scholarly journals Feasibility of Attachable Ring Stimulator for Intraoperative Neuromonitoring during Thyroid Surgery

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Jongjin Kim ◽  
Hyeon Jong Moon ◽  
Young Jun Chai ◽  
Jung-Man Lee ◽  
Ki-Tae Hwang ◽  
...  
Keyword(s):  
Thyroid Surgery ◽  
Medical Records ◽  
Electric Stimulation ◽  
Intraoperative Neuromonitoring ◽  
Vagus Nerves ◽  
Nerve Monitoring ◽  
Continuous Feedback ◽  
The Mean ◽  
Recurrent Laryngeal Nerves ◽  
Intraoperative Nerve Monitoring

Objective. Stimulator-attached dissecting instruments are useful for intraoperative nerve monitoring during thyroidectomy. The aim of this study was to evaluate the feasibility of an attachable ring stimulator (ARS) by comparing the electromyography (EMG) amplitudes evoked by an ARS and a conventional stimulator. Methods. Medical records of fourteen patients who underwent thyroidectomy using intraoperative neuromonitoring between June and August 2019 were retrospectively reviewed. The amplitudes of V1, R1, R2, and V2 signals were checked using both the ARS and a conventional stimulator, at the same point. Results. Both stimulators were tested on 20 recurrent laryngeal nerves (RLNs) and 20 vagus nerves (VNs). In all the nerves, the amplitudes of V1, R1, R2, and V2 were greater than 500 μV. The mean amplitudes of V1, R1, R2, and V2 checked with the ARS were 1175, 1432, 1598, and 1279 μV, respectively. The mean amplitudes of V1, R1, R2, and V2 checked with the conventional stimulator were 1140, 1425, 1557, and 1217 μV, respectively. Difference between amplitudes evoked by the two stimulators for V1, R1, R2, and V2 was 77, 110, 102, and 99 μV, respectively. There was no statistical difference in the amplitudes between the two groups for V1, R1, R2, and V2. Conclusion. The ARS transferred electric stimulation as effectively as the conventional stimulator. It is an effective tool for repeated stimulation and facilitates continuous feedback regarding the functional integrity of nerves during thyroid surgery.

Current status of intraoperative nerve monitoring of laryngeal nerves in thyroid surgery

2020 ◽  
Vol 31 (3) ◽  
pp. 256-269
Author(s):  
M Durán Poveda ◽  
L Zarain Obrador ◽  
O Garnés Camarena
Keyword(s):  
Thyroid Surgery ◽  
Current Status ◽  
Nerve Monitoring ◽  
Laryngeal Nerves ◽  
Calidad De Vida ◽  
Intraoperative Nerve Monitoring

Resumen La lesión de la rama externa del nervio laríngeo superior (RE-NLS) puede producir una disfunción laríngea postoperatoria con afectación directa sobre la voz. La lesión del nervio laríngeo recurrente (NR) es una complicación temida en la cirugía tiroidea por su importante repercusión en la calidad de vida del paciente. Su lesión se asocia con una importante morbilidad que afecta directamente y en diferente grado a la voz, deglución y respiración del paciente. Al deterioro de la calidad de vida de los pacientes se unen los costes clínicos, socio-económicos y repercusiones médico legales derivadas de esta complicación. La incidencia de lesión del NR oscila entre el 2,3% y el 9,8%. La monitorización nerviosa intraoperatoria (MNI) de los nervios laríngeos se introdujo en la cirugía tiroidea para reducir las lesiones nerviosas. Aunque su uso rutinario no está universalmente extendido entre todos los profesionales y su papel dentro de la cirugía tiroidea es controvertido, cada vez son más los cirujanos que recurren a la MNI de forma sistemática, ya que representa un instrumento que complementa a la identificación visual del nervio durante la intervención. La MNI ayuda a la identificación inicial del nervio y a la posterior disección del mismo. Además, permite predecir la función postoperatoria del NR y del NLS en el campo quirúrgico, así como identificar el mecanismo y la localización de la lesión nerviosa durante la intervención, en caso de producirse.

Low-Dose of Rocuronium During Thyroid Surgery: Effects on Intraoperative Nerve-Monitoring and Intubation

2021 ◽  
Vol 265 ◽  
pp. 131-138
Author(s):  
Eugenio Garofalo ◽  
Andrea Bruni ◽  
Giuseppe Scalzi ◽  
Lucia Stella Curto ◽  
Serena Rovida ◽  
...  
Keyword(s):  
Thyroid Surgery ◽  
Low Dose ◽  
Nerve Monitoring ◽  
Intraoperative Nerve Monitoring

scholarly journals Intraoperative Neuromonitoring During Thyroid Surgery: The Effect of Surgical Positioning

2018 ◽  
Vol 26 (1) ◽  
pp. 77-81
Author(s):  
Jason E. Crowther ◽  
Daniah Bu Ali ◽  
Jeremy Bamford ◽  
San-Wook Kang ◽  
Emad Kandil
Keyword(s):  
Vagus Nerve ◽  
Thyroid Surgery ◽  
Intraoperative Neuromonitoring ◽  
Neurological Injury ◽  
Neural Recordings ◽  
Surgical Positioning ◽  
Ultrasound Measurements ◽  
Before And After ◽  
Recurrent Laryngeal Nerves ◽  
Proper Interpretation

Intraoperative neuromonitoring during thyroid surgery has been used to successfully prevent permanent neurological injury by early identification of anatomical variants. Proper interpretation of neuromonitoring data requires knowledge of what factors might affect the data. In this study, we examined the effect of surgical positioning on the latency and amplitude of neural recordings made from the vocalis muscle during thyroid surgery. A retrospective review was performed of 145 patients who underwent thyroid surgery. Eighty-three had open cervical procedures, and 62 had robotic-assisted transaxillary procedures. Intraoperative neuromonitoring recordings were made by stimulation of the vagus and recurrent laryngeal nerves for both groups. Ultrasound measurements were made of a subset of the transaxillary patients immediately before and after arm positioning. Groups differed only on right-sided recordings. Patients with transaxillary surgeries had significantly shorter latencies evoked from the vagus nerve. We found that vagus nerve–evoked latencies were also correlated to ultrasound measurements of the nerves. Surgical positioning during thyroid surgery is a factor that may affect intraoperative neuromonitoring data and should be taken into account by the surgeon during interpretation.

scholarly journals Intraoperative nerve monitoring in thyroid surgery—shifting current paradigms

Gland Surgery ◽  
2020 ◽  
Vol 9 (S2) ◽  
pp. S120-S128 ◽  
Author(s):  
Rick Schneider ◽  
Andreas Machens ◽  
Kerstin Lorenz ◽  
Henning Dralle
Keyword(s):  
Thyroid Surgery ◽  
Nerve Monitoring ◽  
Intraoperative Nerve Monitoring

scholarly journals Intraoperative Monitoring of the Recurrent Laryngeal Nerve during Thyroidectomy: A Standardized Approach (Part 1)

2011 ◽  
Vol 3 (3) ◽  
pp. 144-150 ◽  
Author(s):  
Henning Dralle ◽  
Antonio Sitges-Serra ◽  
Peter Angelos ◽  
Manuel C Durán Poveda ◽  
Gianlorenzo Dionigi ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Thyroid Surgery ◽  
Superior Laryngeal Nerve ◽  
Surgical Anatomy ◽  
Laryngeal Nerve ◽  
Nerve Monitoring ◽  
Visual Identification ◽  
Current State ◽  
Monitoring Procedure ◽  
Intraoperative Nerve Monitoring

ABSTRACT One of the most feared complications in thyroid surgery is injury to the superior laryngeal nerve or recurrent laryngeal nerve. Neural identification during surgery is insufficient to assess nerve injury. Intraoperative nerve monitoring of the vagal nerve and recurrent laryngeal nerve during thyroid surgery is a new adjunct designed to allow better identification of nerves at risk and therefore reduce complications related to their injury. This new working tool does not substitute adequate surgical technique but merely provides the surgeon with an adjunct to routine visual identification and functional assessment. The use of nerve monitoring requires standardization of the monitoring procedure. Pursuant to this, we will discuss in two related articles the current state of the art standardized technique of nerve monitoring in thyroid surgery. The aim of part 1 is to provide a concise overview of nerve monitoring in thyroid surgery and its effectiveness. This will include a brief review of the surgical anatomy of the recurrent laryngeal nerve and the key landmarks used to identify the nerve during surgery. Part 2 will describe how to perform the standardized nerve monitoring in a step by step fashion during thyroid surgery which will diminish variable results and misleading information associated with a nonstandardized nerve monitoring procedure.

scholarly journals Application of intraoperative nerve monitoring for recurrent laryngeal nerves in minimally invasive McKeown esophagectomy

2021 ◽  
Author(s):  
Luo Zhao ◽  
Jia He ◽  
Yingzhi Qin ◽  
Hongsheng Liu ◽  
Shanqing Li ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Pulmonary Complications ◽  
Control Group ◽  
Postoperative Pulmonary Complications ◽  
Nerve Monitoring ◽  
Mediastinal Lymphadenectomy ◽  
Significant Difference ◽  
Recurrent Laryngeal Nerves ◽  
Intraoperative Nerve Monitoring ◽  
Mckeown Esophagectomy

Abstract Background Mediastinal lymphadenectomy is of great importance during esophagectomy for esophageal squamous cell carcinoma. However, recurrent laryngeal nerve (RLN) injury is a severe complication caused by lymphadenectomy along the RLN. Intraoperative nerve monitoring (IONM) can effectively identify the RLN and reduce the incidence of postoperative vocal cord paralysis (VCP). Here, we describe the feasibility and effectiveness of IONM in minimally invasive McKeown esophagectomy. Methods A total of 150 patients who underwent minimally invasive McKeown esophagectomy from 2016 to 2020 were enrolled in this study. We divided the patients into two groups: a neuromonitoring group (IONM, n = 70) and a control group (control, n = 80). Clinical data, surgical variables, and postoperative complications were retrospectively analyzed and compared. Results There was no significant difference in baseline data between the two groups. Postoperative VCP occurred in six cases (8.6%) in the IONM group, which was lower than that in the control group (21.3%, P = 0.032). Postoperative pulmonary complications were found in five cases (7.1%) and 14 in the control group (18.8%, P = 0.037). The postoperative hospital stay in the IONM group was significantly shorter than that in the control group (8 vs. 12, median, P < 0.001). The number of RLN lymph nodes harvested in the IONM group was higher than that in the control group (13.74 ± 5.77 vs. 11.03 ± 5.78, P = 0.005). The sensitivity and specificity of IONM monitoring VCP were 83.8% and 100%, respectively. A total of 66.7% of patients with a reduction in signal showed transient VCP, whereas 100% with a loss of signal showed permanent VCP. Conclusion IONM is feasible in minimally invasive McKeown esophagectomy. It showed advantages for distinguishing RLN and achieving thorough mediastinal lymphadenectomy with less RLN injury. Abnormal IONM signals can provide an accurate prediction of postoperative VCP incidence.

Sign in / Sign up

Export Citation Format

Share Document