scholarly journals Improving Voice Outcomes After Thyroid Surgery – Review of Safety Parameters for Using Energy-Based Devices Near the Recurrent Laryngeal Nerve

2021 ◽  
Vol 12 ◽  
Author(s):  
Jia Joanna Wang ◽  
Tzu-Yen Huang ◽  
Che-Wei Wu ◽  
Yi-Chu Lin ◽  
Hsin-Yi Tseng ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Thyroid Surgery ◽  
Thermal Injury ◽  
Operation Time ◽  
Laryngeal Nerve ◽  
Cooling Time ◽  
Technological Advances ◽  
Standard Procedures ◽  
Thermal Spread ◽  
Safety Parameters

Technological advances in thyroid surgery have rapidly increased in recent decades. Specifically, recently developed energy-based devices (EBDs) enable simultaneous dissection and sealing tissue. EBDs have many advantages in thyroid surgery, such as reduced blood loss, lower rate of post-operative hypocalcemia, and shorter operation time. However, the rate of recurrent laryngeal nerve (RLN) injury during EBD use has shown statistically inconsistent. EBDs generate high temperature that can cause iatrogenic thermal injury to the RLN by direct or indirect thermal spread. This article reviews relevant medical literatures of conventional electrocauteries and different mechanisms of current EBDs, and compares two safety parameters: safe distance and cooling time. In general, conventional electrocautery generates higher temperature and wider thermal spread range, but when applying EBDs near the RLN adequate activation distance and cooling time are still required to avoid inadvertent thermal injury. To improve voice outcomes in the quality-of-life era, surgeons should observe safety parameters and follow the standard procedures when using EBDs near the RLN in thyroid surgery

scholarly journals Efficacy of Intraoperative Single Dose Methylprednisolone on Recurrent Laryngeal Nerve Function After Thyroidectomy

2016 ◽  
Vol 101 (3-4) ◽  
pp. 116-120 ◽  
Author(s):  
Ali Ugur Emre ◽  
Guldeniz Karadeniz Cakmak ◽  
Dilek Karakaya Arpaci ◽  
Sevil Uygun Ilikhan ◽  
Murat Damar
Keyword(s):  
Single Dose ◽  
Recurrent Laryngeal Nerve ◽  
Thyroid Surgery ◽  
Recovery Time ◽  
Recovery Period ◽  
Operation Time ◽  
Laryngeal Nerve ◽  
Nerve Function ◽  
Significant Difference ◽  
Group 1

Recurrent laryngeal nerve (RLN) palsy is an important complication of thyroid surgery. Injuries can either be permanent or temporary. Prevention or shortening the recovery period of temporary palsies is an area of interest. Some surgeons prefer to use corticosteroids for this purpose as is used for facial nerve palsies although there are conflicting data in the literature. We aimed to investigate the efficacy of perioperative single dose methylprednisolone on recurrent laryngeal nerve function. A total of 438 nerves under risk in 237 surgeries are investigated in 2 groups. In Group 1, patients are administered a single intraoperative dose of methylprednisolone (1 mg/kg) intravenously for 220 nerves under risk. A total of 218 nerves under risk in Group 2 were operated and followed without methylprednisolone. The demographic data of the patients, operation time, the final pathology reports, incidence of recurrent laryngeal nerve palsy, and recovery time are documented and compared. No statistically significant difference was determined in terms of age, sex distribution, number of nerves under risk, and the operation time between groups. There were 3 unilateral RLNP in each group and the mean recovery time for Group 1 and 2 palsies were 20.4 and 19.8 days, respectively, without statistical significance. The presented data indicates that a single intraoperative dose of steroid does not seem to affect the rate and recovery period of RLNP in thyroid surgery.

Video Presentation Abstracts

2016 ◽  
Vol 8 (1) ◽  
pp. 132-136
Author(s):  
Tae-Yon Sung ◽  
Jong Ho Yoon ◽  
Yi Ho Lee ◽  
Yu-mi Lee ◽  
Ki-Wook Chung ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Parathyroid Gland ◽  
Thyroid Surgery ◽  
Surgical Complication ◽  
Video Clip ◽  
Surgical Techniques ◽  
Laryngeal Nerve ◽  
Energy Device ◽  
Thermal Change ◽  
Thermal Spread

ABSTRACT BACKGROUND AND AIMS In recent times, robot thyroid surgery has been performed worldwide in thyroid tumors, and reducing surgical complication is also an important factor in robot surgery besides thyroidectomy. This study presents the surgical technique of preserving the recurrent laryngeal nerve and parathyroid gland in transaxillary robot thyroid surgery. METHODS The drawback of robot thyroid surgery is that it cannot tell how strong the surgeon is holding and retracting the tissues or feels the thermal change when energy device is activated. Dissection or manipulation should be performed by layers and structures. The surgeon should not advance to the next procedure immediately after activating the coagulating energy device when related to tissues for preservation since there could be a thermal injury. After the activation, pause or make contact to a gauze placed in the operative field to check the spread of remaining heat. The shielded side of the device should be placed to the remnant structure side. By doing so, the thermal spread could be minimized. When coagulating vessels, the surgeon should not impatiently manipulate the grasped tissues since they could tear before fully coagulated and encounter bleeding. When preserving the recurrent laryngeal nerve and parathyroid gland, these surgical tips are very important to minimize the injury. RESULTS Applying such surgical techniques, the result of preserving the recurrent laryngeal nerve and parathyroid gland is safe and secure in robot thyroid surgery as presented in our video clip. CONCLUSION Endocrine surgeons perform functionally safe thyroidectomy and reduce the surgical complications in any type of thyroid surgery. The above-mentioned techniques will help preserve the recurrent laryngeal nerve and parathyroid gland in robot thyroid surgery

Recurrent laryngeal nerve safety parameters of the Harmonic Focus during thyroid surgery: Porcine model using continuous monitoring

2015 ◽  
Vol 125 (12) ◽  
pp. 2838-2845 ◽  
Author(s):  
Che-Wei Wu ◽  
Young Jun Chai ◽  
Gianlorenzo Dionigi ◽  
Feng-Yu Chiang ◽  
Xiaoli Liu ◽  
...  
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Thyroid Surgery ◽  
Continuous Monitoring ◽  
Porcine Model ◽  
Laryngeal Nerve ◽  
Harmonic Focus ◽  
Safety Parameters

INTRAOPERATIVE CONTINUOUS NEUROMONITORING OF LARYNGEAL RECCURENT NERVES IN PATIENTS WITH THYROID CANCER

2019 ◽  
Vol 65 (3) ◽  
pp. 342-348
Author(s):  
Viktor Makarin ◽  
Anna Uspenskaya ◽  
Arseniy Semenov ◽  
Natalya Timofeeva ◽  
Roman Chernikov ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Postoperative Complications ◽  
Recurrent Laryngeal Nerve ◽  
Thyroid Surgery ◽  
Intraoperative Neuromonitoring ◽  
Laryngeal Nerve ◽  
Laryngeal Muscles ◽  
Neural Transmission ◽  
Continuous Neuromonitoring ◽  
Surgical Manipulation

Laryngeal muscles paresis ranks second in prevalence of postoperative complications after thyroid surgery. Intraoperative neuromonitoring (IONM) of recurrent laryngeal nerve (RLN) results in reduction of cases with dysphonia and prevents such severe complication as bilateral paresis. Currently there are two types of monitoring: intermittent and continual. When using intermittent IONM surgeon has no opportunity to control electrophysiology state of RLN during intervals between stimulations. In case of continual IONM date on amplitude and latency are available to surgeon in real time every second, allowing him instantly react to any disturbance of neural transmission to prevent its damage by changing surgical manipulation. This work presents the first experience of using continual neuromonitoring of RLN in Russia, the procedure is described in details its safety. It is represented the possibility of prevention of bilateral laryngeal muscles paresis.

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