Patterns of the relationship between recurrent laryngeal nerve and inferior thyroid artery in the setting of total thyroidectomy: A prospective single-surgeon study

This study aimed to determine the anatomical position of recurrent laryngeal nerve (RLN) relative to inferior thyroid artery (ITA) in a consecutive total thyroidectomy series. A total of 421 patients (mean (min-max) age: 45.6 (18-78) years, 76.2% were women) who had total thyroidectomy accompanied with intraoperative exposure of the bilateral RLNs were included in this prospective single-surgeon thyroidectomy series study. Patient demographics and thyroidectomy indications (benign and malignant) were recorded in each patient. The relation of RLN to ITA was assessed bilaterally using the 3-subtype system (anterior to the ITA, posterior to the ITA, and between the branches of the ITA). Most of the thyroidectomy indications (69.1%) were related to malignant disease including papillary carcinoma in 54.9% of cases. The posterior RLN-ITA pattern was the most commonly noted pattern, regardless of the side (74.1% on the left and 68.4% on the right), followed by the anterior RLN-ITA pattern (17.3% on the left and 21.1% on the right) and the between pattern (8.6% on the left and 10.4% on the right). In conclusion, this prospective single-surgeon thyroidectomy series study regarding the position of RLN relative to ITA indicate the predominance of posterior RLN-ITA pattern, similarly, on both the right and the left sides. Accordingly, our findings do not support the higher prevalence of "anterior" or "between" RLN-ITA patterns on the right side, opposing the consideration of right RLN to be at a higher risk of iatrogenic injury.