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Dixit H, Kamat L, Potdar M, Modi T. Role of electromyography endotracheal tube in preventing recurrent laryngeal nerve injury during thyroid surgery: A case reportAirway trauma during difficult intubation… from the frying pan into the fire? Indian J Anaesth 2017; 61:435-437. [PMID: 28584356 PMCID: PMC5444225 DOI: 10.4103/ija.ija_414_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Hrudini Dixit
- Department of Anesthesia, Dr. L H Hiranandani Hospital, Mumbai, Maharashtra, India
| | - Laxmi Kamat
- Department of Anesthesia, Dr. L H Hiranandani Hospital, Mumbai, Maharashtra, India
| | - Meenoti Potdar
- Department of Anesthesia, Dr. L H Hiranandani Hospital, Mumbai, Maharashtra, India
| | - Tejash Modi
- Department of Anesthesia, Dr. L H Hiranandani Hospital, Mumbai, Maharashtra, India
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52
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Anuwong A, Kim HY, Dionigi G. Transoral endoscopic thyroidectomy using vestibular approach: updates and evidences. Gland Surg 2017; 6:277-284. [PMID: 28713700 DOI: 10.21037/gs.2017.03.16] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Recently, natural orifice transluminal endoscopic surgery (NOTES) has been applied in thyroid surgery with transoral access. The benefit of transoral endoscopic thyroidectomy is the potential for scar-free surgery. However, there are many concerns over some aspects, such as infection, recurrent laryngeal nerve injury, and oncological outcome. In this paper, we have reviewed the development history and the current clinical evidence of this innovative surgery. We conclude that the transoral endoscopic thyroidectomy vestibular approach (TOETVA) is feasible and can be considered no longer an experimental operation.
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Affiliation(s)
- Angkoon Anuwong
- Department of Surgery, Minimally Invasive and Endocrine Surgery Division, Police General Hospital, Bangkok, Thailand
| | - Hoon Yub Kim
- Department of Surgery, KUMC Thyroid Center, Korea University College of Medicine, Seoul, Korea
| | - Gianlorenzo Dionigi
- Department of Surgical Sciences and Human Morphology, 1st Division of Surgery, Research Center for Endocrine Surgery, University of Insubria (Como-Varese), Varese, Italy
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53
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Baek SK, Lee K, Oh D, Kang SH, Kwon SY, Woo JS, Cho JG, Oh KH, Lee DY, Jung KY. Efficiency of intraoperative neuromonitoring on voice outcomes after thyroid surgery. Auris Nasus Larynx 2017; 44:583-589. [PMID: 28236537 DOI: 10.1016/j.anl.2017.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/16/2017] [Accepted: 01/27/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Voice disturbance is an important problem after thyroidectomy. The aim of this study was to evaluate the efficiency of intraoperative neuromonitoring (IONM) in reducing early phonation change by comparing postoperative voice outcomes. METHODS The study retrospectively enrolled 68 consecutive female patients who had undergone IONM thyroidectomy for papillary thyroid carcinoma occurring between January 2014 and November 2014. A historical group of 117 similar female patients not receiving IONM thyroidectomy was used as an external control. Voice analyses were performed preoperatively and at 1 week, 1 month, and 3 months postoperatively. Voice outcomes between the IONM group and no IONM group were compared in patients who underwent hemithyroidectomy and total thyroidectomy. RESULTS In patients who underwent IONM, there were significantly smaller changes in the fundamental frequency at postoperative 1 month and in the maximum voice pitch of the voice range profile at postoperative 1 week irrespective of the extent of thyroid surgery. CONCLUSION IONM during thyroid surgery resulted in better outcomes regarding fundamental frequency and high-pitch voice in the early postoperative period. IONM appears to be an effective method to reduce temporary phonation alteration after thyroid surgery.
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Affiliation(s)
- Seung-Kuk Baek
- Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kijeong Lee
- Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Dongju Oh
- Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sung Hoon Kang
- Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Soon-Young Kwon
- Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jeong-Soo Woo
- Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jae-Gu Cho
- Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyung Ho Oh
- Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Doh Young Lee
- Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kwang-Yoon Jung
- Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Republic of Korea.
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Wong KP, Mak KL, Wong CKH, Lang BHH. Systematic review and meta-analysis on intra-operative neuro-monitoring in high-risk thyroidectomy. Int J Surg 2017; 38:21-30. [DOI: 10.1016/j.ijsu.2016.12.039] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 12/19/2016] [Indexed: 11/16/2022]
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55
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Lombardi CP, Carnassale G, Damiani G, Acampora A, Raffaelli M, De Crea C, Bellantone R. “The final countdown”: Is intraoperative, intermittent neuromonitoring really useful in preventing permanent nerve palsy? Evidence from a meta-analysis. Surgery 2016; 160:1693-1706. [DOI: 10.1016/j.surg.2016.06.049] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Revised: 06/23/2016] [Accepted: 06/23/2016] [Indexed: 10/21/2022]
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57
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Jitpratoom P, Ketwong K, Sasanakietkul T, Anuwong A. Transoral endoscopic thyroidectomy vestibular approach (TOETVA) for Graves' disease: a comparison of surgical results with open thyroidectomy. Gland Surg 2016; 5:546-552. [PMID: 28149798 DOI: 10.21037/gs.2016.11.04] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Transoral endoscopic thyroidectomy vestibular approach (TOETVA) provides excellent cosmetic results from its potential for scar-free operation. The procedure has been applied successfully for Graves' disease by the authors of this work and compared with the standard open cervical approach to evaluate its safety and outcomes. METHODS From January 2014 to November 2016, a total of 97 patients with Graves' disease were reviewed retrospectively. Open thyroidectomy (OT) and TOETVA were performed in 49 patients and 46 patients, respectively. For TOETVA, a three-port technique through the oral vestibule was utilized. The thyroidectomy was done endoscopically using conventional laparoscopic instruments and an ultrasonic device. Patient demographics and surgical variables, including operative time, blood loss, and complications, were investigated and compared. RESULTS TOETVA was performed successfully in all 45 patients, although conversion to open surgery was deemed necessary in one patient. All patient characteristics for both groups were similar. Operative time was shorter for the OT group compared to the TOETVA group, which totaled 101.97±24.618 and 134.11±31.48 minutes, respectively (P<<0.5). Blood loss was comparable for both groups. The visual analog scale (VAS) pain score for the TOETVA group was significantly lower than for the OT group on day 1 (2.08±1.53 vs. 4.57±1.35), day 2 (0.84±1.12 vs. 2.57±1.08) and day 3 (0.33±0.71 vs. 1.08±1.01) (P<<0.05). Transient recurrent laryngeal nerve (RLN) palsy was found in four and two cases of TOETVA and OT group, respectively. Transient hypocalcemia was found in ten and seven cases of TOETVA and OT group, respectively. No other complications were observed. CONCLUSIONS TOETVA is a feasible and safe treatment for Graves' disease in comparison to the standard open cervical approach. It is considered a viable alternative for patients who have been indicated for surgery with excellent cosmetic results.
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Affiliation(s)
- Pornpeera Jitpratoom
- Minimally Invasive and Endocrine Surgery Division, Department of Surgery, Police General Hospital, Bangkok, Thailand
| | - Khwannara Ketwong
- Minimally Invasive and Endocrine Surgery Division, Department of Surgery, Police General Hospital, Bangkok, Thailand
| | - Thanyawat Sasanakietkul
- Minimally Invasive and Endocrine Surgery Division, Department of Surgery, Police General Hospital, Bangkok, Thailand
| | - Angkoon Anuwong
- Minimally Invasive and Endocrine Surgery Division, Department of Surgery, Police General Hospital, Bangkok, Thailand
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Ghani U, Assad S, Assad S. Role of Intraoperative Nerve Monitoring During Parathyroidectomy to Prevent Recurrent Laryngeal Nerve Injury. Cureus 2016; 8:e880. [PMID: 28003944 PMCID: PMC5161260 DOI: 10.7759/cureus.880] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Injury to the recurrent laryngeal nerve (RLN) is a well known, though less frequent, complication of parathyroid surgery. In recent years, the use of intraoperative nerve monitoring (IONM) has gained popularity amongst surgeons when operating on thyroid gland; however, its utilization in parathyroid surgery is not established. This trend continues to rise, despite multiple studies documenting no statistically significant difference that IONM decreases the incidence of RLN injury. Most surgeons use this technology as an adjunct to visualization alone for identification of RLN. The purpose of this review is to discuss the possible role of IONM in parathyroid surgery with regards to the accuracy, efficacy, and recent trends in the utilization of this technology. There is insufficient evidence that IONM reduces the risk of RLN injury in parathyroidectomy. Although IONM may decrease the likelihood of nerve injury by helping to identify and map the RLN during thyroidectomy, we did not find studies exclusive to parathyroid surgery to see if its use can be supported for parathyroidectomy. Despite this lack of evidence, we believe that IONM is a promising adjunct to visualization alone in detecting nerve structures during neck dissection, but more clinical trials are warranted to establish its role in preventing nerve injury in parathyroid surgery.
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Affiliation(s)
- Usman Ghani
- Department of Medicine, Shifa International Hospital, Islamabad, Pakistan
| | - Salman Assad
- Department of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Shuja Assad
- Department of Urology, Nawaz Sharif Medical College, University of Gujrat
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Anuwong A. Transoral Endoscopic Thyroidectomy Vestibular Approach: A Series of the First 60 Human Cases. World J Surg 2016; 40:491-7. [PMID: 26546193 DOI: 10.1007/s00268-015-3320-1] [Citation(s) in RCA: 326] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Natural orifice transluminal endoscopic surgery has been adopted for thyroid surgery because of its potential for scar-free operation. However, the previous technique still has some limitations. Thus, we present our initial experience in transoral endoscopic thyroidectomy vestibular approach (TOETVA). METHODS From April 2014 to January 2015, we used a three-port technique through the oral vestibule, one 10-mm port for laparoscope and two additional 5-mm ports for instruments. The CO2 insufflation pressure was set at 6 mm Hg. An anterior cervical subplatysmal space was created from the oral vestibule down to the sternal notch. The thyroidectomy was done endoscopically using conventional laparoscopic instruments and an ultrasonic device. RESULTS A series of 60 procedures were accomplished successfully. 42 patients had single-thyroid nodules, and a lobectomy was performed. 22 patients had multinodular goiters and two patients had Graves' disease, with total thyroidectomy or Hartley-Dunhill procedures performed. Two had papillary thyroid carcinoma, and total thyroidectomy with central node dissection was performed. The median operative time was 115.5 min (range 75-300 min). The median blood loss was 30 mL (range 8-130 mL). Two patients experienced a transient hoarseness, which was resolved within 2 months. One patient experienced a late postoperative hematoma, which was treated conservatively. No mental nerve injury or infections were found. The patients were discharged in an average of 3.6 days (range 2-7 days) postoperatively. CONCLUSION TOETVA is safe and feasible, resulting in no visible scarring. This technique may provide a method for ideal cosmetic results.
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Affiliation(s)
- Angkoon Anuwong
- Department of Surgery, Police General Hospital, Faculty of Medicine, Siam University, 492/1, Rama I Road, Pathumwan, Bangkok, 10330, Thailand.
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Intraoperative monitoring of the recurrent laryngeal nerve by vagal nerve stimulation in thyroid surgery. Eur Arch Otorhinolaryngol 2016; 274:421-426. [PMID: 27422627 DOI: 10.1007/s00405-016-4191-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 06/29/2016] [Indexed: 10/21/2022]
Abstract
The aim of the present study was to evaluate the thyroarytenoid muscle response during bilateral thyroid surgery using vagal nerve stimulation. 195 patients (390 nerves at risk) underwent a total thyroidectomy. The recurrent laryngeal nerve's function was checked by analyzing the amplitude and the latency of the thyroarytenoid muscle's responses after a vagal nerve's stimulation (0.5 and 1 mA) using the NIM3 Medtronic system. All patients were submitted to preoperative and postoperative laryngoscopy. 20 patients get no thyroarytenoid muscle response to the vagal nerve stimulation, and 14 postoperative recurrent laryngeal nerve palsies were confirmed (3.8 %). Two palsies were present after 6 months (0.51 %). All the patients with muscle's response have normal mobility vocal fold. The test sensitivity was 100 % and the test specificity was 98 %. Physiologically, the mean latencies of the muscular potentials for the right RLN were, respectively, 3.89 and 3.83 ms (p > 0.05) for the stimulation at 0.5 and 1 mA. The mean latencies for the left RLN were, respectively, 6.25 and 6.22 ms for the stimulation at 0.5 and 1 mA (p > 0.05). The difference of the latencies between the right and the left nerve was 2.30 ms (1.75-3.25 ms) with a stimulation of 0.5 or 1 mA (p < 0.05). Thyroarytenoid muscle's response via a vagal nerve stimulation showed a functional asymmetry of the laryngeal adduction with a faster right response. Surgically, this method can predict accurately an immediate postoperative vocal folds function in patients undergoing a bilateral thyroid surgery.
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61
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Lee J, Fraser S, Glover A, Sidhu S. Prospective evaluation of the utility of routine neuromonitoring for an established thyroid surgical practice. ANZ J Surg 2016; 87:E138-E142. [DOI: 10.1111/ans.13606] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 03/14/2016] [Accepted: 03/14/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Jane Lee
- The University of Sydney Endocrine Surgery Unit; Royal North Shore Hospital; St Leonards New South Wales Australia
| | - Sheila Fraser
- The University of Sydney Endocrine Surgery Unit; Royal North Shore Hospital; St Leonards New South Wales Australia
| | - Anthony Glover
- The University of Sydney Endocrine Surgery Unit; Royal North Shore Hospital; St Leonards New South Wales Australia
- Sydney Medical School Northern, Royal North Shore Hospital; The University of Sydney; Sydney New South Wales Australia
| | - Stan Sidhu
- The University of Sydney Endocrine Surgery Unit; Royal North Shore Hospital; St Leonards New South Wales Australia
- Sydney Medical School Northern, Royal North Shore Hospital; The University of Sydney; Sydney New South Wales Australia
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62
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Interpretation of intraoperative recurrent laryngeal nerve monitoring signals: The importance of a correct standardization. Int J Surg 2016; 28 Suppl 1:S54-8. [DOI: 10.1016/j.ijsu.2015.12.039] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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63
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Karakaya MA, Koç O, Ekiz F, Ağaçhan AF, Göret NE. Analysis of the Istanbul Forensic Medicine Institute expert decisions on recurrent laryngeal nerve injuries due to thyroidectomy between 2008-2012. ULUSAL CERRAHI DERGISI 2016; 32:43-6. [PMID: 26985157 DOI: 10.5152/ucd.2015.2815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Accepted: 09/29/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the approach of Forensic Medicine Institution for recurrent laryngeal nerve injuries. In addition, parameters that were taken into consideration by Forensic Medicine Institution in the differentiation of complication and malpractice were evaluated. MATERIAL AND METHODS The files of 38 patients, with recurrent laryngeal nerve injury following thyroidectomy, that were referred to Istanbul Forensic Medicine Institute with request of expert opinion between 2008-2012 were retrospectively investigated. Data regarding expert decisions, age, gender, diagnosis, hospital type, preoperative vocal cord examination, intraoperative nerve monitoring (IONM), identification of nerve injury during operation, repair of nerve during operation, and type of injury were assessed. RESULTS Surgeons were found to be faulty in all files with bilateral nerve injury, however, one-sided injury files were considered as a medical complication. Twenty-one (55.2%) patients were female, and 17 (44.8%) were male, with a mean age of 35,8 in women, and 34,1 in men. None of these patients had undergone preoperative vocal cord assessment. The recurrent laryngeal nerve was intraoperatively identified in 21 (55.2%) patients, while it was not seen in 17 (44.8%) patients. IONM was not applied in any patients. There was no attempt for nerve repair during any operation. Nineteen patients had unilateral, and 19 patients had bilateral nerve damage. CONCLUSION Bilateral recurrent laryngeal nerve injuries are considered as malpractice, when imaging or pathology reports fail to state a cause for difficulty in nerve identification.
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Affiliation(s)
- M Arif Karakaya
- Department of General Surgery, Forensic Medicine Institute, İstanbul, Turkey
| | - Okay Koç
- Clinic of Gastroenterology, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
| | - Feza Ekiz
- Department of General Surgery, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - A Feran Ağaçhan
- Clinic of General Surgery, Kartal Dr. Lütfi Kırdar Training and Research Hospital, İstanbul, Turkey
| | - Nuri Emrah Göret
- Clinic of General Surgery, Kartal Dr. Lütfi Kırdar Training and Research Hospital, İstanbul, Turkey
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Anuwong A. Transoral Endoscopic Thyroidectomy Vestibular Approach: A Series of the First 60 Human Cases. World J Surg 2016. [PMID: 26546193 DOI: 10.1007/s00268-015-3320-1/tables/4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND Natural orifice transluminal endoscopic surgery has been adopted for thyroid surgery because of its potential for scar-free operation. However, the previous technique still has some limitations. Thus, we present our initial experience in transoral endoscopic thyroidectomy vestibular approach (TOETVA). METHODS From April 2014 to January 2015, we used a three-port technique through the oral vestibule, one 10-mm port for laparoscope and two additional 5-mm ports for instruments. The CO2 insufflation pressure was set at 6 mm Hg. An anterior cervical subplatysmal space was created from the oral vestibule down to the sternal notch. The thyroidectomy was done endoscopically using conventional laparoscopic instruments and an ultrasonic device. RESULTS A series of 60 procedures were accomplished successfully. 42 patients had single-thyroid nodules, and a lobectomy was performed. 22 patients had multinodular goiters and two patients had Graves' disease, with total thyroidectomy or Hartley-Dunhill procedures performed. Two had papillary thyroid carcinoma, and total thyroidectomy with central node dissection was performed. The median operative time was 115.5 min (range 75-300 min). The median blood loss was 30 mL (range 8-130 mL). Two patients experienced a transient hoarseness, which was resolved within 2 months. One patient experienced a late postoperative hematoma, which was treated conservatively. No mental nerve injury or infections were found. The patients were discharged in an average of 3.6 days (range 2-7 days) postoperatively. CONCLUSION TOETVA is safe and feasible, resulting in no visible scarring. This technique may provide a method for ideal cosmetic results.
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Affiliation(s)
- Angkoon Anuwong
- Department of Surgery, Police General Hospital, Faculty of Medicine, Siam University, 492/1, Rama I Road, Pathumwan, Bangkok, 10330, Thailand.
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65
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Pardal-Refoyo JL, Ochoa-Sangrador C. Lesión bilateral del nervio laríngeo recurrente en tiroidectomía total con o sin neuromonitorización intraoperatoria. Revisión sistemática y metaanálisis. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2016; 67:66-74. [DOI: 10.1016/j.otorri.2015.02.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 01/16/2015] [Accepted: 02/01/2015] [Indexed: 12/01/2022]
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66
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Pardal-Refoyo JL, Ochoa-Sangrador C. Bilateral Recurrent Laryngeal Nerve Injury in Total Thyroidectomy With or Without Intraoperative Neuromonitoring. Systematic Review and Meta-analysis. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2016. [DOI: 10.1016/j.otoeng.2015.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Schneider R, Sekulla C, Machens A, Lorenz K, Nguyen Thanh P, Dralle H. Postoperative vocal fold palsy in patients undergoing thyroid surgery with continuous or intermittent nerve monitoring. Br J Surg 2015; 102:1380-7. [DOI: 10.1002/bjs.9889] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 03/24/2015] [Accepted: 06/02/2015] [Indexed: 11/11/2022]
Abstract
Abstract
Background
Continuous monitoring of electromyographic (EMG) amplitudes of the vocal muscles detects impending injury of the recurrent laryngeal nerve (RLN) during thyroid operations earlier than intermittent EMG monitoring. This may alert the surgeon to stop a manoeuvre causing stretching or pressure on the RLN, with better recovery of nerve function.
Methods
Patients with intact preoperative RLN function who underwent thyroid surgery for benign disease between January 2011 and September 2014 under continuous intraoperative nerve monitoring (CIONM) or intermittent intraoperative nerve monitoring (IIONM) were included in this observational study conducted at a tertiary surgical centre. For CIONM, combined EMG events indicative of imminent nerve injury were defined as an EMG amplitude decrease of 50 per cent or more and a latency increase of 10 per cent relative to baseline values. The rates of early and permanent palsy for the two groups of patients were compared.
Results
There were 1526 patients, 788 of whom (1314 nerves at risk) underwent thyroid surgery using CIONM and 738 (965 nerves at risk) had IIONM. With the use of CIONM, 63 (82 per cent) of 77 combined events were reversible during the operation. No permanent vocal fold palsy occurred with CIONM, whereas four unilateral permanent vocal fold palsies (0·4 per cent) were diagnosed after IIONM (P = 0·019).
Conclusion
Operation with CIONM resulted in fewer permanent vocal fold palsies compared with IIONM after thyroid surgery in patients with benign disease.
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Affiliation(s)
- R Schneider
- Department of General, Visceral and Vascular Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - C Sekulla
- Department of General, Visceral and Vascular Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - A Machens
- Department of General, Visceral and Vascular Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - K Lorenz
- Department of General, Visceral and Vascular Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - P Nguyen Thanh
- Department of General, Visceral and Vascular Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - H Dralle
- Department of General, Visceral and Vascular Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
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