Intraoperative Neuromonitoring for Early Localization and Identification of Recurrent Laryngeal Nerve During Thyroid Surgery》.pdf

INTRAOPERATIVE NEUROMONITORING FOR EARLY LOCALIZATION AND IDENTIFICATION OF RECURRENT LARYNGEAL NERVE DURING THYROID SURGERY Feng-Yu Chiang,1,2 I-Cheng Lu,3 Hui-Chun Chen,4 Hsiu-Ya Chen,3 Cheng-Jing Tsai,3 Ka-Wo Lee,1,2 Pi-Jung Hsiao,2,5 and Che-Wei Wu6,7 Departments of 1Otolaryngology, 3Anesthesiology and 4Nursing, and 5Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, 6Department of Otolaryngology, Kaohsiung Municipal Hsaio-Kang Hospital, 2Faculty of Medicine, College of Medicine, 7Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Early and definite identification of the recurrent laryngeal nerve (RLN) is an important step to avoid inadvertent nerve injury during complicated thyroid operations. This study aimed to determine the feasibility of routine use of intraoperative neuromonitoring (IONM) to localize and identify the RLN at an early stage of thyroid surgery. This prospective study enrolled 220 consecutive patients (333 RLNs at risk) who underwent thyroid operations with application of IONM. The RLN was localized and identified routinely with a nerve stimulator after opening the space between the thyroid and carotid sheath. The success rates of early RLN localization and identification were evaluated. The current for localization and the amplitude of evoked laryngeal electromyographic signals were also recorded and analyzed. All RLNs, including 87 (26%) nerves that were regarded as difficult to identify, were successfully localized and identified. The stimu- lation level for RLN localization was 2