Skip to main content

Intraoperative Nerve Stimulation in Minimally Invasive Thyroidectomy

  • Chapter
  • First Online:
Minimally Invasive Thyroidectomy

Abstract

Intraoperative neural monitoring (IONM) of the recurrent laryngeal nerve (RLN) during thyroid surgery has gained widespread acceptance as an adjunct to the gold standard of visual nerve identification. IONM may be used for identification of the RLN, aid in the dissection of the RLN, and be used to anticipate postoperative neural function. This is of great significance in the prevention of bilateral nerve paralysis. In the case of nerve injury, the IONM may be used to identify the exact segment of nerve injured. The potential for reduced visual information during minimally invasive thyroid and parathyroid surgery procedure has led to the great application of neural monitoring in those cases. The use of a flexible tip of a monopolar stimulation probe allows good access to neural structures in areas outside the surgeon’s field of view. IONM in minimally invasive technique probably enables surgeons to feel more confident, indicates the correct plane of dissection, and may reduce the conversion rate to an open technique.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 199.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Angelos P (2009) Recurrent laryngeal nerve monitoring: state of the art, ethical and legal issues. Surg Clin North Am 89(5):1157–1169

    Article  PubMed  Google Scholar 

  • Dedo HH (1970) The paralyzed larynx: an electromyographic study in dogs and humans. Laryngoscope 80(10):1455–1517

    Article  PubMed  CAS  Google Scholar 

  • Dionigi G, Bacuzzi A, Boni L, Rovera F, Dionigi R (2008) What is the learning curve for intraoperative neuromonitoring in thyroid surgery? Int J Surg 6(Suppl 1):S7–S12

    Article  PubMed  Google Scholar 

  • Dionigi G, Boni L, Rovera F, Bacuzzi A, Dionigi R (2009) Neuromonitoring and video-assisted thyroidectomy: a prospective, randomized case–control evaluation. Surg Endosc 23(5):996–1003

    Article  PubMed  Google Scholar 

  • Dralle H, Sekulla C, Haerting J, Timmermann W, Neumann HJ, Kruse E et al (2004) Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery 136(6):1310–1322

    Article  PubMed  Google Scholar 

  • Dralle H, Sekulla C, Lorenz K, Brauckhoff M, Machens A (2008) Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery. World J Surg 32(7):1358–1366

    Article  PubMed  CAS  Google Scholar 

  • Kandil E, Wassef SN, Alabbas H, Freidlander PL (2009) Minimally invasive video-assisted thyroidectomy and parathyroidectomy with intraoperative recurrent laryngeal nerve monitoring. Int J Otolaryngol 2009:739798

    PubMed  Google Scholar 

  • Lahey FH, Hoover WB (1938) Injuries to the recurrent laryngeal nerve in thyroid operations: their management and avoidance. Ann Surg 108(4):545–562

    Article  PubMed  CAS  Google Scholar 

  • Myssiorek D (2004) Recurrent laryngeal nerve paralysis: anatomy and etiology. Otolaryngol Clin North Am 37(1):25–44, v

    Article  PubMed  Google Scholar 

  • Randolph GW (2003) Surgical anatomy of the recurrent laryngeal nerve. In: Randolph GW (ed) Surgery of the thyroid and parathyroid glands. Elsevier Science, Philadelphia

    Google Scholar 

  • Randolph GW, Kamani D (2006) The importance of preoperative laryngoscopy in patients undergoing thyroidectomy: voice, vocal cord function, and the preoperative detection of invasive thyroid malignancy. Surgery 139(3):357–362

    Article  PubMed  Google Scholar 

  • Randolph GW, Dralle H, Abdullah H, Barczynski M, Bellantone R, Brauckhoff M et al (2011) Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Lary­ngoscope 121(Suppl 1):S1–S16

    Article  PubMed  Google Scholar 

  • Terris DJ, Anderson SK, Watts TL, Chin E (2007) Laryngeal nerve monitoring and minimally invasive thyroid surgery: complementary technologies. Arch Otolaryngol Head Neck Surg 133(12):1254–1257

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Gregory W. Randolph M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Mekel, M., Randolph, G.W. (2012). Intraoperative Nerve Stimulation in Minimally Invasive Thyroidectomy. In: Linos, D., Chung, W. (eds) Minimally Invasive Thyroidectomy. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-23696-9_20

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-23696-9_20

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-23695-2

  • Online ISBN: 978-3-642-23696-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics