Experience with the use of intraoperative continuous nerve monitoring in video‐assisted neck surgery and external cervical incisions

Abstract

Objectives Recurrent laryngeal nerve (RLN) injury is one of the severe complications in thyroid surgery. Therefore, intraoperative nerve monitoring (IONM) has been widely used to identify the RLN and confirm its integrity. Recently, the usefulness of continuous IONM (CIONM) with automatic, periodic stimulation to the vagus nerve during thyroid surgery was reported. This study aimed to report our experience with minimally invasive video‐assisted endoscopic endocrine neck surgery (VANS), during which, CIONM was successfully applied for the first time. Methods Consecutive patients who underwent thyroid surgery with CIONM, performed in our department using either external neck incision surgery or VANS between July 2017 and June 2019, were retrospectively analyzed. Results A total of 22 patients who underwent thyroid surgery with neck incision (14 cases; 7 men and 7 women; age, 21‐75 years [mean, 52 years]) or VANS (8 cases; 8 women, age, 20‐61 years [mean, 41 years]) were enrolled in this study. The addition of CIONM in VANS prolonged the operation's duration by approximately 30 minutes as the endoscopic surgery was technically more difficult. No intra‐ and postoperative incidence of transient or permanent RLN palsy was observed in any patient, except for three patients who underwent external neck incision surgery in whom combined resection was unavoidable due to tumor invasion of the RLN. Conclusion We reported the first successful application of CIONM during thyroidectomy using VANS. Future clinical trials should clarify the benefits of CIONM when compared to intermittent IONM in VANS. Level of Evidence 5.

Clinical Experience of Use of Percutaneous Continuous Nervemonitoring in Robotic Bilateral Axillo-Breast Thyroid Surgery

“…The procedure is cosmetic and leaves only a 1-mm needle hole in the neck, which usually heals completely within 1 day after the procedure. In the literature there are technical reports on the use of C-IONM in robotic thyroid surgery ( 26 ) as well as experimental and original studies with cases series mainly for the transaxillary and vestibular approach ( 27 ). We reported the first successful application of C-IONM during trans-areola thyroidectomy in a large series of patients.…”

Lateral approach contributes to shortened surgical time in video-assisted neck surgery (VANS) for thyroid nodule

“…Furthermore, we reviewed complications of our patients in VANS. Postoperative RLNP is the most common complication in thyroid surgery; the reported incidence ranges between 1.4% and 6.3% [ [21] , [22] , [23] , [24] ]. In our series, RLNP was noted in 4 patients (5.7%) including permanent palsy in 1 case (1.4%); the incidence ratio was considered to be no different from reports of conventional surgery, which is considered about 3% to 6% [ 19 ].…”

“…In our series, RLNP was noted in 4 patients (5.7%) including permanent palsy in 1 case (1.4%); the incidence ratio was considered to be no different from reports of conventional surgery, which is considered about 3% to 6% [ 19 ]. Recently, Noda et al used a continuous nerve monitoring system for VANS to reduce the risk of postoperative RLNP [ 23 ], although their findings have not yet been confirmed in subsequent reports. Once RLNP has occurred, 70% of patients recover within 3 months, and 90% of patients recover within 6 months in conventional surgery [ 19 ].…”

Endoscopic thyroidectomy to minimize light exposure of an erythropoietic protoporphyria patient: A case report

“…As the patient had erythropoietic protoporphyria, her consulting dermatologist recommended dimming the surgical lights as much as possible and covering her skin with a drape to minimize light exposure. Based on these factors and our extensive experience [5] , [6] , an endoscopic thyroidectomy using the VANS method was considered to be a rational choice. The patient provided consent to this surgery.…”