Intraoperative neuromonitoring for the early detection and prevention of RLN traction injury in thyroid surgery: A porcine model

Wu, Che‐Wei; Dionigi, Gianlorenzo; Sun, Hui; Liu, Xiaoli; Kim, Hoon Yub; Hsiao, Pi‐Jung; Tsai, Kuo-Bow; Chen, Hui‐Chun; Chen, Hsiu-Ya; Chang, Po-Chun; Lu, I‐Cheng

doi:10.1016/j.surg.2013.08.015

Cited by 99 publications

(124 citation statements)

References 17 publications

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“…However, there are limitations in all present porcine studies (22)(23)(24)(25)(26)(27). Firstly, these are animal models with median sample size, and caution must be taken in translating these data into clinical context.…”

Section: Discussionmentioning

confidence: 99%

“…Experimental histological studies of vessel sealed with EBD demonstrated 1.5 to 3.3 mm thermal spread, beyond the tissue within the forceps' jaws (22)(23)(24)(25)(26)(27). Authors suggested not using the device closer than 2-3 mm to the RLN (22)(23)(24)(25)(26)(27). After activation, a lag time at least 2 seconds or touching tissue is needed before the use of LSJ for blunt dissection around the RLN.…”

Section: Discussionmentioning

confidence: 99%

“…Different surveys describe the safety of EBD around the RLN (22)(23)(24)(25)(26)(27). Such investigations are needful as they highlighted areas for correction in the adoption of the technology in thyroid and parathyroid surgery (19).…”

Section: Introductionmentioning

confidence: 99%

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Safety of energy based devices for hemostasis in thyroid surgery

Dionigi¹,

Wu²,

Kim³

et al. 2016

Gland Surg.

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Energy based devices (EBD) have been developed, implemented and increasingly applied in thyroid surgery because they can provide a combined dissection and haemostatic effect. In particular, advantages of EBD have been described in terms of efficacious haemostasis, reduction of procedureassociated time, reduced incision length, less operative blood loss and transfusion need, decreased postoperative drain, pain and hospital stay. In addition, EBD are essential for endoscopic procedures. On the contrary, a potential drawback is the increased health care costs. This paper reviews relevant medical literature published on the safety of new devices for achieving hemostasis and dissection around the recurrent laryngeal nerve (RLN).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Safety of energy based devices for hemostasis in thyroid surgery

Dionigi¹,

Wu²,

Kim³

et al. 2016

Gland Surg.

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“…Pulling the thyroid mass out of the mediastinum at the beginning of the operation is likely to overstretch the RLN imbedded in the inferior part of the goiter. In retrosternal goiters, extensive traction from the mediastinum should be avoided until the goiter is mobilized (52,53). All structures adherent to the inferior part of the goiter should be mapped using IONM.…”

Section: The Rln Attached To the Inferior Part Of A Goiter In Reoperamentioning

confidence: 99%

Intermittent neural monitoring of the recurrent laryngeal nerve in surgery for recurrent goiter

Wojtczak

Barczyński

2016

Gland Surg.

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Reoperative thyroid surgery is still challenging even for skilled surgeons, and is associated with a higher incidence of complications, such as hypoparathyroidism and recurrent laryngeal nerve (RLN) palsy. Displacement of the RLN, scar tissue from previous neck surgery and difficulty in maintaining good hemostasis are risk factors in reoperations. The prevalence of RLN injury in reoperative thyroid surgery ranges as high as 12.5% for transient injury and up to 3.8% for permanent injury. Bilateral paresis can also occur during reoperations, and is a dangerous complication influencing the quality of life, sometimes requiring tracheostomy. RLN identification is the gold standard during thyroidectomy, and the use of intraoperative neuromonitoring (IONM) can be a valuable adjunct to visual identification. This technique can be used to identify the RLN and the external branch of the superior laryngeal nerve (EBSLN), both of which are standardized procedures. The aim of this review was to evaluate the use of intermittent neural monitoring of the RLN in surgery for recurrent goiter, and to assess the prevalence of RLN injury while using IONM reported in the current literature.

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“…[18][19][20] Hopefully, by defining the normative RLN monitoring parameters, we can predict the degree of nerve injury following which nerve monitoring signals may be altered or lost. [21][22][23] Our study aims to establish the normal RLN EMG data in an Asian population.…”

Section: Role Of Intraoperative Neuromonitoringmentioning

confidence: 99%