Recurrent laryngeal nerve preservation in thyroid cancer involving the ligament of Berry

The ligament of Berry (LOB) is a dense consolidation of pretracheal vascular fascia or suspensory ligament which anchors the thyroid to the trachea and is located medial and deep to the tubercle of Zuckerkandl. The LOB is closely related to the distal 2 cm of the extralaryngeal course of the recurrent laryngeal nerve and to the superior parathyroid gland. When thyroid cancer is present in the LOB, proper preoperative imaging, meticulous dissection with extra caution in the area of the LOB, and use of intraoperative nerve monitoring are helpful tools in preservation of recurrent laryngeal nerve. Additionally, when thyroid cancer is preoperatively suspected to involve LOB, proper preoperative counseling, detailed consent, as well as communication regarding accurate patient expectations are essential.