Serkan AKBULUT, Kağan GÖKÇE, Sancar BAYAR, Ali Ekrem ÜNAL

Rekürren Laringeal Sinirin Hidrodiseksiyon ile Görülmesi ve Korunması

Amaç: Rekürren Laringeal Sinir (RLS) hasarı tiroid cerrahisinin en korkulan komplikasyonudur. Laparoskopik kolesistektomi, katarakt cerrahisi, karpal tünel sendromu tedavisi gibi titiz diseksiyon yapılan durumlarda da tarif edildiği gibi hidrodiseksiyon dokuların sıvıların kullanımı ile diseke edilip, ayrıştırılmasıdır. Bu çalışmada, tiroid cerrahisi sırasında hidrodiseksiyon ile RLS’ nin görülmesi ve hasarlanma oranlarının saptanması amaçlanmıştır. Gereç ve Yöntem: Bu çalışmaya Şubat 2016- Ağustos 2017 arasında çeşitli tiroid hastalıkları nedeni ile art arda opere edilen 34 hasta dahil edilmiştir. Olguların yaş, cinsiyet gibi demografik verileri, yapılan operasyon tipleri (bilateral total tiroidektomi, hemitiroidektomi (total lobektomi ve istmektomi), tamamlayıcı tiroidektomi, santral boyun diseksiyonu yapılıp yapılmadığı), patoloji raporları, risk altındaki sinirler retrospektif olarak kayıt altına alınmıştır. Bulgular: Sadece dev toksik multinodüler guatr için total tiroidektomi yapılan bir olguda ses kısıklığına neden olan tek taraflı geçici RLS hasarı gözlendi. Sonuç: Hidrodiseksiyon kolay uygulanabilir, zaman almayan, ucuz bir tekniktir. Bu öncü çalışma daha geniş örneklemlerde yapılan çalışmalarla takip edilebilir.

Anahtar Kelimeler:

hidrodiseksiyon, rekürren laringeal sinir, tiroidektomi, paralizi, ses kısıklığı

Visualization and Preservation of Recurrent Laryngeal Nerve by Hydrodissection

Aim: Recurrent laryngeal nerve (RLN) injury is the most feared complication of thyroid surgery. Hydrodissection; separation of tissues by fluids is described in laparoscopic cholecystectomy, cataract surgery, carpal tunnel syndrome treatment where meticulous dissection must be carried out. In this study, we aimed to assess the incidence of RLN damage observed in our series by hydrodissection of RLN during thyroid surgery. Material and Method: Thirty four consecutive patients underwent thyroidectomy for various thyroid diseases in 24 months were included in the study. All the patients’ demographic variables (age, sex), operation type (bilateral total thyroidectomy, hemithyroidectomy (total lobectomy and isthmectomy), completion total thyroidectomy, whether central neck compartment dissection was performed), pathology reports, nerves at risk were noted retrospectively. Results: Only in one case, temporary unilateral RLN paralysis causing hoarseness was observed, after total thyroidectomy performed for voluminous toxic multinodular goitre. Conclusion: Hydrodissection is an easily applicable, non time-consuming and cheap technique. This preliminary study may be followed by further researches with larger sample sizes.

Keywords:

hydrodissection, recurrent laryngeal nerve, thyroidectomy, paralysis, hoarseness,

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