Feng-Yu Chiang1,2, I-Cheng Lu3,2, Pi-Ying Chang3, Hui Sun4, Ping Wang5, Xiu-Bo Lu6, Hui-Chun Chen7, Hsiu-Ya Chen3, Hoon Yub Kim8, Gianlorenzo Dionigi9, Che-Wei Wu1,2. 1. Department of Otorhinolaryngology-Head and Neck Surgery, Kaohsiung Medical University (KMU), Kaohsiung, Taiwan. 2. Faculty of Medicine, Graduate Institute of Clinical Medicine, and Department of Respiratory Therapy, College of Medicine, KMU, Kaohsiung, Taiwan. 3. Department of Anesthesiology, Kaohsiung Medical University (KMU). 4. Department of Thyroid and Parathyroid Surgery, China-Japan Union Hospital, Jilin University & Jilin Provincial Key Laboratory of Surgical Translational Medicine, Changchun, Jilin. 5. Department of Surgery, the 2nd Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang. 6. Department of Thyroid Surgery, the first Affiliated Hospital of Zhengzhou University, Henan, China. 7. Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University (KMU), Kaohsiung, Taiwan. 8. Department of Surgery, Korea University College of Medicine (h.y.k.), Seoul, Korea. 9. Endocrine Surgery Research Center, Department of Surgical Sciences and Human Morphology, University of Insubria, Varese-Como, Varese, Italy.
Abstract
OBJECTIVES/HYPOTHESIS: During intraoperative neuromonitoring (IONM) of recurrent laryngeal nerve (RLN) in thyroid surgery, the need for frequent shifting between the dissecting instruments and stimulating probe is troublesome and time-consuming. Therefore, use of these two instruments in combination would be a noticeable future direction. This study aimed to investigate the feasibility and safety of using stimulating dissecting instruments (SDIs) that combine the function of surgical dissection and nerve stimulation during IONM. STUDY DESIGN: Prospective outcomes research. METHODS: One hundred consecutive patients with 168 RLNs at risk were enrolled. We developed prototypes of SDIs and applied them to early detect adverse EMG changes during the risky phase of RLN dissection. In the case of substantial EMG change (amplitude decrease > 50%) during dissection, the surgical maneuver was paused and thyroid traction was released immediately. RESULTS: The application of SDIs was feasible in all cases and did not result in any morbidity. Nineteen RLNs were detected with substantial EMG change that was caused by traction stress during dissection with SDIs and that featured progressive gradual EMG recovery after releasing thyroid traction. After thyroid resection, 10 RLNs had a weak point of nerve conduction detected at region of Berry's ligament, but only one nerve with 79% amplitude reduction developed postoperative temporary vocal palsy. CONCLUSION: The application of SDIs is a simple and effective way to monitor the nerve's function instantly during the risky phase of RLN injury in thyroid surgery. It provides surgeons with real-time feedback of EMG response and can be applied as a tool for the early detection of adverse EMG change caused by traction distress. LEVEL OF EVIDENCE: 4.
OBJECTIVES/HYPOTHESIS: During intraoperative neuromonitoring (IONM) of recurrent laryngeal nerve (RLN) in thyroid surgery, the need for frequent shifting between the dissecting instruments and stimulating probe is troublesome and time-consuming. Therefore, use of these two instruments in combination would be a noticeable future direction. This study aimed to investigate the feasibility and safety of using stimulating dissecting instruments (SDIs) that combine the function of surgical dissection and nerve stimulation during IONM. STUDY DESIGN: Prospective outcomes research. METHODS: One hundred consecutive patients with 168 RLNs at risk were enrolled. We developed prototypes of SDIs and applied them to early detect adverse EMG changes during the risky phase of RLN dissection. In the case of substantial EMG change (amplitude decrease > 50%) during dissection, the surgical maneuver was paused and thyroid traction was released immediately. RESULTS: The application of SDIs was feasible in all cases and did not result in any morbidity. Nineteen RLNs were detected with substantial EMG change that was caused by traction stress during dissection with SDIs and that featured progressive gradual EMG recovery after releasing thyroid traction. After thyroid resection, 10 RLNs had a weak point of nerve conduction detected at region of Berry's ligament, but only one nerve with 79% amplitude reduction developed postoperative temporary vocal palsy. CONCLUSION: The application of SDIs is a simple and effective way to monitor the nerve's function instantly during the risky phase of RLN injury in thyroid surgery. It provides surgeons with real-time feedback of EMG response and can be applied as a tool for the early detection of adverse EMG change caused by traction distress. LEVEL OF EVIDENCE: 4.
Authors: Jongjin Kim; Hyeon Jong Moon; Young Jun Chai; Jung-Man Lee; Ki-Tae Hwang; Che-Wei Wu; Gianlorenzo Dionigi; Hoon Yub Kim; Kyung Sik Park; Sang Wan Kim; Ka Hee Yi Journal: Int J Endocrinol Date: 2020-01-30 Impact factor: 3.257