The Effect of Different Hemostatic Systems on the Injury of the External Branch of the Superior Laryngeal Nerve in Thyroidectomy

Abstract

Introduction:Vessel-sealing and ultrasonic coagulation systems that provide rapid and effective hemostasis are widely used in thyroid surgery. An important disadvantage of these systems is injury to the neighboring anatomical structures by thermal damage. However, data on injury to the external branch of the superior laryngeal nerve is limited. The aim of this study was to evaluate the effect of different vascular closure systems on this nerve injury in thyroidectomy.Methods:A total of 45 patients who underwent thyroidectomy for benign thyroid disease between October 2008 and February 2009 were included in the study. Patients were randomized and divided into three groups, each consisting of 15 patients. Systems used were vessel-sealer in the first group, harmonic scalpel in the second group and conventional suture ligation technique in the third group. Laryngeal electromyography findings and voice complaints were compared.Results:There were 37 female (82%) and 8 male patients. The mean age was 47.9±11.1 years. Demographic features and surgical procedures were statistically similar in all groups (p>0.05). The control electromyography of 84 nerves with preoperatively confirmed normal findings showed that three (10.7%) of the 28 nerves in the vessel sealer group, two (7.1%) of the 28 nerves in the harmonic scalpel group, and two (7.1%) of the 28 nerves in the suture ligation group had complete or partial nerve injury (p>0.05). No significant difference was found between the groups in terms of voice complaints (p>0.05).Conclusion:Compared to the conventional suture ligation technique, the use of vascular closure devices does not increase the risk of injury to the external branch of the superior laryngeal nerve.

Keywords

• Electromyography
• external branch of the superior laryngeal nerve
• nerve injury
• thyroidectomy
• vascular closure systems