title: Detection of evolving injury to the brachial plexus during transaxillary robotic thyroidectomy.
abstract: OBJECTIVE
  Continuous intraoperative neuromonitoring (IONM) of transcranial electric motor evoked potentials (tceMEPs) and somatosensory evoked potentials (SSEPs) has gained universal acceptance as an efficacious method for detecting emerging positional brachial plexopathy or peripheral nerve compression during spinal and shoulder surgery. This has implications for transaxillary thyroid surgery.
  
  
  METHODS
  Case report with literature review.
  
  
  METHODS
  The patient underwent robotic transaxillary thyroid surgery with continuous tceMEP and SSEP monitoring of brachial plexus function. We present detailed IONM data depicting the emergence of positional brachial plexopathy.
  
  
  RESULTS
  Significant amplitude loss of both IONM modalities were identified during an evolving positional plexopathy, which resolved upon upper extremity repositioning and conversion to an open procedure. No permanent nerve injury or deficit was noted following surgery.
  
  
  CONCLUSIONS
  Given the potential for brachial plexus injury during robotic transaxillary thyroid surgery secondary to arm positioning, we recommend that continuous tceMEP and SSEP monitoring be considered during such procedures.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, PA 19107, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Luginbuhl
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Schwartz
authors.forename: Anthony K
authors.initials: AK
authors.lastname: Sestokas
authors.forename: David
authors.initials: D
authors.lastname: Cognetti
authors.forename: Edmund
authors.initials: E
authors.lastname: Pribitkin
mesh_terms: D001365:Axilla; D001917:Brachial Plexus / Q000293:injuries*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis*; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D012371:Robotics; D013965:Thyroidectomy / Q000379:methods*