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.

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 DIAGNOSTICS AND TREATMENT OF RECURRENT POSTOPERATIVE GOITER

2017 ◽  
Vol 176 (1) ◽  
pp. 52-55
Author(s):  
M. F. Zarivchatskiy ◽  
S. A. Denisov ◽  
S. A. Blinov ◽  
I. N. Mugatarov ◽  
N. S. Teplykh ◽  
...  
Keyword(s):  
Thyroid Gland ◽  
Medical Records ◽  
Subtotal Resection ◽  
Recurrent Nerve ◽  
Radical Operation ◽  
Laryngeal Nerves ◽  
Recurrent Laryngeal Nerves ◽  
Transient Hypoparathyroidism ◽  
Nerve Trauma ◽  
Made In

The study developed the system of therapeutic and prophylactic methods in patients with recurrent postoperative goiter. These patients (103) have been accepted and registered in the medical records since 2007. Only 48 patients underwent recurrent operation. The subtotal resection of the thyroid gland was performed on 20 patients and thyroidectomy was carried out in 28 patients. The perioperative visualization of recurrent laryngeal nerves was made in 58,3% cases. Postoperative period was complicated by unilateral recurrent nerve trauma in one patient and transient hypoparathyroidism was noted in two patients. The recurrent operative interventions must be performed in specialized centers and it should be extremely radical operation with visualization of recurrent laryngeal nerves.

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.

Disorder of mobility of vocal folds on the background of hypoparathyroidism at patient after subtotal resection of thyroid gland

2020 ◽  
Vol 85 (3) ◽  
pp. 88
Author(s):  
V.M. Svistushkin ◽  
O.Yu. Karpova ◽  
A.V. Zolotova ◽  
P.S. Artamonova
Keyword(s):  
Thyroid Gland ◽  
Vocal Folds ◽  
Subtotal Resection

scholarly journals USING INDOCYANIN GREEN IN ENDOSCOPIC THYROID SURGERY. OUR FIRST EXPERIENCE

2020 ◽  
Vol 23 (2) ◽  
pp. 20-24
Author(s):  
M. E. Beloshitskiy ◽  
T.A. Britvin ◽  
D. Yu. Semenov
Keyword(s):  
Thyroid Gland ◽  
White Light ◽  
Thyroid Surgery ◽  
Side Wall ◽  
Vocal Folds ◽  
Anatomical Structure ◽  
Fluorescent Imaging ◽  
Surgical Interventions ◽  
Endoscopic Thyroid Surgery ◽  
Light Mode

One of the directions of the safety strategy in thyroid surgery is to preserve the integrity of the recurrent laryngeal nerves (RLN). In this regard, we used «Indocyanin green – Pulsion» (ICG, Germany) to improve the quality of visual control of the RLN during endoscopic operations on the thyroid gland. Goal: to evaluate the possibility of RLN visualization during endoscopic operations on the thyroid gland using fluorescent navigation with the ICG. Materials and methods. The results of 52 endoscopic hemithyroidectomies from axillary approach for various thyroid diseases were analyzed. Surgical interventions were performed using the KARL STORZ endovideosurgical stand, with the ability to work in double mode: with white light visualization and ICG-fluorescent visualization. In 14 cases, intraoperative RLN monitoring was performed using the ISIS C2 neuromonitor («Inomed», Germany), in 18 cases RLN imaging was performed in standard white light, and in another 20 cases – in ICG-fluorescence mode. Results. Endoscopic hemithyroidectomy from axillary access was performed according to the standard method in white light mode until the anatomical structure was detected based on the topographic location, diameter and color of the corresponding RLN. Then the patient received intravenous administration of the drug with a volume of 5.0 ml. The camera switched to the NIR range, effective fluorescence in the operating field area appeared after 10-15 seconds and lasted up to 15 minutes. In 9 patients, the anatomical structure detected in the standard mode did not change its whitish color when the camera was repeatedly switched to NIR mode and was regarded as RLN. In 6 patients, the anatomical structure resembling RLN, when switching the camera to NIR mode, turned bright blue or green depending on the selected spectrum, which corresponds to the blood vessel, and therefore the search for the RLN continued. In 5 patients, in the projection of the possible location of the RLN in the white light mode, several anatomical structures were simultaneously detected that run parallel to each other along the side wall of the trachea, similar in color, diameter and structure. In these observations, only the introduction of ICG to change the color when switching camera modes allowed to distinguish blood vessels from the RLN. In the postoperative period, in the group of patients who used the ICG-fluorescent RLN imaging technique, there were no violations of the mobility of the vocal folds according to the results of laryngeal endosonography. Of the 14 patients whose RLN control was performed using variable neuromonitoring, 1 observation showed transient laryngeal paresis. In the group of patients whose RLN was visualized only in the standard white light mode, persistent paresis of the vocal fold was diagnosed in 1, and transient paresis was diagnosed in 1 more patient. Conclusion: Fluorescent imaging using ICG allows differentiating vascular and neural structures, thereby evaluating the course of the RLN, and may have certain clinical prospects for thyroid endoscopic surgery.

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 Concurrent YAP/TAZ and SMAD signaling mediate vocal fold fibrosis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ryosuke Nakamura ◽  
Nao Hiwatashi ◽  
Renjie Bing ◽  
Carina P. Doyle ◽  
Ryan C. Branski
Keyword(s):  
Vocal Fold ◽  
Vocal Folds ◽  
Nuclear Accumulation ◽  
Smad Pathway ◽  
Surgical Interventions ◽  
Smad Signaling ◽  
Iatrogenic Damage ◽  
Tgf Β1

AbstractVocal fold (VF) fibrosis is a major cause of intractable voice-related disability and reduced quality of life. Excision of fibrotic regions is suboptimal and associated with scar recurrence and/or further iatrogenic damage. Non-surgical interventions are limited, putatively related to limited insight regarding biochemical events underlying fibrosis, and downstream, the lack of therapeutic targets. YAP/TAZ integrates diverse cell signaling events and interacts with signaling pathways related to fibrosis, including the TGF-β/SMAD pathway. We investigated the expression of YAP/TAZ following vocal fold injury in vivo as well as the effects of TGF-β1 on YAP/TAZ activity in human vocal fold fibroblasts, fibroblast-myofibroblast transition, and TGF-β/SMAD signaling. Iatrogenic injury increased nuclear localization of YAP and TAZ in fibrotic rat vocal folds. In vitro, TGF-β1 activated YAP and TAZ in human VF fibroblasts, and inhibition of YAP/TAZ reversed TGF-β1-stimulated fibroplastic gene upregulation. Additionally, TGF-β1 induced localization of YAP and TAZ in close proximity to SMAD2/3, and nuclear accumulation of SMAD2/3 was inhibited by a YAP/TAZ inhibitor. Collectively, YAP and TAZ were synergistically activated with the TGF-β/SMAD pathway, and likely essential for the fibroplastic phenotypic shift in VF fibroblasts. Based on these data, YAP/TAZ may evolve as an attractive therapeutic target for VF fibrosis.

scholarly journals PREDICTING OF RESPIRATORY TRACT PATHOLOGY RISK FACTORS AND THE NURSES’ KNOWLEDGE IN NOSOCOMIAL PNEUMONIA PREVENTING

2019 ◽  
pp. 50-57
Author(s):  
I. Ya. Krynytska ◽  
M. I. Marushchak ◽  
L. P. Mazur ◽  
T. I. Dzetsiukh ◽  
A. O. Hrad ◽  
...  
Keyword(s):  
Risk Factors ◽  
Nosocomial Pneumonia ◽  
Educational Programs ◽  
Preoperative Period ◽  
Poor Knowledge ◽  
Surgical Interventions ◽  
Surgical Department ◽  
Level Of Knowledge ◽  
Poor Nutrition ◽  
Nurses Knowledge

The aim of the work. To analyze the prevalence of nosocomial pneumonias (NP) in surgical and therapeutic departments and determine the nurses’ knowledge on the problem of preventing hospital pneumonia. Materials and Methods. In order to determine the nurses’ level of knowledge on the problems of preventing nosocomial pneumonia, a questionnaire was developed and applied, which included 20 questions with answers. Results and Discussion. The prevalence of hospital pneumonia in the departments of the therapeutic and surgical profiles is high. The incidence of NP in the surgical department is predominant in males, among the risk factors in which tobacco smoking prevails. In females with NP, the main etiological factors include poor nutrition and obesity. Comparing the level of nurses’ knowledge in therapeutic and surgical departments it was found that nurses of surgical department have shown better knowledge of NP identifying and epidemiology. Nursing stuff of both profiles has poor knowledge about pathogens of NP. The most problematic for nurses of both departments is the issue of preventing NP in case of various surgical interventions during preoperative period. Conclusions. The results of the surveys with this questionnaire can be used to focus educational programs on NP prevention.

scholarly journals MODERN TRENDS IN THE TREATMENT OF ACUTE ADHESION IN INTESTINAL OBSTRUCTION

2020 ◽  
pp. 58-61
Author(s):  
V. V. Lesnoy ◽  
A. S. Lesnay
Keyword(s):  
Intestinal Obstruction ◽  
Inpatient Treatment ◽  
Conservative Therapy ◽  
Postoperative Treatment ◽  
Surgical Interventions ◽  
Surgical Department ◽  
Results Of Treatment ◽  
Restoration Time ◽  
Days Open ◽  
Adhesive Obstruction

Summary. Aim. To perform the modern tactics of acute adhesive obstruction (AAO) treatment. Materials and methods. The basis of the work is the analysis of the results of treatment of 38 patients hospitalized in an urgent order to the surgical department with the clinic AAO. Results. 20 (52.6 %) patients with the background of conservative therapy, the phenomenon of intestinal obstruction was regressed. Repeated hospitalization during the year with the hospital was required by AAO 2 (5.3 %) patients. Laparoscopic adhesion was performed 4 (10.5 %) patients whose average intestinal restoration time was (1.8±1.2) days, and the duration of postoperative inpatient treatment was (5.1±1.3) days. Open surgical interventions were performed 14 (36.8 %) patients, in whom the period of restoration of the intestine function was (3.8±1.5) days, and the duration of postoperative treatment was (10.1±1.2) days. Conclusion. Conservative therapy is effective in 52.6 % of patients. Laparoscopic adhesion is indicated in the absence of peritoneal symptoms, if ≤ 2 laparotomies were noted in the history, with a peritoneal index of adhesion ≤ 9 points.

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