Objectives/hypothesis: Intraoperative neural monitoring is a useful adjunct for the laryngeal nerve function assessment during thyroid and parathyroid surgery. Typically, monitoring is performed by measurement of electromyographic responses recorded by endotracheal tube (ETT) surface electrodes. Tube position alterations during surgery can cause displacement of the electrodes relative to the vocal cords, leading to false positive loss of signal. Numerous reports have denoted monitoring equipment-related issues, especially endotracheal tube displacement, as the dominant source of false positive error. The false positive error may result in inappropriate decisions by the surgeon. This study tests the hypothesis that anterior laryngeal electrodes (ALEs) can help reduce this error. Placement of ALEs directly onto the thyroid cartilage represent an adjunctive and possible alternative method to standard ETT surface electrodes.
Study Design: Retrospective review.
Methods: Fifteen consecutive patients undergoing thyroid and parathyroid surgery with intraoperative neuromonitoring using both ETT electrodes and ALEs were studied. Data collected included site of neural stimulation, laterality, and electromyographic parameters.
Results: With vagal and recurrent laryngeal nerve stimulation, the ALEs recorded mean vocalis muscle waveform amplitude within 83% of that recorded with standard ETT electrodes. The latency measurements with the anterior laryngeal and endotracheal electrodes were similar, with both electrodes recording significantly longer latency for the left vagus nerve as compared to the right vagus nerve. With superior laryngeal nerve stimulation, the ALEs recorded a 800% greater mean amplitude than the ETT electrodes. The ALEs demonstrated similar sensitivity to stimulation at low current as ETT electrodes and provided stable intraoperative monitoring information.
Conclusions: Compared to ETT surface electrodes, the ALEs provide similar and stable electromyographic responses with equal sensitivity for recording evoked responses during neural monitoring in thyroid and parathyroid surgery. The ALEs offer significantly more robust monitoring of the external branch of the superior laryngeal nerve. Furthermore, ALEs are contained within the operative field, are totally surgeon controlled, and are unaffected by the potential vicissitudes of ETT position during surgery.
Level Of Evidence: 4 Laryngoscope, 128:2910-2915, 2018.
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http://dx.doi.org/10.1002/lary.27362 | DOI Listing |
BMC Cancer
January 2025
Department of Ultrasound, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, China.
Background: Lymphatic metastasis commonly occurs in patients with papillary thyroid carcinoma and medullary thyroid carcinoma. The clinical and imaging characteristics of recurrent laryngeal nerve (RLN) invasion by extranodal extension (ENE) of metastatic lymph nodes remain understudied. This study aimed to evaluate these characteristics in patients with thyroid carcinoma.
View Article and Find Full Text PDFJ Thorac Dis
December 2024
Department of Thoracic Surgery, China-Japan Union Hospital of Jilin University, Changchun, China.
Background: Minimally invasive esophagectomy (MIE) can lead to a severe complication known as recurrent laryngeal nerve paralysis (RLNP). Existing literature supports that recurrent laryngeal nerve (RLN) injury is the principal etiology of RLNP, a complication potentially mitigated through intraoperative neuromonitoring (IONM). In this study, we examined the comprehensive effectiveness of IONM during esophageal resection by performing a meta-analysis.
View Article and Find Full Text PDFBMC Surg
January 2025
Department of Cardiothoracic Surgery, Fifth Affiliated Hospital of Sun Yat-Sen University, No.52 East Meihua Road, Zhuhai, Guangdong Province, 519000, China.
Background: Laparoscopic-assisted single-port mediastinoscopic esophagectomy is a safe and effective emerging minimally invasive esophagectomy, but little has been reported about the learning curve for this technology. The goal of the study was to determine the number of procedures to achieve different levels of proficiency on the learning curve.
Methods: This study retrospectively analyzed data from consecutive surgeries performed by the same surgeon at the same center from 2016 to 2021.
Indian J Thorac Cardiovasc Surg
February 2025
Department of Cardiovascular & Thoracic Surgery, Seth GS Medical College & KEM Hospital, Mumbai, Maharashtra India.
The subclavian artery's intrathoracic segment is a rare peripheral artery aneurysm site. Common causes are atherosclerosis, trauma, vasculitis, and infection. Subclavian artery aneurysms have a higher propensity for rupture, thrombosis, embolization, and compression of surrounding structures, thus necessitating urgent surgical care.
View Article and Find Full Text PDFJAMA Otolaryngol Head Neck Surg
January 2025
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Importance: Intraoperative nerve monitoring (IONM) is not considered standard of care during thyroidectomy, and guidelines are vague about its use in the absence of strong evidence of superiority over visualization of the recurrent laryngeal nerve (RLN) alone.
Objective: To characterize patterns of IONM use during thyroidectomy in the US and evaluate the association of IONM with postoperative outcomes.
Design, Setting, And Participants: This cohort study used the National Surgical Quality Improvement Program (NSQIP) thyroidectomy data from January 1, 2016, to December 31, 2022.
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