Feasibility and efficacy of intraoperative neural monitoring in remote access robotic and endoscopic thyroidectomy

Ji, Yong Bae; Ko, Seok Hwa; Song, Chang Myeon; Sung, Eui Suk; Lee, Byung‐Joo; Wu, Che‐Wei; Chiang, Feng‐Yu; Tae, Kyung

doi:10.1016/j.oraloncology.2020.104617

Cited by 23 publications

(28 citation statements)

References 37 publications

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“…Dionigi et al identified 42% of EBSLNs visually in 72 video‐assisted thyroidectomies, whereas they identified 84% of EBSLNs using IONM ( P < .05) 26 . However, no study has evaluated the feasibility of IONM of the EBSLN in transoral thyroidectomy or even in other remote‐access thyroidectomy approaches, although several studies evaluated IONM of the RLN 21,34–37 …”

Section: Discussionmentioning

confidence: 99%

“…All surgical procedures followed the standardized intermittent IONM protocol recommended by the International Neural Monitoring Study Group and routine neural monitoring of the EBSLN by obtaining V1‐S1‐S2‐R1‐R2‐V2 signals, in principle 16,19,20 . We used the robotic/endoscopic instrument itself as a stimulating probe by connecting it to the interface‐connector box 21 …”

Section: Methodsmentioning

confidence: 99%

“…16,19,20 We used the robotic/endoscopic instrument itself as a stimulating probe by connecting it to the interface-connector box. 21 Pulsatile neural stimulation was used at 4 Hz, for duration of 100 ms, at 1 to 2 mA. The intensity of stimulation was increased up to 3 to 5 mA if there was no response at 1 to 2 mA, especially for stimulation of the vagus nerve.…”

Section: Methodsmentioning

confidence: 99%

“…26 However, no study has evaluated the feasibility of IONM of the EBSLN in transoral thyroidectomy or even in other remote-access thyroidectomy approaches, although several studies evaluated IONM of the RLN. 21,[34][35][36][37] To the best of our knowledge, this is the first study to evaluate the feasibility and identification rate of the EBSLN using IONM in transoral thyroidectomy. In this study, we were able to identify the EBSLN only in 31 NARs (35.6%) using EMG signals.…”

Section: E673mentioning

confidence: 99%

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Neural Monitoring of the External Branch of the Superior Laryngeal Nerve During Transoral Thyroidectomy

Jeong

et al. 2020

The Laryngoscope

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Objectives/Hypothesis There is no study regarding intraoperative neural monitoring (IONM) of the external branch of the superior laryngeal nerve (EBSLN) during transoral thyroidectomy. The objective of this study was to evaluate the feasibility and success rate of electrical identification of the EBSLN during transoral robotic or endoscopic thyroidectomy. Study Design Case series study. Methods We studied a cohort of 76 patients (87 nerves at risk, (NARs)) who underwent transoral robotic or endoscopic thyroidectomy and simultaneous intermittent IONM between July 2017 and May 2019. We performed the standard IONM procedure plus routine neural monitoring of the EBSLN. IONM and surgical outcome data were prospectively collected. Results Sixty‐one patients underwent the robotic procedure, and 15 patients underwent the endoscopic procedure. Thirty‐seven external branches of the superior laryngeal nerves at risk (42.5%) were electrically identified using electromyography signals (31 NARs, 35.6%) or cricothyroid muscle twitches (6 NARs, 6.9%). The mean pre‐(S1) and post‐dissection (S2) amplitudes of the EBSLN were 372 ± 147 and 351 ± 159 μV, respectively. The identification rates were not different between the robotic and endoscopic procedures. In comparing the early 20 NARs (18 patients) and the later 67 NARs (58 patients), the identification rate was higher in the later cases, although the difference was not statistically significant (25.0% vs. 47.8%, P = .079). Conclusion IONM of the EBSLN is feasible and useful in identifying and preserving the nerve during transoral thyroidectomy, although the identification rate of the nerve is relatively low. Level of Evidence 4 Laryngoscope, 131:E671–E676, 2021

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: E673mentioning

confidence: 99%

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Neural Monitoring of the External Branch of the Superior Laryngeal Nerve During Transoral Thyroidectomy

Jeong

et al. 2020

The Laryngoscope

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“…I would like to emphasize that the benefit and efficiency of precise NMB management on facilitating neural mapping of the abnormal situations in RLN or EBSLN deserve further investigation and novel technologies should be giving better tools to surgeons [5]. Imaging?…”

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confidence: 99%

Are We Ready for an Optimal Neuromuscular Block Management for Neural Monitoring during Thyroid Surgery?

Vilallonga

2020

Journal of Investigative Surgery

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Success rate and learning curve of intraoperative neural monitoring of the external branch of the superior laryngeal nerve in thyroidectomy

Choi

Kim

et al. 2021

Head & Neck

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Background: This study aimed to evaluate the success rate and learning curve of intraoperative neural monitoring (IONM) of the external branch of the superior laryngeal nerve (EBSLN) in thyroidectomy.Methods: We studied 130 consecutive patients (200 nerves at risk [NARs]) who had undergone conventional thyroidectomy with IONM of the recurrent laryngeal nerve (RLN) and EBSLN from January 2017 to March 2020. The learning curve was defined as the number of NARs required to achieve an effective and reliable neuromonitoring rate.Results: IONM of the EBSLN was successful in 136/200 (68%) NARs. The cutoff point of the learning curve was 45 NARs (28 patients). The neural identification rate of EBSLN was significantly higher in the post-learning 155 NARs group than the pre-learning group (82.6% vs. 17.8%, p < 0.001).Conclusions: Approximately 45 NAR neuromonitoring attempts were required to reach a significant increase in the EBSLN identification rate and overcome the learning curve.

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Feasibility and efficacy of intraoperative neural monitoring in remote access robotic and endoscopic thyroidectomy

Cited by 23 publications

References 37 publications

Neural Monitoring of the External Branch of the Superior Laryngeal Nerve During Transoral Thyroidectomy

Neural Monitoring of the External Branch of the Superior Laryngeal Nerve During Transoral Thyroidectomy

Are We Ready for an Optimal Neuromuscular Block Management for Neural Monitoring during Thyroid Surgery?

Success rate and learning curve of intraoperative neural monitoring of the external branch of the superior laryngeal nerve in thyroidectomy

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