The influence of loss of intraoperative nerve monitoring signal on decision-making of total thyroidectomy: similarities and differences between Chinese and western perspectives / 中华内分泌外科杂志

With the popularization of intraoperative nerve monitoring (IONM) , it is possible to determine the intraoperative nerve function, which provides evidence-based basis for surgical decision making. Intraoperative loss of nerve signal (LOS) often indicates postoperative vocal cord dyskinesia. Once LOS occurs intraoperatively, the next surgical strategy adopted by the operator has always been controversial among Chinese and western experts. Therefore, this paper makes a comparative analysis of the differences between the viewpoints of domestic experts and western scholars and the possible causes through the investigation of domestic and foreign literature to provide theoretical basis for better thyroid surgery decision.

Study of technology learning curve of thyroid cancer intraoperative nerve monitoring / 国际外科学杂志

Objective To investigate the technology learning curve of thyroid cancer intraoperative nerve monitoring aiming to reduce the recurrent laryngeal nerve injury complication.Methods Eighty-two cases of thyroid cancer accepted thyroid cancer radical mastectomy or combined radical operation,dissected 147 recurrent laryngeal nerve,used intraoperative nerve monitoring technology,monitored recurrent laryngeal nerve function with four steps method.The recurrent laryngeal nerve injury can be diagnosed when the intraoperative signal decay rate was more than 50％.The damage point and reason can be judged.Results The recurrent laryngeal nerve search time was 0.5 to 2 minutes.The recurrent laryngeal nerve damage rate was 2.7％.Recurrent laryngeal nerve damage cases were all diagnosed during the operation.Recurrent laryngeal nerve damage points were all located in the throat or approaching into the throat.The damage reasons were pull,tumor adhesion,thermal damage and clamp.The technology learning curve of thyroid cancer intraoperative nerve monitoring formatted through search time and injury cases of each group according to the time sequence.Recurrent laryngeal nerve search time and injury cases were obviously downtrend.Conclusions The technology learning curve of thyroid cancer intraoperative nerve monitoring existed.It can be used to protect recurrent laryngeal nerve.

Bilateral Vocal Cord Palsy after Thyroidectomy Detected by McGrath Videolaryngoscope / 대한내분비외과학회지

Bilateral vocal cord palsy (BVCP) is a rare complication of thyroid surgery, and it is confusing and frustrating for both patients and medical staff. We found postoperative vocal cord dysfunction using a McGrath videolaryngoscope from a patient with stridor and dyspnea after thyroidectomy performed with intraoperative recurrent laryngeal nerve monitoring. Soon after, the patient was diagnosed with BVCP by an ENT otolaryngologist using a laryngeal fiberscope. The patient underwent exploration and received a permanent tracheostoma. The possibility of false negative findings from intraoperative nerve monitoring should considered if there is suspicion of BVCP in a high risk patient after thyroidectomy. The McGrath video-laryngoscope can be useful for early discovery of postoperative vocal cord dysfunction.

Intraoperative assessment of recurrent laryngeal nerve function by monitoring EMG of lateral cricoaryteoid muscle / 中华普通外科杂志

ObjectiveTo investigate the effectiveness and feasibility of intraoperaive recurrent laryngeal nerve(RLN) monitoring via lateral cricoarytenoid muscle(LCA) compound muscle action potential (CMAP) monitoring by bipolar electrode implanting. MethodsSeventy-four cases were evenly divided into nerve monitoring group and non-monitoring group,NIM-Response 2.0 was applied into monitoring group for intraoperative nerve monitoring.A bipolar electrode was inserted into LCA to record CMAP,stimulating electrode intermittently stimulated exposed or unexposed recurrent laryngeal nerve to monitor the RLN function during cervical operation under the block anaesthesia of cervical plexus. ResultsThere were no statistically significant differences (P ＞ 0.05 ) in postoperative hospitalization days (5.14 ± 1.44 days,5.05 ± 1.31 days),operation time ( 125.54 ±42.23 min,107.30 ± 39.36 min) between monitoring group and the control group.Thirty-two RLNs were mapped their anatomical course with the NIM-Response 2.0 assistance before exposure,and 25 RLNs were anatomically exposed.The stimulating threshold between unexposed RLN (2.23 ± 0.57 mA) and exposed RLN ( 0.44 ± 0.20 mA) were statistically different ( P ＜ 0.01 ),but the evoked EMG amplitude(307.98 ± 253.47 μV,234.36 ± 142.18 μV) were not statistically different (P ＞ 0.05 ).With the NIM-Response 2.0 assistance the course of the unexposed RLNs detected were consistent to the course of the RLNs when exposed completely.ConclusionsIt is a effective and feasible method to monitor the RLN function by recording the CMAP of lateral cricoarytenoid muscle(LCA) via bipolar electrode implanted into LCA under block anaesthesia of the cervical plexus.

Application of Evoked Potentials in Spinal Orthopedics and Reasons for Changes (review) / 中国康复理论与实践

@#Evoked potentials which can monitor spinal cord function in operation continuously and timely has been widely used in spinal orthopedics. However, intraoperative evoked potentials are affected by the technique in a variety of factors, how to improve the accuracy of intraoperative monitoring is still a problem to explore. In this paper, intraoperative nerve monitoring application and intraoperative potential reasons for the changes in the spine surgery orthopedic surgery were reviewed.