Incidence of Recurrent Laryngeal Nerve Injury While Using LigaSure in Total Thyroidectomy as Compared to Conventional Knot Tying

RLN Injury and LigaSure in Thyroidectomy as Compared to Conventional Knot Tying

Abstract

Recurrent laryngeal nerve (RLN) injury is a recognized complication of thyroid surgery. Although LigaSure enables faster vessel sealing, concerns remain about thermal injury to the RLN. As local randomized evidence is limited, this trial compared LigaSure with conventional knot tying to assess the risk of RLN injury. Objective: To compare the incidence of recurrent laryngeal nerve (RLN) injury between LigaSure and conventional knot tying in patients undergoing total thyroidectomy. Methods: This randomized controlled trial was conducted at Gulab Devi Hospital, Lahore, from July 2025 to March 2026, including 120 patients undergoing total thyroidectomy who were consecutively enrolled and randomly allocated, with allocation concealment, to Group A (conventional knot tying, n=60) or Group B (LigaSure, n=60). RLN injury was assessed postoperatively by clinical examination and laryngoscopy over 6 months of follow-up. Fisher’s Exact Test was used for comparison, with statistical significance defined as p<0.050. Results: The mean age was 36.29 ± 7.63 years, and 75% of patients were female. Multinodular goitre was the most common indication (60%). RLN injury occurred in 1 patient (1.7%) in the conventional group, and 2 patients (3.3%) in the LigaSure group; the overall rate was 2.5%. All injuries were unilateral and temporary, resolving within follow-up, and the difference between groups was not statistically significant (p=1.000). The risk ratio for RLN injury (LigaSure vs conventional) was 2.0 (95% CI 0.2–21.5). Conclusions: Only three RLN injury events occurred, with no significant difference between LigaSure and conventional knot tying during total thyroidectomy.