scholarly journals Learning Curve for Using Intraoperative Neural Monitoring Technology of Thyroid Cancer

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Ning Zhao ◽  
Zhigang Bai ◽  
Changsheng Teng ◽  
Zhongtao Zhang
Keyword(s):  
Thyroid Cancer ◽  
Learning Curve ◽  
Recurrent Laryngeal Nerve ◽  
Nerve Injury ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Cancer Surgery ◽  
Monitoring Technology ◽  
Laryngeal Nerve Injury ◽  
Neural Monitoring

We investigated the learning curve for using intraoperative neural monitoring technology in thyroid cancer, with a view to reducing recurrent laryngeal nerve injury complications. Radical or combined radical surgery for thyroid cancer was performed in 82 patients with thyroid cancer and 147 recurrent laryngeal nerves were dissected. Intraoperative neural monitoring technology was applied and the “four-step method” used to monitor recurrent laryngeal nerve function. When the intraoperative signal was attenuated by more than 50%, recurrent laryngeal nerve injury was diagnosed, and the point and causes of injury were determined. The time required to identify the recurrent laryngeal nerve was 0.5–2 min and the injury rate was 2.7%; injuries were diagnosed intraoperatively. Injury most commonly occurred at or close to the point of entry of the nerve into the larynx and was caused by stretching, tumor adhesion, heat, and clamping. The groups are divided in chronological order; a learning curve for using intraoperative neural monitoring technology in thyroid cancer surgery was generated based on the time to identify the recurrent laryngeal nerve and the number of cases with nerve injury. The time to identify the recurrent laryngeal nerve and the number of injury cases decreased markedly with increasing patient numbers. There is a clear learning curve in applying intraoperative neural monitoring technology to thyroid cancer surgery; appropriate use of such technology aids in the protection of the recurrent laryngeal nerve.

scholarly journals Endoscopic thyroidectomy versus conventional open thyroidectomy for early differentiated thyroid cancer

2020 ◽  
Vol 10 (4) ◽  
Author(s):  
Hoang Hiep Phan ◽  
Keyword(s):  
Thyroid Cancer ◽  
Recurrent Laryngeal Nerve ◽  
Nerve Injury ◽  
Open Surgery ◽  
Differentiated Thyroid Cancer ◽  
Endoscopic Thyroidectomy ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Laryngeal Nerve Injury ◽  
Open Lobectomy

Introduction: Endoscopic thyroidectomy has been applied prudently for malignant thyroid tumors. The aim of our study was to compare the outcomes of endoscopic lobectomy and conventional open lobectomy for early differentiated thyroid cancer. Materials and Methods: From October 2018 to October 2019, 485 patients with early differentiated thyroid cancer underwent thyroid lobectomy in National hospital of Endocrinology enrolled. Of them, 235 patients underwent endoscopic lobectomy (EL) and 250 patients underwent conventional open lobectomy (OL). Results: The mean age of the patients was lower in the EL group (22,3 ± 3,6 years) than in the OL group (31,0 ± 5,8 years, P = 0,013). The ratio female/male was higher in the EL group than in the OL group (12/1 vs 7/1, P = 0,002). The operation time in the EL group was longer than in the OL group (58,4 ± 12,9 vs 42,3 ± 9 minutes, P = 0,014). However, there was no significant differences between EL group and OL group in tumor size (1,2 ± 0,2 vs 1,1 ± 0,6, P = 0,123), blood loss (12,5 ± 0,9 vs 13,6 ± 1,6ml, P = 0,457), postoperative hospital day (4,35 ± 1,4 vs 4,1 ± 1,1 days, P = 0,061), transient hypoparathyroidism (0,85% vs 0,8%, P = 0,431) or transient recurrent laryngeal nerve injury (1,27% vs 1,2%, P = 0,311). The drainage volume in the EL group was higher than in the OL group (75,5 ± 11,4 vs 54,1 ± 10,1ml, P = 0,046). Postoperative bleeding was similar in two groups (0,42% vs 0,4%, P = 0,457). There was no postoperative complications such as permanent recurrent laryngeal nerve injury, tracheal perforation, conversion to open surgery, chyle leak, surgical site infection. Patients in the EL group experienced with less pain than those in the OL group at 1 and 2 days after operation according to a visual analog scale (VAS) (P = 0,047). Wound site numbness is significantly less pronounced in the OL group (p = 0,032). Cosmetically, patients in the EL group were more satisfied than in OL group according to the questionnaire we used (P = 0,021). Conclusions: Endoscopic thyroidectomy for patients with early differentiated thyroid cancer is a safe and effective procedure with excellent cosmetic outcome. Postoperative hospital length stays and complications were similar to conventional open surgery.

Neural monitoring during H-type tracheoesophageal fistula division: A way to decrease recurrent laryngeal nerve injury?

2019 ◽  
Vol 54 (8) ◽  
pp. 1711-1714 ◽  
Author(s):  
Tiffany N. Wright ◽  
Christa Grant ◽  
Ronald B. Hirschl ◽  
Dave R. Lal ◽  
Peter C. Minneci ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Nerve Injury ◽  
Tracheoesophageal Fistula ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Laryngeal Nerve Injury ◽  
Neural Monitoring

scholarly journals Intraoperative nerve monitoring during thyroidectomy: evaluation of signal loss, prognostic value and surgical strategy

2019 ◽  
Vol 101 (8) ◽  
pp. 589-595
Author(s):  
EO Gür ◽  
M Haciyanli ◽  
S Karaisli ◽  
S Haciyanli ◽  
E Kamer ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Vocal Cord ◽  
Nerve Injury ◽  
Vocal Cord Paralysis ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Surgical Strategy ◽  
Signal Loss ◽  
Laryngeal Nerve Injury ◽  
Neural Monitoring

Introduction Intraoperative neural monitoring of the recurrent laryngeal nerve has been widely used to avoid nerve injury during thyroidectomy. We discuss the results of the change in surgical strategy after unilateral signal loss surgeries using intermittent intraoperative neural monitoring in a high-volume referral centre. Materials and methods Details of consecutive patients who underwent thyroidectomy with intermittent intraoperative neural monitoring between January 2014 and December 2017 were prospectively recorded and retrospectively reviewed. Loss of signal was defined as recurrent laryngeal nerve amplitude level lower than 100 μV during surgery. The rate of loss of signal and change in surgical strategy during the operation were evaluated. Results Loss of signal was detected in 25 (5.4%) of 456 patients for whom intermittent intraoperative neural monitoring was performed. Four patients had anatomic nerve disruption and surgery was completed by an experienced endocrine surgeon making use of intraoperative neural monitoring with continuous vagal stimulation. Staged thyroidectomy was performed on 16 patients with unilateral loss of signal in whom the nerves were intact visually. Postoperative vocal cord paralysis was encountered in 18 of 21 (85.7%) patients with loss of signal, and 16 of 18 (88.8%) were improved during the follow-up period. Patients’ voices were subjectively normal to the surgeon postoperatively in 9 of 21 (42.8%) patients who were found to have loss of signal with intact nerves. Conclusions Intraoperative neural monitoring can be used safely in thyroid surgery to avoid recurrent laryngeal nerve injury. It enables the surgeon to diagnose recurrent laryngeal nerve injury intraoperatively to estimate the postoperative nerve function and to modify the surgical strategy to avoid bilateral vocal cord paralysis.

scholarly journals Thyroid surgery in 103 children in a single institution from 2000-2014

2020 ◽  
Vol 40 (4) ◽  
pp. 316-320
Author(s):  
Osama Ibrahim Almosallam ◽  
Ali Aseeri ◽  
Ahmed Alhumaid ◽  
Ali S. AlZahrani ◽  
Saif Alsobhi ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Recurrent Laryngeal Nerve ◽  
Nerve Injury ◽  
Thyroid Surgery ◽  
Radioactive Iodine ◽  
Pediatric Population ◽  
Recurrent Laryngeal Nerve Injury ◽  
Outcome Data ◽  
Laryngeal Nerve ◽  
Laryngeal Nerve Injury

ABSTRACT BACKGROUND: Data on thyroid surgery in children are scarce. OBJECTIVE: Analyze outcome data on thyroid surgery in a pediatric population. DESIGN: Medical record review. SETTING: Tertiary health care institution. PATIENTS AND METHODS: We collected demographic and clinical data on patients 18 years or younger who had thyroid surgery in the period 2000 to 2014. Descriptive data are presented. MAIN OUTCOME MEASURES: Indications for thyroidectomy, thyroid pathology, complications, length of stay, and radioactive iodine treatment and recurrences. SAMPLE SIZE: 103. RESULTS: Of 103 patients who underwent 112 thyroidectomy procedures, 80 (78%) were females and the mean age at operation was 13.2 years. and 17 (16%) were associated with multiple endocrine neoplasia type 2. There was no history of radiation exposure. Eighty-one patients (78%) had fine needle aspiration (FNA) which correlated with the final histopathology in 94% of cases. Sixty-six patients (64%) had malignant cancer (61 papillary), 44 (74.6%) of 59 patients who had neck dissection had lymph node metastasis and 7 (11%) had distant metastases to the lung. Procedures included total thyroidectomy (50%), hemithyroidectomy (17%), completion (31%), and subtotal thyroidectomy (2%). Twenty-three patients (22%) developed hypocalcemia (3 permanent) and 6 (5.8%) had unilateral recurrent laryngeal nerve injury (3 permanent). Patients were followed up for a mean duration of 71.7 months (median 60 months). Of 66 patients with thyroid cancer, 43 (65%) received radioactive iodine, and 10 (15%) had recurrence. CONCLUSION: Malignancy is the commonest indication for thyroid surgery in children and FNA is highly diagnostic. Hypocalcemia and recurrent laryngeal nerve injury are significant complications. The recurrence rate in thyroid cancer is 15%. LIMITATIONS: Retrospective. CONFLICT OF INTEREST: None.

scholarly journals Recurrent laryngeal nerve injury in thyroid surgery: a review

2012 ◽  
Vol 83 (1-2) ◽  
pp. 15-21 ◽  
Author(s):  
Nathan James Hayward ◽  
Simon Grodski ◽  
Meei Yeung ◽  
William R. Johnson ◽  
Jonathan Serpell
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Nerve Injury ◽  
Thyroid Surgery ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Laryngeal Nerve Injury

Observations of recurrent laryngeal nerve injury and recovery using a rat model

2009 ◽  
Vol 119 (8) ◽  
pp. 1644-1651 ◽  
Author(s):  
Belachew Tessema ◽  
Rick M. Roark ◽  
Michael J. Pitman ◽  
Philip Weissbrod ◽  
Sansar Sharma ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Nerve Injury ◽  
Rat Model ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Laryngeal Nerve Injury

scholarly journals A current view on recurrent laryngeal nerve injury in total thyroidectomy

2021 ◽  
Vol 28 (1) ◽  
pp. 7-12
Author(s):  
Lucian ALECU ◽  
◽  
Iulian SLAVU ◽  
Adrian TULIN ◽  
Vlad BRAGA ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Total Thyroidectomy ◽  
Nerve Injury ◽  
Unintentional Injury ◽  
Recurrent Laryngeal Nerve Injury ◽  
Laryngeal Nerve ◽  
Current View ◽  
Pubmed Database ◽  
Laryngeal Nerve Injury ◽  
The Moment

Introduction: Recurrent laryngeal nerve damage during total thyroidectomy was, is, and probably will be in the near future the Achilles’ heel of total thyroidectomy. Material and method: To perform the research we used the PubMed database. The questions were conceived to respect the PICOS guidelines. The PRISMA checklist was used to filter the results. The search was structured following the words: „recurrent laryngeal nerve injury” AND „total thyroidectomy”. Results: A total of 60 papers were identified. We excluded 12 papers as they were duplicates. From the 48 papers left, another 4 could not be obtained. Another 3 papers from the 44 left were excluded due to the fact they were not written in English. One paper was excluded as the subject did not follow our research purpose. 40 papers were left for analysis and discussion. Conclusion: To prevent recurrent laryngeal nerve lesions, at the moment in the literature there is no consensus. Unintentional injury to the recurrent laryngeal nerve is predictable but not an avertible situation thus bilateral lesions still represent a dramatic situation across the world for the patients and the operating surgeon.

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