Korean J Endocr Surg.  2016 Mar;16(1):13-17. 10.16956/kaes.2016.16.1.13.

Non-recurrent Laryngeal Nerve Identified During Robotic Thyroidectomy in a Patient with Papillary Thyroid Carcinoma

• Kang SY
• Kim SK
• Youn HJ
• Jung SH

• KMID: 2158623
• DOI: http://doi.org/10.16956/kaes.2016.16.1.13

Abstract

A non-recurrent laryngeal nerve is a rare anatomical variant that entails considerable risk for iatrogenic injury during thyroid surgery. We encountered a patient with a non-recurrent laryngeal nerve that went unnoticed on preoperative imaging but was discovered incidentally during robotic thyroidectomy. A 44 year old woman presented at our department with papillary thyroid microcarcinoma, diagnosed by ultrasonography-guided fine needle aspiration cytology. During robotic right thyroidectomy and central lymph node dissection, we could not detect any structure resembling the recurrent laryngeal nerve around the inferior thyroid artery. Thus, we suspected the existence of a non-recurrent laryngeal nerve, and successfully identified a nerve entering the larynx directly from the vagus nerve without recurring. A three-dimensional high magnification view via a robotic endoscope can aid thyroid surgeons to safely identify and preserve a non-recurrent laryngeal nerve.

Keyword

Recurrent laryngeal nerve; Robotics; Thyroidectomy; Papillary thyroid carcinoma

MeSH Terms

Arteries
Biopsy, Fine-Needle
Endoscopes
Female
Humans
Laryngeal Nerves*
Larynx
Lymph Node Excision
Recurrent Laryngeal Nerve
Robotics
Thyroid Gland*
Thyroid Neoplasms*
Thyroidectomy*
Vagus Nerve

Figure

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  Fig. 1 Preoperative radiological imaging of papillary thyroid carcinoma. (A) Ultrasonography shows a 0.5×0.4 cm sized, taller than wide, and hypoechoic nodule in the mid-pole of the right thyroid gland. (B) A neck computed tomography scan shows a 0.6 cm hypodense nodule in the right thyroid gland, and no metastatic lymph node in either cervical chain.

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  Fig. 2 Right aberrant subclavian artery on a preoperative neck computed tomography scan. Axial contrast enhanced computed tomography scan of the neck shows an aberrant right subclavian artery (A) passing behind the common carotid artery, and (B) located on the dorsal side of the trachea and right side of the esophagus.

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  Fig. 3 Lateral view of the robot thyroidectomy operative field. The thyroid gland was dissected and retracted superiormedially. The right non-recurrent laryngeal nerve branched from the vagus nerve and entered the larynx at the lower margin of the inferior constrictor muscle.

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