Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University Hospital G. Martino, University of Messina, Messina, Italy.
Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Surg Technol Int. 2021 May 20;38:145-150. doi: 10.52198/21.STI.38.OS1442.
Due to the direct anatomical relationship between the recurrent laryngeal nerve (RLN) and the thyroid gland, the function and anatomical integrity of the RLN is fundamentally at risk in every thyroid operation. While a RLN morbidity rate of less than 5% is achieved in specialized clinics, the morbidity rates are significantly higher in non-specialized centers. Thus, the aim is to reduce the complication rate by establishing standardized interventions. Exact knowledge of the anatomical course of the RLN, the nerve-sparing dissection technique and the supportive use of intraoperative neuro-monitoring (IONM) to identify anatomical variations are the basis for nerve-sparing surgery. We tested the new C2 Xplore® system (inomed Medizintechnik GmbH, Emmendingen, Germany) as a tool for performing intermittent and continuous laryngeal nerve monitoring during thyroid surgery. The C2 Xplore® helps to enhance surgeon-IONM interaction, and provides comprehensive digital EMG documentation with EMG quantification. EMG artifacts are removed. Image quality and EMG feedback are highly acceptable for intraoperative monitoring. The C2 Xplore® system does not have a deleterious impact on the proper function of other surgical instruments. C2 Xplore® is effective for intraoperative monitoring, optimizing RLN dissection, and supporting surgical deliberations, and for forensic use and research. A step-by-step C2 Xplore® procedure is described.
由于喉返神经（RLN）与甲状腺之间存在直接的解剖关系，因此在每一次甲状腺手术中，RLN 的功能和解剖完整性都存在根本风险。虽然在专业诊所中，RLN 的发病率低于 5%，但在非专业中心，发病率要高得多。因此，目标是通过建立标准化干预措施来降低并发症的发生率。确切了解 RLN 的解剖路径、神经保护的解剖技术以及术中神经监测（IONM）的支持性使用以识别解剖变异是神经保护手术的基础。我们测试了新的 C2 Xplore®系统（inomed Medizintechnik GmbH，德国埃门丁根）作为在甲状腺手术中进行间歇性和连续性喉返神经监测的工具。C2 Xplore®有助于增强外科医生与 IONM 的互动，并提供具有 EMG 量化功能的全面数字 EMG 记录。去除 EMG 伪影。图像质量和 EMG 反馈对于术中监测非常令人满意。C2 Xplore®系统不会对其他手术器械的正常功能产生不利影响。C2 Xplore®系统可有效用于术中监测，优化 RLN 解剖，并支持手术决策，以及用于法医使用和研究。描述了一个逐步的 C2 Xplore®程序。
