Background: The risk of an injury of the laryngeal recurrent nerve is an important issue during any surgical procedure in the lower neck.
Methods: Based on our experience with the transcervical-subxiphoid bilateral videothoracoscopic maximal thymectomies, we developed an original technique of visualization for both of these nerves. The key point of the presented technique is the dissection in the lower part of the neck, beneath the level of the thyroid gland. The central step is the division of the deep cervical fascial layers covering and obscuring the recurrent nerves. Preservation of the deepest layer protects the nerves from an injury.
Results: We used this technique in 100 consecutive transcervical-subxiphoid bilateral videothoracoscopic maximal thymectomies without any case of permanent recurrent nerve palsy.
Conclusion: The presented technique is safe, reliable, and relatively simple. It may be used during an extended thymectomy, as well as during a thyroid resection and other operations in the lower neck.