Kim Su-Jin, Lee Kyu Eun, Oh Byung-Mo, Oh Eun Mee, Bae Dong Sik, Choi June Young, Myong Jun Pyo, Youn Yeo-Kyu
Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Ann Surg Treat Res. 2015 Nov;89(5):233-9. doi: 10.4174/astr.2015.89.5.233. Epub 2015 Oct 28.
The aim of this study was to evaluate the feasibility of monitoring external branch of the superior laryngeal nerve (EBSLN) during robotic thyroid surgery.
A total of 10 patients undergoing bilateral axillo-breast approach (BABA) robotic thyroid surgery were enrolled. The nerve integrity monitor (NIM Response 2.0 System) was used for EBSLN monitoring. We performed voice assessments preoperatively and at 1 and 3 months postoperatively using Voice Handicap Index-10 (VHI-10), maximal phonation time (MPT), phonation efficient index (PEI), and laryngeal electromyography (EMG).
A total of 19 EBSLNs were at risk and 14 EBSLNs (73.7%) were identified using neuromonitoring. VHI-10 showed a change of voice over time (0.1 vs. 3.6 vs. 1.3); however, this was not statistically significant. VHI-10 scores normalized at 3 months postoperatively compared to the preoperative scores. MPT (a) (16.0 vs. 15.6 vs. 15.4), and MPT (e) (20.1 vs. 15.4 vs. 18.5) showed no significant differences preoperatively compared to the values obtained 1 and 3 months postoperatively. There was a significant change of PEI over time (4.8 vs. 1.1 vs. 4.6) (P = 0.036); however, the values normalized at 3 months postoperatively. Laryngeal EMG results showed 4 cases (21.2%) of neuropathy of EBSLNs at 1 month postoperatively, and electrodiagnostic studies revealed nearly complete recovery of the function of EBSLNs in 4 patients at 3 months postoperatively.
It is suggested that neuromonitoring of EBSLNs during BABA robotic thyroid surgery is feasible and might be helpful to preserve voice quality.
本研究旨在评估在机器人甲状腺手术中监测喉上神经外支（EBSLN）的可行性。
共纳入10例行双侧腋窝-乳房入路（BABA）机器人甲状腺手术的患者。使用神经完整性监测仪（NIM Response 2.0系统）对EBSLN进行监测。我们在术前以及术后1个月和3个月使用嗓音障碍指数-10（VHI-10）、最长发声时间（MPT）、发声效率指数（PEI）和喉肌电图（EMG）进行嗓音评估。
共有19支EBSLN面临风险，其中14支（73.7%）通过神经监测得以识别。VHI-10显示嗓音随时间变化（0.1对3.6对1.3）；然而，这无统计学意义。与术前评分相比，术后3个月VHI-10评分恢复正常。MPT（a）（16.0对15.6对15.4）和MPT（e）（20.1对15.4对18.5）术前与术后1个月和3个月获得的值相比无显著差异。PEI随时间有显著变化（4.8对1.1对4.6）（P = 0.036）；然而，术后3个月这些值恢复正常。喉肌电图结果显示术后1个月有4例（21.2%）EBSLN神经病变，电诊断研究显示术后3个月4例患者的EBSLN功能几乎完全恢复。
提示在BABA机器人甲状腺手术中对EBSLN进行神经监测是可行的，且可能有助于保持嗓音质量。
