Application Of Intraoperative Neuromonitoring During Thyroid Carcinoma Surgery

Purpose To discuss apply the intraoperative neuromonitoring as an adjunct to avoid recurrent laryngeal nerve injury during thyroid carcinoma surgery.Method The study was performed from February 2015 till February 2016,including 26 patients performed total thyroidectomy(bilateral thyroid carcinoma or thyroid carcinoma with cervical lymph node metastasis) using intraoperative neuromonitoring during thyroid carcinoma surgery in general surgery department of the Chinese PLA General Hospital, The patients were divided into 2 groups depending on the technique used for RLN integrity verification:group A-with intraoperative nerve monitoring; group B-with continuous intraoperative nerve monitoring to search,recognize and protect the RLN,recording the electromyography data and evaluating postoperative laryngeal recurrent nerve injury and vocal cord function recovery.Results All operations were completed successfully with the help of intraoperative neuromonitoring, and total 47 nerves at risk were exposed during surgery performed total thyroidectomy with(or without) lymph node dissection. In 4 of 14 patients(28.6%) in group A developed postoperative voice tone and volume change and recovered in 2 weeks, in 1 of 14 patients(7.1%) developed postoperative temporary vocal cord paralysis and recovered in 2 months. In 2 of 12 patients(16.7%) in group B developed postoperative voice tone and volume change and recovered in 1 weeks, the postoperative temporary vocal cord paralysis has not occurred.Conclution Intraoperative neuromonitoring is a useful adjunct to identificate recurrent laryngeal nerve more reliabe and precise, test the functional integrity of recurrent laryngeal nerve, and reduce recurrent laryngeal nerve palsy rate in thyroid operation. The continuous intraoperative nerve monitoring as new technology can prevent recurrent laryngeal nerve from injury during operation, and reduce the incidence of iatrogenic laryngeal recurrent nerve injury. The continuous intraoperative nerve monitoring is worth popularizing in thyroid carcinoma surgery.