Division of General Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Rd, Zuoying District, Kaohsiung, 813414, Taiwan.
School of Medicine, National Yang Ming Chiao Tung University, No.155, Sec.2, Linong Street, Taipei, 112304, Taiwan.
Surg Endosc. 2023 Oct;37(10):7486-7492. doi: 10.1007/s00464-023-10244-1. Epub 2023 Jul 5.
The use of intraoperative neuromonitoring (IONM) during endoscopic thyroidectomy has not been fully explored, with limited studies focusing solely on the recurrent laryngeal nerve (RLN) and neglecting the external branch of the superior laryngeal nerve (EBSLN). This study aimed to compare the effectiveness of IONM in two endoscopic thyroidectomy techniques, namely the transoral and bilateral axillo-breast approach (BABA).
We retrospectively reviewed patients who underwent endoscopic thyroidectomy with IONM and compared the outcomes between those who underwent different surgical techniques (transoral or BABA). We recorded the detection method and identification rate of the EBSLN and RLN, along with the amplitude and latency of the evoked potential.
We monitored 98 nerves at risk (NAR) from 74 patients (60 and 38 in the transoral and BABA groups, respectively). Almost all EBSLNs were identified using electromyography (EMG) signals and/or cricothyroid muscle twitches, except for one patient in the transoral group who developed EBSLN palsy. Patients in the transoral group were more likely to have the sternothyroid muscle divided (75.0% vs. 15.8%, p < 0.001) and had a lower rate of visual recognition of the EBSLN fibers (10.0% vs. 31.6%, p = 0.007) than did those in the BABA group. All RLNs were identified in both groups; however, patients in the BABA group had a relatively higher rate of post-dissection amplitude reduction > 50% (15.8% vs. 5.0%, p = 0.072), and one patient had transient RLN palsy.
Both the EBSLN and RLN could be adequately identified and monitored during endoscopic transoral and BABA thyroidectomies using IONM.
术中神经监测（IONM）在经内镜甲状腺手术中的应用尚未得到充分探索，仅有有限的研究仅关注于喉返神经（RLN），而忽略了喉上神经外支（EBSLN）。本研究旨在比较两种经内镜甲状腺手术技术（经口和双侧腋窝-乳晕入路[BABA]）中 IONM 的效果。
我们回顾性分析了接受 IONM 辅助经内镜甲状腺切除术的患者，并比较了不同手术技术（经口或 BABA）患者的结果。我们记录了 EBSLN 和 RLN 的检测方法和识别率，以及诱发电位的振幅和潜伏期。
我们监测了 74 例患者的 98 条风险神经（NAR）（经口组 60 例，BABA 组 38 例）。除了一名经口组患者发生 EBSLN 麻痹外，几乎所有 EBSLN 均通过肌电图（EMG）信号和/或环甲肌抽搐来识别。经口组患者更有可能被切开胸骨甲状肌（75.0% vs. 15.8%，p < 0.001），且 EBSLN 纤维的肉眼识别率较低（10.0% vs. 31.6%，p = 0.007）。两组患者的所有 RLN 均被识别；然而，BABA 组患者在解剖后振幅降低>50%的比例相对较高（15.8% vs. 5.0%，p = 0.072），且有 1 例患者发生一过性 RLN 麻痹。
IONM 可在经内镜经口和 BABA 甲状腺切除术中充分识别和监测 EBSLN 和 RLN。
