Standardization of Intraoperative Neuromonitoring of Recurrent Laryngeal Nerve in Thyroid Operation
- 784 Downloads
The lack of standardized procedures of intraoperative neuromonitoring (IONM) during thyroid operations may lead to highly variable results, and many of these results can cause misleading information and, conversely, increase the risk of recurrent laryngeal nerve (RLN) injury. Therefore, standardization of IONM procedures is necessary.
A total of 289 patients (435 nerves at risk) who underwent thyroidectomy by the same surgeon were enrolled in this study. Each patient was intubated with EMG endotracheal tube by the same anesthesiologist. Standardized IONM procedures were applied in each patient. The procedures include preoperative and postoperative video-recording of vocal cord movement, ensuring the correct position of electrodes after the neck was placed at full extension, vagal stimulation and registration of EMG signals before and after RLN dissection, and photographic documentation of the exposed RLN.
Five patients encountered dysfunction of IONM, which was caused by malposition of electrodes and the problem was detected at once. One patient with non-RLN was detected at the earlier stage of operation. Eighteen nerves experienced loss of EMG signals during thyroid dissection, and the causes of nerve injuries were well elucidated with the application of our standardized IONM procedures.
The standardized IONM procedures are useful and helpful not only to eliminate false IONM results, but also to elucidate the mechanism of RLN injury. After ascertaining the surgical pitfalls and improving the surgical techniques, the palsy rate was significantly reduced in this study.
KeywordsVagus Nerve Recurrent Laryngeal Nerve Thyroid Operation Recurrent Laryngeal Nerve Injury Vocal Cord Movement
Supplementary material 1 (2101647 kb)
- 2.Lore JM, Jr, Kim D, Elias S (1977) Total thyroid lobectomy and isthmusectomy with exposure and preservation of the recurrent laryngeal nerve. Trans Sect Otolaryngol Am Acad Ophthalmol Otolaryngol 84:ORL896–ORL897Google Scholar
- 6.Steurer M, Passler C, Denk DM et al (2002) Advantages of recurrent laryngeal nerve identification in thyroidectomy and parathyroidectomy and the importance of preoperative and postoperative laryngoscopic examination in more than 1000 nerves at risk. Laryngoscope 112:124–133CrossRefPubMedGoogle Scholar
- 24.Randolph GW (2003) Surgical anatomy of the recurrent laryngeal nerve. In: Randolph GW (ed) Surgery of the thyroid and parathyroid glands. Saunders, Philadelphia, pp 300–342Google Scholar