Scholarly Dialogue on Risk to the Recurrent Laryngeal Nerve with Thermal Ablation Procedures: A Reflection on Empirical Practices

Background: Radiofrequency and other ablative treatments for thyroid nodules and thyroid malignancies are increasingly being adopted into clinical practice. The safety of these procedures with respect to the recurrent laryngeal nerve (RLN) is not well-characterized. Summary: Our current understanding of RLN injury with thermal ablation procedures is nascent. Review of surgical literature and practices offers a framework for voice and laryngeal evaluation and reveals important features of RLN injury. At present, current strategies to mitigate and manage RLN injury in thyroid ablation procedures are offered by physicians of varying specialties and are empirical. An in-depth understanding of lessons learned from surgical management of the thyroid and RLN should optimize the safety of thermal ablation procedures. Critically examining commonly recommended ablation techniques through a surgical framework may provide practical insights that can be used to minimize the risk of RLN injury. Conclusions: Further work is needed to characterize the risk of thermal injury to the RLN in ablation procedures. Research should address the safety and efficacy of hydrodissection and cold irrigation techniques.