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laryngeal nerve thyroidectomy

William S Duke, F Christopher Holsinger, Emad Kandil, Jeremy D Richmon, Michael C Singer, David J Terris
BACKGROUND: Robotic facelift thyroidectomy (RFT) was developed as a new surgical approach to the thyroid gland using a remote incision site. Early favorable results led to this confirmatory multi-institutional experience. METHODS: Prospectively collected data on consecutive patients undergoing RFT in five North American academic endocrine surgical practices were compiled. Surgical indications, operative times, final pathology, nodule size, complications, and postoperative management (drain use and length of hospital stay) were evaluated...
October 13, 2016: World Journal of Surgery
Daniel J Rocke, David P Goldstein, John R de Almeida
Importance: Intraoperative nerve monitoring (IONM) of the recurrent laryngeal nerve (RLN) is used as a tool to decrease the rate of nerve injury, although study findings are divergent on IONM efficacy. The cost-effectiveness of this approach to total thyroidectomy has not been well studied. Objective: To determine whether IONM is a cost-effective intervention in the setting of total thyroidectomy. Design and Setting: This study creates a decision-tree model of total thyroidectomy to analyze, from a societal perspective, the cost-effectiveness of universal IONM (ie, use in every case) vs selective IONM (ie, high-risk cases including reoperative cases, substernal or toxic goiters, and cases with known cancer) vs no IONM (visual identification only)...
October 13, 2016: JAMA Otolaryngology—Head & Neck Surgery
Ibrahim Ali Ozemir, Ferman Ozyalvac, Gorkem Yildiz, Tunc Eren, Zeynep Aydin-Ozemir, Orhan Alimoglu
BACKGROUND: Diabetes mellitus may cause degeneration in the myelin and/or axonal structures of peripheral nerves. The aim of this study was to investigate the effects of diabetic neuropathy on intraoperative neuromonitoring findings such as latency and amplitude values of the recurrent laryngeal nerves during thyroidectomy. To our knowledge this is the first study to report comparison of the electrophysiologic features of diabetic and non-diabetic patients. MATERIALS AND METHODS: One-hundred-and-eleven consecutive patients who received neuromonitoring during thyroidectomy between 2013 and 2015 were included to study...
October 5, 2016: International Journal of Surgery
Paolo Del Rio, Piercosimo Nisi, Sara Benedicenti, Elisa Bertocchi, Enrico Luzietti, Mario Sianesi
AIM: To evaluate the learning curve in the use of intraoperative neuromonitoring of recurrent laryngeal nerve and vagus in thyroid surgery. MATERIALS OF THE STUDY: We analyzed 140 pts treated consecutively for thyroid disease. All the patients were neuromonitored with Intraoperative neuromonitoring of recurrent laryngeal nerve and vagus. We divided these patients in 7 groups to collect the adverse events during our learning curve. RESULTS: We monitored consecutively 271 nerves...
2016: Annali Italiani di Chirurgia
Sayaka Kuba, Kosho Yamanouchi, Naomi Hayashida, Shigeto Maeda, Toshiyuki Adachi, Chika Sakimura, Fusako Kawakami, Hiroshi Yano, Megumi Matsumoto, Ryota Otsubo, Shuntaro Sato, Hikaru Fujioka, Tamotsu Kuroki, Takeshi Nagayasu, Susumu Eguchi
BACKGROUND: In patients with papillary thyroid carcinoma (PTC), the role of total thyroidectomy (TT) versus that of thyroid lobectomy (TL) has been controversial. METHODS: This retrospective study was approved by our institutional review board, and the requirement to obtain informed consent was waived. In total, 173 patients with 1- to 5-cm stage cN0 and cM0 PTC tumors treated by curative surgery from 1994 to 2008 were evaluated. Clinicopathologic features and adverse events were compared between patients who underwent TT and those who underwent TL...
September 24, 2016: International Journal of Surgery
Urte Kunz-Zurbuchen, Heinz Johannes Buhr, Hubert G Hotz, Martin E Kreis, Kai S Lehmann
PURPOSE: To evaluate the rate of surgical complications during the change from subtotal resection to hemithyroidectomy or thyroidectomy over a period of 17 years. METHODS: All operations for benign goiter at our hospital were analyzed for the periods 1996-2002 (Group 1) and 2003-2012 (Group 2). The groups were compared for recurrent laryngeal nerve damage, hypocalcemia, and other surgical complications directly postoperatively. RESULTS: In total, 1462 patients were operated on for goiter between 1996 and 2012...
September 19, 2016: Asian Journal of Surgery
Nina Irawati, Richa Vaish, Devendra Chaukar, Anuja Deshmukh, Anil D'Cruz
To study the incidence of the tubercle of Zuckerkandl (ZT) among Indian patients subjected to thyroid surgery at a tertiary care cancer centre and its relevance in localization of recurrent laryngeal nerve (RLN). Prospective study on 144 patients (48 males, 96 females) undergoing thyroidectomy (35 hemithyroidectomies, 109 total thyroidectomies) from September 1st 2010 - February 28th 2013. 144 specimen/253 lobes (129 right, 124 left) were evaluated. Findings were recorded by the same team to ensure consistency...
September 2016: Indian Journal of Surgical Oncology
Angkoon Anuwong, Matteo Lavazza, Hoon Yub Kim, Che-Wei Wu, Stefano Rausei, Vincenzo Pappalardo, Cesare Carlo Ferrari, Davide Inversini, Andrea Leotta, Antonio Biondi, Feng-Yu Chiang, Gianlorenzo Dionigi
The objective is to compare the consequences of routine visualization (RV) and the application of intermitted (I-IONM), standardized (S-IONM), and continuous monitoring (C-IONM) of recurrent laryngeal nerve (RLN) management. RV includes that 698 RLNs managed solely with visual identification. In a second period 777, RLNs were handled by the I-IONM. The third period 768 RLNs monitoring was performed according to the standards. C-IONM via VN stimulation included 626 RLNs. The following issues were analyzed and compared per each period study: RLN identification rate, branching detection, assessment of NRLN, intraoperative recognizable nerve damage, stage thyroidectomy rate, transient or definitive lesions, bilateral nerve palsy, and recovery time...
September 20, 2016: Updates in Surgery
K Verónica Chavez, E Manuel Barajas, Jaqueline Ramírez, Juan Pablo Pantoja, Mauricio Sierra, David Velázquez-Fernandez, Miguel F Herrera
BACKGROUND: Advanced bipolar and ultrasonic devices have shown significant reduction in the surgical time of thyroid operations. This randomized, controlled trial assessed if operative time and other relevant outcomes are different for thyroidectomies performed either with a second-generation advanced bipolar device or traditional tie and suture technique. METHODS: Forty-one patients were randomized into 2 groups (advanced bipolar device and traditional tie and suture)...
September 7, 2016: Surgery
James C Lee, Daniel Breen, Amanda Scott, Simon Grodski, Meei Yeung, William Johnson, Jonathan Serpell
BACKGROUND: Up to 80% of patients without a recurrent laryngeal nerve palsy report alteration in their voice after a thyroid procedure. The aims of this study were (1) to quantify voice changes after thyroid operation; (2) to correlate the changes to the extent of operation; and (3) to correlate voice changes to intraoperative recurrent laryngeal nerve swelling. METHODS: Patients undergoing total and hemithyroidectomy were recruited prospectively from the Monash University Endocrine Surgery Unit during a 12-month period...
September 2, 2016: Surgery
Yong Wang, Xing Yu, Ping Wang, Chundi Miao, Qiuping Xie, Haichao Yan, Qunzi Zhao, Maolin Zhang, Cheng Xiang
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. MATERIALS AND METHODS: Patients with thyroid carcinoma received transoral endoscopic thyroid surgery through vestibular approach (TOETVA) for thyroidectomy and central node dissection (CND)...
September 1, 2016: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
Gianlorenzo Dionigi, Feng-Yu Chiang, Hoon Yub Kim, Gregory W Randolph, Alberto Mangano, Pi-Ying Chang, I-Cheng Lu, Yi-Chu Lin, Hui-Chun Chen, Che-Wei Wu
OBJECTIVES/HYPOTHESIS: This study investigated recurrent laryngeal nerve (RLN) real-time electromyography (EMG) data to define optimal safety parameters of the LigaSure Small Jaw (LSJ) instrument during thyroidectomy. STUDY DESIGN: Prospective animal model. METHODS: Dynamic EMG tracings were recorded from 32 RLNs (16 piglets) during various applications of LSJ around using continuous electrophysiologic monitoring. At varying distances from the RLN, the LSJ was activated (activation study)...
August 31, 2016: Laryngoscope
A Bergenfelz, A F Salem, H Jacobsson, E Nordenström, M Almquist
BACKGROUND: Vocal cord palsy occurs in 3-5 per cent of patients after thyroidectomy. To reduce this complication, intraoperative nerve monitoring (IONM) has been introduced, although its use remains controversial. This study investigated the risk of postoperative vocal cord palsy with and without the use of intermittent IONM. METHODS: Patients registered in the Scandinavian Quality Register for Thyroid, Parathyroid and Adrenal Surgery, 2009-2013, were included. Early palsy of the recurrent laryngeal nerve was diagnosed within 6 weeks after surgery...
August 18, 2016: British Journal of Surgery
Chad M Hall, Samuel K Snyder, Yolanda Muñoz Maldonado, Terry C Lairmore
BACKGROUND: Treatment strategies for papillary thyroid cancer remain controversial due to the lack of large, randomized controlled trials. The purpose of this study was to review the benefit of routine bilateral central lymph node dissection (CLND) by analyzing local recurrence and complication rates from a single institution over a 15-year period. METHODS: A retrospective, institutional review board-approved review of the Baylor Scott & White Tumor Registry was performed on all patients who underwent operation for papillary thyroid cancer between 2000 and 2015...
October 2016: Surgery
Ioannis Vasileiadis, Theodore Karatzas, Georgios Charitoudis, Efthimios Karakostas, Sofia Tseleni-Balafouta, Gregory Kouraklis
Importance: Injury of the recurrent laryngeal nerve (RLN) is one of the most serious complications of thyroid surgery. Intraoperative neuromonitoring (IONM) has been introduced to verify RLN function integrity and may be a helpful adjunct in nerve dissection. Objective: To determine whether the use of IONM can reduce the incidence of RLN injury in patients undergoing total thyroidectomy. Design, Setting, and Participants: This cohort study included 2556 patients who underwent total thyroidectomy between January 2002 and December 2012 in the Department of Otolaryngology-Head and Neck Surgery of Venizeleio General Hospital, Heraklion, Greece...
August 4, 2016: JAMA Otolaryngology—Head & Neck Surgery
Jiangke Tian, Lei Li, Peng Liu, Xuan Wang
Despite minimal evidence, thyroid drains are routinely used as a precaution against hematoma in thyroidectomy. We undertook the present meta-analysis to evaluate the patient outcomes associated with post-surgical drainage, and whether it offers any advantage over no drainage in patients undergoing thyroidectomy. Randomized and two-arm studies comparing the efficacy of total or partial thyroidectomy with or without post-surgery drainage, in patients undergoing thyroid surgery were included. Medline, Cochrane, EMBASE, and Google Scholar databases were searched until January 22, 2015, using the terms, "thyroidectomy, subtotal thyroidectomy, total thyroidectomy, drainage, thyroid cancer, and goiter...
July 28, 2016: European Archives of Oto-rhino-laryngology
Yujie Li, Xiaodong Zhou
BACKGROUND: Endoscopic thyroidectomy (ET) has gained acceptance among surgeons as its feasibility has been well-documented. The aim of this systematic review with meta-analysis has been to assess and validate the safety and feasibility of ET when compared to conventional open thyroidectomy (COT) for papillary thyroid microcarcinoma (PTMC) and to verify other potential benefits and drawbacks. MATERIALS AND METHODS: PubMed, Web of Knowledge are searched for studies concerning treatment for papillary thyroid microcarcinoma between 2000 and 2013, the method of meta-analysis is performed to compare the effect of different treatment...
April 2016: Journal of Cancer Research and Therapeutics
Tao Li, Gang Zhou, Yang Yang, Zhi-Dong Gao, Peng Guo, Zhan-Long Shen, Xiao-Dong Yang, Qi-Wei Xie, Ying-Jiang Ye, Ke-Wei Jiang, Shan Wang
BACKGROUND: Intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN) has been widely applied during thyroid surgery. However, the safe range of stimulation intensity for IONM remains undetermined. METHODS: Total thyroidectomies were performed on twenty dogs, and their RLNs were stimulated with a current of 5-20 mA (step-wise in 5 mA increments) for 1 min. The evoked electromyography (EMG) of vocal muscles before and after supramaximal stimulation were recorded and compared...
August 5, 2016: Chinese Medical Journal
Brian C Brajcich, Christopher R McHenry
BACKGROUND: Damage to the recurrent laryngeal nerve (RLN) can lead to vocal cord paralysis, resulting in hoarseness, aspiration, stridor, and respiratory distress. The purpose of this study was to examine the impact of intraoperative nerve monitoring (IONM) on RLN injury during thyroidectomy when it is used as an adjunct to confirm the functional integrity of the RLN during delineation of its anatomic course after it has been visually identified. METHODS: A retrospective cohort study was performed comparing the rate of RLN injury in patients undergoing thyroidectomy with IONM, which was implemented in 2012, to patients who underwent thyroidectomy without IONM during the 3-year period immediately before IONM...
July 2016: Journal of Surgical Research
Brigitte Farizon, Marie Gavid, Alexandre Karkas, Jean-Marc Dumollard, Michel Peoc'h, Jean-Michel Prades
The aim of the present study was to evaluate the thyroarytenoid muscle response during bilateral thyroid surgery using vagal nerve stimulation. 195 patients (390 nerves at risk) underwent a total thyroidectomy. The recurrent laryngeal nerve's function was checked by analyzing the amplitude and the latency of the thyroarytenoid muscle's responses after a vagal nerve's stimulation (0.5 and 1 mA) using the NIM3 Medtronic system. All patients were submitted to preoperative and postoperative laryngoscopy. 20 patients get no thyroarytenoid muscle response to the vagal nerve stimulation, and 14 postoperative recurrent laryngeal nerve palsies were confirmed (3...
July 15, 2016: European Archives of Oto-rhino-laryngology
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