Recurrent Laryngeal Nerve Monitoring in Thyroid and Parathyroid Surgery: The University of Michigan Experience

Marcus, Benjamin C.; Edwards, Bruce M.; Yoo, Sirius; Byrne, Anne; Gupta, Anurag; Kandrevas, Janet; Bradford, Carol R.; Chepeha, Douglas B.; Teknos, Theodoros N.

doi:10.1097/00005537-200302000-00028

Cited by 99 publications

(70 citation statements)

References 13 publications

(13 reference statements)

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“…Despite numerous improvements in imaging and surgical technique, the need for reexcision to achieve complete tumor resection in the United States typically ranges from 20-40% (7)(8)(9)(10)(11)(12)(13)(14)(15), and has been reported as being as high as 60% (16). The importance of reexcision is underscored by numerous studies, which have shown that incomplete resection of tumor and positive margins are associated with increased locoregional recurrence compared with negative margins (12,(17)(18)(19)(20). Furthermore, the landmark meta-analysis performed by the Early Breast Cancer Trialists' Collaborative Group (18,21) directly linked local recurrence to survival, placing great emphasis on the surgeon's role in minimizing local recurrence by obtaining adequate margins.…”

mentioning

confidence: 99%

“…The importance of reexcision is underscored by numerous studies, which have shown that incomplete resection of tumor and positive margins are associated with increased locoregional recurrence compared with negative margins (12,(17)(18)(19)(20). Furthermore, the landmark meta-analysis performed by the Early Breast Cancer Trialists' Collaborative Group (18,21) directly linked local recurrence to survival, placing great emphasis on the surgeon's role in minimizing local recurrence by obtaining adequate margins.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Application of desorption electrospray ionization mass spectrometry imaging in breast cancer margin analysis

Calligaris

Caragacianu

Liu

et al. 2014

Proc. Natl. Acad. Sci. U.S.A.

211

198

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Distinguishing tumor from normal glandular breast tissue is an important step in breast-conserving surgery. Because this distinction can be challenging in the operative setting, up to 40% of patients require an additional operation when traditional approaches are used.Here, we present a proof-of-concept study to determine the feasibility of using desorption electrospray ionization mass spectrometry imaging (DESI-MSI) for identifying and differentiating tumor from normal breast tissue. We show that tumor margins can be identified using the spatial distributions and varying intensities of different lipids. Several fatty acids, including oleic acid, were more abundant in the cancerous tissue than in normal tissues. The cancer margins delineated by the molecular images from DESI-MSI were consistent with those margins obtained from histological staining. Our findings prove the feasibility of classifying cancerous and normal breast tissues using ambient ionization MSI. The results suggest that an MSbased method could be developed for the rapid intraoperative detection of residual cancer tissue during breast-conserving surgery.B reast cancer is the most commonly diagnosed carcinoma in women in the United States and Western countries. Breast conservation surgery (BCS) has become the preferred treatment option for many women with early-stage breast cancer (1). BCS entails resection of the tumor, with a clean margin of normal tissue around it. Surgery is usually followed by radiation therapy. Results from seven large randomized prospective studies, with the largest two having over 20 y of follow-up, have shown equal survival when comparing BCS coupled with whole-breast radiation and mastectomy (2, 3).Normally, breast surgeons aim to remove a patient's tumor, along with a rim of normal tissue that is free of cancer. Preoperative mammography, ultrasonography, or MRI may be used by the surgeon to guide adequate resection (4-6). Despite numerous improvements in imaging and surgical technique, the need for reexcision to achieve complete tumor resection in the United States typically ranges from 20-40% (7-15), and has been reported as being as high as 60% (16). The importance of reexcision is underscored by numerous studies, which have shown that incomplete resection of tumor and positive margins are associated with increased locoregional recurrence compared with negative margins (12,(17)(18)(19)(20). Furthermore, the landmark meta-analysis performed by the Early Breast Cancer Trialists' Collaborative Group (18, 21) directly linked local recurrence to survival, placing great emphasis on the surgeon's role in minimizing local recurrence by obtaining adequate margins.Breast tumor reexcisions are accompanied by a number of undesirable problems: The completion of therapy is delayed, infection rates are increased, cost is increased, there can be a negative psychological impact on the patient, and there can be diminished aesthetic outcomes (22-24). The development of an intraoperative technique that allows the fast and accurate ident...

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mentioning

confidence: 99%

mentioning

confidence: 99%

Application of desorption electrospray ionization mass spectrometry imaging in breast cancer margin analysis

Calligaris

Caragacianu

Liu

et al. 2014

Proc. Natl. Acad. Sci. U.S.A.

211

198

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“…Marcus et al described in the University of Michigan Experience the use of a postcricoid surface electrode [13]. Their initial report established normative data and conWrmed its simplicity.…”

Section: Discussionmentioning

confidence: 99%

Use of a single bipolar electrode in the posterior arytenoid muscles for bilateral monitoring of the recurrent laryngeal nerves in thyroid surgery

Haerle

Sidler

Linder

et al. 2008

Eur Arch Otorhinolaryngol

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The aims were to assess the technical feasibility of using a single electrode in the posterior arytenoid muscles (PAM) for intraoperative monitoring of the recurrent laryngeal nerve (RLN) in thyroid surgery, to validate the new method against the insertion of electrodes placed in the vocal cord muscle, and to report the results of the clinical application of the new concept. A total of 52 patients were enrolled. The handling and safety of RLN monitoring was tested by simultaneous registration of the EMG response from vocal fold electrodes and PAM electrodes. Acoustically and electromyographically we found nearly the same values for the arytenoid muscles as for the vocal folds, although the signals taken from the vocal folds were slightly stronger. PAM recording using a single bipolar electrode is technically feasible and as reliable compared to the standard vocal cord monitoring.

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“…Despite that, RLN stimulation will provide a positive signal from the vocal cords, innervated by the anterior branch. Since the posterior cricoarytenoid muscle is the only muscle responsible for opening the glottis, its isolated injury may result in postoperative paresis or paralysis of the vocal cords [12,13].…”

Section: Elements Necessary For Ensuring Optimal Ionm According To Inmsgmentioning

confidence: 99%

Thoracic surgery Practical comments on recurrent laryngeal nerve neuromonitoring during thyroid surgery

Masiak-Segit¹,

Dabrowski²,

Abramowicz³

et al. 2013

kitp

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StreszczenieNeuromonitoring (intraoperative neurophysiological monitoring -IONM) jest nową nieinwazyjną techniką, niestanowią-cą dodatkowego obciążenia dla pacjenta. Chirurg za pomocą sondy stymulacyjnej poszukuje w polu operacyjnym nerwu krtaniowego wstecznego. W momencie gdy sonda znajduje się w pobliżu nerwu, system IONM powiadamia o tym sygnałem dźwiękowym i wizualnym. W trakcie stymulacji nerwu pobudzane są mięśnie głosowe, a w rezultacie struny głosowe zaciskają się w rytm podawanych impulsów prądowych na elektrodzie odbiorczej naklejonej na rurkę intubacyjną pacjenta. Neuromonitoring wymaga ścisłej współpracy chirurga z anestezjologiem. System IONM nie zastąpi jednak umiejętności technicznych i gruntownej znajomości warunków anatomicznych szyi. Jego zastosowanie w znaczny sposób poprawia bezpieczeństwo pacjenta i komfort pracy chirurga. Autorzy pracy, na podstawie literatury i własnych doświadczeń, opisali standardy postępowania obowiązujące w neuromonitoringu oraz problemy praktyczne, które mogą wystąpić w trakcie jego stosowania, i sposoby ich rozwiązywania. Słowa kluczowe: neuromonitoring, nerw krtaniowy wsteczny, chirurgia tarczycy. THORACIC SURGERY AbstractNeuromonitoring (intraoperative neurophysiological monitoring -IONM) is a new non-invasive technique, which does not place any additional strain on the patient. The surgeon uses a stimulation probe to search for the recurrent laryngeal nerve within the surgical site. IONM provides auditory and visual cues when the probe is in the vicinity of the nerve. During the stimulation of the nerve, vocal muscles are stimulated as well, which causes the vocal cords to tighten to the rhythm of the electric pulses fed to the recording electrode attached to the endotracheal tube. Neuromonitoring requires close cooperation between the surgeon and the anesthesiologist. IONM cannot serve as a substitute for technical skills and thorough knowledge of neck anatomy. Its use significantly improves patient safety and the comfort of the surgeon. Based on the literature and their own experience, the authors of the article describe the standards of the neuromonitoring procedure, the problems that may occur during its use, as well as solutions for these problems.

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Recurrent Laryngeal Nerve Monitoring in Thyroid and Parathyroid Surgery: The University of Michigan Experience

Abstract: Electromyographic monitoring of the RLN using a postcricoid surface electrode provides a safe, simple, and effective method for intraoperative monitoring during thyroid or parathyroid surgery. Further, evoked electromyography confirms RLN integrity at the conclusion of surgery.

Cited by 99 publications

References 13 publications

Application of desorption electrospray ionization mass spectrometry imaging in breast cancer margin analysis

Application of desorption electrospray ionization mass spectrometry imaging in breast cancer margin analysis

Use of a single bipolar electrode in the posterior arytenoid muscles for bilateral monitoring of the recurrent laryngeal nerves in thyroid surgery

Thoracic surgery Practical comments on recurrent laryngeal nerve neuromonitoring during thyroid surgery

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