Del Rio P, Cozzani F, Nisi P C, Loderer T, Piva G, Bonati E
G Chir. 2018 Sep-Oct;34(5):291-296.
We know that benefits of MIVAT are related to a better cosmetic result and lower post-operative pain in comparison to CT. The incidence of nerve cold palsy is related to a correct identification of the recurrent laringeal nerve (RLN) as standard procedure in thyroid surgery. From September 2014 we have introduced the use of intraoperative neural monitoring(I-IONM) in all thyroidectomies in the Unit of General Surgery of University Hospital of Parma, including in MIVAT.
We have considered all patients treated from September 2014 to September 2017 for thyroid diseases using MIVAT and IONM. Intermittent neuromonitoring with NIM-3.0 equipment (Medtronic, Jacksonville, FL, USA) was used during all operations. We have recorded all data about age, sex, diagnosis, surgical time, i-IONM signal, postoperative pain, postoperative hypocalcemia after 24 hours, haematoma and vocal cord palsy. The mean hospital stay was collected from surgical procedure to hospital discharge. We have considered vocal dysfunctions that persist six months after surgery as permanent.
From September 2014 to September 2017 we treated consecutively with both MIVAT and i-IONM 100 patients. Considering the extent of surgery, 26 pts underwent to hemithyroidectomy and 74 pts to total thyroidectomy. The mean surgical time was 61.8 minutes. In 7 cases the patients were affected by preoperative clinical dysphonia. Using I-IONM during thyroidectomy, we recorded in 5 cases (5%) a loss of signal; in two cases (2%) we experienced a temporary postoperative vocal cord palsy.
In our experience the use of IONM has improved the safety during thyroidectomy because precision that can be achieved by endoscopic procedures is further improved by complementary use of IONM. The costs associated to a potential reduction of medical litigation have not been investigated.
我们知道，与传统甲状腺切除术（CT）相比，微波消融术（MIVAT）的优势在于具有更好的美容效果和更低的术后疼痛。神经冷麻痹的发生率与甲状腺手术中正确识别喉返神经（RLN）这一标准操作有关。自2014年9月起，我们在帕尔马大学医院普通外科的所有甲状腺切除术中引入了术中神经监测（I-IONM），包括MIVAT手术。
我们纳入了2014年9月至2017年9月期间所有采用MIVAT和I-IONM治疗甲状腺疾病的患者。所有手术均使用NIM-3.0设备（美国美敦力公司，佛罗里达州杰克逊维尔）进行间歇性神经监测。我们记录了所有关于年龄、性别、诊断、手术时间、I-IONM信号、术后疼痛、术后24小时低钙血症、血肿和声带麻痹的数据。从手术操作到出院收集平均住院时间。我们将术后持续六个月的声带功能障碍视为永久性的。
2014年9月至2017年9月期间，我们连续对100例患者进行了MIVAT和I-IONM治疗。考虑手术范围，26例患者接受了半甲状腺切除术，74例患者接受了全甲状腺切除术。平均手术时间为61.8分钟。7例患者术前存在临床性发音障碍。在甲状腺切除术中使用I-IONM时，我们记录到5例（5%）信号丢失；2例（2%）出现术后暂时性声带麻痹。
根据我们的经验，I-IONM的使用提高了甲状腺切除术的安全性，因为内镜手术的精确性通过补充使用I-IONM得到了进一步提高。与潜在减少医疗诉讼相关的成本尚未进行调查。
