Use of intraoperative neural monitoring for prognostication of recovery of vocal mobility and reduction of permanent vocal paralysis after thyroidectomy

Thong, Gerard; Brophy, Catherine; Sheahan, Patrick

doi:10.1002/hed.26440

Cited by 7 publications

(8 citation statements)

References 36 publications

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“…IONM is useful in identifying the RLN during thyroidectomy ( 21 ). Our center firstly implemented IONM in trans breast and transoral endoscopy thyroidectomy ( 17 , 22 ).…”

Section: Discussionmentioning

confidence: 99%

Effects of Intraoperative Neural Tunnel in Protecting Recurrent Laryngeal Nerve: Experiences in Open, Trans Breast, and Transoral Endoscopic Thyroidectomy

Xing

Liu

et al. 2022

Front. Oncol.

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BackgroundEnergy-based devices (EBDs) increase the risks of thermal nerve injuries. This study aimed to introduce a surgical strategy of intraoperative neural tunnel protecting (INTP) for evaluating the effect in reducing the incidence of recurrent laryngeal nerve (RLN) damage in open, trans breast, and transoral endoscopic thyroidectomy.MethodsINTP strategy was introduced: a tunnel was established and protected by endoscopic gauze along the direction of the nerve. A total of 165, 94, and 200 patients with papillary thyroid carcinoma (PTC) were to use INTP in respectively open, trans breast, and transoral endoscopic thyroidectomy as the INTP group. Additionally, 150, 95, and 225 patients who received the same methods without INTP were enrolled in the control group. Ipsilateral thyroidectomy or total thyroidectomy, and central compartment dissection were performed on the enrolled patients.ResultsClinicopathologic characteristics, surgical outcomes, and surgical complications were similar between the INTP group and the control group in open, trans breast, and transoral endoscopic thyroidectomy. The incidences of electromyography (EMG) changes in the INTP group were lower as compared to the control group in trans breast endoscopic thyroidectomy (p < 0.05). The incidence of postoperative hoarse in the INTP group was lower as compared to the control group in open and transoral endoscopic thyroidectomy (p < 0.05). Postoperative calcium levels (p < 0.01) were significantly higher, and the white blood cells (p < 0.05) and C-reactive protein levels (p < 0.01) were significantly decreased in the INTP group compared with the control group in transoral endoscopic thyroidectomy.ConclusionsThis was the first instance of the INTP strategy being introduced and was found to be an effective method for protecting the RLN in open, trans breast, and transoral endoscopic thyroidectomy. Additionally, INTP helped protect other important tissues such as the parathyroid glands in transoral endoscopic thyroidectomy as well as in reducing postoperative inflammatory responses.

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“…IONM is useful in identifying the RLN during thyroidectomy ( 21 ). Our center firstly implemented IONM in trans breast and transoral endoscopy thyroidectomy ( 17 , 22 ).…”

Section: Discussionmentioning

confidence: 99%

Effects of Intraoperative Neural Tunnel in Protecting Recurrent Laryngeal Nerve: Experiences in Open, Trans Breast, and Transoral Endoscopic Thyroidectomy

Xing

Liu

et al. 2022

Front. Oncol.

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“…In our study, both groups of patients had a history of exploration and re-exploration of RLNs. Identification of RLN during thyroid reoperation is sometimes difficult, but IONM may be helpful [26,27] . Our results showed that IONM helps to improve the recognition rate of RLN and shorten the confirmation time of RLN compared with the VA group (Table 2).…”

Section: Discussionmentioning

confidence: 67%

“…Identification of RLN during thyroid reoperation is sometimes difficult, but IONM may be helpful. [ 26 , 27 ] Our results showed that IONM helps to improve the recognition rate of RLN and shorten the confirmation time of RLN compared with the VA group (Table 2 ). This is because IONM can distinguish the RLN from the vessels and scarred tissue and locate the nerve before visual confirmation.…”

Section: Discussionmentioning

confidence: 76%

The value of intraoperative nerve monitoring against recurrent laryngeal nerve injury in thyroid reoperations

et al. 2021

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Reoperative thyroidectomy is challenging for surgeons because of the higher incidence of recurrent laryngeal nerve (RLN) palsy. RLN identification is the gold standard during thyroidectomy; however, it is sometimes difficult to perform thyroid reoperations. In recent years, intraoperative nerve monitoring (IONM) has gained increased acceptance, and the use of IONM can be a valuable adjunct to visual identification. The aim of this study was to evaluate the value of IONM during thyroid reoperation. A total of 109 patients who met our criteria at the Affiliated Hospital of Hangzhou Normal University from January 2010 to June 2020 were retrospectively analyzed and divided into the IONM group and the visualization-alone group (VA group) according to whether neuromonitoring was used during the operation. The patients’ characteristics, perioperative data, and intraoperative information including the RLN identification, time of RLNs confirmation, operative time, intraoperative blood loss, and the rate of RLN injury were collected. Sixty-five procedures (94 RLNs at risk) were performed in the IONM group, whereas 44 (65 RLNs at risk) were in the VA group. The rate of RLN identification was 96.8% in the IONM group and 75.4% in the VA group ( P < .05). The incidence of RLN injury was 5.3% in the IONM group and 13.8% in the VA group ( P > .05). The incidence of surgeon-related RLN injury rate was 0% in the IONM group compared to 7.7% in the VA group ( P < .05), but the tumor-related or scar-related RLN injury rate between the 2 groups were not significantly different (4.3% vs 3.1%, 1.1% vs 3.1%, P > .05). IONM in thyroid reoperation was helpful in improving the RLN identification rate and reducing the surgeon-related RLN injury rate, but was ineffective in reducing the tumor-related and scar-related RLN injury rate. In the future, multicenter prospective studies with large sample sizes may be needed to further assess the role of IONM in thyroid reoperations.

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“…At this time, nerve monitoring forceps were used to monitor the electric signals of the vagus nerve beside the aorta, the RLN in Berry's ligament was detected and separated with nerve monitoring forceps, and the ligament was cut by an ultrasonic knife. [ 6 ] Then, the blood vessels in the lower pole of the thyroid were cut, followed by complete exposure of thyroid tissues and lymphatic adipose tissues in the central region [ Figure 2b ]. Subsequently, the inferior pole parathyroid glands could be preserved in situ, and the lymphatic adipose tissue in the central region could be removed.…”

Section: Methodsmentioning

confidence: 99%

Thyroidectomy using a single-port cervico-mental angle approach

Lin

Xie

2022

Journal of Minimal Access Surgery

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Background: Over the last two decades, several endoscopic thyroidectomy methods have been developed. However, there are some limitations in these procedures. To date, the optimal surgical approach for thyroid cancer has not yet been developed. This study reported the surgical operation steps, clinical outcomes, and experience of 30 patients who underwent trans-cervico-mental angle single-port endoscopic thyroidectomy (TCMASPET) at our centre. Patients and Methods: A total of 30 patients were enrolled in the present study. Patients underwent unilateral or bilateral thyroidectomy through a cervico-mental angle incision of 2.48 ± 0.31 cm, after which the lymphoid adipose tissues in the central region were dissected. Results: All surgeries were successfully completed. Two patients underwent bilateral thyroid carcinoma resection with bilateral central region lymph node dissection, 23 patients received unilateral thyroid cancer resection with unilateral central region lymph node dissection, four patients underwent unilateral thyroid resection, and one patient received bilateral thyroid resection with unilateral central region lymph node dissection. No permanent post-operative complications were observed. Conclusions: TCMASPET was a safe and feasible approach that was relatively easy to perform. This approach may expand the indications for endoscopic thyroidectomy while maintaining excellent cosmetic outcomes.

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Use of intraoperative neural monitoring for prognostication of recovery of vocal mobility and reduction of permanent vocal paralysis after thyroidectomy

Cited by 7 publications

References 36 publications

Effects of Intraoperative Neural Tunnel in Protecting Recurrent Laryngeal Nerve: Experiences in Open, Trans Breast, and Transoral Endoscopic Thyroidectomy

Effects of Intraoperative Neural Tunnel in Protecting Recurrent Laryngeal Nerve: Experiences in Open, Trans Breast, and Transoral Endoscopic Thyroidectomy

The value of intraoperative nerve monitoring against recurrent laryngeal nerve injury in thyroid reoperations

Thyroidectomy using a single-port cervico-mental angle approach

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