Abstract
We have done almost 1000 thryoidectomies and parathryoidectomies during the last three years, monitoring 2000 RLN, multiple methods we used during the monitoring to ensure the integrity of the RLN. Monitoring EMG activity, MEP with transcraneal stimulation, transcutaneus vagus stimulation, on the neck and direct recurrent nerve stimulation by the surgeon using a laryngeal electrode placed in the endotracheal tube. In our experience the best method, to ensure RLN safety; is direct observation of EMG activity. In all the cases there was an increase of EMG activity (double or triple amplitude) when the surgeon was nearby the nerves, including superior laryngeal nerve (SLN), or pulling the thryroid gland, so warning the surgeon and stopping the dissection for a while or changing the field, lead to stop or decrease the EMG activity. Stimulation of the RLN, SLN or vagus nerve confirms the integrity of the nerve or the suffering to stop or delay surgery. A latency delay in RLN response was seen sometimes, directly relationated to RLN compromise. In none of our cases a nerve lesion was seen, so we can say our method is working well, better than only RLN identification by stimulation or direct surgeon identification, so we think our experience can improve RLN monitoring, also superior laryngeal nerve, leading to a superior control of the nerves in this type of surgery always controversy about the effectiveness of monitoring recurrent laryngeal nerves.
Published Version
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