Real-Time Monitoring of Recurrent Laryngeal Nerve During Thyroid Reoperation_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WEI Tao , LI Zhihui , ZHU Jingqiang.

Department of Thyroid and Breast Surgery, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

Keywords：

Thyroid; Reoperation; Recurrent laryngeal nerve; Complication

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Objective To assess the value and usage of real-time monitoring of the recurrent laryngeal nerve (RLN) during thyroid reoperation by RLN monitor.
Methods One hundred and one patients were under general anesthesia and thyroidectomy. NIM-Response electromyographic (EMG) monitor system was used for assistant of dissection, exposure and protection of the RLN during the surgical procedures.
Results There were 192 RLN were exposed during the surgeries in all 101 patients. The unilateral RLN injured in 10 patients was not specially explored the same side nerve. Among them 190 nerves were confirmed intact, the rest 2 nerves were resected because of tumor involving.
Conclusions NIM-Response electromyographic monitor system is sensitive and accurate for preserving the integrity of RLN during the thyroid reoperations. It is valuable for protecting RLN against iatrogenic injury. This system deserves general utilization for thyroid surgery, especially reoperation.

Citation： WEI Tao,LI Zhihui,ZHU Jingqiang.. Real-Time Monitoring of Recurrent Laryngeal Nerve During Thyroid Reoperation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(8): 772-774. doi: Copy

1.	武林枫, 刘连新, 赵明, 等. 甲状腺手术中显露喉返神经的意义 [J]. 中华普通外科杂志, 2005; 20(2): 9294.
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13.	刘连新, 武林枫, 刘冰, 等. 显露喉返神经的甲状腺手术574 例 [J]. 中国普通外科杂志, 2004; 13(5): 340342.
14.	Jatzko GR, Lisborg PH, Müller MG, et al. Recurrent nerve palsy after thyroid operations-principal nerve identification and a literature review [J]. Surgery, 1994; 115(2): 139144.
15.	Canbaz H, Dirlik M, Colak T, et al. Total thyroidectomy is safer with identification of recurrent laryngeal nerve [J]. J Zhejiang Univ Sci B, 2008; 9(6): 482488.
16.	吕新生, 李新营, 王志明, 等. 甲状腺手术所致喉返神经损伤的手术治疗 [J]. 中华外科杂志, 2005; 43(5): 301303.
17.	陈世彩, 郑宏良, 周水淼, 等. 甲状腺手术喉返神经损伤规律及治疗的探讨 [J]. 中华耳鼻咽喉科杂志, 2004; 39(8): 464468.
18.	周建平, 牛俊波, 袁建明, 等. 甲状腺手术中喉返神经损伤的预防及处理 [J]. 外科理论与实践, 2007; 12(4): 345347.
19.	符活, 张国庆. 甲状腺切除术中喉返神经损伤的防治 [J]. 中国普外基础与临床杂志, 2009; 16(9): 762.
20.	Filho JG, Kowalski LP. Surgical complications after thyroid surgery performed in a cancer hospital [J]. Otolaryngol Head Neck Surg, 2005; 132(3): 490494.
21.	Cavicchi O, Caliceti U, Fernandez IJ, et al. The value of neurostimulation and intraoperative nerve monitoring of inferior laryngeal nerve in thyroid surgery [J]. Otolaryngology Head Neck Surg, 2009; 140(6): 866870.
22.	Lefevre JH, Tresallet C, Leenhardt L, et al. Reoperative surgery for thyroid disease [J]. Langenbecks Arch Surg, 2007; 392(6): 685691.
23.	Dionigi G, Bacuzzi A, Boni L, et al. What is the learning curve for intraoperative neuromonitoring in thyroid surgery? [J]. Int J Surg, 2008; 6 Suppl 1: S7S12.
24.	Haerle S, Sidler D, Linder T, et al. Use of a single bipolar electrode in the posterior arytenoid muscles for bilateral monitoring of the recurrent laryngeal nerves in thyroid surgery [J]. Eur Arch Otorhinolaryngol, 2008; 265(12): 15491552.

1. 武林枫, 刘连新, 赵明, 等. 甲状腺手术中显露喉返神经的意义 [J]. 中华普通外科杂志, 2005; 20(2): 9294.
2. Jamski J, Jamska A, Graca M, et al. Recurrent laryngeal nerve injury following thyroid surgery [J]. Przegl Lek, 2004; 61(1): 1316.
3. Affleck BD, Swartz K, Brennan J. Surgical considerations and controversies in thyroid and parathyroid surgery [J]. Otolaryngol Clin North Am, 2003; 36(1): 159187.
4. 黄耿文, 杨连粤. 甲状腺癌的再次手术治疗 [J]. 中国实用外科杂志, 2004; 24(10): 589590.
5. Djohan RS, Rodriguez HE, Connolly MM, et al. Intraoperative monitoring of recurrent laryngeal nerve function [J]. Am Surg, 2000; 66(6): 595597.
6. Marcus B, Edwards B, Yoo S, et al. Recurrent laryngeal nerve monitoring in thyroid and parathyroid surgery: the University of Michigan experience [J]. Laryngoscope, 2003; 113(2): 356361.
7. 刘仁斌, Randolph GW, 吕伟明, 等. 喉肌电活动实时监测喉返神经在甲状腺手术中的应用 [J]. 中山大学学报(医学科学版), 2008; 29(6): 724727, 732.
8. Randolph GW, Kobler JB, Wilkins J. Recurrent laryngeal nerve identification and assessment during thyroid surgery: laryngeal palpation [J]. World J Surg, 2004; 28(8): 755760.
9. 刘春萍, 黄韬. 甲状腺手术喉返神经损伤的原因及处理探讨 [J]. 中国普外基础与临床杂志, 2008; 15(5): 314317.
10. 王永福, 陈建超. 甲状腺手术中喉返神经损伤原因分析 [J]. 中国普外基础与临床杂志, 2003; 10(3): 229.
11. 龚日祥, 张敏, 罗书画, 等. 甲状腺手术中常规显露喉返神经的安全性分析 [J]. 四川大学学报(医学版), 2008; 39(3): 464466.
12. 张海添, 陆云飞, 廖清华, 等. 甲状腺手术中显露喉返神经价值的Meta分析 [J]. 中华普通外科杂志, 2005; 20(4): 204206.
13. 刘连新, 武林枫, 刘冰, 等. 显露喉返神经的甲状腺手术574 例 [J]. 中国普通外科杂志, 2004; 13(5): 340342.
14. Jatzko GR, Lisborg PH, Müller MG, et al. Recurrent nerve palsy after thyroid operations-principal nerve identification and a literature review [J]. Surgery, 1994; 115(2): 139144.
15. Canbaz H, Dirlik M, Colak T, et al. Total thyroidectomy is safer with identification of recurrent laryngeal nerve [J]. J Zhejiang Univ Sci B, 2008; 9(6): 482488.
16. 吕新生, 李新营, 王志明, 等. 甲状腺手术所致喉返神经损伤的手术治疗 [J]. 中华外科杂志, 2005; 43(5): 301303.
17. 陈世彩, 郑宏良, 周水淼, 等. 甲状腺手术喉返神经损伤规律及治疗的探讨 [J]. 中华耳鼻咽喉科杂志, 2004; 39(8): 464468.
18. 周建平, 牛俊波, 袁建明, 等. 甲状腺手术中喉返神经损伤的预防及处理 [J]. 外科理论与实践, 2007; 12(4): 345347.
19. 符活, 张国庆. 甲状腺切除术中喉返神经损伤的防治 [J]. 中国普外基础与临床杂志, 2009; 16(9): 762.
20. Filho JG, Kowalski LP. Surgical complications after thyroid surgery performed in a cancer hospital [J]. Otolaryngol Head Neck Surg, 2005; 132(3): 490494.
21. Cavicchi O, Caliceti U, Fernandez IJ, et al. The value of neurostimulation and intraoperative nerve monitoring of inferior laryngeal nerve in thyroid surgery [J]. Otolaryngology Head Neck Surg, 2009; 140(6): 866870.
22. Lefevre JH, Tresallet C, Leenhardt L, et al. Reoperative surgery for thyroid disease [J]. Langenbecks Arch Surg, 2007; 392(6): 685691.
23. Dionigi G, Bacuzzi A, Boni L, et al. What is the learning curve for intraoperative neuromonitoring in thyroid surgery? [J]. Int J Surg, 2008; 6 Suppl 1: S7S12.
24. Haerle S, Sidler D, Linder T, et al. Use of a single bipolar electrode in the posterior arytenoid muscles for bilateral monitoring of the recurrent laryngeal nerves in thyroid surgery [J]. Eur Arch Otorhinolaryngol, 2008; 265(12): 15491552.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Real-Time Monitoring of Recurrent Laryngeal Nerve During Thyroid Reoperation

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