Abstract
Purpose
To investigate the safety of the Thunderbeat™ (TB) device in thyroid surgery by clarifying its thermal effects on the recurrent laryngeal nerve (RLN).
Methods
We performed thyroidectomy using TB on four female pigs under general anesthesia. TB was applied 0, 1, and 2 mm from the RLN. The effects of incisions made in tissues in the vicinity of the RLN were evaluated by intraoperative neuromonitoring and pathological examination.
Results
The value of the neural integrity monitor (NIM) was unchanged at 2 and 1 mm, but there was loss of signal at 0 mm. The differences between 2 and 0 mm were not clear from the pathological findings.
Conclusions
When using the TB device during thyroid surgery, it is recommended that it is visually kept from making any contact with the RLN.
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References
Manouras A, Markogiannakis H, Koutras AS, Antonakis PT, Drimousis P, Lagoudianakis EE, et al. Thyroid surgery: comparison between the electrothermal bipolar vessel sealing system, harmonic scalpel, and classic suture ligation. Am J Surg. 2008;195(1):48–52.
Seehofer D, Mogl M, Boas-Knoop S, Unger J, Schirmeier A, Chopra S, et al. Safety and efficacy of new integrated bipolar and ultrasonic scissors compared to conventional laparoscopic 5-mm sealing and cutting instruments. Surg Endosc. 2012;26(9):2541–9.
Chandrasekhar SS, Randolph GW, Seidman MD, Rosenfeld RM, Angelos P, Barkmeier-Kraemer J, et al. Clinical practice guideline: improving voice outcomes after thyroid surgery. Otolaryngol Head Neck Surg. 2013;148(6 Suppl):1–37.
Lin YC, Dionigi G, Randolph GW, Lu IC, Chang PY, Tsai SY, et al. Electrophysiologic monitoring correlates of recurrent laryngeal nerve heat thermal injury in a porcine model. Laryngoscope. 2015;125(8):E283-90.
Dionigi G, Wu CW, Kim HY, Rausei S, Boni L, Chiang FY. Severity of recurrent laryngeal nerve injuries in thyroid surgery. World J Surg. 2016;40(6):1373–81.
Delbridge L, Guinea AI, Reeve TS. Total thyroidectomy for bilateral benign multinodular goiter: effect of changing practice. Arch Surg. 1999;134(12):1389–93.
Bron LP, O’Brien CJ. Total thyroidectomy for clinically benign disease of the thyroid gland. Br J Surg. 2004;91(5):569–74.
Petrakis IE, Kogerakis NE, Lasithiotakis KG, Vrachassotakis N, Chalkiadakis GE. LigaSure versus clamp-and-tie thyroidectomy for benign nodular disease. Head Neck. 2004;26(10):903–9.
Dilek ON, Yilmaz S, Degirmenci B, Ali Sahin D, Akbulut G, Dilek FH. The use of a vessel sealing system in thyroid surgery. Acta Chir Belg. 2005;105(4):369–72.
Melck AL, Wiseman SM. Harmonic scalpel compared to conventional hemostasis in thyroid surgery: a meta-analysis of randomized clinical trials. Int J Surg Oncol. 2010;396079.
Hwang SO, Jung JH, Park HY, Kim WW. A prospective, randomized study between the small jaw(R) and the harmonic focus(R) in open thyroidectomy. Otolaryngol Head Neck Surg. 2014;150(6):943–8.
Milsom J, Trencheva K, Monette S, Pavoor R, Shukla P, Ma J, et al. Evaluation of the safety, efficacy, and versatility of a new surgical energy device (THUNDERBEAT) in comparison with Harmonic ACE, LigaSure V, and EnSeal devices in a porcine model. J Laparoendosc Adv Surg Tech A. 2012;22(4):378–86.
Lee KE, Jee HG, Kim HY, Park WS, Park SH, Youn YK. Development of a canine model for recurrent laryngeal injury by harmonic scalpel. Lab Anim Res. 2012;28(4):223–8.
Kwak HY, Dionigi G, Kim D, Lee HY, Son GS, Lee JB, et al. Thermal injury of the recurrent laryngeal nerve by THUNDERBEAT during thyroid surgery: findings from continuous intraoperative neuromonitoring in a porcine model. J Surg Res. 2016;200(1):177–82.
Karla V, Chavez EM, Barajas F, Soroa A, Gamboa-Dominguez S, Ordonez S, Juan P. Safety assessment of the use of ultrasonic energy in the proximity of the recurrent laryngeal nerve in a porcine model. Am J Surg. 2018;215:186–90.
Rotshenker S. Wallerian degeneration: the innate-immune response to traumatic nerve injury. J Neuroinflammation. 2011;8:109.
Acknowledgements
We thank Olympus Co., Ltd. and Medtronic Co., Ltd. who cooperated in this experiment.
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Tamura, A., Tsutsui, H., Yano, Y. et al. Thermal effects of the Thunderbeat™ device on the recurrent laryngeal nerve during thyroid surgery. Surg Today 48, 1076–1080 (2018). https://doi.org/10.1007/s00595-018-1692-1
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DOI: https://doi.org/10.1007/s00595-018-1692-1