title: Implementation of Intraoperative Neuromonitoring for Transoral Endoscopic Thyroid Surgery: A Preliminary Report.
abstract: BACKGROUND
  Transoral endoscopic approach is the natural orifice surgery applied in thyroidectomy to achieve an excellent cosmetic result. Recurrent laryngeal nerve (RLN) injury is the most common complication and little advancement was achieved in the previous clinical studies of transoral thyroid surgery. Herein, we introduced the method of intraoperative neuromonitoring (IONM) for transoral endoscopic thyroid surgery.
  
  
  METHODS
  Patients with thyroid carcinoma received transoral endoscopic thyroid surgery through vestibular approach (TOETVA) for thyroidectomy and central node dissection (CND). IONM was implemented to identify whether the RLN benefited from oral tracheal intubation. The laryngeal electromyography (EMG) response, operation time, number of CND, drainage volume, hospital duration, surgical complications, and cosmetic results were evaluated.
  
  
  RESULTS
  From August to October 2015, 10 cases were performed with TOETVA and IONM. All EMG responses were recorded intraoperatively, and no case experienced transient or permanent RLN palsy. The operation time ranged from 130 to 215 minutes in ipsilateral lobectomy with CND, whereas bilateral lobectomy with ipsilateral CND lasted 345 minutes. The number of CNDs ranged from three to eight. The average time of drainage extubation and discharge was 4 days (3-5 days) postoperatively. All patients were satisfied with the cosmetic results, and no infection was observed at lip wound or in the anterior neck region.
  
  
  CONCLUSIONS
  IONM system implemented in transoral thyroid surgery was feasible and serviceable in preventing RLN injury. The method of TOETVA shows promise for thyroidectomy with CND due its ideal cosmetic results.
authors: Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University College of Medicine , Hangzhou, China .
authors: Yong
authors: Y
authors: Wang
authors: Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University College of Medicine , Hangzhou, China .
authors: Xing
authors: X
authors: Yu
authors: Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University College of Medicine , Hangzhou, China .
authors: Ping
authors: P
authors: Wang
authors: Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University College of Medicine , Hangzhou, China .
authors: Chundi
authors: C
authors: Miao
authors: Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University College of Medicine , Hangzhou, China .
authors: Qiuping
authors: Q
authors: Xie
authors: Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University College of Medicine , Hangzhou, China .
authors: Haichao
authors: H
authors: Yan
authors: Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University College of Medicine , Hangzhou, China .
authors: Qunzi
authors: Q
authors: Zhao
authors: Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University College of Medicine , Hangzhou, China .
authors: Maolin
authors: M
authors: Zhang
authors: Department of Thyroid Surgery, The Second Affiliated Hospital of Zhejiang University College of Medicine , Hangzhou, China .
authors: Cheng
authors: C
authors: Xiang
mesh_terms: D000328:Adult; D002277:Carcinoma / Q000601:surgery*; D002291:Carcinoma, Papillary; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000517:prevention & control; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D037981:Neck Dissection / Q000009:adverse effects / Q000379:methods*; D061646:Operative Time; D061226:Recurrent Laryngeal Nerve Injuries / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods*; D014826:Vocal Cord Paralysis / Q000209:etiology
keywords: endoscopic surgery; neural monitoring; thyroid carcinoma; vestibular approach