Huaxi Tunnel Technique For Recurrent Laryngeal Nerve Exposure And Dissection In Thyroid Surgery

NCT ID: NCT07298616

Last Updated: 2025-12-23

Basic Information

• Recruitment Status: RECRUITING
• Clinical Phase: PHASE3
• Total Enrollment: 700 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2025-03-01
• Study Completion Date: 2026-03-01

Brief Summary

Protection of the recurrent laryngeal nerve (RLN) is a key focus and difficulty in thyroid surgery. Unilateral RLN injury can lead to ipsilateral vocal cord paralysis, resulting in hoarseness in patients postoperatively. Bilateral RLN injury, however, may cause bilateral vocal cord paralysis, leading to dyspnea and even asphyxiation; in severe cases, tracheotomy and permanent tracheal cannulation are required. Consequently, RLN injury significantly impacts patients' postoperative quality of life and career development. Guidelines and consensuses both domestically and internationally recommend that during the management of the posterior thyroid capsule, active detection, exposure, and dissection of the RLN, combined with meticulous capsular dissection along the RLN, should be performed to effectively reduce the incidence of RLN injury. While active anatomical identification of the RLN can clarify the nerve branches and their relationship with surrounding tissues, facilitating surgical procedures such as ligation and hemostasis, the traditional method of dissecting with instruments like hemostats or right-angle forceps (either blunt or sharp dissection along the nerve surface) increases the risk of nerve injury due to traction, clamping, or thermal damage. This is particularly challenging for less experienced surgeons, who face great difficulties in using energy devices near the RLN without causing injury-a major concern in the field of thyroid surgery.

Diluted epinephrine solution exhibits excellent hemostatic effects in local surgery, improves surgical field clarity, and shortens operation time. Its safety has been clinically verified, and it is commonly used in plastic and cosmetic surgery, joint surgery, and the cavity creation process of endoscopic thyroid surgery. Based on this, this study innovatively proposes the "Huaxi Tunnel Technique": on the basis of meticulous posterior capsular dissection in traditional thyroid surgery, the RLN detection point on the posterior capsule below the lower pole of the thyroid is located using the "cross method" and exposed. A syringe containing diluted epinephrine solution is then used, with its front hose inserted along the RLN towards the laryngeal entry direction. Rapid injection is performed, and the pressure generated by this injection separates the fibrous connective tissue on the RLN surface, forming a "tunnel" from the RLN detection point to the laryngeal entry site-thus achieving exposure and dissection of the RLN.

This technique offers multiple advantages: epinephrine reduces local bleeding, enhancing surgical safety and the convenience of meticulous capsular dissection; tunnel formation causes edema and discoloration of the fibrous connective tissue in the posterior thyroid capsule (while the parathyroid glands remain uncolored), facilitating the rapid identification and protection of the parathyroid glands. Preliminary preclinical experiments have confirmed that the technique reduces the difficulty of RLN exposure and dissection, decreases intraoperative bleeding and complication rates, and improves the safety of thyroid surgery. To further evaluate the efficacy, safety, and operability of this tunnel technique for RLN exposure and dissection, a prospective single-blind randomized controlled trial comparing it with traditional thyroid surgery methods is hereby conducted.

Detailed Description

This study is a multicenter, single-blind, randomized controlled trial. Eligible patients will be randomly assigned in a 1:1 ratio to either the experimental group (Tunnel Method group) or the control group (Traditional Method group).

Conditions

Patients Undergoing Open Thyroid Surgery

Keywords

thyroid surgery; recurrent laryngeal nerve; Huaxi tunnel technique; epinephrine

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Huaxi Tunnel Technique Group

Experimental group (Huaxi tunnel technique group):

A 5-ml syringe was loaded with adrenaline solution diluted in normal saline (1 mg adrenaline in 250 ml saline, concentration 4 µg/ml) and fitted with a 2-3 cm soft extension tube as the injection tip. After the recurrent laryngeal nerve (RLN) was identified by the cross-hatch method at the posteroinferior capsule below the lower pole of the thyroid gland, the solution was rapidly injected along the RLN's course toward its laryngeal entry point. The hydraulic pressure created by this rapid injection separated the fibrous connective tissue surrounding the nerve, forming a tissue tunnel from the initial identification site to the laryngeal entry point. Subsequent nerve dissection was then performed within this tunnel.

Group Type: EXPERIMENTAL

Huaxi Tunnel Technique

Intervention Type: PROCEDURE

A 5-ml syringe was loaded with adrenaline solution diluted in normal saline (1 mg adrenaline in 250 ml saline, concentration 4 µg/ml) and fitted with a 2-3 cm soft extension tube as the injection tip. After the recurrent laryngeal nerve (RLN) was identified by the cross-hatch method at the posteroinferior capsule below the lower pole of the thyroid gland, the solution was rapidly injected along the RLN's course toward its laryngeal entry point. The hydraulic pressure created by this rapid injection separated the fibrous connective tissue surrounding the nerve, forming a tissue tunnel from the initial identification site to the laryngeal entry point. Subsequent nerve dissection was then performed within this tunnel.

Control group

Control group (conventional group): the group in which the recurrent laryngeal nerve was exposed and the thyroid gland was resected by standard thyroid surgical techniques.

Group Type: NO_INTERVENTION

No interventions assigned to this group

Interventions

Huaxi Tunnel Technique

A 5-ml syringe was loaded with adrenaline solution diluted in normal saline (1 mg adrenaline in 250 ml saline, concentration 4 µg/ml) and fitted with a 2-3 cm soft extension tube as the injection tip. After the recurrent laryngeal nerve (RLN) was identified by the cross-hatch method at the posteroinferior capsule below the lower pole of the thyroid gland, the solution was rapidly injected along the RLN's course toward its laryngeal entry point. The hydraulic pressure created by this rapid injection separated the fibrous connective tissue surrounding the nerve, forming a tissue tunnel from the initial identification site to the laryngeal entry point. Subsequent nerve dissection was then performed within this tunnel.

Intervention Type: PROCEDURE

Other Intervention Names

adrenaline

Eligibility Criteria

Inclusion Criteria

Aged 18-75 years, regardless of gender Patients hospitalized for open thyroid surgery (undergoing at least unilateral lobe and isthmus resection) and undergoing the procedure for the first time Preoperative color Doppler or contrast-enhanced ultrasound assessment indicates no significant invasion of the recurrent laryngeal nerve by the lesion Participants voluntarily agree to join the trial and provide signed informed consent.

Exclusion Criteria

History of thyroid nodule ablation therapy Patients scheduled for lateral neck dissection History of hypertension, atrial fibrillation, or severe arrhythmia Uncontrolled subacute thyroiditis or hyperthyroidism Severe comorbidities affecting major organs (cardiac, pulmonary, hepatic, or renal) Presence of cancer-related cachexia syndrome History of psychiatric disorders or cognitive impairment Pregnant or lactating women Participation in other clinical trials within 90 days Other conditions deemed by investigators as unsuitable for trial participation

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 75 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

West China Hospital

OTHER

Sponsor Role: lead

West China Tianfu Hospital, Sichuan University

UNKNOWN

Sponsor Role: collaborator

Shang Jin Hospital of West China Hospital,Sichuan University

UNKNOWN

Sponsor Role: collaborator

Sun Yat-sen University Cancer Center (SUSUCC)

UNKNOWN

Sponsor Role: collaborator

Sichuan Provincial People's Hospital

OTHER

Sponsor Role: collaborator

Sanya People's Hospital

UNKNOWN

Sponsor Role: collaborator

Responsible Party

Yu Feng

West China Hospital, Sichuan University

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

West China hospital of Sichuan University

Chengdu, Sichuan, China

Site Status: RECRUITING

Countries

China

Central Contacts

Jianyong Lei

Role: CONTACT

Phone: +86 19983137992

Email: leijianyong@scu.edu.cn

Yu Feng

Role: CONTACT

Phone: +86 15183042703

Email: 1350502131@qq.com

Facility Contacts

Yu Feng

Role: primary

References

GBD 2019 Diseases and Injuries Collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020 Oct 17;396(10258):1204-1222. doi: 10.1016/S0140-6736(20)30925-9.

Reference Type: RESULT

PMID: 33069326 (View on PubMed)

Haymart MR. Progress and Challenges in Thyroid Cancer Management. Endocr Pract. 2021 Dec;27(12):1260-1263. doi: 10.1016/j.eprac.2021.09.006. Epub 2021 Sep 22.

Reference Type: RESULT

PMID: 34562612 (View on PubMed)

Other Identifiers

2024（2498）

Identifier Type: -

Identifier Source: org_study_id