Non-recurrent Laryngeal Nerve Identified During Robotic Thyroidectomy in a Patient with Papillary Thyroid Carcinoma

Non-recurrent Laryngeal Nerve Identified During Robotic Thyroidectomy in a Patient with Papillary Thyroid Carcinoma

A non-recurrent laryngeal nerve is a rare anatomical variant that entails considerable riskfor iatrogenic injury during thyroid surgery. We encountered a patient with a non-recurrentlaryngeal nerve that went unnoticed on preoperative imaging but was discoveredincidentally during robotic thyroidectomy. A 44 year old woman presented at ourdepartment with papillary thyroid microcarcinoma, diagnosed by ultrasonography-guidedfine needle aspiration cytology. During robotic right thyroidectomy and central lymphnode dissection, we could not detect any structure resembling the recurrent laryngeal nervearound the inferior thyroid artery. Thus, we suspected the existence of a non-recurrentlaryngeal nerve, and successfully identified a nerve entering the larynx directly from thevagus nerve without recurring. A three-dimensional high magnification view via a roboticendoscope can aid thyroid surgeons to safely identify and preserve a non-recurrentlaryngeal nerve.