CRANIO-CAUDAL AND LATERAL APPROACH FOR RECURRENT LARYNGEAL NERVE

During the thyroid surgery, the identification of the recurrent laryngeal nerve (RLN) and the dissection through its entry point is still the gold standard in prevention of the nerve injury and to decrease the RLN palsy rate. Intraoperative nerve monitoring (IONM) has also so many benefits to search, identify and dissect the nerve through its course during thyroid surgery and especially the most important benefit of the IONM is to have real time information about the function of the RLN. Most of the endocrine surgeons use the inferolateral approach for RLN identification under the guidance of the IONM in the recent years. However after the definition of the transoral endoscopic thyroidectomy vestibular approach (TOETVA) technique, the approach to the RLN have to be changed to craniocaudal approach in which a way that most of the surgeons are not familiar with. The different approaches of the recurrent laryngeal nerve depend on the indications and on the surgeon's habit. Several approaches exist such as the superior approach ,the lateral approach, and the inferior approach.

Inclusion criteria

• Multinoduler Goitre
• Thyroid papillary cancer
• Solitary thyroid nodule

Exclusion criteria

• previous thyroid or parathyroid surgery,
• substernal goiter,
• preoperative VCP,
• evidence of lateral lymph node metastasis,
• intentional transection of the RLN due to tumor invasion,
• failure to assess RLN functioning due to equipment issues with the IONM setup,
• presurgical dissection amplitude of <500µV,
• patient's refusal to participate