CRANIO-CAUDAL AND LATERAL APPROACH FOR RECURRENT LARYNGEAL NERVE
CRANIO-CAUDAL AND LATERAL APPROACH FOR RECURRENT LARYNGEAL NERVE
The recurrent laryngeal nerve (RLN) dissection should be performed cranio-caudally in TOETVA
 approach.The aim of this study was to compare the cranio-caudal and lateral approach for RLN
 dissection in regard with the rates of LOS during conventional thyroidectomy using continuous
 intraoperative nerve monitoring (CIONM).
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