Control of the Functionality of the Brachial Plexus during Robot-Assisted Transaxillary Thyroid Surgery

Abstract

At present, such a type of endoscopic surgery as robot-assisted transaxillary thyroidectomy has become available. In this case, traumatization of the brachial plexus is a rare but possible complication. For the control of the function of the brachial plexus during the above operation we used monitoring of somatosensory evoked potentials (SSEPs) induced by stimulation of the median nerve. Fifteen patients (14 women and one man) were included in this study. All interventions were robot-assisted transaxillary thyroidectomies using the daVinci SI Surgical System. We found that such surgery induced mild but significant increases in the latency of the cortical N20 potential, especially when the tissue was tensioned by the autostatic retractor. The latency prolongation was a valuable signal given to the surgeon, followed by repositioning or loosening of the retractor. In the examined group, no significant decreases in the amplitude of the N20 potential were observed. We conclude that SSEP monitoring during robotic thyroid surgery is an available and safe method providing valuable information on the functional integrity of somatosensory pathways during surgical maneuvers.