scholarly journals Post-thyroidectomy vocal cords paralysis despiste normal intraoperative neuromonitoring of the laryngeal nerves during surgery

2016 ◽  
Author(s):  
Astrid Batalla
Keyword(s):  
Intraoperative Neuromonitoring ◽  
Vocal Cords ◽  
Laryngeal Nerves

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.

Intraoperative Neuromonitoring of the laryngeal nerves in thyroid surgery

2019 ◽  
Author(s):  
Mikhail O Vozdvizhenskii ◽  
AE Orlov ◽  
AA Makhonin ◽  
VV Stadler ◽  
Ya.S Matyash
Keyword(s):  
Thyroid Surgery ◽  
Intraoperative Neuromonitoring ◽  
Laryngeal Nerves

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 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 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.

scholarly journals Role of intraoperative neuromonitoring of recurrent laryngeal nerves in the outcomes of surgery for thyroid cancer

2014 ◽  
Vol 12 ◽  
pp. S213-S217 ◽  
Author(s):  
Pietro Giorgio Calò ◽  
Fabio Medas ◽  
Enrico Erdas ◽  
Maria Rita Pittau ◽  
Roberto Demontis ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Intraoperative Neuromonitoring ◽  
Laryngeal Nerves ◽  
Recurrent Laryngeal Nerves
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