Department of General Surgery, Izmir Kâtip Celebi University Ataturk Training and Research Hospital, Izmir, Turkey.
Eur Arch Otorhinolaryngol. 2022 Jan;279(1):443-447. doi: 10.1007/s00405-021-06801-w. Epub 2021 Apr 13.
Recurrent laryngeal nerve (RLN) paralysis is one of the most devastating complications after thyroidectomy. Thyroid reoperation is a great challenge for surgeons due to anatomical distortion and fibrosis and associated with a higher risk of RLN injury. In this study, we aimed to compare stimulating dissector (SD) with intermittent stimulating probe (ISP) in thyroid reoperations. This study is the first one which compares the impact of different nerve stimulating devices in thyroid reoperations.
Included in this randomized prospective study were patients who had a bilateral subtotal thyroidectomy and would undergo a completion thyroidectomy due to a diagnosis of thyroid papillary cancer between January 2015 and January 2017. Patients were divided into two groups as SD group and ISP group. Age, sex, nerve amplitudes, latencies, the first identification time of RLN and complications were compared in both groups.
A total of 32 patients, 16 in both groups, were included in the study. The demographics, nerve signal amplitudes and latencies were similar in both groups (p > 0.05). The mean RLN identification time in the SD group was 17.4 ± 4.3 min, which was significantly shorter than those in the ISP group (mean 21.3 ± 3.9) (p = 0.014).
The first identification of RLN in the thyroid reoperations was faster with the use of SD than with the use of the ISP. Since the electromyographic amplitudes of RLN and vagus nerve with using SD were similar to the bipolar ISP, SD can be used safely for thyroid reoperations.
喉返神经（RLN）麻痹是甲状腺手术后最严重的并发症之一。由于解剖结构扭曲和纤维化，甲状腺再次手术对外科医生来说是一个巨大的挑战，并且与更高的 RLN 损伤风险相关。在这项研究中，我们旨在比较刺激解剖器（SD）与间歇性刺激探头（ISP）在甲状腺再次手术中的应用。这是第一项比较不同神经刺激设备在甲状腺再次手术中影响的研究。
本随机前瞻性研究纳入了 2015 年 1 月至 2017 年 1 月期间因甲状腺乳头状癌诊断行双侧甲状腺次全切除术并需行甲状腺全切除术的患者。患者分为 SD 组和 ISP 组。比较两组患者的年龄、性别、神经幅度、潜伏期、RLN 首次识别时间和并发症。
共有 32 例患者（每组 16 例）纳入本研究。两组患者的人口统计学、神经信号幅度和潜伏期相似（p>0.05）。SD 组 RLN 识别时间的平均值为 17.4±4.3 分钟，明显短于 ISP 组（21.3±3.9 分钟）（p=0.014）。
与使用 ISP 相比，SD 可更快地识别甲状腺再次手术中的 RLN。由于使用 SD 时 RLN 和迷走神经的肌电图幅度与双极 ISP 相似，因此 SD 可安全用于甲状腺再次手术。
