Role of intraoperative neuromonitoring of recurrent laryngeal nerve in thyroid and parathyroid surgery

doi:10.3969/j.issn.1006-7795.2017.04.026

Abstract

Abstract: The recurrent laryngeal nerve(RLN) injury is one of the important complications during the thyroid and parathyroid surgery, which can result in hoarseness and dyspnea. Intraoperative neuromonitoring (IONM) of recurrent laryngeal nerve has already become the effective method to protect the recurrent laryngeal nerve during the thyroid and parathyroid surgery, which has developed from invasive electrode to noninvasive endotracheal intubation with electrode, and standardized procedures of IONM was proposed. Furthermore, the continuous intraoperative neuromonitorying (C-IONM) and the standardized monitoring procedure of external branch of superior laryngeal nerve (EBSLN) has been accepted by an increasing number of surgeons. The probable damage mechanisms are gradually demonstrated through IONM. It is an effective technique that IONM could be to assist surgeons to recognize RLN and reduce the risk of recurrent laryngeal nerve injury during thyroid or parathyroid surgery, especially in complicated operations and reoperations.It will be of great importance in the aspect of improving the operation procedure, making staged secondary/completion procedure strategy, and the development of low-volume surgeons.

Key words: intraoperative recurrent laryngeal nerve neuromonitoring, thyroid, parathyroid, surgery

CLC Number:

R653

Ling Yuwei, Kang Hua. Role of intraoperative neuromonitoring of recurrent laryngeal nerve in thyroid and parathyroid surgery[J]. Journal of Capital Medical University, 2017, 38(4): 626-630.

0
/ / Recommend

Add to citation manager EndNote|Reference Manager|ProCite|BibTeX|RefWorks

URL: https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/10.3969/j.issn.1006-7795.2017.04.026

https://journal03.magtech.org.cn/Jweb_sdykdxxb/EN/Y2017/V38/I4/626

References

[1] Ardito G, Revelli L, D'Alatri L, et al. Revisited anatomy of the recurrent laryngeal nerves[J]. Am J Surg, 2004, 187(2): 249-253.
[2] Julien N, Mosnier I, Bozorg Grayeli A, et al. Intraoperative laryngeal nerve monitoring during thyroidectomy and parathyroidectomy: A prospective study[J]. Eur Anna Otorhinolaryngol, Head Neck Dis, 2012, 129(2): 69-76.
[3] Sanabria A, Ramirez A, Kowalski L P, et al. Neuromonitoring in thyroidectomy: a meta-analysis of effectiveness from randomized controlled trials[J]. Eur Arch Oto Rhino Laryngol, 2013, 270(8): 2175-2189.
[4] Calò P G, Pisano G, Medas F, et al. Identification alone versus intraoperative neuromonitoring of the recurrent laryngeal nerve during thyroid surgery: experience of 2 034 consecutive patients[J]. J Otolaryngol Head Neck Surg,2014, 43: 16.
[5] Pisanu A, Porceddu G, Podda M, et al. Systematic review with meta-analysis of studies comparing intraoperative neuromonitoring of recurrent laryngeal nerves versus visualization alone during thyroidectomy[J]. J Surg Res, 2014, 188(1): 152-161.
[6] Page C, Cuvelier P, Biet A, et al. Value of intra-operative neuromonitoring of the recurrent laryngeal nerve in total thyroidectomy for benign goitre[J]. J Laryngol Otol, 2015, 129(6): 553-557.
[7] Chiang F, Lu I C, Chen H, et al. Intraoperative neuromonitoring for early localization and identification of recurrent laryngeal nerve during thyroid surgery[J]. Kaohsiung J Med Sci, 2010, 26(12): 633-639.
[8] Hemmerling T M, Schmidt J, Bosert C, et al. Intraoperative monitoring of the recurrent laryngeal nerve in 151 consecutive patients undergoing thyroid surgery[J]. Anesth Analg, 2001, 93(2): 396-399.
[9] 刘晓莉,孙辉,郑泽霖,等. 甲状腺术中喉返神经监测技术的应用与进展[J]. 中国普通外科杂志,2009,18(11): 1187-1190.
[10] Dralle H, Sekulla C, Haerting J, et al. Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery[J]. Surgery, 2004, 136(6): 1310-1322.
[11] Godballe C, Madsen A R, Sørensen C H, et al. Risk factors for recurrent nerve palsy after thyroid surgery: a national study of patients treated at danish departments of ENT head and neck surgery[J]. Eur Arch Otorhinolaryngol, 2014, 271(8): 2267-2276.
[12] Shedd D P, Durham C. Electrical identification of the recurrent laryngeal nerve. I. Response of the canine larynx to electrical stimulation of the recurrent laryngeal nerve[J]. Ann Surg, 1966, 163(1): 47-50.
[13] Flisberg K, Lindholm T. Electrical stimulation of the human recurrent laryngeal nerve during thyroid operation[J]. Acta Otolaryngol Suppl, 1969, 263: 63-67.
[14] Eisele D W. Intraoperative electrophysiologic monitoring of the recurrent laryngeal nerve[J]. Laryngoscope, 1996, 106(4): 443-449.
[15] 孙辉. 甲状腺及甲状旁腺手术中神经电生理监测临床指南(中国版)[J]. 中国实用外科杂志,2013,33(6): 470-474.
[16] Dionigi G, Wu C, Kim H Y, et al. Severity of recurrent laryngeal nerve injuries in thyroid surgery[J]. World J Surg, 2016, 40(6): 1373-1381.
[17] Randolph G W, Dralle H, International Intraoperative Monitoring Study Group, et al. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: International standards guideline statement[J]. Laryngoscope, 2011, 121(Suppl 1): S1-S16.
[18] Jeannon J P, Orabi A A, Bruch G A, et al. Diagnosis of recurrent laryngeal nerve palsy after thyroidectomy: a systematic review[J]. Int J Clin Pract, 2009, 63(4): 624-629.
[19] Wu C W, Dionigi G, Sun H, et al. Intraoperative neuromonitoring for the early detection and prevention of RLN traction injury in thyroid surgery: A porcine model[J]. Surgery, 2014, 155(2): 329-339.
[20] Schneider R, Sekulla C, Machens A, et al. Dynamics of loss and recovery of the nerve monitoring signal during thyroidectomy predict early postoperative vocal fold function[J]. Head Neck, 2016, Suppl 1(38): E1144-E1151.
[21] Lin Y C, Dionigi G, Randolph G W, et al. Electrophysiologic monitoring correlates of recurrent laryngeal nerve heat thermal injury in a porcine model[J]. Laryngoscope, 2015, 125(8): E283-E290.
[22] Wu C W, Wang M H, Chen C C, et al. Loss of signal in recurrent nerve neuromonitoring: causes and management[J]. Gland Surg, 2015, 4(1): 19-26.
[23] Barczyński M, Randolph G W, Cernea C. International survey on the identification and neural monitoring of the EBSLN during thyroidectomy[J]. Laryngoscope, 2016, 126(1): 285-291.
[24] Barczyński M, Konturek A, Cichoń S. Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy[J]. Brit J Surg, 2009, 96(3): 240-246.
[25] Schneider R, Randolph G W, Sekulla C, et al. Continuous intraoperative vagus nerve stimulation for identification of imminent recurrent laryngeal nerve injury[J]. Head & Neck, 2013, 35(11): 1591-1598.
[26] Hatton K W, McLarney J T, Pittman T, et al. Vagal nerve stimulation: overview and implications for anesthesiologists[J]. Anesth Analg, 2006, 103(5): 1241-1249.
[27] Ulmer C, Friedrich C, Kohler A, et al. Impact of continuous intraoperative neuromonitoring on autonomic nervous system during thyroid surgery[J]. Head Neck, 2011,(33): 976-984.
[28] Koulouris C, Papavramidis T S, Pliakos I, et al. Intraoperative stimulation neuromonitoring versus intraoperative continuous electromyographic neuromonitoring in total thyroidectomy: identifying laryngeal complications[J]. Am J Surg, 2012, 204(1): 49-53.
[29] Barczyński M, Randolph G W, Cernea C R, et al. External branch of the superior laryngeal nerve monitoring during thyroid and parathyroid surgery: International neural monitoring study group standards guideline statement[J]. Laryngoscope, 2013, 123 Suppl 4: S1-S14.
[30] Barczyński M, Konturek A, Stopa M, et al. Randomized controlled trial of visualization versus neuromonitoring of the external branch of the superior laryngeal nerve during thyroidectomy[J]. World J Surg, 2012, 36(6): 1340-1347.