tracheal ring, adjacent to the thyroid, there are four small glands called parathyroid glands. In the clinical routine of horses, thyropathies are difficult to be diagnosed, as they have a silent evolution. Thyroid neoplasia is the most common finding in horses, usually unilateral and normally present in older animals. The present study reports a case of equine thyroid carcinoma and its systemic clinical effects, which was successfully treated by means of hemitieroidectomy. Case: A 12-year-old male mixed breed horse weighing 436 kg, was admitted to the Veterinary Medical Teaching Hospital of the FZEA/USP    with the main complaint of volume increase in the right ventrolateral region of the neck, difficulty in swallowing, significant weight loss and weakness of the pelvic limbs. On inspection, there was an increase in volume in the topographic region of the thyroid gland and on palpation, there was a firm mass, with delimited edges, with a smooth, mobile surface, without increasing the temperature and without pain. The animal was sent for ultrasound examination, which revealed a delimited mass, with an apparent capsule around it, differentiated and disorganized cellularity with small hypoechoic points of liquid inside the structure, with no apparent vascularization inside the mass. These findings, associated with the anatomical location of the mass, were consistent with thyroid tissue. The clinical signs commonly observed in thyroid neoformations are respiratory stridor, decreased performance, difficulty in swallowing and suffocation. As there was a compromised diet and weight gain, as well as athletic performance, he chose to have a hemithyroidectomy. After surgery, histopathology of the tissue was performed and thyroid carcinoma was diagnosed. Postoperatively, the animal was medicated with antibiotics, anti-inflammatory and anti-tetanus serum, after 10 days the stitches were removed and the animal was discharged. Discussion: Neoplasia is the most frequent cause of progressive thyroid growth and in case of suspicion of thyroid disorders, thin needle aspiration (FNAB) is recommended and, later, histopathological examination, which is considered the gold standard for diagnosis pathologies of the thyroid gland. In the present case, no FNAB or preoperative histopathological examination was performed due to the time required to obtain the result, associated with difficulty in swallowing and significant weight loss, which required immediate removal of the mass. Considering that the ultrasound examination revealed the absence of noble structures or important vascularization very close to or adhered to the mass, its removal prior to the histopathological examination was indicated. As there was compromised feeding and weight gain, he opted for hemithyroidectomy, the recommended treatment for unilateral tumors in horses. When performing a hemithyroidectomy, it should be remembered that the parathyroid glands accompany the thyroid and are located in its posterior portion, in the pre tracheal region, with its variable final position. With this variation in topography, the identification of parathyroid glands becomes challenging and, consequently, after thyroidectomy, a portion of parathyroid glands stops operating, and this fact is marked clinically by hypocalcemia and its consequences. In this case described, in which the animal had a tumor in thyroid tissue, possibly the parathyroid functions were also altered, which probably reflected in the lameness in the pelvic limbs. It is concluded that partial hemithyroidectomy in horses is an easy procedure to perform and has favorable results in relation to prognosis and quality of life. Keywords: carcinoma, hemithyroidectomy, thyroid. Título: Hemitireoidectomia por carcinoma em equinoDescritores: carcinoma, hemitireoidectomia, tireóide. 

Neuromonitoring of the recurrent laryngeal nerve in thyroid gland surgery – results and experiences

2021 ◽  
Vol 70 (2) ◽  
pp. 89-96
Author(s):  
Jiří Hložek ◽  
Jan Rotnágl ◽  
Jaromír Astl
Keyword(s):  
Thyroid Gland ◽  
Recurrent Laryngeal Nerve ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Laryngeal Nerve ◽  
Operative Strategy ◽  
Predictive Values ◽  
Group A ◽  
Group B ◽  
Neural Monitoring

Paresis of the recurrent laryngeal nerve (RLN) is one of the serious complications of thyroid and parathyroid gland surgery. The intraoperative neural monitoring (IONM) enables to verify the functionality of RLN. The aim of this study is to compare the incidence of postoperative RLN palsy in patients who underwent surgery with and without the use of IONM RLN and to evaluate the positive and negative predictive values, sensitivity, specifi city and accuracy of the method. Methods: Retrospective analysis of thyroid gland surgeries performed within the period from 1. 7. 2016 to 1. 7. 2018. A total of 467 operations were performed (780 nerves exposed). One hundred and thirty procedures (215 nerves) were carried out without IONM (group A). In total, 337 procedures (565 nerves) were performed with IONM (group B). Results: In group A, unilateral postoperative RLN paresis occurred in 7 cases (3.26%); 6 of them were temporary (2.79%) and 1 was permanent (0.47%). In group B, unilateral postoperative RLN paresis occurred in 33 cases (5.84%); 32 of them were temporary (5.66%) and 1 was permanent (0.18%). The incidence of postoperative RLN paresis related to the use of IONM was not considered statistically signifi cant. (Chi-square test: P = 0.146; Fisher‘s exact test: P = 0.2015, P = 0.4715). The sensitivity, specifi city, positive predictive value, negative predictive value and accuracy were 78.79%, 99.25%, 86.67%, 98.69%, and 98.05%, respectively. There was no case of bilateral postoperative RLN paresis. Conclusion: There was no statistically significant diff erence in the incidence of postoperative RLN palsy in patients who underwent surgery with IONM compared to the group without IONM. The high negative predictive value, specifi city and accuracy indicate high reliability of the method. The IONM provides the surgeon with valuable information regarding the functional status of the nerve. This knowledge allows for changing the operative strategy during the procedure. Keywords: intraoperative neural monitoring – IONM – recurrent laryngeal nerve injury – recurrent laryngeal nerve – thyroid surgery

scholarly journals Clinical impacts of the Sudanese anatomical variations in a relation of the recurrent laryngeal nerve to the inferior thyroid artery

2020 ◽  
Vol 8 (2) ◽  
pp. 25
Author(s):  
Mohamed Elghazali Elhasan ◽  
Wael Mohialddin Doush
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Anatomical Variations ◽  
Cross Sectional Study ◽  
Laryngeal Nerve ◽  
Inferior Thyroid Artery ◽  
Parathyroid Glands ◽  
Main Trunk ◽  
Cross Sectional ◽  
Relationship Of ◽  
The Relationship

Background: Until recently, the knowledge of the anatomical variations in the relationship between the recurrent laryngeal nerve (RLN) and the inferior thyroid artery (ITA) combined with visual intraoperative RLN identification are essential for the protection of these life-important structures during surgical exposure and the mobilization of thyroid and parathyroid glands. This leads to the proper treatment of patients and improvement of the surgical techniques.Aim: To describe anatomical variations in the relationship of the recurrent laryngeal nerve to the inferior thyroid artery in the Sudanese population.Patients and methods: Following ethical committee approval, an observational descriptive prospective cross-sectional study in the period between March 2019 and February 2020, for anatomical variations in the relation of the recurrent laryngeal nerve to the inferior thyroid artery in seventy-two cervical sides of thirty-six well-dissected embalmed Sudanese cadavers. The RLN was investigated in three positions: posterior to the ITA main trunk, anterior to the ITA main trunk and between the ITA branches. Then, the results were analyzed according to the gender, age and dissection side.Results: We found that the anatomical variations were more frequent in males (97.2%) than females (2.8%). The age of these variations ranged between 31–45 years which represents (61.1%). On the right side of the neck, the commonest position of the RLN is posterior to the ITA (63.9%) followed by in decreasing order of frequency, the RLNs run between the ITA branches (30.6%) and anterior to the ITA (5.6%). On the left side of the neck, the commonest position of the RLN is posterior to the ITA (69.4%). It passed between the ITA branches in (30.6%) of specimens. There was no anterior location of the RLN to the ITA. Variations in a relationship of the RLN to the ITA on one side is significantly different from the opposite side.Conclusions: Although the risk of potential damage to the RLN during surgical neck procedures involving the thyroid gland and parathyroid glands is well recognized, pre-operative detailed surgeon’s knowledge for these frequent anatomical variations and the usage of the ITA as an anatomical landmark for intraoperative RLN recognition is important. This will lead to a reduction of iatrogenic RLN injury prevalence. Future studies are recommended to compare the findings on this cadaveric study with a larger sample size in the long-term period.  

scholarly journals A novel way of identification of recurrent laryngeal nerve during thyroid surgeries

2021 ◽  
Vol 8 (10) ◽  
pp. 2956
Author(s):  
Joe Mathew
Keyword(s):  
Thyroid Gland ◽  
Recurrent Laryngeal Nerve ◽  
Subclavian Artery ◽  
Direct Observation ◽  
Laryngeal Nerve ◽  
Areolar Tissue ◽  
Review Of Literature ◽  
The Right

Background: This was a report of a movement of the recurrent laryngeal nerve which can be demonstrated during thyroid surgeries which can be used for locating the nerve, or identifying it if already exposed and causing confusion with other nearby structures or when alone too.Methods: The nerve is located by observing for a superior-inferior movement of the recurrent laryngeal nerve transmitted by the loose areolar tissue over it and dissecting over this site to locate the nerve right underneath it. This was by direct observation of the movement which will be there so long as the thyroid is held retracted to the opposite side and is not separated from the thyroid at the tissues that constitute the condensation of pre-tracheal fascia called the Berry’s ligament.Results: The recurrent laryngeal nerve originates from the vagus and loops posteriorly and then upwards around the arch of aorta on the left side and the subclavian artery on the right side. When the thyroid gland is retracted away and thus the nerve put on slight stretch, a superior-inferior to and fro- movement of the nerve can be seen. This movement can be used for identification and dissection of the nerve along its course.Conclusions: A review of literature has been done and it is clear that this movement has not been hitherto identified or published

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