Research Article

Medial to Superior Surgical Approach to Sparing Recurrent Laryngeal Nerve and Avoid its Injury and Association Complications during Total Thyroidectomy- Prospective Study

Authors: Samir Yeslam Baothman, Salah Ahmed Binziad, Mohammed Abdulla Baamer.

DOI: 10.33425/2833-0390.1046

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Abstract

Background: Injury to the recurrent laryngeal nerve (RLN) remains a significant and potentially debilitating complication of thyroid surgery. This prospective study evaluates the safety and efficacy of a medial-to-superior surgical approach for RLN identification and preservation during total thyroidectomy.

Methods: A total of 347 patients undergoing thyroidectomy between January 2013 and March 2025 were prospectively enrolled across three surgical centers in Hadhramout, Yemen. Patients underwent Total Thyroidectomy (TT; n=198), TT with Modified Radical Neck Dissection (TT+MRND; n=138), or Completion Thyroidectomy (n=11), utilizing a standardized medial-to-superior approach to RLN dissection. Postoperative complications, including hypocalcemia, hematoma, seroma, vocal changes, and hypertrophic scarring, were documented and analyzed using chi-square tests for association.

Results: The cohort was predominantly female (87.6%). Multinodular goiter (46.7%) and papillary thyroid carcinoma (37.8%) were the most prevalent diagnoses. The overall complication rate was 2.6%, with hypocalcemia (0.85%) and seroma (0.85%) being most frequent. No cases of confirmed RLN injury were recorded. Completion thyroidectomy had the highest complication rate (18.2%) compared to TT (1.5%) and TT+MRND (2.8%). A statistically significant association was identified between the type of surgery performed and the incidence of postoperative complications (χ² = 19.086, p = 0.039).

Conclusion: The medial-to-superior surgical approach offers a reliable and anatomically sound technique for RLN preservation during thyroidectomy. Its implementation is associated with low complication rates and may serve as a safe alternative in settings where intraoperative neuromonitoring is not routinely available.

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