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Minimally invasive video-assisted thyroidectomy and parathyroidectomy with intraoperative recurrent laryngeal nerve monitoring.

Kandil E, Wassef SN, Alabbas H, Freidlander PL - Int J Otolaryngol (2010)

Bottom Line: Conclusions.Neuromonitoring during MIVAT/P is effective in providing identification of laryngeal nerves and enables surgeons to feel more comfortable with MIVAT/P.Comparative series are needed for further evaluation.

View Article: PubMed Central - PubMed

Affiliation: Division of Endocrine and Oncological Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA.

ABSTRACT
Objective. Our goal is to study the feasibility of using intraoperative neuromonitoring (IONM) in minimally invasive video-assisted thyroidectomy and parathyroidectomy (MIVAT/P) with emphasis given to the identification of recurrent laryngeal nerve (RLN). Methods. Consecutive series of forty-seven patients with seventy-seven recurrent laryngeal nerves at risk undergoing both MIVAT/P and IONM were enrolled in this retrospective, nonrandomized analysis study. All operations were performed by the same surgeon within an academic institution setting. All patients underwent vocal cord evaluation postoperatively. Demographics and intraoperative and postoperative complications following surgery were collected. Results. Out of seventy-seven RLNs, there was one permanent unilateral RLN injury (1.29%) in a patient with advanced papillary thyroid cancer, managed by cord injection. There was another transient RLN paresis that resolved spontaneously (1.29%). There were no instances of equipment malfunction or interference. Conclusions. To our knowledge, this is the first reported MIVAT/P series from the United States of America with a standardized IONM technique. The technical feasibility of IONM seems acceptable and may serve as a meaningful adjunct to the visual identification of nerves. Neuromonitoring during MIVAT/P is effective in providing identification of laryngeal nerves and enables surgeons to feel more comfortable with MIVAT/P. Comparative series are needed for further evaluation.

No MeSH data available.


Related in: MedlinePlus

Intra operative nerve monitoring of right recurrent laryngeal nerve.
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Related In: Results  -  Collection


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fig1: Intra operative nerve monitoring of right recurrent laryngeal nerve.

Mentions: A standard MIVAT/P gasless approach to the thyroid gland was performed under general anesthesia [4]. The surgeon stands at the lesion side, the camera operator on the other side, and an assistant at the patient's head. We routinely use a 30°5 mm endoscope. All vessel ligation during the procedure was done using the harmonic scalpel (Ethicon, NJ). Additionally, the harmonic scalpel was also used to divide the isthmus in lobectomies, to isolate the gland from the trachea. After routine attempted anatomical observation of the RLN, stimulation of the nerve was done with a hand-held nerve stimulator with either the Medtronic Varistim III Nerve Stimulator (Medtronic Inc., Minneapolis, MI, USA) or the Nervona system (Nervona, CA, USA) at currents of 1 to 2 mA on completion of dissection [2, 5]. The RLN was stimulated at the most proximal exposed site of the nerve (Figure 1).


Minimally invasive video-assisted thyroidectomy and parathyroidectomy with intraoperative recurrent laryngeal nerve monitoring.

Kandil E, Wassef SN, Alabbas H, Freidlander PL - Int J Otolaryngol (2010)

Intra operative nerve monitoring of right recurrent laryngeal nerve.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2821655&req=5

fig1: Intra operative nerve monitoring of right recurrent laryngeal nerve.
Mentions: A standard MIVAT/P gasless approach to the thyroid gland was performed under general anesthesia [4]. The surgeon stands at the lesion side, the camera operator on the other side, and an assistant at the patient's head. We routinely use a 30°5 mm endoscope. All vessel ligation during the procedure was done using the harmonic scalpel (Ethicon, NJ). Additionally, the harmonic scalpel was also used to divide the isthmus in lobectomies, to isolate the gland from the trachea. After routine attempted anatomical observation of the RLN, stimulation of the nerve was done with a hand-held nerve stimulator with either the Medtronic Varistim III Nerve Stimulator (Medtronic Inc., Minneapolis, MI, USA) or the Nervona system (Nervona, CA, USA) at currents of 1 to 2 mA on completion of dissection [2, 5]. The RLN was stimulated at the most proximal exposed site of the nerve (Figure 1).

Bottom Line: Conclusions.Neuromonitoring during MIVAT/P is effective in providing identification of laryngeal nerves and enables surgeons to feel more comfortable with MIVAT/P.Comparative series are needed for further evaluation.

View Article: PubMed Central - PubMed

Affiliation: Division of Endocrine and Oncological Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA.

ABSTRACT
Objective. Our goal is to study the feasibility of using intraoperative neuromonitoring (IONM) in minimally invasive video-assisted thyroidectomy and parathyroidectomy (MIVAT/P) with emphasis given to the identification of recurrent laryngeal nerve (RLN). Methods. Consecutive series of forty-seven patients with seventy-seven recurrent laryngeal nerves at risk undergoing both MIVAT/P and IONM were enrolled in this retrospective, nonrandomized analysis study. All operations were performed by the same surgeon within an academic institution setting. All patients underwent vocal cord evaluation postoperatively. Demographics and intraoperative and postoperative complications following surgery were collected. Results. Out of seventy-seven RLNs, there was one permanent unilateral RLN injury (1.29%) in a patient with advanced papillary thyroid cancer, managed by cord injection. There was another transient RLN paresis that resolved spontaneously (1.29%). There were no instances of equipment malfunction or interference. Conclusions. To our knowledge, this is the first reported MIVAT/P series from the United States of America with a standardized IONM technique. The technical feasibility of IONM seems acceptable and may serve as a meaningful adjunct to the visual identification of nerves. Neuromonitoring during MIVAT/P is effective in providing identification of laryngeal nerves and enables surgeons to feel more comfortable with MIVAT/P. Comparative series are needed for further evaluation.

No MeSH data available.


Related in: MedlinePlus