Abstract
Objective. Our goal is to study the feasibility of using intraoperative neuromonitoring (IONM) in minimally invasive video-assisted thyroidectomy and parathyroidectomy (MIVAT/P) with emphasis given to the identification of recurrent laryngeal nerve (RLN). Methods. Consecutive series of forty-seven patients with seventy-seven recurrent laryngeal nerves at risk undergoing both MIVAT/P and IONM were enrolled in this retrospective, nonrandomized analysis study. All operations were performed by the same surgeon within an academic institution setting. All patients underwent vocal cord evaluation postoperatively. Demographics and intraoperative and postoperative complications following surgery were collected. Results. Out of seventy-seven RLNs, there was one permanent unilateral RLN injury (1.29%) in a patient with advanced papillary thyroid cancer, managed by cord injection. There was another transient RLN paresis that resolved spontaneously (1.29%). There were no instances of equipment malfunction or interference. Conclusions. To our knowledge, this is the first reported MIVAT/P series from the United States of America with a standardized IONM technique. The technical feasibility of IONM seems acceptable and may serve as a meaningful adjunct to the visual identification of nerves. Neuromonitoring during MIVAT/P is effective in providing identification of laryngeal nerves and enables surgeons to feel more comfortable with MIVAT/P. Comparative series are needed for further evaluation.
Highlights
The recurrent laryngeal nerve (RLN) injury during surgeries on thyroid and parathyroid remains the most significant commonly found complication of endocrine surgery in the neck, and it can result in significant morbidity including temporary or permanent paralytic dysphonia and dysphagia
It has long been accepted that anatomic identification of both the RLN and the external branch of the superior laryngeal nerve (EBSLN) is the safest way to reduce nerve injury rates to a minimum [2] and certainly injury rates are lowest when surgery is carried out by experienced endocrine surgeons or thyroid surgeons in specialized centers with high caseloads [3]
Conventional thyroidectomy requires a transverse cervical incision that leaves a visible scar on the anterior surface of the neck
Summary
The recurrent laryngeal nerve (RLN) injury during surgeries on thyroid and parathyroid remains the most significant commonly found complication of endocrine surgery in the neck, and it can result in significant morbidity including temporary or permanent paralytic dysphonia and dysphagia. It has long been accepted that anatomic identification of both the RLN and the external branch of the superior laryngeal nerve (EBSLN) is the safest way to reduce nerve injury rates to a minimum [2] and certainly injury rates are lowest when surgery is carried out by experienced endocrine surgeons or thyroid surgeons in specialized centers with high caseloads [3]. An anatomically intact nerve may still show altered function postoperatively due to multiple factors, such as neural stretch during goiter retraction
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