Nonrecurrent Laryngeal Nerve Identification and Preservation during Transoral Robotic Thyroidectomy

Abstract

The nonrecurrent laryngeal nerve (NRLN), a rare, anatomic variation of the recurrent laryngeal nerve, is associated with increased injury risk during thyroid surgery. Here, we report a 44-year-old female presenting with right NRLN, receiving transoral robotic thyroidectomy with intraoperative neuromonitoring (IONM). Ultrasonogram of the patient's thyroid gland revealed a solitary nodule, with fine-needle aspiration cytology, indicating papillary carcinoma. Preoperative computed tomography scan revealed an aberrant right subclavian artery arising from the distal aortic arch, suggesting right NRLN. During transoral robotic hemi-thyroidectomy, IONM identified a NRLN emanating from the right vagus nerve and entering the larynx. The post-operative period was uneventful, and laryngoscopic examination demonstrated normal vocal cord movement with no changes observed in patient voice. This is the first report of transoral robotic thyroidectomy in a patient with NRLN. During transoral thyroidectomy, the right NRLN was easily identified and its integrity was preserved utilizing IONM.