Kandil Emad, Wassef Shafik N, Alabbas Haytham, Freidlander Paul L
Division of Endocrine and Oncological Surgery, Department of Surgery, Tulane University School of Medicine, New Orleans, LA 70112, USA.
Int J Otolaryngol. 2009;2009:739798. doi: 10.1155/2009/739798. Epub 2010 Feb 8.
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.
目的。我们的目标是研究在微创视频辅助甲状腺切除术和甲状旁腺切除术（MIVAT/P）中使用术中神经监测（IONM）的可行性，重点是识别喉返神经（RLN）。方法。本回顾性、非随机分析研究纳入了连续47例患者，共77条喉返神经有风险，均接受了MIVAT/P和IONM。所有手术均由同一外科医生在学术机构环境中进行。所有患者术后均进行了声带评估。收集了患者的人口统计学资料以及手术中的和术后的并发症。结果。在77条喉返神经中，1例晚期乳头状甲状腺癌患者出现1例永久性单侧喉返神经损伤（1.29%），通过声带注射进行处理。还有1例短暂性喉返神经麻痹，自行缓解（1.29%）。未出现设备故障或干扰情况。结论。据我们所知，这是美国首次报道的采用标准化IONM技术的MIVAT/P系列病例。IONM的技术可行性似乎是可以接受的，并且可以作为神经视觉识别的有意义辅助手段。MIVAT/P期间的神经监测在识别喉神经方面是有效的，能让外科医生在进行MIVAT/P时感觉更安心。需要更多对比系列研究进行进一步评估。
