Stimulating dissecting instruments during neuromonitoring of RLN in thyroid surgery

Feng Yu Chiang, I. Cheng Lu, Pi Ying Chang, Hui Sun, Ping Wang, Xiu Bo Lu, Hui Chun Chen, Hsiu Ya Chen, Hoon Yub Kim, Gianlorenzo Dionigi, Che Wei Wu

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Objectives/Hypothesis During intraoperative neuromonitoring (IONM) of recurrent laryngeal nerve (RLN) in thyroid surgery, the need for frequent shifting between the dissecting instruments and stimulating probe is troublesome and time-consuming. Therefore, use of these two instruments in combination would be a noticeable future direction. This study aimed to investigate the feasibility and safety of using stimulating dissecting instruments (SDIs) that combine the function of surgical dissection and nerve stimulation during IONM. Study Design Prospective outcomes research. Methods One hundred consecutive patients with 168 RLNs at risk were enrolled. We developed prototypes of SDIs and applied them to early detect adverse EMG changes during the risky phase of RLN dissection. In the case of substantial EMG change (amplitude decrease > 50%) during dissection, the surgical maneuver was paused and thyroid traction was released immediately. Results The application of SDIs was feasible in all cases and did not result in any morbidity. Nineteen RLNs were detected with substantial EMG change that was caused by traction stress during dissection with SDIs and that featured progressive gradual EMG recovery after releasing thyroid traction. After thyroid resection, 10 RLNs had a weak point of nerve conduction detected at region of Berry's ligament, but only one nerve with 79% amplitude reduction developed postoperative temporary vocal palsy. Conclusion The application of SDIs is a simple and effective way to monitor the nerve's function instantly during the risky phase of RLN injury in thyroid surgery. It provides surgeons with real-time feedback of EMG response and can be applied as a tool for the early detection of adverse EMG change caused by traction distress. Level of Evidence 4. Laryngoscope, 125:2832-2837, 2015

Original languageEnglish
Pages (from-to)2832-2837
Number of pages6
JournalLaryngoscope
Volume125
Issue number12
DOIs
Publication statusPublished - 2015 Dec 1

Fingerprint

Recurrent Laryngeal Nerve
Traction
Thyroid Gland
Dissection
Recurrent Laryngeal Nerve Injuries
Laryngoscopes
Neural Conduction
Ligaments
Paralysis
Fruit
Outcome Assessment (Health Care)
Prospective Studies
Morbidity
Safety

Keywords

  • electromyography
  • intraoperative neuromonitoring
  • recurrent laryngeal nerve
  • stimulating dissecting instruments
  • thyroid surgery

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Chiang, F. Y., Lu, I. C., Chang, P. Y., Sun, H., Wang, P., Lu, X. B., ... Wu, C. W. (2015). Stimulating dissecting instruments during neuromonitoring of RLN in thyroid surgery. Laryngoscope, 125(12), 2832-2837. https://doi.org/10.1002/lary.25251

Stimulating dissecting instruments during neuromonitoring of RLN in thyroid surgery. / Chiang, Feng Yu; Lu, I. Cheng; Chang, Pi Ying; Sun, Hui; Wang, Ping; Lu, Xiu Bo; Chen, Hui Chun; Chen, Hsiu Ya; Kim, Hoon Yub; Dionigi, Gianlorenzo; Wu, Che Wei.

In: Laryngoscope, Vol. 125, No. 12, 01.12.2015, p. 2832-2837.

Research output: Contribution to journalArticle

Chiang, FY, Lu, IC, Chang, PY, Sun, H, Wang, P, Lu, XB, Chen, HC, Chen, HY, Kim, HY, Dionigi, G & Wu, CW 2015, 'Stimulating dissecting instruments during neuromonitoring of RLN in thyroid surgery', Laryngoscope, vol. 125, no. 12, pp. 2832-2837. https://doi.org/10.1002/lary.25251
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 Dec 1;125(12):2832-2837. https://doi.org/10.1002/lary.25251
Chiang, Feng Yu ; Lu, I. Cheng ; Chang, Pi Ying ; Sun, Hui ; Wang, Ping ; Lu, Xiu Bo ; Chen, Hui Chun ; Chen, Hsiu Ya ; Kim, Hoon Yub ; Dionigi, Gianlorenzo ; Wu, Che Wei. / Stimulating dissecting instruments during neuromonitoring of RLN in thyroid surgery. In: Laryngoscope. 2015 ; Vol. 125, No. 12. pp. 2832-2837.
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abstract = "Objectives/Hypothesis During intraoperative neuromonitoring (IONM) of recurrent laryngeal nerve (RLN) in thyroid surgery, the need for frequent shifting between the dissecting instruments and stimulating probe is troublesome and time-consuming. Therefore, use of these two instruments in combination would be a noticeable future direction. This study aimed to investigate the feasibility and safety of using stimulating dissecting instruments (SDIs) that combine the function of surgical dissection and nerve stimulation during IONM. Study Design Prospective outcomes research. Methods One hundred consecutive patients with 168 RLNs at risk were enrolled. We developed prototypes of SDIs and applied them to early detect adverse EMG changes during the risky phase of RLN dissection. In the case of substantial EMG change (amplitude decrease > 50{\%}) during dissection, the surgical maneuver was paused and thyroid traction was released immediately. Results The application of SDIs was feasible in all cases and did not result in any morbidity. Nineteen RLNs were detected with substantial EMG change that was caused by traction stress during dissection with SDIs and that featured progressive gradual EMG recovery after releasing thyroid traction. After thyroid resection, 10 RLNs had a weak point of nerve conduction detected at region of Berry's ligament, but only one nerve with 79{\%} amplitude reduction developed postoperative temporary vocal palsy. Conclusion The application of SDIs is a simple and effective way to monitor the nerve's function instantly during the risky phase of RLN injury in thyroid surgery. It provides surgeons with real-time feedback of EMG response and can be applied as a tool for the early detection of adverse EMG change caused by traction distress. Level of Evidence 4. Laryngoscope, 125:2832-2837, 2015",
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N2 - Objectives/Hypothesis During intraoperative neuromonitoring (IONM) of recurrent laryngeal nerve (RLN) in thyroid surgery, the need for frequent shifting between the dissecting instruments and stimulating probe is troublesome and time-consuming. Therefore, use of these two instruments in combination would be a noticeable future direction. This study aimed to investigate the feasibility and safety of using stimulating dissecting instruments (SDIs) that combine the function of surgical dissection and nerve stimulation during IONM. Study Design Prospective outcomes research. Methods One hundred consecutive patients with 168 RLNs at risk were enrolled. We developed prototypes of SDIs and applied them to early detect adverse EMG changes during the risky phase of RLN dissection. In the case of substantial EMG change (amplitude decrease > 50%) during dissection, the surgical maneuver was paused and thyroid traction was released immediately. Results The application of SDIs was feasible in all cases and did not result in any morbidity. Nineteen RLNs were detected with substantial EMG change that was caused by traction stress during dissection with SDIs and that featured progressive gradual EMG recovery after releasing thyroid traction. After thyroid resection, 10 RLNs had a weak point of nerve conduction detected at region of Berry's ligament, but only one nerve with 79% amplitude reduction developed postoperative temporary vocal palsy. Conclusion The application of SDIs is a simple and effective way to monitor the nerve's function instantly during the risky phase of RLN injury in thyroid surgery. It provides surgeons with real-time feedback of EMG response and can be applied as a tool for the early detection of adverse EMG change caused by traction distress. Level of Evidence 4. Laryngoscope, 125:2832-2837, 2015

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