Application of intraoperative neuromonitoring during endoscopic thyroidectomy via breast approach

Abstract

Objective To explore the technique and significance of intraoperative neuromonitoring (IONM) for scarless in the neck endoscopic thyroidectomy (SET) via breast approach. Methods From Apr. 2015 to Oct. 2015, 101 consecutive patients undergoing SET with IONM were included. During the operation, patients received radical resection of the thyroid cancer by Wang’s seven-step method. The lymph nodes in the central area were dissected and Wang’s multi-functional separation forceps were implemented for recurrent laryngeal nerve (RLN) positioning, monitoring and protection. Also, time required for RLN positioning and exposure, postoperative transient and permanent RLN damage incidence were calculated to assess the feasibility of IONM under SET. Results Among 101 patients, 130 RLNs in total were exposed. The average time required for RLN positioning under IONM was (3.26 ± 1.08) min, with round-nerve management time of (13.95 ± 4.58) min. Nerve signal change happened in 16.9% (22/130) patients. Positive predictive value was 13.6% and negative predictive value was 100%. The overall accuracy rate was 85.4%. Conclusion IONM during SET is feasible, and can be helpful for the localization and functional protection of RLN and was useful to predict vocal cord paralysis. Key words: Breast approach; Endoscopic thyroidectomy; Intraoperative neuromonitoring; Recurrent laryngeal nerve; Multi-functional separation forceps