Intraoperative neuromonitoring for the early detection and prevention of RLN traction injury in thyroid surgery

A porcine model

Che Wei Wu, Gianlorenzo Dionigi, Hui Sun, Xiaoli Liu, Hoon Yub Kim, Pi Jung Hsiao, Kuo Bow Tsai, Hui Chun Chen, Hsiu Ya Chen, Pi Ying Chang, I. Cheng Lu, Feng Yu Chiang

Research output: Contribution to journalArticle

53 Citations (Scopus)

Abstract

Background Operative traction of the thyroid lobe is a necessary component of thyroid surgery. This surgical maneuver can cause traction injury of the recurrent laryngeal nerve (RLN), and this complication has been reported to be the most common mechanism of nerve injury. The goal of this study was to investigate the electromyographic (EMG) signal pattern during an acute RLN traction injury and establish reliable strategies to prevent the injury using intraoperative neuromonitoring (IONM). Methods Fifteen piglets (30 RLNs) underwent IONM via automated periodic vagal nerve stimulation and had their EMG tracings recorded and correlated with various models of nerve injury. Results In the pilot study, a progressive, partial EMG loss was observed under RLN tractions with different tension (n = 8). The changes in amplitudes were more marked and consistent than were the changes in latency. The EMG gradually gained partial recovery after the traction was relieved. Among the nerves injured with electrothermal (n = 4), clamping (n = 1), and transection (n = 1) models, the EMG showed immediate partial or complete loss, and no gradual EMG recovery was observed. Another 16 RLNs were used to investigate the potential of EMG recovery after different extents of RLN traction. We noted the EMG showed nearly full recovery if the traction stress was relieved before the loss of signal (LOS), but the recovery was worse if prolonged or repeated traction was applied. The mean restored amplitudes after the traction was relieved before, during, and after the LOS were 98 ± 3% (n = 6), 36 ± 4% (n = 4), and 15 ± 2% (n = 6), respectively. Conclusion RLN traction injury showed graded, partial EMG changes; early release of the traction before the EMG has degraded to LOS offers a good chance of EMG recovery. IONM can be used as a tool for the early detection of adverse EMG changes that may alert surgeons to correct certain maneuvers immediately to prevent irreversible nerve injury during the thyroid operation.

Original languageEnglish
Pages (from-to)329-339
Number of pages11
JournalSurgery (United States)
Volume155
Issue number2
DOIs
Publication statusPublished - 2014 Feb 1

Fingerprint

Recurrent Laryngeal Nerve Injuries
Traction
Thyroid Gland
Swine
Recurrent Laryngeal Nerve
Wounds and Injuries
Vagus Nerve Stimulation
Constriction

ASJC Scopus subject areas

  • Surgery

Cite this

Intraoperative neuromonitoring for the early detection and prevention of RLN traction injury in thyroid surgery : A porcine model. / Wu, Che Wei; Dionigi, Gianlorenzo; Sun, Hui; Liu, Xiaoli; Kim, Hoon Yub; Hsiao, Pi Jung; Tsai, Kuo Bow; Chen, Hui Chun; Chen, Hsiu Ya; Chang, Pi Ying; Lu, I. Cheng; Chiang, Feng Yu.

In: Surgery (United States), Vol. 155, No. 2, 01.02.2014, p. 329-339.

Research output: Contribution to journalArticle

Wu, CW, Dionigi, G, Sun, H, Liu, X, Kim, HY, Hsiao, PJ, Tsai, KB, Chen, HC, Chen, HY, Chang, PY, Lu, IC & Chiang, FY 2014, 'Intraoperative neuromonitoring for the early detection and prevention of RLN traction injury in thyroid surgery: A porcine model', Surgery (United States), vol. 155, no. 2, pp. 329-339. https://doi.org/10.1016/j.surg.2013.08.015
Wu, Che Wei ; Dionigi, Gianlorenzo ; Sun, Hui ; Liu, Xiaoli ; Kim, Hoon Yub ; Hsiao, Pi Jung ; Tsai, Kuo Bow ; Chen, Hui Chun ; Chen, Hsiu Ya ; Chang, Pi Ying ; Lu, I. Cheng ; Chiang, Feng Yu. / Intraoperative neuromonitoring for the early detection and prevention of RLN traction injury in thyroid surgery : A porcine model. In: Surgery (United States). 2014 ; Vol. 155, No. 2. pp. 329-339.
@article{de6c73c5c1e14301bc831c2f943d6036,
title = "Intraoperative neuromonitoring for the early detection and prevention of RLN traction injury in thyroid surgery: A porcine model",
abstract = "Background Operative traction of the thyroid lobe is a necessary component of thyroid surgery. This surgical maneuver can cause traction injury of the recurrent laryngeal nerve (RLN), and this complication has been reported to be the most common mechanism of nerve injury. The goal of this study was to investigate the electromyographic (EMG) signal pattern during an acute RLN traction injury and establish reliable strategies to prevent the injury using intraoperative neuromonitoring (IONM). Methods Fifteen piglets (30 RLNs) underwent IONM via automated periodic vagal nerve stimulation and had their EMG tracings recorded and correlated with various models of nerve injury. Results In the pilot study, a progressive, partial EMG loss was observed under RLN tractions with different tension (n = 8). The changes in amplitudes were more marked and consistent than were the changes in latency. The EMG gradually gained partial recovery after the traction was relieved. Among the nerves injured with electrothermal (n = 4), clamping (n = 1), and transection (n = 1) models, the EMG showed immediate partial or complete loss, and no gradual EMG recovery was observed. Another 16 RLNs were used to investigate the potential of EMG recovery after different extents of RLN traction. We noted the EMG showed nearly full recovery if the traction stress was relieved before the loss of signal (LOS), but the recovery was worse if prolonged or repeated traction was applied. The mean restored amplitudes after the traction was relieved before, during, and after the LOS were 98 ± 3{\%} (n = 6), 36 ± 4{\%} (n = 4), and 15 ± 2{\%} (n = 6), respectively. Conclusion RLN traction injury showed graded, partial EMG changes; early release of the traction before the EMG has degraded to LOS offers a good chance of EMG recovery. IONM can be used as a tool for the early detection of adverse EMG changes that may alert surgeons to correct certain maneuvers immediately to prevent irreversible nerve injury during the thyroid operation.",
author = "Wu, {Che Wei} and Gianlorenzo Dionigi and Hui Sun and Xiaoli Liu and Kim, {Hoon Yub} and Hsiao, {Pi Jung} and Tsai, {Kuo Bow} and Chen, {Hui Chun} and Chen, {Hsiu Ya} and Chang, {Pi Ying} and Lu, {I. Cheng} and Chiang, {Feng Yu}",
year = "2014",
month = "2",
day = "1",
doi = "10.1016/j.surg.2013.08.015",
language = "English",
volume = "155",
pages = "329--339",
journal = "Surgery",
issn = "0039-6060",
publisher = "Mosby Inc.",
number = "2",

}

TY - JOUR

T1 - Intraoperative neuromonitoring for the early detection and prevention of RLN traction injury in thyroid surgery

T2 - A porcine model

AU - Wu, Che Wei

AU - Dionigi, Gianlorenzo

AU - Sun, Hui

AU - Liu, Xiaoli

AU - Kim, Hoon Yub

AU - Hsiao, Pi Jung

AU - Tsai, Kuo Bow

AU - Chen, Hui Chun

AU - Chen, Hsiu Ya

AU - Chang, Pi Ying

AU - Lu, I. Cheng

AU - Chiang, Feng Yu

PY - 2014/2/1

Y1 - 2014/2/1

N2 - Background Operative traction of the thyroid lobe is a necessary component of thyroid surgery. This surgical maneuver can cause traction injury of the recurrent laryngeal nerve (RLN), and this complication has been reported to be the most common mechanism of nerve injury. The goal of this study was to investigate the electromyographic (EMG) signal pattern during an acute RLN traction injury and establish reliable strategies to prevent the injury using intraoperative neuromonitoring (IONM). Methods Fifteen piglets (30 RLNs) underwent IONM via automated periodic vagal nerve stimulation and had their EMG tracings recorded and correlated with various models of nerve injury. Results In the pilot study, a progressive, partial EMG loss was observed under RLN tractions with different tension (n = 8). The changes in amplitudes were more marked and consistent than were the changes in latency. The EMG gradually gained partial recovery after the traction was relieved. Among the nerves injured with electrothermal (n = 4), clamping (n = 1), and transection (n = 1) models, the EMG showed immediate partial or complete loss, and no gradual EMG recovery was observed. Another 16 RLNs were used to investigate the potential of EMG recovery after different extents of RLN traction. We noted the EMG showed nearly full recovery if the traction stress was relieved before the loss of signal (LOS), but the recovery was worse if prolonged or repeated traction was applied. The mean restored amplitudes after the traction was relieved before, during, and after the LOS were 98 ± 3% (n = 6), 36 ± 4% (n = 4), and 15 ± 2% (n = 6), respectively. Conclusion RLN traction injury showed graded, partial EMG changes; early release of the traction before the EMG has degraded to LOS offers a good chance of EMG recovery. IONM can be used as a tool for the early detection of adverse EMG changes that may alert surgeons to correct certain maneuvers immediately to prevent irreversible nerve injury during the thyroid operation.

AB - Background Operative traction of the thyroid lobe is a necessary component of thyroid surgery. This surgical maneuver can cause traction injury of the recurrent laryngeal nerve (RLN), and this complication has been reported to be the most common mechanism of nerve injury. The goal of this study was to investigate the electromyographic (EMG) signal pattern during an acute RLN traction injury and establish reliable strategies to prevent the injury using intraoperative neuromonitoring (IONM). Methods Fifteen piglets (30 RLNs) underwent IONM via automated periodic vagal nerve stimulation and had their EMG tracings recorded and correlated with various models of nerve injury. Results In the pilot study, a progressive, partial EMG loss was observed under RLN tractions with different tension (n = 8). The changes in amplitudes were more marked and consistent than were the changes in latency. The EMG gradually gained partial recovery after the traction was relieved. Among the nerves injured with electrothermal (n = 4), clamping (n = 1), and transection (n = 1) models, the EMG showed immediate partial or complete loss, and no gradual EMG recovery was observed. Another 16 RLNs were used to investigate the potential of EMG recovery after different extents of RLN traction. We noted the EMG showed nearly full recovery if the traction stress was relieved before the loss of signal (LOS), but the recovery was worse if prolonged or repeated traction was applied. The mean restored amplitudes after the traction was relieved before, during, and after the LOS were 98 ± 3% (n = 6), 36 ± 4% (n = 4), and 15 ± 2% (n = 6), respectively. Conclusion RLN traction injury showed graded, partial EMG changes; early release of the traction before the EMG has degraded to LOS offers a good chance of EMG recovery. IONM can be used as a tool for the early detection of adverse EMG changes that may alert surgeons to correct certain maneuvers immediately to prevent irreversible nerve injury during the thyroid operation.

UR - http://www.scopus.com/inward/record.url?scp=84892599938&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84892599938&partnerID=8YFLogxK

U2 - 10.1016/j.surg.2013.08.015

DO - 10.1016/j.surg.2013.08.015

M3 - Article

VL - 155

SP - 329

EP - 339

JO - Surgery

JF - Surgery

SN - 0039-6060

IS - 2

ER -