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Updates in Surgery

, Volume 69, Issue 2, pp 171–179 | Cite as

Neuromonitoring in endoscopic and robotic thyroidectomy

  • Gianlorenzo Dionigi
  • Hoon Yub KimEmail author
  • Che-Wei WuEmail author
  • Matteo Lavazza
  • Gabriele Materazzi
  • Celestino Pio Lombardi
  • Angkoon Anuwong
  • Ralph P. Tufano
Review Article
Part of the following topical collections:
  1. Endocrine surgery

Abstract

Intraoperative neuromonitoring (IONM) has proven effective for intraoperative verification of RLN function in the conventional thyroid surgery. However, no studies have performed a systematic evidence-based assessment of this novel health technology in endoscopic and robotic thyroidectomy. Evidence-based criteria were used in a systematic review of relevant literature for years 2000–2015. Four electronic databases (CENTRAL, MEDLINE, Cochrane and EMBASE) were used to retrieve relevant reports published from January 1, 2000 to September 1, 2016. The search terms included “endoscopic thyroidectomy”, “robotic thyroidectomy”, “IONM”, “continuous IONM (CIONM)”, “neural monitoring”, “recurrent laryngeal nerve monitoring”, and “superior laryngeal monitoring”. The following data were retrieved from eligible studies of patients undergoing endoscopic or robotic thyroidectomy: objective of study, design and setting of study, population, intervention examined, quality of data, follow-up and dropout rate, risk of bias, and outcomes assessed. Of 160 studies retrieved, only 9 (5%) studies used IONM. Eight studies reported 522 nerve at risk (NAR) with IONM. Only three were prospective randomized studies. Reports of IONM endoscopic and robotic procedures included their use for re-surgery and use in both benign and malignant cases. None of the IONM endoscopic procedures involved bilateral palsy. Two studies reported the use of a staged strategy. The rates of recurrent laryngeal palsy were 0–3.6% for transient and 0–0.4% for permanent. Only 30% of the studies performed vagus nerve stimulation, and only 25% performed superior laryngeal nerve monitoring. In addition to the use of IONM as an assistive technology for navigating the anatomy in challenging procedures such as endoscopic and robotic thyroidectomy, IONM has potential use as a routine adjunct to the conventional video-assisted nerve identification in thyroidectomy.

Keywords

Endoscopic thyroidectomy Robotic thyroidectomy Neural monitoring Recurrent laryngeal nerve 

Notes

Author contributions

(I) Conception and design of study: GD, HYK, and AA; (II) administrative support for study: GD and RPTAA; (III) collection and assembly of data: GD, HYK, and RPT; (IV) analysis and interpretation of data: GD, HYK, RPT, and AA; (V) preparation of manuscript: all authors; and (VI) final approval of manuscript: all authors.

Compliance with ethical standards

Conflicts of interest

The authors have no funding or financial relationships with manufacturers of surgical products and no other conflicts of interest in the publication of this study.

Research involving human participants and/or animals

The study was approved by the institutional ethics committee of Hospital.

Informed consent

All participants were provided the particular details for their surgeries and informed consent obtained from each patient.

References

  1. 1.
    Duke WS, Terris DJ (2014) Alternative approaches to the thyroid gland. Endocrinol Metab Clin North Am 43(2):459–474. doi: 10.1016/j.ecl.2014.02.009 (Review) CrossRefPubMedGoogle Scholar
  2. 2.
    Dionigi G, Alesina PF, Barczynski M, Boni L, Chiang FY, Kim HY, Materazzi G, Randolph GW, Terris DJ, Wu CW (2012) Recurrent laryngeal nerve injury in video-assisted thyroidectomy: lessons learned from neuromonitoring. Surg Endosc 26(9):2601–2608. doi: 10.1007/s00464-012-2239-y CrossRefPubMedGoogle Scholar
  3. 3.
    Seybt MW, Terris DJ (2010) Minimally invasive thyroid and parathyroid surgery: where are we now and where are we going? Otolaryngol Clin North Am. 43(2):375–380. doi: 10.1016/j.otc.2010.02.005 (ix) (Review) CrossRefPubMedGoogle Scholar
  4. 4.
    Terris DJ, Seybt MW (2008) Cosmesis in thyroid and parathyroid surgery: a matter of perspective. Arch Otolaryngol Head Neck Surg. 134(10):1120. doi: 10.1001/archotol.134.10.1120-a (author reply 1120-1) CrossRefPubMedGoogle Scholar
  5. 5.
    Lee HY, Lee JY, Dionigi G, Bae JW, Kim HY (2015) The efficacy of intraoperative neuromonitoring during robotic thyroidectomy: a prospective, randomized case-control evaluation. J Laparoendosc Adv Surg Tech A 25(11):908–914. doi: 10.1089/lap.2014.0544 CrossRefPubMedGoogle Scholar
  6. 6.
    Dionigi G, Chiang FY, Hui S, Wu CW, Xiaoli L, Ferrari CC, Mangano A, Lianos GD, Leotta A, Lavazza M, Frattini F, Annoni M, Rausei S, Boni L, Kim HY (2015) Continuous intraoperative neuromonitoring (C-IONM) technique with the automatic periodic stimulating (APS) accessory for conventional and endoscopic thyroid surgery. Surg Technol Int. 26:101–114 (Review) PubMedGoogle Scholar
  7. 7.
    Dionigi G, Kim HY, Wu CW, Lavazza M, Ferrari C, Leotta A, Spampatti S, Rovera F, Rausei S, Boni L, Chiang FY (2013) Vagus nerve stimulation for standardized monitoring: technical notes for conventional and endoscopic thyroidectomy. Surg Technol Int. 23:95–103PubMedGoogle Scholar
  8. 8.
    Dionigi G, Duran-Poveda M (2011) New approaches in thyroid surgery: is there an increased risk of nerve injury? Ann Surg Oncol 18(Suppl 3):S252–S253. doi: 10.1245/s10434-011-1869-y CrossRefPubMedGoogle Scholar
  9. 9.
    Dionigi G, Boni L, Duran-Poveda M (2011) Evolution of endoscopic thyroidectomy. Surg Endosc. 25(12):3951–3952. doi: 10.1007/s00464-011-1763-5 (author reply 3953) CrossRefPubMedGoogle Scholar
  10. 10.
    Dionigi G, Boni L, Rovera F, Rausei S, Dionigi R (2011) Wound morbidity in mini-invasive thyroidectomy. Surg Endosc 25(1):62–67. doi: 10.1007/s00464-010-1130-y CrossRefPubMedGoogle Scholar
  11. 11.
    Dionigi G (2009) Robotic thyroid surgery: need for initial stricter patient selection criteria. Surg Laparosc Endosc Percutan Tech 19(6):518. doi: 10.1097/SLE.0b013e3181c4ea0e (author reply 518–9) CrossRefPubMedGoogle Scholar
  12. 12.
    Dionigi G, Boni L, Rovera F, Bacuzzi A, Dionigi R (2009) Neuromonitoring and video-assisted thyroidectomy: a prospective, randomized case-control evaluation. Surg Endosc 23(5):996–1003. doi: 10.1007/s00464-008-0098-3 CrossRefPubMedGoogle Scholar
  13. 13.
    Dionigi G, Rovera F, Boni L (2009) Commentary on transoral access for endoscopic thyroid resection. Surg Endosc 23(2):454–455. doi: 10.1007/s00464-008-0241-1 (discussion 456) CrossRefPubMedGoogle Scholar
  14. 14.
    Witzel K, von Rahden BH, Kaminski C, Stein HJ (2008) Transoral access for endoscopic thyroid resection. Surg Endosc 22(8):1871–1875CrossRefPubMedGoogle Scholar
  15. 15.
    Dionigi G (2009) Evidence-based review series on endoscopic thyroidectomy: real progress and future trends. World J Surg 33(2):365–366. doi: 10.1007/s00268-008-9834-z CrossRefPubMedGoogle Scholar
  16. 16.
    Dionigi G, Boni L, Rovera F, Dionigi R (2008) The use of electrothermal bipolar vessel sealing system in minimally invasive video-assisted thyroidectomy (MIVAT). Surg Laparosc Endosc Percutan Tech. 18(5):493–497. doi: 10.1097/SLE.0b013e3181775afd CrossRefPubMedGoogle Scholar
  17. 17.
    Dionigi G, Rovera F, Boni L, Dionigi R (2008) Video-assisted thyroidectomy performed in a one-day surgery setting. Int J Surg 6(Suppl 1):S4–S6. doi: 10.1016/j.ijsu.2008.12.022 CrossRefPubMedGoogle Scholar
  18. 18.
    Dionigi G, Boni L, Rovera F, Annoni M, Villa F, Dionigi R (2008) Defining the learning curve for video-assisted thyroidectomy. Int J Surg 6(Suppl 1):S1–S3. doi: 10.1016/j.ijsu.2008.12.004 CrossRefPubMedGoogle Scholar
  19. 19.
    Bakkar S, Materazzi G, Biricotti M, De Napoli L, Conte M, Galleri D, Aghababyan A, Miccoli P (2016) Minimally invasive video-assisted thyroidectomy (MIVAT) from A to Z. Surg Today 46(2):255–259. doi: 10.1007/s00595-015-1241-0 CrossRefPubMedGoogle Scholar
  20. 20.
    Materazzi G, Fregoli L, Manzini G, Baggiani A, Miccoli M, Miccoli P (2014) Cosmetic result and overall satisfaction after minimally invasive video-assisted thyroidectomy (MIVAT) versus robot-assisted transaxillary thyroidectomy (RATT): a prospective randomized study. World J Surg 38(6):1282–1288. doi: 10.1007/s00268-014-2483-5 CrossRefPubMedGoogle Scholar
  21. 21.
    Minuto MN, Berti P, Miccoli M, Ugolini C, Matteucci V, Moretti M, Basolo F, Miccoli P (2012) Minimally invasive video-assisted thyroidectomy: an analysis of results and a revision of indications. Surg Endosc 26(3):818–822. doi: 10.1007/s00464-011-1958-9 CrossRefPubMedGoogle Scholar
  22. 22.
    Lu JH, Materazzi G, Miccoli M, Baggiani A, Hu S, Miccoli P (2012) Minimally invasive video assisted thyroidectomy versus endoscopic thyroidectomy via the areola approach: a retrospective analysis of safety, postoperative recovery, and patient satisfaction. Minerva Chir 67(1):31–37 PubMed PMID: 22361674 PubMedGoogle Scholar
  23. 23.
    Miccoli P, Materazzi G, Berti P (2010) Natural orifice surgery on the thyroid gland using totally transoral video-assisted thyroidectomy: report of the first experimental results for a new surgical method: are we going in the right direction? Surg Endosc 24(4):957–958. doi: 10.1007/s00464-009-0677-y (author reply 959–60) CrossRefPubMedGoogle Scholar
  24. 24.
    Miccoli P, Ambrosini CE, Berti P (2009) Video-assisted surgery: what is its role in the treatment of thyroid carcinoma? Miner Endocrinol 34(1):71–80 (Review) Google Scholar
  25. 25.
    Miccoli P, Minuto MN, Ugolini C, Pisano R, Fosso A, Berti P (2008) Minimally invasive video-assisted thyroidectomy for benign thyroid disease: an evidence-based review. World J Surg 32(7):1333–1340. doi: 10.1007/s00268-008-9479-y (Review) CrossRefPubMedGoogle Scholar
  26. 26.
    Miccoli P, Materazzi G, Berti P (2008) Minimally invasive video-assisted lateral lymphadenectomy: a proposal. Surg Endosc 22(4):1131–1134CrossRefPubMedGoogle Scholar
  27. 27.
    Lombardi CP, Raffaelli M, De Crea C, Sessa L, Rampulla V, Bellantone R (2012) Video-assisted versus conventional total thyroidectomy and central compartment neck dissection for papillary thyroid carcinoma. World J Surg 36(6):1225–1230. doi: 10.1007/s00268-012-1439-x CrossRefPubMedGoogle Scholar
  28. 28.
    Lombardi CP, Raffaelli M, De Crea C, D’Amore A, Bellantone R (2009) Video-assisted thyroidectomy: lessons learned after more than one decade. Acta Otorhinolaryngol Ital 29(6):317–320PubMedPubMedCentralGoogle Scholar
  29. 29.
    Lombardi CP, Raffaelli M, D’alatri L, De Crea C, Marchese MR, Maccora D, Paludetti G, Bellantone R (2008) Video-assisted thyroidectomy significantly reduces the risk of early postthyroidectomy voice and swallowing symptoms. World J Surg 32(5):693–700. doi: 10.1007/s00268-007-9443-2 CrossRefPubMedGoogle Scholar
  30. 30.
    Lombardi CP, Raffaelli M, de Crea C, Princi P, Castaldi P, Spaventa A, Salvatori M, Bellantone R (2007) Report on 8 years of experience with video-assisted thyroidectomy for papillary thyroid carcinoma. Surgery 142(6):944–951 (discussion 944–51) CrossRefPubMedGoogle Scholar
  31. 31.
    Lombardi CP, Raffaelli M, Princi P, De Crea C, Bellantone R (2007) Minimally invasive video-assisted functional lateral neck dissection for metastatic papillary thyroid carcinoma. Am J Surg 193(1):114–118CrossRefPubMedGoogle Scholar
  32. 32.
    Lombardi CP, Raffaelli M, Princi P, De Crea C, Bellantone R (2006) Video-assisted thyroidectomy: report of a 7-year experience in Rome. Langenbecks Arch Surg 391(3):174–177CrossRefPubMedGoogle Scholar
  33. 33.
    Lombardi CP, Raffaelli M, Princi P, De Crea C, Bellantone R (2006) Video-assisted thyroidectomy: report on the experience of a single center in more than four hundred cases. World J Surg 30(5):794–800 (discussion 801) CrossRefPubMedGoogle Scholar
  34. 34.
    Lombardi CP, Raffaelli M, Princi P, Lulli P, Rossi ED, Fadda G, Bellantone R (2005) Safety of video-assisted thyroidectomy versus conventional surgery. Head Neck 27(1):58–64CrossRefPubMedGoogle Scholar
  35. 35.
    Anuwong A, Lavazza M, Kim HY, Wu CW, Rausei S, Pappalardo V, Ferrari CC, Inversini D, Leotta A, Biondi A, Chiang FY, Dionigi G (2016) Recurrent laryngeal nerve management in thyroid surgery: consequences of routine visualization, application of intermittent, standardized and continuous nerve monitoring. Updat Surg 68(4):331–341CrossRefGoogle Scholar
  36. 36.
    Dionigi G, Lombardi D, Lombardi CP, Carcoforo P, Boniardi M, Innaro N, Chiofalo MG, Cavicchi O, Biondi A, Basile F, Zaccaroni A, Mangano A, Leotta A, Lavazza M, Calò PG, Nicolosi A, Castelnuovo P, Nicolai P, Pezzullo L, De Toma G, Bellantone R, Sacco R, Working Group for Neural Monitoring in Thyroid and Parathyroid Surgery in Italy (2014) Intraoperative neuromonitoring in thyroid surgery: a point prevalence survey on utilization, management, and documentation in Italy. Updat Surg. 66(4):269–276. doi: 10.1007/s13304-014-0275-y CrossRefGoogle Scholar
  37. 37.
    Teksoz S, Bukey Y, Ozcan M, Arikan AE, Ozyegin A (2013) Sutureless thyroidectomy with energy-based devices: Cerrahpasa experience. Updat Surg. 65(4):301–307. doi: 10.1007/s13304-013-0231-2 CrossRefGoogle Scholar
  38. 38.
    Materazzi G, Caravaglios G, Matteucci V, Aghababyan A, Miccoli M, Miccoli P (2013) The impact of the Harmonic FOCUS™ on complications in thyroid surgery: a prospective multicenter study. Updates Surg. 65(4):295–299. doi: 10.1007/s13304-013-0223-2 CrossRefPubMedGoogle Scholar
  39. 39.
    De Palma M, Grillo M, Borgia G, Pezzullo L, Lombardi CP, Gentile I (2013) Antibiotic prophylaxis and risk of infections in thyroid surgery: results from a national study (UEC-Italian Endocrine Surgery Units Association). Updat Surg 65(3):213–216. doi: 10.1007/s13304-013-0219-y CrossRefGoogle Scholar
  40. 40.
    Dionigi G, Bacuzzi A, Barczynski M, Biondi A, Boni L, Chiang FY, Dralle H, Randolph GW, Rausei S, Sacco R, Sitges-Serra A (2011) Implementation of systematic neuromonitoring training for thyroid surgery. Updat Surg 63(3):201–207. doi: 10.1007/s13304-011-0098-z PubMed PMID: 21785880 CrossRefGoogle Scholar
  41. 41.
    Frattini F, Mangano A, Boni L, Rausei S, Biondi A, Dionigi G (2010) Intraoperative neuromonitoring for thyroid malignancy surgery: technical notes and results from a retrospective series. Updat Surg 62(3–4):183–187. doi: 10.1007/s13304-010-0036-5 CrossRefGoogle Scholar
  42. 42.
    Jonas J (2016) Total-endoscopic thyroid resection in ABBA-technique: comments onthe integration of intraoperative neuromonitoring. Zentralbl Chir 141(5):565–569 (German) PubMedGoogle Scholar
  43. 43.
    Wang Y, Yu X, Wang P, Miao C, Xie Q, Yan H, Zhao Q, Zhang M, Xiang C (2016) Implementation of intraoperative neuromonitoring for transoral endoscopic thyroid surgery: a preliminary report. J Laparoendosc Adv Surg Tech A 26:965–971 [Epub ahead of print] CrossRefPubMedGoogle Scholar
  44. 44.
    Xie Q, Wang P, Yan H, Wang Y (2016) Feasibility and effectiveness of intraoperative nerve monitoring in total endoscopic thyroidectomy for thyroid cancer. J Laparoendosc Adv Surg Tech A 26(2):109–115. doi: 10.1089/lap.2015.0401 CrossRefPubMedGoogle Scholar
  45. 45.
    Pavier Y, Saroul N, Pereira B, Tauveron I, Gilain L, Mom T (2015) Acute prediction of laryngeal outcome during thyroid surgery by electromyographic laryngeal monitoring. Head Neck 37(6):835–839. doi: 10.1002/hed.23676 CrossRefPubMedGoogle Scholar
  46. 46.
    Bae DS, Kim SJ (2015) Intraoperative neuromonitoring of the recurrent laryngeal nerve in robotic thyroid surgery. Surg Laparosc Endosc Percutan Tech. 25(1):23–26. doi: 10.1097/SLE.0000000000000074 CrossRefPubMedGoogle Scholar
  47. 47.
    Lorenz K, Abuazab M, Sekulla C, Schneider R, Nguyen Thanh P, Dralle H (2014) Results of intraoperative neuromonitoring in thyroid surgery and preoperative vocal cord paralysis. World J Surg 38(3):582–591. doi: 10.1007/s00268-013-2402-1 CrossRefPubMedGoogle Scholar
  48. 48.
    Randolph GW, Dralle H, International Intraoperative Monitoring Study Group, Abdullah H, Barczynski M, Bellantone R, Brauckhoff M, Carnaille B, Cherenko S, Chiang FY, Dionigi G, Finck C, Hartl D, Kamani D, Lorenz K, Miccolli P, Mihai R, Miyauchi A, Orloff L, Perrier N, Poveda MD, Romanchishen A, Serpell J, Sitges-Serra A, Sloan T, Van Slycke S, Snyder S, Takami H, Volpi E, Woodson G (2011) Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Laryngoscope 121(Suppl 1):S1–S16. doi: 10.1002/lary.21119 (Review) CrossRefPubMedGoogle Scholar
  49. 49.
    Dralle H, Lorenz K (2010) Intraoperative neuromonitoring of thyroid gland operations: surgical standards and aspects of expert assessment. Chirurg 81(7):612–619. doi: 10.1007/s00104-009-1882-x CrossRefPubMedGoogle Scholar
  50. 50.
    Puram SV, Chow H, Wu CW, Heaton JT, Kamani D, Gorti G, Chiang FY, Dionigi G, Barczynski M, Schneider R, Dralle H, Lorenz K, Randolph GW (2016) Posterior cricoarytenoid muscle electrophysiologic changes are predictive of vocal cord paralysis with recurrent laryngeal nerve compressive injury in a canine model. Laryngoscope 126(12):2744–2751. doi: 10.1002/lary.25967 CrossRefPubMedGoogle Scholar
  51. 51.
    Liddy W, Barber SR, Cinquepalmi M, Lin BM, Patricio S, Kyriazidis N, Bellotti C, Kamani D, Mahamad S, Dralle H, Schneider R, Dionigi G, Barczynski M, Wu CW, Chiang FY, Randolph G (2016) The electrophysiology of thyroid surgery: electrophysiologic and muscular responses with stimulation of the vagus nerve, recurrent laryngeal nerve, and external branch of the superior laryngeal nerve. Laryngoscope. doi: 10.1002/lary.26147 [Epub ahead of print] Google Scholar
  52. 52.
    Schneider R, Randolph G, Dionigi G, Barczyński M, Chiang FY, Triponez F, Vamvakidis K, Brauckhoff K, Musholt TJ, Almquist M, Innaro N, Jimenez-Garcia A, Kraimps JL, Miyauchi A, Wojtczak B, Donatini G, Lombardi D, Müller U, Pezzullo L, Ratia T, Van Slycke S, Nguyen Thanh P, Lorenz K, Sekulla C, Machens A, Dralle H (2016) Prospective study of vocal fold function after loss of the neuromonitoring signal in thyroid surgery: the International Neural Monitoring Study Group’s POLT study. Laryngoscope 126(5):1260–1266. doi: 10.1002/lary.25807 CrossRefPubMedGoogle Scholar
  53. 53.
    Puram SV, Chow H, Wu CW, Heaton JT, Kamani D, Gorti G, Chiang FY, Dionigi G, Barczyński M, Schneider R, Dralle H, Lorenz K, Randolph GW (2016) Vocal cord paralysis predicted by neural monitoring electrophysiologic changes with recurren laryngeal nerve compressive neuropraxic injury in a canine model. Head Neck 38(Suppl 1):E1341–E1350. doi: 10.1002/hed.24225 CrossRefPubMedGoogle Scholar
  54. 54.
    Bacuzzi A, Dralle H, Randolph GW, Chiang FY, Kim HY, Barczyński M, Dionigi G (2016) Safety of continuous intraoperative neuromonitoring (C-IONM) in thyroid surgery. World J Surg 40(3):768–769. doi: 10.1007/s00268-015-3288-x CrossRefPubMedGoogle Scholar
  55. 55.
    Barczyński M, Randolph GW, Cernea CR, Dralle H, Dionigi G, Alesina PF, Mihai R, Finck C, Lombardi D, Hartl DM, Miyauchi A, Serpell J, Snyder S, Volpi E, Woodson G, Kraimps JL, Hisham AN, International Neural Monitoring Study Group (2013) External branch of the superior laryngeal nerve monitoring during thyroid and parathyroid surgery: International Neural Monitoring Study Group standards guideline statement. Laryngoscope 123(Suppl 4):S1–S14. doi: 10.1002/lary.24301 (Review) CrossRefPubMedGoogle Scholar
  56. 56.
    Dionigi G, Chiang FY, Dralle H, Boni L, Rausei S, Rovera F, Piantanida E, Mangano A, Barczyński M, Randolph GW, Dionigi R, Ulmer C (2013) Safety of neural monitoring in thyroid surgery. Int J Surg 11(Suppl 1):S120–S126. doi: 10.1016/S1743-9191(13)60031-X (Review) CrossRefPubMedGoogle Scholar
  57. 57.
    Dionigi G, Barczynski M, Chiang FY, Dralle H, Duran-Poveda M, Iacobone M, Lombardi CP, Materazzi G, Mihai R, Randolph GW, Sitges-Serra A (2010) Why monitor the recurrent laryngeal nerve in thyroid surgery? J Endocrinol Invest 33(11):819–822 (Review) CrossRefPubMedGoogle Scholar
  58. 58.
    Lombardi CP, Carnassale G, Damiani G, Acampora A, Raffaelli M, De Crea C, Bellantone R (2016) “The final countdown”: is intraoperative, intermittent neuromonitoring really useful in preventing permanent nerve palsy? Evidence from a meta-analysis. Surgery 160(6):1693–1706. doi: 10.1016/j.surg.2016.06.049 (Review) CrossRefPubMedGoogle Scholar
  59. 59.
    Terris DJ, Anderson SK, Watts TL, Chin E (2007) Laryngeal nerve monitoring and minimally invasive thyroid surgery: complementary technologies. Arch Otolaryngol Head Neck Surg 133(12):1254–1257CrossRefPubMedGoogle Scholar
  60. 60.
    Lifante JC, McGill J, Murry T, Aviv JE, Inabnet WB 3rd (2009) A prospective, randomized trial of nerve monitoring of the external branch of the superior laryngeal nerve during thyroidectomy under local/regional anesthesia and IV sedation. Surgery 146(6):1167–1173. doi: 10.1016/j.surg.2009.09.023 CrossRefPubMedGoogle Scholar
  61. 61.
    Inabnet WB, Murry T, Dhiman S, Aviv J, Lifante JC (2009) Neuromonitoring of the external branch of the superior laryngeal nerve during minimally invasive thyroid surgery under local anesthesia: a prospective study of 10 patients. Laryngoscope 119(3):597–601. doi: 10.1002/lary.20071 CrossRefPubMedGoogle Scholar
  62. 62.
    Lörincz BB, Möckelmann N, Busch CJ, Hezel M, Knecht R (2016) Automatic periodic stimulation of the vagus nerve during single-incision transaxillary robotic thyroidectomy: feasibility, safety, and first cases. Head Neck 38(3):482–485. doi: 10.1002/hed.24259 CrossRefPubMedGoogle Scholar
  63. 63.
    Lang BH, Wong KP (2011) Feasibility on the use of intraoperative vagal nerve stimulation in gasless, transaxillary endoscopic, and robotic-assisted thyroidectomy. J Laparoendosc Adv Surg Tech A 21(10):911–917. doi: 10.1089/lap.2011.0204 CrossRefPubMedGoogle Scholar
  64. 64.
    Witzel K, Benhidjeb T (2009) Monitoring of the recurrent laryngeal nerve in totally endoscopic thyroid surgery. Eur Surg Res 43(2):72–76. doi: 10.1159/000220596 CrossRefPubMedGoogle Scholar
  65. 65.
    Inabnet WB 3rd, Suh H, Fernandez-Ranvier G (2016) Transoral endoscopic thyroidectomy vestibular approach with intraoperative nerve monitoring. Surg Endosc. doi: 10.1007/s00464-016-5322-y

Copyright information

© Italian Society of Surgery (SIC) 2017

Authors and Affiliations

  • Gianlorenzo Dionigi
    • 1
  • Hoon Yub Kim
    • 2
    Email author
  • Che-Wei Wu
    • 3
    • 4
    Email author
  • Matteo Lavazza
    • 1
  • Gabriele Materazzi
    • 5
  • Celestino Pio Lombardi
    • 6
  • Angkoon Anuwong
    • 7
  • Ralph P. Tufano
    • 8
  1. 1.1st Division of General Surgery, Research Center for Endocrine Surgery, Department of Medicine and Surgery, ASST Sette Laghi Ospedale di Circolo e Fondazione Macchi - Polo UniversitarioUniversity of Insubria (Varese-Como)VareseItaly
  2. 2.Division of Breast and Endocrine Surgery, Department of Surgery, Anam Hospital, Minimally Invasive Surgery and Robotic Surgery CenterKUMC Thyroid Center Korea UniversitySeoulKorea
  3. 3.Faculty of Medicine, College of Medicine, Kaohsiung Medical University HospitalKaohsiung Medical UniversityKaohsiungTaiwan
  4. 4.Department of Otolaryngology-Head and Neck SurgeryKaohsiung Medical University HospitalKaohsiung Medical UniversityKaohsiungTaiwan
  5. 5.Department of Surgical Pathology, Medical, Molecular and Critical AreaUniversity of PisaPisaItaly
  6. 6.Department of Surgical Sciences, University Hospital Agostino GemelliCatholic University of Sacred HeartRomeItaly
  7. 7.Minimally Invasive and Endocrine Surgery Division, Department of SurgeryPolice General HospitalBangkokThailand
  8. 8.Division of Head and Neck Endocrine Surgery, Department of Otolaryngology-Head and Neck SurgeryJohns Hopkins University School of MedicineBaltimoreUSA

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