Exclusive real-time monitoring during recurrent laryngeal nerve dissection in conventional monitored thyroidectomy.
During conventional intermittent intraoperative neuromonitoring (IONM) in thyroidectomy, recurrent laryngeal nerve (RLN) injury is detected by an electromyographic (EMG) loss of signal (LOS) after the nerve dissection. Exclusive continuous monitoring during the phase of RLN dissection may be helpful in detecting adverse EMG changes earlier. A total of 208 RLNs at risk were enrolled in this study. Standardized IONM procedures were followed. We continuously stimulated the RLN at the lower exposed end with a stimulator to exclusively monitor the real-time quantitative EMG change during RLN dissection. Once the amplitude decreased by more than 50% of the initial signal, the surgical maneuver was paused and the RLN was retested every minute for 10 minutes to determine amplitude recovery before restarting the dissection. The procedure was feasible in all patients. No LOS was encountered in this study. Nineteen RLNs had an amplitude reduction of more than 50%. Eighteen nerves showed gradual amplitude recovery (16 nerves had a traction injury and two nerves had a compression injury). After 10 minutes, the recovery was complete (i.e., >90%) in eight nerves, 70-90% in seven nerves, and 50-70% in three nerves. Among these 18 nerves, only one nerve developed temporary vocal palsy because it was exposed to unavoidable repeated nerve traction after restarting the dissection. Another nerve showed no gradual recovery from thermal injury, and developed temporary vocal palsy. The temporary and permanent palsy rates were 1% and 0%, respectively. During intermittent IONM, exclusive real-time monitoring of the RLN during dissection is an effective procedure to detect an adverse EMG change, and prevent severe RLN injuries that cause LOS.
Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Changchun City, Jilin Province, China.
Xiao-Li
XL
Liu
Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Che-Wei
CW
Wu
Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Changchun City, Jilin Province, China.
Yi-Shen
YS
Zhao
Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Changchun City, Jilin Province, China.
Tie
T
Wang
Division of Anesthesia, China-Japan Union Hospital of Jilin University, Changchun City, Jilin Province, China.
Peng
P
Chen
Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Changchun City, Jilin Province, China.
Jing-Wei
JW
Xin
Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Changchun City, Jilin Province, China.
Shi-Jie
SJ
Li
Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Changchun City, Jilin Province, China.
Da-Qi
DQ
Zhang
Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Changchun City, Jilin Province, China.
Guang
G
Zhang
Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Changchun City, Jilin Province, China.
Yan-Tao
YT
Fu
Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Changchun City, Jilin Province, China.
Li-Na
LN
Zhao
Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Changchun City, Jilin Province, China.
Le
L
Zhou
First Division of Surgery, Research Center for Endocrine Surgery, Department of Surgical Sciences and Human Morphology, University of Insubria (Como-Varese), Varese, Italy.
Gianlorenzo
G
Dionigi
Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Feng-Yu
FY
Chiang
Division of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Changchun City, Jilin Province, China. Electronic address: sunhui1229@163.com.
Hui
H
Sun
D000293:Adolescent; D000328:Adult; D000368:Aged; D003199:Computer Systems; D004210:Dissection; D004576:Electromyography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012009:Recurrent Laryngeal Nerve / Q000601:surgery*; D013965:Thyroidectomy; D055815:Young Adult
Intraoperative neurophysiological monitoring; Recurrent laryngeal nerve; Thyroidectomy