Korean Journal of Head & Neck Oncology (대한두경부종양학회지)

The Korean Society for Head and Neck Oncology (대한두경부종양학회)
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Effectiveness of Intraoperative Neuromonitoring According to the Mechanism of Recurrent Laryngeal Nerve Injury During Thyroid Surgery

갑상선 수술 중 반회후두신경의 손상 기전에 따른 신경 감시술의 효용성

  • Shin, Sung-Chan (Department of Otorhinolaryngology, Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University and Biomedical Research Institute, Pusan National University Hospital) ;
  • Lee, Byung-Joo (Department of Otorhinolaryngology, Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University and Biomedical Research Institute, Pusan National University Hospital)
  • 신성찬 (부산대학교 의학전문대학원 이비인후과학교실) ;
  • 이병주 (부산대학교 의학전문대학원 이비인후과학교실)
  • Received : 2020.05.03
  • Accepted : 2020.05.10
  • Published : 2020.05.31
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Abstract

Visual identification of recurrent laryngeal nerve (RLN) is considered as a gold standard of RLN preservation during thyroid surgery. Intraoperative neuromonitoring (IONM) is classified into the intermittent type and continuous type and helps surgeons identify the functional integrity of RLN and predict the postoperative vocal cord function. RLN injury during thyroid surgery is associated with tumor factors and surgeon factors. Tumor factors mean such as direct tumor invasion, adhesion of RLN to the tumor, and compression by a large thyroid tumor. Surgeon factors include nerve transection, stretching, thermal injury, and ligation injury. A recent meta-analysis reported that the IONM could reduce the RLN injury. Considering various nerve injury mechanism, we suggest that using both I-ONM and C-IONM together is more effective method in preventing nerve damage than using I-IONM alone.

Keywords

References

  1. Randolph GW, Dralle H, International Intraoperative Monitoring Study G, Abdullah H, Barczynski M, Bellantone R, et al. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Laryngoscope. 2011;121 Suppl 1:S1-16. https://doi.org/10.1002/lary.21119
  2. Chiang FY, Wang LF, Huang YF, Lee KW, Kuo WR. Recurrent laryngeal nerve palsy after thyroidectomy with routine identification of the recurrent laryngeal nerve. Surgery 2005;137(3):342-7. https://doi.org/10.1016/j.surg.2004.09.008
  3. Bai B, Chen W. Protective Effects of Intraoperative Nerve Monitoring (IONM) for Recurrent Laryngeal Nerve Injury in Thyroidectomy: Meta-analysis. Sci Rep. 2018;8:7761. https://doi.org/10.1038/s41598-018-26219-5
  4. Shin SC, Lee BJ. Utility of intraoperative neuromonitoring in thyroid surgery. J Clinical Otolaryngol 2018;29:157-161.
  5. Dralle H, Sekulla C, Lorenz K, Brauckhoff M, Machens A, German ISG. Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery. World J Surg. 2008;32:1358-1366. https://doi.org/10.1007/s00268-008-9483-2
  6. Almquist M, Thier M, Salem F. Cardiac arrest with vagal stimulation during intraoperative nerve monitoring. Head Neck. 2016;38:E2419-E2420. https://doi.org/10.1002/hed.24358
  7. Dionigi G, Kim HY, Wu CW, Lavazza M, Ferrari C, Leotta A, et al. Vagus nerve stimulation for standardized monitoring: technical notes for conventional and endoscopic thyroidectomy. Surg Technol Int 2013;23:95-103.
  8. Dionigi G, Kim HY, Wu CW, Lavazza M, Materazzi G, Lombardi CP, et al. Neuromonitoring in endoscopic and robotic thyroidectomy. Updates Surg. 2017;69:171-179. https://doi.org/10.1007/s13304-017-0442-z
  9. Schneider R, Machens A, Lorenz K, Dralle H. Intraoperative nerve monitoring in thyroid surgery-shifting current paradigms. Gland Surg. 2020;9:S120-S128. https://doi.org/10.21037/gs.2019.11.04
  10. Myssiorek D. Recurrent laryngeal nerve paralysis: anatomy and etiology. Otolaryngologic Clinics of North America. 2004;37:25-44. https://doi.org/10.1016/S0030-6665(03)00172-5
  11. Wu CW, Dionigi G, Sun H, Liu X, Kim HY, Hsiao PJ, et al. Intraoperative neuromonitoring for the early detection and prevention of RLN traction injury in thyroid surgery: a porcine model. Surgery. 2014;155:329-339. https://doi.org/10.1016/j.surg.2013.08.015
  12. Brauckhoff K, Aas T, Biermann M, Husby P. EMG changes during continuous intraoperative neuromonitoring with sustained recurrent laryngeal nerve traction in a porcine model. Langenbecks Arch Surg. 2017;402:675-681. https://doi.org/10.1007/s00423-016-1419-y
  13. Dionigi G, Wu CW, Kim HY, Rausei S, Boni L, Chiang FY. Severity of Recurrent Laryngeal Nerve Injuries in Thyroid Surgery. World J Surg. 2016;40:1373-1381. https://doi.org/10.1007/s00268-016-3415-3
  14. Schneider R, Sekulla C, Machens A, Lorenz K, Nguyen Thanh P, Dralle H. Postoperative vocal fold palsy in patients undergoing thyroid surgery with continuous or intermittent nerve monitoring. Br J Surg. 2015;102:1380-1387. https://doi.org/10.1002/bjs.9889
  15. Chiang FY, Lu IC, Chang PY, Sun H, Wang P, Lu XB, et al. Stimulating dissecting instruments during neuromonitoring of RLN in thyroid surgery. Laryngoscope 2015;125(12):2832-2837. https://doi.org/10.1002/lary.25251
  16. Sung ES, Lee JC, Shin SC, Choi SW, Jung DW, Lee BJ. Development of a Novel Detachable Magnetic Nerve Stimulator for Intraoperative Neuromonitoring. World J Surg. 2018;42:137-142. https://doi.org/10.1007/s00268-017-4159-4
  17. Brauckhoff K, Svendsen OS, Stangeland L, Biermann M, Aas T, Husby PJA. Injury mechanisms and electromyographic changes after injury of the recurrent laryngeal nerve: Experiments in a porcine model. Head Neck. 2018;40:274-282. https://doi.org/10.1002/hed.24940
  18. Dionigi G, Chiang FY, Kim HY, Randolph GW, Mangano A, Chang PY, et al. Safety of LigaSure in recurrent laryngeal nerve dissection-porcine model using continuous monitoring. Laryngoscope. 2017;127:1724-1729. https://doi.org/10.1002/lary.26271
  19. Wu CW, Chai YJ, Dionigi G, Chiang FY, Liu X, Sun H, et al. Recurrent laryngeal nerve safety parameters of the Harmonic Focus during thyroid surgery: Porcine model using continuous monitoring. Laryngoscope. 2015;125:2838-2845. https://doi.org/10.1002/lary.25412
  20. Lee SH, Nguyen TK, Ong WS, Haaland B, Tay GC, Tan NC, et al. Comparing the Utility and Surgical Outcomes of Harmonic Focus Ultrasonic Scalpel with Ligasure Small Jaw Bipolar Device in Thyroidectomies: A Prospective Randomized Controlled Trial. Ann Surg Oncol. 2019;26:4414-4422. https://doi.org/10.1245/s10434-019-07806-w
  21. Ban MJ, Chang EHE, Lee DY, Park JH, Lee C, Kim DH, et al. Analysis of neuromonitoring signal loss during retroauricular versus conventional thyroidectomy. Laryngoscope. 2019;129:2199-2204. https://doi.org/10.1002/lary.27749
  22. Kwak HY, Dionigi G, Kim D, Lee HY, Son GS, Lee JB, et al. Thermal injury of the recurrent laryngeal nerve by THUNDERBEAT during thyroid surgery: findings from continuous intraoperative neuromonitoring in a porcine model. J Surg Res 2016;200(1):177-182. https://doi.org/10.1016/j.jss.2015.06.066
  23. Shin SC, Sung ES, Choi SW, Kim SD, Jung DW, Kim SH, et al. Feasibility and safety of nerve stimulator attachment to energy-based devices: A porcine model study. Int J Surg. 2017;48:155-159. https://doi.org/10.1016/j.ijsu.2017.10.071
  24. Thomusch O, Machens A, Sekulla C, Ukkat J, Lippert H, Gastinger I, et al. Multivariate analysis of risk factors for postoperative complications in benign goiter surgery: prospective multicenter study in Germany. World J Surg. 2000;24:1335-1341. https://doi.org/10.1007/s002680010221
  25. Snyder SK, Lairmore TC, Hendricks JC, Roberts JW. Elucidating mechanisms of recurrent laryngeal nerve injury during thyroidectomy and parathyroidectomy. J Am Coll Surg. 2008;206:123-130. https://doi.org/10.1016/j.jamcollsurg.2007.07.017
  26. Wojtczak B, Sutkowski K, Kaliszewski K, Barczynski M, Bolanowski M. Thyroid reoperation using intraoperative neuromonitoring. Endocrine. 2017;58:458-466. https://doi.org/10.1007/s12020-017-1443-x
  27. Sung ES, Lee JC, Kim SH, Shin SC, Jung DW, Lee BJ. Development of an Attachable Endoscopic Nerve Stimulator for Intraoperative Neuromonitoring during Endoscopic or Robotic Thyroidectomy. Otolaryngol Head Neck Surg. 2018;158:465-468. https://doi.org/10.1177/0194599817742841
  28. Sapalidis K, Papanastasiou A, Fyntanidou V, Aidoni Z, Michalopoulos N, Katsaounis A, et al. Comparison between Magnification Techniques and Direct Vision in Thyroid Surgery: A Systematic Review and Meta-Analysis. Medicina (Kaunas). 2019;55:725-732 https://doi.org/10.3390/medicina55110725