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Nerve Monitoring for Transoral Thyroid Surgery: Why, How, and What to Expect

  • Transoral Thyroid and Parathyroid Surgery (R Tufano and G Dionigi, Section Editors)
  • Published:
Current Otorhinolaryngology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

We primarily describe technical tips, and attempt to demonstrate the value of using intermitted neural monitoring (IONM) during transoral endoscopic thyroidectomy vestibular approach (TOETVA), with emphasis and respect given to nerve monitoring standards described by the International Neural Monitoring Study Group (INMSG).

Recent Findings

Any modifications to the established operative technique for TOETVA should result in similar or improved patient outcomes with lower rates of complications. TOETVA is a new technique that demands full protection of RLN function during the cranial to caudal thyroid and RLN dissection. Standardized IONM is feasible and safe in TOETVA. IONM is complementary to the video-endoscopic identification of the RLN.

Summary

The role of IONM in transoral thyroid surgery continues to be defined. It may be that as one starts performing this surgery, intermittent IONM may provide value in confirming and preserving the neurophysiologic integrity of the RLN. Further studies are needed to evaluate this.

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Availability of Data and Materials

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Author information

Authors and Affiliations

  1. Division of Thyroid Surgery, China-Japan Union Hospital Of Jilin University, Jilin Provincial Key Laboratory Of Surgical Translational Medicine, Changchun City, Jilin Province, China

    Daqi Zhang & Hui Sun

  2. Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, 126 Xiantai Blvd, Changchun City, China

    Daqi Zhang & Hui Sun

  3. Division of General Surgery and Emergency Surgery, Department of Human Pathology, Department of Human Pathology in Adulthood and Childhood “ G. Barresi”, University Hospital G. Martino, Via C. Valeria 1, 98125, Messina, Italy

    Carmelo Mazzeo

  4. Division of Endocrine and Minimally Invasive Surgery, Department of Human Pathology, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University Hospital G. Martino, Via C. Valeria 1, 98125, Messina, Italy

    Gianlorenzo Dionigi

  5. Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Che-Wei Wu

  6. Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Che-Wei Wu

  7. Department of Surgery and Department of Morphology, Surgery and Experimental Medicine, S. Anna University Hospital and University of Ferrara, Ferrara, Italy

    Paolo Carcoforo

  8. Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy

    Gabriele Materazzi

  9. Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Ralph P. Tufano

  10. Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, South Korea

    Hoon Yub Kim

Authors
  1. Daqi Zhang
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All authors equally contributed to the conception, design, manuscript writing, and final approval of the manuscript.

Corresponding authors

Correspondence to Carmelo Mazzeo or Hui Sun.

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This article is part of the Topical Collection on Transoral Thyroid and Parathyroid Surgery

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Zhang, D., Mazzeo, C., Dionigi, G. et al. Nerve Monitoring for Transoral Thyroid Surgery: Why, How, and What to Expect. Curr Otorhinolaryngol Rep 7, 225–231 (2019). https://doi.org/10.1007/s40136-019-00251-z

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