Wang C-C, Wu C-H
School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Department of Radiology, Taichung Veterans General Hospital, Taipei, Taiwan.
J Laryngol Otol. 2014 Feb;128(2):199-202. doi: 10.1017/S0022215114000012. Epub 2014 Jan 30.
A non-recurrent inferior laryngeal nerve is a rare anomaly in which the nerve enters the larynx directly off the cervical vagus nerve, without descending to the thoracic level. It is very susceptible to damage during surgery. This report describes the important pre-operative radiological evaluations and surgical landmarks in a case of a non-recurrent inferior laryngeal nerve, identified during the recently developed technique of robotic thyroidectomy.
A 38-year-old woman presented with suspected papillary microcarcinoma, as indicated by aspiration cytology. Pre-operative computed tomography showed a right aberrant subclavian artery that indicated a possible right non-recurrent inferior laryngeal nerve. Using robotic thyroidectomy methods, it was possible to carefully dissect along the thyroid capsule. The laryngeal entrance point of the right non-recurrent inferior laryngeal nerve (a constant anatomical landmark) was successfully identified via the three-dimensional, high-magnification views provided by the robotic endoscope.
With proper knowledge of radiological and surgical anatomy, and the benefits of high-magnification endoscopic views, a non-recurrent inferior laryngeal nerve can be safely preserved during robotic surgery.
非返喉下神经是一种罕见的异常情况，即该神经直接从颈迷走神经进入喉部，而不降至胸部水平。它在手术过程中极易受损。本报告描述了在最近发展起来的机器人甲状腺切除术技术中发现的一例非返喉下神经病例的重要术前影像学评估和手术标志。
一名38岁女性，细针穿刺活检显示疑似甲状腺微小乳头状癌。术前计算机断层扫描显示右锁骨下动脉异常，提示可能存在右非返喉下神经。采用机器人甲状腺切除方法，能够沿甲状腺包膜仔细解剖。通过机器人内窥镜提供的三维高倍视野，成功确定了右非返喉下神经的喉入口点（一个恒定的解剖标志）。
通过掌握放射学和手术解剖学知识，以及高倍内窥镜视野的优势，在机器人手术中可安全保留非返喉下神经。
