scholarly journals PREVENTION OF YATROGENIC DAMAGES OF THE LARYNGEAL NERVES IN TRADITIONAL AND MINIMALLY INVASIVE THYROID SURGERY

2017 ◽  
Vol 19 (1) ◽  
pp. 17-24
Author(s):  
Pavel N Romashchenko ◽  
Nikolay A Maistrenko ◽  
Denis S Krivolapov
Keyword(s):  
Thyroid Gland ◽  
Minimally Invasive ◽  
Main Group ◽  
Intraoperative Neuromonitoring ◽  
Laryngeal Nerve ◽  
Control Group ◽  
Laryngeal Nerves ◽  
Functional Dysphonia ◽  
Minimally Invasive Thyroid Surgery ◽  
Regional Metastases

Objective. To assess the effectiveness of using the intraoperative neuromonitoring for conventional and minimally invasive surgical interventions on the thyroid gland for the prevention of the laryngeal nerve damage. Material and methods. For achieving this goal it was performed the retrospective analysis of surgical treatment of 310 patients with thyroid gland diseases, and 54 patients were selected, which were divided into 2 groups matched by sex and age, the nature of thyroid pathology and volume of surgical intervention: in the first (main, n = 27) operations were carried out using intraoperative neuromonitoring, in the second (control, n = 27) - visual monitoring of the laryngeal nerves was performed. The survey was performed according to the Russian and international clinical guidelines. Laryngoscopy was performed for all patients before operation and for patients with impaired phonation function - after it. «NIM-Neuro® 3.0» device with special armored endotracheal tubes preloaded with circular (detecting), as well as stimulating electrodes for searching and continuous monitoring of laryngeal nerves was used for intraoperative neuromonitoring during the operation. Results of the study. Traditional interventions were conducted on the 6 patients, minimally invasive nonendoscopic surgical - on 25, video-assisted - on 23. The exterior branch of the superior laryngeal nerve has found in 25 (92.6%) patients of the main group and 8 of the (29.6%) control group. Recurrent laryngeal nerve was identified in 27 (100%) patients of the 1st group and in 26 (96.3%) patients of the 2nd group by visual inspection. In the main group there are no cases of intraoperative fixation of the loss or signal attenuation during the laryngeal nerves monitoring, which is proved by the absence of single- and double-sided paresis of the larynx in the postoperative period. Only in 2 patients there was functional dysphonia on hypotonic type. In the control group the laryngeal dysfunction in the form of functional dysphonia (n = 1), paresis (n = 1) and paralysis (n = 1) has occurred in 3 patients. Conclusion. It has been found out that intraoperative neuromonitoring is an effective additional method of neural structures detecting, and it does not substitute the anatomic visualization of laryngeal nerves. intraoperative neuromonitoring in patients with high risk of complications (repeated operations on the thyroid gland, thyroid cancer with extrathyroidal proliferation and regional metastases) can reduce the incidence of paresis and paralysis of the larynx. All minimally invasive interventions on the thyroid gland should be accompanied by the intraoperative neuromonitoring of laryngeal nerves (8 figs, 1 table, bibliography: 15 refs).

scholarly journals The Effect of Intraoperative Neuromonitoring on Damage to the Laryngeal Nerves in Patients Undergoing Total Thyroidectomy.

2021 ◽  
Author(s):  
Piotr Bryk ◽  
Stanisław Głuszek
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Total Thyroidectomy ◽  
Nodular Goiter ◽  
Intraoperative Neuromonitoring ◽  
Laryngeal Nerve ◽  
Control Group ◽  
Study Group ◽  
Laryngeal Nerves ◽  
Recurrent Laryngeal Nerves

Abstract Background: Assessment of intraoperative neuromonitoring in the prevention of damage to the recurrent laryngeal nerve during total thyroidectomy.Material and methods: A group of 367 patients qualified for the study, including 312 women (85.01%) and 55 (14.99%) men, aged 18-79, having undergone total thyroidectomy due to a neutral nodular goiter. The patients were operated on by one surgeon. The study group consisted of 205 patients, including 173 (84.39%) women and 32 (15.61%) men, aged 19-79, who were operated on with the use of intraoperative neuromonitoring. The control group consisted of 162 patients, including 139 (85.80%) women and 23 (14.20%) men, aged 18-77 years, who had undergone surgery only with macroscopic visualization of the recurrent laryngeal nerve without the application of intraoperative neuromonitoring. Then, in the period from 2 to 10 years after the surgery, follow-up examinations were performed, which included 153 patients from the control group (74.6% [153/205]) and 122 patients from the study group (75.3% [122 / 162] Results: The frequency of vocal fold palsy did not differ significantly statistically in the study group and the control group (study group: 4.9% [10/205], control group: 4.9% [8/162]; p = 0.979). In the follow-up study, the incidence of laryngeal fold palsy did not show statistically significant differences between the study and control groups. Most of the damage to the recurrent laryngeal nerves was persistent.Conclusions: Neuromonitoring did not reduce the number of recurrent laryngeal nerve injuries in relation to the nerve visualization alone in noncapsular total thyroidectomy for benign nodular goiter, performed by the same experienced surgeon.

scholarly journals Efficiency of minimally invasive surgery for liver echinococcosis and its complications

2021 ◽  
Vol 26 (1) ◽  
pp. 84-91
Author(s):  
Z. A. Azizzoda ◽  
K. M. Kurbonov ◽  
K. R. Ruziboyzoda ◽  
S. G. Ali-Zade
Keyword(s):  
Minimally Invasive Surgery ◽  
Comparative Analysis ◽  
Surgical Treatment ◽  
Liver Resection ◽  
Minimally Invasive ◽  
Postoperative Mortality ◽  
Main Group ◽  
Control Group ◽  
Surgical Methods ◽  
Access Surgery

Aim. Improving outcomes of diagnosis and treatment of patients with liver echinococcosis and its complications. Materials and methods. A comparative analysis of the results of surgical treatment of liver echinococcosis and its complications with traditional laparotomy access surgery (control group) and minimally invasive interventions (main group) was performed.Results. The study included 300 patients (170 in the control and 130 in the main group). In the main group, 37 (28.4%) cases performed open echinococcectomy from various mini-accesses, and 27 (20.7%) performed twostage operations using minimally invasive technology. Laparoscopic echinococcectomy was performed in 23 (17.7%) patients, laparoscopic pericystectomy 12 (9.2%) and laparoscopic liver resection in 10 (7.7%) patients. The frequency of postoperative complications in the main group was 17.7%, in the control 51.8%, postoperative mortality decreased from 2.3% to 0.8%.Conclusion. Minimally invasive technologies in the surgical treatment of liver echinococcosis show the better immediate results compared to traditional open surgical methods.

scholarly journals Minimally Invasive Video-Assisted versus Minimally Invasive Nonendoscopic Thyroidectomy

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Zdeněk Fík ◽  
Jaromír Astl ◽  
Michal Zábrodský ◽  
Petr Lukeš ◽  
Ilja Merunka ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Prospective Study ◽  
Surgical Procedures ◽  
Thyroid Surgery ◽  
Laryngeal Nerve ◽  
Postoperative Course ◽  
Advantages And Disadvantages ◽  
Video Assisted ◽  
Minimally Invasive Thyroid Surgery ◽  
Feasible Alternative

Minimally invasive video-assisted thyroidectomy (MIVAT) and minimally invasive nonendoscopic thyroidectomy (MINET) represent well accepted and reproducible techniques developed with the main goal to improve cosmetic outcome, accelerate healing, and increase patient’s comfort following thyroid surgery. Between 2007 and 2011, a prospective nonrandomized study of patients undergoing minimally invasive thyroid surgery was performed to compare advantages and disadvantages of the two different techniques. There were no significant differences in the length of incision to perform surgical procedures. Mean duration of hemithyroidectomy was comparable in both groups, but it was more time consuming to perform total thyroidectomy by MIVAT. There were more patients undergoing MIVAT procedures without active drainage in the postoperative course and we also could see a trend for less pain in the same group. This was paralleled by statistically significant decreased administration of both opiates and nonopiate analgesics. We encountered two cases of recurrent laryngeal nerve palsies in the MIVAT group only. MIVAT and MINET represent safe and feasible alternative to conventional thyroid surgery in selected cases and this prospective study has shown minimal differences between these two techniques.

scholarly journals ISSUES OF APPLICATION OF INTRAOPERATIVE NEUROMONITORING OF THE LARYNX NERVES IN ENDOVIDEO SURGICAL OPERATIVE INTERVENTIONS ON THYROID GLAND

2020 ◽  
Vol 23 (2) ◽  
pp. 138-142
Author(s):  
V. L. Meshcheryakov ◽  
I. A. Turlykova ◽  
S. V. Vertyankin ◽  
A. A. Znamensky ◽  
V. A. Makaryin ◽  
...  
Keyword(s):  
Thyroid Gland ◽  
Vocal Folds ◽  
Intraoperative Neuromonitoring ◽  
Subtotal Resection ◽  
Vocal Cords ◽  
Active Electrode ◽  
Surgical Interventions ◽  
Surgical Department ◽  
Laryngeal Nerves ◽  
Technical Errors

Introduction: Among the specific complications of operations on the organs of the neck, the main place is occupied by a violation of the mobility of the vocal cords. Thanks to the introduction of non-invasive methods for recording a signal from the vocal folds using intraoperative neuromonitoring (IONM), it became possible to assess the preservation of the laryngeal nerves, to avoid the development of bilateral paresis of the vocal cords, by assessing the preservation of nerves during the operation. Objective: to develop a methodology for the implementation of intraoperative neuromonitoring during video endosurgical operations on thyroid gland. Materials and methods: On the basis of the surgical department No. 1 of the Central Clinical Hospital, Administrative departments of the President of the Russian Federation, Clinic of Faculty Surgery and Oncology, Saratov State Medical University V.I. Razumovsky” during May 2013-April 2020, 412 patients with various pathologies of the thyroid glands underwent videoendosurgical interventions. Results: We performed the following surgical interventions for thyroidectomy - 112, hemithyroidectomy - 145, subtotal resection - 47 cases. The volume of the thyroid gland was from 17 to 200 ml. At the same time, we try to adhere to a certain algorithm of actions, taking into account the fact that during the operation, irritation of the laryngeal nerves can cause a variety of problems that will give an incorrect answer to these reasons: anesthesiology factors, incorrect operation of the active electrode, technical errors of the operation itself. Conclusions: Intraoperative neuromonitoring for videoendoscopic interventions provides the ability to visualize all anatomical structures incomparable with open operations, reduces the risks of trauma to the laryngeal nerves, allows you to monitor the signal in real time, improves the quality of intraoperative navigation and the safety of surgical intervention.

Dystyreoz as risk factors for the formation of secondary amenoreyeyi girls who live in low iodine deficiency

2017 ◽  
pp. 16-20
Author(s):  
S.I. Turchinа ◽  
◽  
T.A. Nachetova ◽  
Keyword(s):  
Thyroid Gland ◽  
Iodine Deficiency ◽  
Thyroid Dysfunction ◽  
Thyroid Volume ◽  
Main Group ◽  
Control Group ◽  
Menstrual Dysfunction ◽  
Normal Thyroid ◽  
Secondary Amenorrhea ◽  
Toxic Goiter

The article highlights new data on the effect of thyroid dysfunction on the formation of secondary amenorrhea in adolescent girls who live for a long time in conditions of weak iodine deficiency. The objective: to determine the state of the thyroid system in girls with SA, taking into account the presence of thyroid disorders. Materials and methods. Under observation were 68 girls aged 14-17 years with SA, living in conditions of weak iodine deficiency in Kharkov and the Kharkov region. The examination provided for an ultrasound of the thyroid gland and determination of the functional state of the pituitary-thyroid system. Girls with SA entered the main group. Depending on the presence of thyreopathy, namely, diffuse non-toxic goiter (DNG), the patients of the main group were divided into two subgroups: 1-st subgroup consists of a girls with SA and normal thyroid volume (n=39); 2-nd subgroup consists of girls with SA and DNG (n=29). The control group included 78 female peers with normal thyroid volume, harmonious physical development and normal menstrual function. Results. The obtained results allowed to establish that the formation of SA in girls living in conditions of low iodine deficiency occurs against a background of thyroid dysfunction, the character of which differs in girls with normal thyroid gland volume and DNG. This can be regarded as a succession of stages of the pathological process when, in conditions of prolonged residence in regions with a mild iodine deficiency, a distearosis is formed which is characterized by an increase in the fT4 conversion in fT3, reflecting an increase in the fT3/fT4 ratio in the vast majority of the girls surveyed. These changes in the thyroid profile negatively affect the development of the reproductive system and can cause menstrual dysfunction even in the absence of thyroid disease. The conclusion. Prevention and treatment of SA in girls living in conditions of low iodine deficiency, provides long-term use of pharmacological drugs potassium iodide in age doses. Key words: girls, thyroid gland, thyroid status, secondary amenorrhea.

Impact of the anatomy of laryngeal nerves on intraoperative neuromonitoring results in surgery of thyroid gland and functional results after partial laryngectomies

2018 ◽  
Vol 91 (2) ◽  
pp. 30-37
Author(s):  
Greta Berger ◽  
Bożena Kosztyła - Hojna ◽  
Lech Chyczewski
Keyword(s):  
Thyroid Gland ◽  
Surgical Technique ◽  
Superior Laryngeal Nerve ◽  
Functional Results ◽  
Surgical Anatomy ◽  
Intraoperative Neuromonitoring ◽  
Laryngeal Nerve ◽  
Partial Laryngectomy ◽  
Profound Knowledge ◽  
The Impact

The aim of this work was to describe, interpret and highlight the impact of neuroanatomy in the region of the larynx on intraoperative neuromonitoring (IONM) during thyroidectomy. A rich network of anastomoses of the recurrent laryngeal nerve (RLN) and superior laryngeal nerve (SLN) may have impact on the results of thyroidectomy and partial laryngectomy. Intraoperative neuromonitoring is a useful tool in the armamentarium of a head and neck surgeon but it will never replace profound knowledge of surgical anatomy and good surgical technique.

Impact of the laryngeal nerves anatomy on the intraoperative neuromonitoring results in surgery of thyroid gland and functional results after partial laryngectomies

2018 ◽  
Vol 90 (5) ◽  
pp. 1-5
Author(s):  
Greta Berger ◽  
Bożena Kosztyła-Hojna ◽  
Lech Chyczewski
Keyword(s):  
Thyroid Gland ◽  
Surgical Technique ◽  
Recurrent Laryngeal Nerve ◽  
Superior Laryngeal Nerve ◽  
Functional Results ◽  
Surgical Anatomy ◽  
Intraoperative Neuromonitoring ◽  
Laryngeal Nerve ◽  
Partial Laryngectomy ◽  
The Impact

Goal of this work was to describe, interpret and highlight the impact of neuroanatomy in the region of the larynx on the intraoperative neuromonitoring (IONM) during thyroidectomy. Rich anastomoses network of the recurrent laryngeal nerve (RLN) and superior laryngeal nerve (SLN) may have impact on results of thyroidectomy and partial laryngectomy. Intraoperative neuromonitoring is a useful tool in the armamentarium of the Head and Neck surgeon but it will never replace deep knowledge of surgical anatomy and good surgical technique.

scholarly journals New approaches to the treatment of endometrial pathology in patients with extragenital diseases

2021 ◽  
pp. 22-27
Author(s):  
Ihor I. Chermak ◽  
Volodymyr I. Chermak ◽  
Roman M. Zakordonets ◽  
Olori Sharon Oboghene ◽  
Anatolii Ya. Senchuk
Keyword(s):  
Minimally Invasive ◽  
Main Group ◽  
Minimally Invasive Treatment ◽  
Control Group ◽  
Thromboembolic Complications ◽  
Prevention Measures ◽  
Invasive Treatment ◽  
Treatment And Prevention ◽  
Group I ◽  
Endometrial Pathology

With purpose to increase efficiency and decrease frequencies of complications after treatment of endo- and myometrium pathology in patients of the perimenopausal period with extragenital pathology this study has been conducted. Different conducted clinic-laboratory, instrumental and pathology examination were performed. 130 patients of the perimenopausal period from somatic pathology (46-60 years) were divided into representative groups. The main group consisted of 100 patients who suffered from endometrium hyperplasia and adenomyosis. The control group included 30 healthy women without pathology of endoand myometrium. Patients of the main group, depending on the applied treatment-and-prophylactic approach, were divided into two subgroups. Group I included 50 women who underwent hysteroscopy and intrauterine cryosurgery, magnesium supplements, and thromboembolic complications (TEC) prevention measures. Patients of the II group (50 patients) underwent hysteroscopy and treatment and prevention measures following the recommendations of the Protocol of the Ministry of Health of Ukraine (№ 676 of 31.12.2004). T he effectiveness of the proposed approach to diagnosis, minimally invasive treatment (hysteroscopy and intrauterine cryosurgery), and prevention of TEC and inflammatory complications of endo pathology- and myometrium in patients of the perimenopausal period with extragenital pathology, according to the clinic-laboratory and cytomorphological examination, the results of ultrasound was 82.0 %, prevention of TEC and inflammatory complications — 100 % cases. According to generally accepted approaches, the effectiveness of treatment was 36.0 %, TEC prevention — 96.0 %, prevention of inflammatory complications — 78.0 %.

scholarly journals Loss of signal during intraoperative neuromonitoring of laryngeal nerves as a predictor of postoperative larynx paresis: Analysis of 1065 consequetive thyroid and parathyroid operations. Surgeons' algorythm (tactics)

2017 ◽  
Vol 10 (3) ◽  
pp. 15-24
Author(s):  
Viktor A. Makarin ◽  
Anna A. Uspenskaya ◽  
Arseniy A. Semenov ◽  
Natalia I. Timofeeva ◽  
Roman A. Chernikov ◽  
...  
Keyword(s):  
Thyroid Gland ◽  
Negative Predictive Value ◽  
Sensitivity And Specificity ◽  
Postoperative Period ◽  
Predictive Value ◽  
Intraoperative Neuromonitoring ◽  
Parathyroid Glands ◽  
Laryngeal Nerves ◽  
Gland Tissue ◽  
Thyroid Gland Tissue

During thyroid and parathyroid operations performed with laryngeal nerves neuromonitoring, a segmental or global loss of signal may occur. The most frequent cause of loss of signal – is tension of thyroid gland tissue and at the same time tension of the laryngeal nerves. There is no consensus if this complication arises regarding surgeon’s actions.Aim. Evaluation of predictive value of loss of signal during IONM regarding larynx paresis in postoperative period, and algorithm suggestion in case of loss of signal develops.Materials and methods. 1065 patients were operated on thyroid and parathyroid glands with neuromonitoring of laryngeal nerves. Neuromonitore C2 (Inomed, Emmendingen, Germany) was used. We evaluated frequency of loss of signal, described types of loss of signal, showed sensitivity and specificity of loss of signal and development of postoperative larynx paresis.Results. Loss of signal developed in 32 (1,9%) patients. More frequently loss of signal was detected at left side (p=0,01, χ2 = 4,2 OR=2,9). Sensitivity (Se)  of loss of signal and postoperative larynx paresis development reached 59,2%, specificity – 99,7% (Sp), positive predicitive value (PPV) – 91,4%, negative predictive value (NPV) – 97,8%. There are no statistically reliable differences in recovery periods of larynx function depending on type of loss of signal (segmental or global) (p=0,5).Conclusions. In most cases loss of electromyographical signal indicates injury of laryngeal nerves during operation on thyroid and parathyroid glands. When there is loss of signal in case of bilateral thyroid gland disease it is reasonable to make a decision to stop operation to prevent development of bilateral larynx paresis.

Sign in / Sign up

Export Citation Format

Share Document