ANALYSIS OF RECURRENT LARYNGEAL NERVE PALSY AND POSSIBLE RISK FACTORS IN TRANSORAL ENDOSCOPIC (PARA-)THYROIDECTOMY: RESULTS OF THE EUROPEAN TOETVA/TOEPVA STUDY GROUP

AUTHORS:
M. Arikan (Vienna, Austria) , L. Hargitai (Vienna, Austria) , C. Scheuba (Vienna, Austria) , P. Riss (Vienna, Austria) , S. Schopf (Bad Aibling, Germany) , E. Karakas (Krefeld, Germany) , G. Klein (Vienna, Austria) , L. Michlmayr (Vienna, Austria) , H.M. Schardey (Hausham, Germany) , P. Busch (Hausham, Germany) , G. Dionigi (Milano, Italy) , A. Casaril (Peschiera del Garda, Italy) , M. Hermann (Vienna, Austria) , T. Grabner (Vienna, Austria) , Z. Karimov (Izmir, Turkey) , M. Özdemir (izmir, Turkey) , O. Makay (Izmir, Turkey) , C. Nomine-Criqui (Nancy, France) , L. Brunaud (Nancy, France) , P. Moreno-Llorente (Barcelona, Spain) , J.V. Fortuny (Geneva, Switzerland) , M. Barczynski (Krakow, Poland) , M. Dedecjus (Warsaw, Poland) , P. Goralski (Warsaw, Poland) , G. Deroide (Levallois-Perret, France) , F. Tunca (Istanbul, Turkey) , Y. Iscan (Istanbul, Turkey) , C. Chiapponi (Cologne, Germany)
Background:
The aim of this study was to investigate the rate of recurrent laryngeal nerve palsy (RLNP) after TOETVA and/or TOEPVA and to analyse possible risk factors.
Methods:
Overall, 693 patients who underwent transoral endoscopic thyroid and/or parathyroid surgery via vestibular approach from June 2017 to December 2023 in 16 centres in Austria, Germany, Switzerland, Italy, France, Spain, Poland and Turkey were included in this study. Data was analysed regarding RLNP. Both correlation and multivariate analysis of possible risk factors were calculated.
Results:
Transoral thyroid and parathyroid surgery were performed in 594(85.6%) and 41(5.9%) patients with 1437 nerves at risk. Intraoperative neuromonitoring (IONM) was performed in 682(98%) patients. In 230(33.2%) patients IONM was performed before and after resection of the specimen whereas in only 84(12.1%) patients monitoring of the vagal nerve was performed before and after resection of the specimen. Transient RLNP occurred in 36(5.2%) patients which was present in 11(30.6%) on the left side and in 6(16.7%) on the right side. Permanent unilateral RLNP was present in 10(1.4%) patients. In one(10%) patient permanent RLNP occurred on the left side and in 3(30%) on the right side. Mean regression time of transient palsy was 2.5±0.71 months (8 days to 3 months). RLNP does not show statistically significant correlation with surgery time>120 minutes, BMI> 26 kg/m2, specimen volume>20 ml and perioperative complications.
Conclusions:
RLNP rate in TOETVA/TOEPVA is comparable to open thyroid surgery. Temporary RLNP is more often affecting the left RLN whereas permanent palsy is more frequently affecting the right RLN.