Noda Takuya, Ishisaka Tomo, Okano Keiichiro, Kobayashi Yoshiaki, Shimode Yuzo, Tsuji Hiroyuki
Department of Head and Neck Surgery Kanazawa Medical University Kahoku Ishikawa Japan.
Laryngoscope Investig Otolaryngol. 2021 Feb 26;6(2):346-353. doi: 10.1002/lio2.540. eCollection 2021 Apr.
Recurrent laryngeal nerve (RLN) injury is one of the severe complications in thyroid surgery. Therefore, intraoperative nerve monitoring (IONM) has been widely used to identify the RLN and confirm its integrity. Recently, the usefulness of continuous IONM (CIONM) with automatic, periodic stimulation to the vagus nerve during thyroid surgery was reported. This study aimed to report our experience with minimally invasive video-assisted endoscopic endocrine neck surgery (VANS), during which, CIONM was successfully applied for the first time.
Consecutive patients who underwent thyroid surgery with CIONM, performed in our department using either external neck incision surgery or VANS between July 2017 and June 2019, were retrospectively analyzed.
A total of 22 patients who underwent thyroid surgery with neck incision (14 cases; 7 men and 7 women; age, 21-75 years [mean, 52 years]) or VANS (8 cases; 8 women, age, 20-61 years [mean, 41 years]) were enrolled in this study. The addition of CIONM in VANS prolonged the operation's duration by approximately 30 minutes as the endoscopic surgery was technically more difficult. No intra- and postoperative incidence of transient or permanent RLN palsy was observed in any patient, except for three patients who underwent external neck incision surgery in whom combined resection was unavoidable due to tumor invasion of the RLN.
We reported the first successful application of CIONM during thyroidectomy using VANS. Future clinical trials should clarify the benefits of CIONM when compared to intermittent IONM in VANS.
喉返神经（RLN）损伤是甲状腺手术中的严重并发症之一。因此，术中神经监测（IONM）已被广泛用于识别喉返神经并确认其完整性。最近，有报道称在甲状腺手术中对迷走神经进行自动、定期刺激的连续IONM（CIONM）的有效性。本研究旨在报告我们首次成功应用CIONM的微创视频辅助内镜颈部内分泌手术（VANS）的经验。
回顾性分析2017年7月至2019年6月期间在我科接受使用CIONM的甲状腺手术的连续患者，这些手术采用颈部外切口手术或VANS进行。
本研究共纳入22例接受甲状腺手术的患者，其中颈部切口手术14例（7例男性和7例女性；年龄21 - 75岁[平均52岁]），VANS手术8例（8例女性，年龄20 - 61岁[平均41岁]）。由于内镜手术技术难度较大，在VANS中增加CIONM使手术时间延长了约30分钟。除3例行颈部外切口手术的患者因肿瘤侵犯喉返神经而不可避免地进行联合切除外，任何患者均未观察到术中及术后出现短暂或永久性喉返神经麻痹。
我们报告了在使用VANS进行甲状腺切除术中首次成功应用CIONM。未来的临床试验应阐明与VANS中间歇性IONM相比CIONM的益处。
5级。
