Application of transoral continuous intraoperative neuromonitoring in natural orifice transluminal endoscopic surgery for thyroid disease: a preliminary study

Abstract

Cont-IONM is feasible and safe to use during transoral endoscopic thyroidectomies and may assist in the early detection of adverse EMG changes, thereby preventing paralysis of the RLNs.

Monitored transoral endoscopic thyroidectomy

“…The transoral endoscopic approach is an application to thyroidectomy of the natural orifice surgery in order to obtain an excellent aesthetic result (2)(3)(4)(5). It is an emerging experimental alternative to traditional surgery that eliminates visible skin incisions and scars because it uses an endoscope passed through the mouth into the thyroid (6).…”

“…This technique has been demonstrated to be feasible in cadaver, porcine models and in patients (7). However, it still has several technical issues, including a different method of dissection, reduced surgical space, and bad visibility, which make it difficult to identify and preserve the recurrent laryngeal nerve (RLN) (3). Current instrumentation and technology make this approach technically difficult and place a high risk on the mental nerve (7).…”

“…Intraoperative neuromonitoring (IONM) during thyroidectomy is widely accepted in addition to the visual identification of the RLN (3,13), allowing to detect RLN anatomic variations, to predict the outcome of the vocal cord function, and elucidating RLN injury mechanism (3). RLNP is the most frequent and severe complication after thyroidectomy and it is the main reason of medico legal controversies after endocrine surgery (14).…”

Experience with the use of intraoperative continuous nerve monitoring in video‐assisted neck surgery and external cervical incisions

“…The VANS technique, reported by Shimizu et al in 1998, which was the first endoscopic neck surgery approach aimed at avoiding a conspicuous scar on the anterior neck, is widely used in Japan 7 . The use of this approach with CIONM has not been described previously, whereas combinations of CIONM with transoral endoscopic thyroidectomy via the vestibular approach, as well as with endoscopic and robotic thyroidectomy, have been reported 19,20 . In endoscopic thyroid surgery, it is sometimes difficult to identify anatomical landmarks in the operating field until one becomes accustomed to this technique.…”

Scarless thyroidectomy: transoral endoscopic thyroidectomy by vestibular approach

“…Ayrıca son zamanlarda 10 mm portun altından loja gönderilen sürekli vagus probunun, vagusun diseke edililip vagusa uygulanması ile süreki (continuous) İONM yapılabileceği de bildirilmiştir (63).…”