Intra Operative Recurrent Laryngeal Nerve Monitering During Thyroid Surgery - Is It Worth?

被引:1
作者
Ojha, Tarun [1 ]
Kansara, Anuj [2 ]
Prasad, Shreya [3 ]
Kansara, Atul [2 ]
机构
[1] Mahatma Gandhi Med Coll & Hosp, Dept otorhinolaryngol, Jaipur, Rajasthan, India
[2] Narendra Modi Med Coll & LG Hosp, Dept Otorhinolaryngol, Ahmadabad 380008, Gujarat, India
[3] Mahatma Gandhi Med Coll & Res Inst, Dept Otorhinolaryngol, Pondicherry, India
关键词
Thyroid surgery; Recurrent laryngeal nerve; Intraoperative nerve monitoring (IONM); Thyroidectomy; RISK-FACTORS; INJURY; METAANALYSIS; PARALYSIS;
D O I
10.1007/s12070-023-03615-6
中图分类号
R61 [外科手术学];
学科分类号
摘要
The basic principle of head and neck surgery is based on the identification and preservation of important structures, rather than avoidance. Thyroid surgeries are the most frequently performed endocrine procedures worldwide. Recurrent laryngeal nerve (RLN) palsy after thyroid surgery is a serious postoperative complication that can diminish the quality of life. While it is generally accepted that direct visualisation of the nerve is the gold standard, intraoperative nerve monitoring (IONM) is being used increasingly as an adjuvant to help identify the nerve. This study was carried out in Mahatma Gandhi medical college and hospital, Jaipur, Rajasthan from June 2018 to March 2020. 100 patients were enrolled in the study. RLN is identified & visualized in Beahr's triangle or in Lore's triangle. We have randomly selected the patient and use IONM as an adjunct to standard visual identification of the recurrent laryngeal nerve (RLN) to prevent nerve lesion. 8 out of 108 nerves which were at risk during thyroid surgery were found injured. 2 of 50 (4%) nerves at risk were injured with IONM that caused temporary paresis. Without IONM, 5 of 58 (8.6%) nerves at risk suffered temporary paresis and 1of 58(1.72%) had paralysis. Visual nerve identification alone remains the gold standard of recurrent laryngeal nerve management in thyroid surgery and one can use operating microscope for magnification. Neuromonitoring helps to identify the RLN particularly in difficult cases, but it does not decrease the injury to RLN as compared to visualization alone.
引用
收藏
页码:1469 / 1473
页数:5
相关论文
共 20 条
[1]   Intraoperative Neuromonitoring does not Reduce the Incidence of Recurrent Laryngeal Nerve Palsy in Thyroid Reoperations: Results of a Retrospective Comparative Analysis [J].
Alesina, Piero F. ;
Rolfs, Thomas ;
Hommeltenberg, Silvia ;
Hinrichs, Jakob ;
Meier, Beate ;
Mohmand, Wazma ;
Hofmeister, Sebastian ;
Walz, Martin K. .
WORLD JOURNAL OF SURGERY, 2012, 36 (06) :1348-1353
[2]  
[Anonymous], 2016, INT J BIOMEDICAL ADV, DOI DOI 10.7439/IJBAR.V7I10.3684
[3]   Intraoperative recurrent laryngeal nerve monitoring in thyroid surgery: is it really useful? [J].
Calo, P. G. ;
Pisano, G. ;
Medas, F. ;
Tatti, A. ;
Pittau, M. R. ;
Demontis, R. ;
Favoriti, P. ;
Nicolosi, A. .
CLINICA TERAPEUTICA, 2013, 164 (03) :E193-E198
[4]  
Calò PG, 2012, G CHIR, V33, P335
[5]  
Calò PG, 2012, ANN ITAL CHIR, V83, P7
[6]   The role of intraoperative neuromonitoring of recurrent laryngeal nerve during thyroidectomy: A comparative study on 1000 nerves at risk [J].
Chan, Wai-Fan ;
Lang, Brian Hung-Hin ;
Lo, Chung-Yau .
SURGERY, 2006, 140 (06) :866-872
[7]   The mechanism of recurrent laryngeal nerve injury during thyroid surgery - The application of intraoperative neuromonitoring [J].
Chiang, Feng-Yu ;
Lu, I-Chen ;
Kuo, Wen-Rei ;
Lee, Ka-Wo ;
Chang, Ning-Chia ;
Wu, Che-Wei .
SURGERY, 2008, 143 (06) :743-749
[8]  
Dillon Francis X, 2010, Anesthesiol Clin, V28, P423, DOI 10.1016/j.anclin.2010.07.011
[9]   Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery [J].
Dralle, H. ;
Sekulla, C. ;
Lorenz, K. ;
Brauckhoff, M. ;
Machens, A. .
WORLD JOURNAL OF SURGERY, 2008, 32 (07) :1358-1366
[10]   Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery [J].
Dralle, H ;
Sekulla, C ;
Haerting, J ;
Timmermann, W ;
Neumann, HJ ;
Kruse, E ;
Grond, S ;
Mühlig, HP ;
Richter, C ;
Voss, J ;
Thomusch, O ;
Lippert, H ;
Gastinger, I ;
Brauckhoff, M ;
Gimm, O .
SURGERY, 2004, 136 (06) :1310-1321