Detection of Brachial Plexopathy during Transaxillary Robotic Thyroidectomy (original) (raw)
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Intraoperative neuromonitoring in thyroid surgery
European Surgery, 2003
Recurrent laryngeal nerve (RLN) injury is the most feared complication in thyroid surgery, resulting in a worse patients' quality of life, and is the most common cause of medical claim. Visualization of RLN before proceeding with dissection of the gland is considered the gold standard. In the last decade, intraoperative neuromonitoring (IONM) of RLN has progressively gained acceptance; nowadays, this method is widely spread, being routinely used in large workflow centers. IONM is helpful in the identification of RLN and allows to asses nerve functionality during and at the end of surgical procedure. In this chapter, IONM features, its advantages and limits, and its usefulness will be discussed.
Continuous Intraoperative Nerve Monitoring during Thyroid Surgery: Realistic Utility
Journal of Surgery: Open Access, 2017
Objectives: Intraoperative nerve monitoring (IONM) with intermittent stimulation, can predict recurrent laryngeal nerve injury after the damage has been already done; on the other hand, continuous IONM (CIONM) via stimulation of the vagus nerve (VN) by the automated periodic stimulation (APS) electrode, should permit more reliable monitoring of the nerve's functional integrity during surgery. Methods: The advantages CIONM offers over its intermittent counterpart are indeed related to its ability to provide accurate and real-time feedback to enable the surgeon to act before damage has been inflicted on the nerve. Furthermore, these characteristics do not compromise safety and effectiveness of the surgical procedure. Results: The indications for its use have been progressively expanding, despite the still living surrounding skepticism, and recurrent thyroid disease, thyroidectomy with neck dissection, pre-existing unilateral vocal cord paralysis, previous neck treatment and high risk for intraoperative hemorrhage, represent the main situations with strong indications for CIONM use. Conclusions: This article provides a detailed description of this effective, patient's safety tool. Here we enclose IONM with APS technical and practical steps, in order to give the idea of a clear awareness of its benefits and to encourage surgeons to widen their skills and knowledge about its potential use.
Updates in Surgery, 2010
This study evaluates the role of intraoperative neuromonitoring (IONM) for thyroidectomy performed in cancer patients with emphasis on postoperative recurrent laryngeal nerve paralysis (RLNP). The study is a retrospective series comprising 76 thyroidectomy alone (control group) versus 76 thyroidectomy with IONM. In the control group the laryngeal nerves have been identified by visualization solely. In the IONM group both vagal nerve and RLN have been localized and monitored during thyroid resection. The main surgical outcome was RLN morbidity. All patients undergo pre-and postoperative laryngeal examination. Overall RLN morbidity was 3.9% in the IONM group and 9.2% in the control group (P \ 0.05). There have been two cases of permanent RLNP (2.6%) in the control group and one in the IONM group (1.3%), one case of bilateral RLN injury in the control group. The incidences of temporary RLNP in the IONM group have been 2.6 versus 6.5% in the control group. IONM is an effective procedure in thyroid cancer patients.
Intraoperative nerve monitoring during thyroid surgery
Current opinion in endocrinology, diabetes, and obesity, 2016
Laryngeal nerve injury, resulting in speech and swallowing dysfunction, is a feared complication of thyroid operations. Routine visualization of the recurrent laryngeal nerve (RLN) has decreased the likelihood of nerve injury, and intraoperative nerve monitoring has been applied in the hope of further enhancing safety. There is conflicting evidence about the value of nerve monitoring during thyroid operations, despite ample research. The data favor nerve monitoring in certain situations, such as neck re-explorations, contralateral RLN injury, extensive or challenging dissections, invasive tumors or large goiters, and nonrecurrent or branching recurrent laryngeal nerves. Continuous intraoperative nerve monitoring may reduce the chances of excessive traction, which is the most common mechanism of injury. Nerve monitoring may also identify and protect the external branches of the superior laryngeal nerve. Surgeons should routinely identify recurrent laryngeal nerves during thyroid oper...
Children
Intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN) has been shown in adults to minimize nerve palsy after thyroid surgery, but only few studies on its efficacy in a pediatric population have been reported. We conducted a retrospective study on patients operated for thyroid lesions from 2016 to 2022. The analyzed population was divided in two groups: patients treated from 2016 to 2020, when the identification of the RLN was performed without IONM (Group A); and patients treated since 2021, when IONM was implemented in every surgical procedure on the thyroid (Group B). Intraoperative Neurophysiological Monitoring was performed by using corticobulbar motor-evoked potentials and continuous electromyography. Twentyfive children underwent thyroid resection, 19 (76%) of which due to thyroid carcinoma. Each patient’s recurrent nerve was identified; IONM was used in 13 patients. In Group A, one temporary nerve palsy was identified postoperatively (8.3%), while in gr...
Basic principles and standardization of intraoperative nerve monitoring in thyroid surgery
SiSli Etfal Hastanesi Tip Bulteni / The Medical Bulletin of Sisli Hospital, 2017
Basic principles and standardization of intraoperative nerve monitoring in thyroid surgery Voice changes after thyroid surgery are frequent and one of the most important complications. Both the recurrent laryngeal nerve (RLN) and the external branch of the superior laryngeal nerve (EBSLN) must be preserved to minimize the patient's voice and respiratory problems after surgery. Intraoperative neuromonitoring (IONM) is a method based on dynamically evaluating motor function of the nerve during surgery in addition to the visual identification of the nerve. Intraoperative neuromonitoring was introduced 50 years ago in thyroid surgery and IONM via endotracheal tube with surface electrodes has become a standard applied method for reasons such as convenience, simplicity, non-invasiveness and safety, and nowadays is used in thyroid surgery. The use of IONM for RLN and EBSLN is increasing in thyroid surgery. Experience and standardization is essential for proper use of IONM for both anesthesiologist and surgeon. In this context, the learning curve for both surgeons and anesthetists is about 50-100 cases. Intraoperative neuromonitoring makes a significant contribution to the identification and functional evaluation of both RLN and EBSLN. RLN monitorisation can be performed intermittently with the monitoring probe or continuously with the aid of a probe applied to the vagus. Standardization of RLN monitoring includes the vocal cord examination via preoperative laryngoscopy (L1), getting signals from ipsilateral vagus prior to RLN dissection (V1), stimulation of RLN at the first point found in the tracheoesophageal groove (R1), stimulation of the RLN from the most proximal point it was revealed after the dissection was completed (R2), vagus stimulation after surgical site bleeding control is complete (V2), vocal cord examination via postoperative laryngoscopy (L2). V2 is the most appropriate test to predict postoperative vocal cord function. In the intermittent IONM of RLN, only the nerve stimulated by the probe and the point that the nerve is stimulated inform about the function of the distal part. Continuous IONM allows continuous follow-up of RLN function while dissecting the thyroid gland by continuous stimulation of the RLN with the probe applied to the vagus at the neck before RLN leaves the vagus. Primarily in EBSLN monitoring, the contraction of the cricothyroid muscle, which is located in the surgical field and whose motor neuron is EBSLN, is evaluated. Intraoperative neuromonitoring is a method that contributes to many aspects of thyroidectomy and increases the standards of thyroidectomy, together with significant contribution to the detection and functional evaluation of both RLN and EBSLN.
International Medical Journal Malaysia, 2021
INTRODUCTION: Vocal cord palsy is one of the major concerns in thyroid surgery especially among professional voice users. Continuous intraoperative neuromonitoring (cIONM) allows real-time nerve function during surgery that will reduce the risk of injury. The procedure involved is not without complication thus meticulous usage and strict adherence to standard operating procedure is of utmost importance. This study was aimed to investigate the potential morbidity of the procedure. MATERIALS AND METHODS: A prospective observational study was conducted on 20 patients who underwent routine thyroid surgery using cIONM. The procedure of cIONM adhered to the standard guidelines. Measurements of vagal stimulation were taken proximal (V3) and distal (V2) to the automatic periodic stimulation (APS) electrode to document any injury to the vagus nerve. Blood pressure and pulse rate were also documented throughout the surgery, in order to observe the physiological effect of the stimulation. The function of the vocal cord was assessed by pre and post-operative laryngoscopy. RESULTS: 18 patients with 29 nerves at risk were included as the vagal stimulation did not achieve the acceptable amplitude (500 mA) in two patients. There were drops of amplitude between V3 and V2 in 14 nerves at risks but there was no clinical evidence of palsy on laryngoscopy. There was also the fluctuation of mean arterial pressure and pulse rate but not significant enough to warrant intervention. CONCLUSION: The use of cIONM during thyroidectomy does exert a minimal effect on the vagus nerve. It is safe and able to help the surgeon identify and preserve the nerve function especially in difficult thyroidectomy.
Effectiveness of Nerve Monitor in Thyroidectomy; A Single Centre Retrospective Analysis
Background: Individuals with hyperthyroidism, goiter, or thyroid cancer frequently undergo a surgical intervention called thyroidectomy, which entails the extraction of the thyroid gland. It is critical to address concerns regarding vocal cord problems caused by injuries to the recurrent laryngeal nerve (RLN). The efficacy of intraoperative neuromonitoring in preventing RLN injury is a topic of debate. However, it allows for realtime assessment of RLN function during surgery. Aims of the study: The study aims to compare procedures performed with and without intraoperative nerve monitoring.
Neuromonitoring in Thyroid Surgery
Annals of Surgery, 2004
Objective: We evaluated the ability of neuromonitoring to predict postoperative outcome in patients undergoing thyroid surgery for different indications. Summary Background Data: Neuromonitoring has been advocated to reduce the risk of vocal cord palsy and to predict postoperative vocal cord function. Methods: Three hundred twenty-eight patients (502 nerves at risk) were studied prospectively at a single center. Neuromonitoring was performed with the Neurosign 100® device by transligamental placement of the recording electrode into the vocalis muscles. Cumulative distribution of stimulation thresholds was determined by stepwise decreases in current (1 mA to 0.05 mA) for both the vagus and the recurrent nerve. Patients were grouped according to surgical risk (benign and malignant disease, reoperation for benign and for malignant disease). Results: If the electrophysiological response was correlated to postoperative vocal cord function, the sensitivity of neuromonitoring was modest (86% in surgery for benign disease) to low (25% in reoperation for malignant disease); the positive predictive value was modest (overall rate 62%) but acceptable (87%) if corrected for technical problems. Specificity and negative predictive values were high (ie, overall Ͼ95%). Stimulation thresholds were not augmented in 11 patients, in whom postoperative palsy developed despite normal intraoperative recordings. Similarly, an electrical field response was elicited in 14 of 21 patients with preoperative vocal cord palsy. Electromyographic recordings did not reveal an abnormal amplitude or a decline in nerve conduction velocity. Conclusions: Neuromonitoring is useful for identifying the recurrent laryngeal nerve, in particular if the anatomic situation is complicated by prior surgery, large tissue masses, aberrant nerve course. However, neuromonitoring does not reliably predict postoperative outcome.
Technical Instructions for Continuous Intraoperative Neural Monitoring in Thyroid Surgery
Journal of Endocrine Surgery, 2018
One of the most significant advancements in neural monitoring for thyroid surgery is currently the permanent recording of the vagus nerve (VN) in order to prevent intraoperatively recurrent laryngeal nerve (RLN) iatrogenic injuries. Continuous intraoperative neuromonitoring (CIONM) seems to be superior to intermitted intraoperative neural monitoring (I-IONM) because it enhances standardization, and it provides entire and constant RLN function surveillance as the surgeon dissects the thyroid gland. It also has to be highlighted that the surgical maneuvers for the CIONM probe placement must be accurate in order to avoid a potential iatrogenic morbidity on the VN function. With this review article the Korean Intraoperative Neural Monitoring Society (KINMoS) provides a comprehensive analyses of CIONM technique.