Comparison of needle electrode and endotracheal tube surface electrode for intraoperative neuromonitoring during thyroid and parathyroid surgery
Öz
Abstract
Aim: Intraoperative neuromonitoring using an endotracheal tube surface electrode has become the most widely used technique due to its safety and simplicity. Intraoperative neuromonitoring with an endotracheal tube surface electrode has some disadvantages, such as false positive loss of signal. Therefore, electrodes on the thyroid cartilage are an alternative means to assess the thyroarytenoid muscle and recurrent laryngeal nerve function. This study aims to evaluate and compare the EMG signals recorded simultaneously using thyroid cartilage needle electrodes and standard endotracheal tube surface electrodes during intermittent intraoperative neuromonitoring in thyroid and parathyroid surgery.
Materials and Methods: In this study, the data of the first 21 thyroid and parathyroid surgeries, in which both thyroid cartilage needle electrodes and endotracheal tube surface electrodes were used together as the recording side of the intermittent intraoperative neuromonitoring system in a single center, and EMG signals were recorded simultaneously, were analyzed retrospectively.
Results: Overall, EMG amplitudes recorded from thyroid cartilage needle electrodes on both the right and left sides were significantly higher than those recorded from endotracheal tube surface electrodes at each step (V1-R1-R2-V2) (p<0.05 at all stimulation steps)
Conclusion: Although the endotracheal tube surface electrodes are generally used for intraoperative neuromonitoring during thyroid and parathyroid surgery and are the recording-side method recommended by the International Neural Monitoring Study Group, the use of thyroid cartilage needle electrodes is an inexpensive, easy, and efficient alternative.
Keywords: Thyroid cartilage electrodes, endotracheal tube surface electrodes, thyroidectomy, recurrent laryngeal nerve, intraoperative neural monitoring
Anahtar Kelimeler
Thyroid cartilage electrodes endotracheal tube surface electrodes thyroidectomy recurrent laryngeal nerve intraoperative neural monitoring
Kaynakça
- Lahey FH, Hoover WB. Injuries to the recurrent laryngeal nerve in thyroid operations: their management and avoidance. Ann Surg. 1938;108(4):545.
- Hermann M, Alk G, Roka R, Glaser K, Freissmuth M. Laryngeal recurrent nerve injury in surgery for benign thyroid diseases: effect of nerve dissection and impact of individual surgeon in more than 27,000 nerves at risk. Ann Surg. 2002;235(2):261.
- Jeannon J, Orabi AA, Bruch GA, Abdalsalam HA, Simo R. Diagnosis of recurrent laryngeal nerve palsy after thyroidectomy: a systematic review. Int J Clin Pract. 2009;63(4):624–9.
- Randolph GW, Dralle H, Group with the IIMS, Abdullah H, Barczynski M, Bellantone R, et al. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Laryngoscope. 2011;121(S1):S1–16.
- Wong KP, Mak KL, Wong CKH, Lang BHH. Systematic review and meta-analysis on intra-operative neuromonitoring in high-risk thyroidectomy. Int J Surg. 2017;38:21–30.
- Lombardi CP, Carnassale G, Damiani G, Acampora A, Raffaelli M, De Crea C, et al. “The final countdown”: is intraoperative, intermittent neuromonitoring really useful in preventing permanent nerve palsy? Evidence from a meta-analysis. Surgery. 2016;160(6):1693–706.
- Chiang F, Lu I, Chang P, Dionigi G, Randolph GW, Sun H, et al. Comparison of EMG signals recorded by surface electrodes on endotracheal tube and thyroid cartilage during monitored thyroidectomy. Kaohsiung J Med Sci. 2017;33(10):503–9.
- Van Slycke S, Van Den Heede K, Magamadov K, Brusselaers N, Vermeersch H. New placement of recording electrodes on the thyroid cartilage in intra-operative neuromonitoring during thyroid surgery. Langenbeck’s Arch Surg. 2019;404(6):703–9.
- Dionigi G, Bacuzzi A, Boni L, Rovera F, Dionigi R. What is the learning curve for intraoperative neuromonitoring in thyroid surgery? Int J Surg. 2008;6:S7–12.
- Schneider R, Randolph GW, Dionigi G, Wu C, Barczynski M, Chiang F, et al. International neural monitoring study group guideline 2018 part I: staging bilateral thyroid surgery with monitoring loss of signal. Laryngoscope. 2018;128:S1–17.
- Chiang F-Y, Wu C-W, Chang P-Y, Wu S-H, Chen H-Y, Lin Y-C, et al. Trans-thyroid cartilage recording for neural monitoring of the recurrent laryngeal nerve in thyroid surgery. Laryngoscope. 2020;130(4):E280–3.
- Li P, Liang Q-Z, Wang D-L, Han B, Yi X, Wei W. Modified arytenoid muscle electrode recording method for neuromonitoring during thyroidectomy. Gland Surg. 2019;8(5):469.
- 13. Zhao Y, Li C, Zhang D, Zhou L, Liu X, Li S, et al. Experimental study of needle recording electrodes placed on the thyroid cartilage for neuromonitoring during thyroid surgery. J Br Surg. 2019;106(3):245–54.
- 14. Jung SM, Tae K, Song CM, Lee SH, Jeong JH, Ji YB. Efficacy of transcartilaginous electrodes for intraoperative neural monitoring during thyroid surgery. Clin Exp Otorhinolaryngol. 2020;13(4):422–8.
- Chiang F-Y, Lee K-W, Chen H-C, Chen H-Y, Lu I-C, Kuo W-R, et al. Standardization of intraoperative neuromonitoring of recurrent laryngeal nerve in thyroid operation. World J Surg. 2010;34(2):223–9.
- Phelan E, Schneider R, Lorenz K, Dralle H, Kamani D, Potenza A, et al. Continuous vagal IONM prevents recurrent laryngeal nerve paralysis by revealing initial EMG changes of impending neuropraxic injury: a prospective, multicenter study. Laryngoscope. 2014;124(6):1498–505.
- Schneider R, Randolph GW, Sekulla C, Phelan E, Thanh PN, Bucher M, et al. Continuous intraoperative vagus nerve stimulation for identification of imminent recurrent laryngeal nerve injury. Head Neck. 2013;35(11):1591–8. Sitges-Serra A, Gallego-Otaegui L, Fontané J, Trillo L, Lorente-Poch L, Sancho J. Contralateral surgery in patients scheduled for total thyroidectomy with initial loss or absence of signal during neural monitoring. J Br Surg. 2019;106(4):404–11.
- Sadowski SM, Soardo P, Leuchter I, Robert JH, Triponez F. Systematic use of recurrent laryngeal nerve neuromonitoring changes the operative strategy in planned bilateral thyroidectomy. Thyroid. 2013;23(3):329– 33.
- Dralle H, Sekulla C, Lorenz K, Brauckhoff M, Machens A. Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery. World J Surg. 2008;32(7):1358–66.
- Wu C-W, Wang M-H, Chen C-C, Chen H-C, Chen H-Y, Yu J-Y, et al. Loss of signal in recurrent nerve neuromonitoring: causes and management. Gland Surg. 2015;4(1):19.
- Türk Y, Kıvratma G, Özdemir M, İçöz G, Makay Ö. The use of thyroid cartilage needle electrodes in intraoperative neuromonitoring during thyroidectomy: C ase–control study. Head Neck. 2021;43(11):3287–93.
- Chiang F-Y, Lu I-C, Chen H-C, Chen H-Y, Tsai C-J, Hsiao P-J, et al. Anatomical variations of recurrent laryngeal nerve during thyroid surgery: how to identify and handle the variations with intraoperative neuromonitoring. Kaohsiung J Med Sci. 2010;26(11):575–83.
- Chiang F, Lu I, Chen H, Chen H, Tsai C, Lee K, et al. Intraoperative neuromonitoring for early localization and identification of recurrent laryngeal nerve during thyroid surgery. Kaohsiung J Med Sci. 2010;26(12):633–9.
Tiroid ve paratiroid cerrahisinde intraoperatif nöromonitörizasyon uygulamasında iğne elektrot ve yüzey elektrotlu endotrakeal tüp kullanımının karşılaştırılması
Öz
Öz:
Amaç: Yüzey elektrotlu endotrakeal tüp kullanılarak yapılan intraoperatif nöromonitörizasyon güvenli ve basit olması sebebiyle günümüzde en yaygın kullanılan teknik haline gelmiştir. Yüzey elektrotlu endotrakeal tüp ile intraoperatif nöromonitörizasyonun, yanlış pozitif sinyal kaybı gibi bazı dezavantajları vardır. Bu nedenle, tiroid kıkırdağına yerleştirilen elektrotlar, tiroaritenoid kasın ve RLS' nin fonksiyonunu değerlendirmek için alternatif bir araçtır. Bu çalışmanın amacı, tiroid ve paratiroid cerrahisinde uygulanan aralıklı intraoperatif nöromonitörizasyon esnasında tiroid kıkırdak iğne elektrotları ve standart endotrakeal tüp yüzey elektrotları beraber kullanılarak eşzamanlı olarak kaydedilen EMG sinyallerinin değerlendirilmesi ve karşılaştırılmasıdır.
Gereç ve Yöntem: Bu çalışmada tek merkezde, aralıklı intraoperatif nöromonitörizasyon sisteminin kayıt tarafı olarak hem tiroid kıkırdak iğne elektrotları hem de endotrakeal tüp yüzey elektrotları birlikte kullanılıp eş zamanlı olarak EMG sinyali kaydedilen ilk 21 tiroid ve paratiroid ameliyatının verileri retrospektif olarak analiz edilmiştir.
Bulgular: Genel olarak, hem sağ hem de sol tarafta tiroid kıkırdak iğne elektrotlarından kaydedilen EMG genlikleri, her adımda (V1-R1-R2-V2) endotrakeal tüp yüzey elektrotlarından kaydedilenlerden belirgin olarak daha yüksek olarak saptanmıştır (tüm uyarı basamaklarında p<0.05)
Sonuç: Her ne kadar endotrakeal tüp yüzey elektrotları Uluslararası Sinir Monitörizasyonu Çalışma Grubu tarafından tiroid ameliyatları sırasında intraoperatif nöromonitörizasyon için önerilen kayıt tarafı yöntemi olsa da, tiroid kıkırdak iğne elektrotları, tiroid cerrahisi sırasında RLS fonksiyonunun monitörize edilmesinde yararlı, basit ve ucuz bir alternatif tekniktir.
Anahtar sözcükler: Tiroid kıkırdak iğne elektrotu, endotrakeal tüp yüzey elektrotu, tiroidektomi, rekürren laringeal sinir, intraoperative sinir monitörizasyonu
Anahtar Kelimeler
Tiroid kıkırdak iğne elektrotu endotrakeal tüp yüzey elektrotu tiroidektomi rekürren laringeal sinir intraoperative sinir monitörizasyonu
Kaynakça
- Lahey FH, Hoover WB. Injuries to the recurrent laryngeal nerve in thyroid operations: their management and avoidance. Ann Surg. 1938;108(4):545.
- Hermann M, Alk G, Roka R, Glaser K, Freissmuth M. Laryngeal recurrent nerve injury in surgery for benign thyroid diseases: effect of nerve dissection and impact of individual surgeon in more than 27,000 nerves at risk. Ann Surg. 2002;235(2):261.
- Jeannon J, Orabi AA, Bruch GA, Abdalsalam HA, Simo R. Diagnosis of recurrent laryngeal nerve palsy after thyroidectomy: a systematic review. Int J Clin Pract. 2009;63(4):624–9.
- Randolph GW, Dralle H, Group with the IIMS, Abdullah H, Barczynski M, Bellantone R, et al. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Laryngoscope. 2011;121(S1):S1–16.
- Wong KP, Mak KL, Wong CKH, Lang BHH. Systematic review and meta-analysis on intra-operative neuromonitoring in high-risk thyroidectomy. Int J Surg. 2017;38:21–30.
- Lombardi CP, Carnassale G, Damiani G, Acampora A, Raffaelli M, De Crea C, et al. “The final countdown”: is intraoperative, intermittent neuromonitoring really useful in preventing permanent nerve palsy? Evidence from a meta-analysis. Surgery. 2016;160(6):1693–706.
- Chiang F, Lu I, Chang P, Dionigi G, Randolph GW, Sun H, et al. Comparison of EMG signals recorded by surface electrodes on endotracheal tube and thyroid cartilage during monitored thyroidectomy. Kaohsiung J Med Sci. 2017;33(10):503–9.
- Van Slycke S, Van Den Heede K, Magamadov K, Brusselaers N, Vermeersch H. New placement of recording electrodes on the thyroid cartilage in intra-operative neuromonitoring during thyroid surgery. Langenbeck’s Arch Surg. 2019;404(6):703–9.
- Dionigi G, Bacuzzi A, Boni L, Rovera F, Dionigi R. What is the learning curve for intraoperative neuromonitoring in thyroid surgery? Int J Surg. 2008;6:S7–12.
- Schneider R, Randolph GW, Dionigi G, Wu C, Barczynski M, Chiang F, et al. International neural monitoring study group guideline 2018 part I: staging bilateral thyroid surgery with monitoring loss of signal. Laryngoscope. 2018;128:S1–17.
- Chiang F-Y, Wu C-W, Chang P-Y, Wu S-H, Chen H-Y, Lin Y-C, et al. Trans-thyroid cartilage recording for neural monitoring of the recurrent laryngeal nerve in thyroid surgery. Laryngoscope. 2020;130(4):E280–3.
- Li P, Liang Q-Z, Wang D-L, Han B, Yi X, Wei W. Modified arytenoid muscle electrode recording method for neuromonitoring during thyroidectomy. Gland Surg. 2019;8(5):469.
- 13. Zhao Y, Li C, Zhang D, Zhou L, Liu X, Li S, et al. Experimental study of needle recording electrodes placed on the thyroid cartilage for neuromonitoring during thyroid surgery. J Br Surg. 2019;106(3):245–54.
- 14. Jung SM, Tae K, Song CM, Lee SH, Jeong JH, Ji YB. Efficacy of transcartilaginous electrodes for intraoperative neural monitoring during thyroid surgery. Clin Exp Otorhinolaryngol. 2020;13(4):422–8.
- Chiang F-Y, Lee K-W, Chen H-C, Chen H-Y, Lu I-C, Kuo W-R, et al. Standardization of intraoperative neuromonitoring of recurrent laryngeal nerve in thyroid operation. World J Surg. 2010;34(2):223–9.
- Phelan E, Schneider R, Lorenz K, Dralle H, Kamani D, Potenza A, et al. Continuous vagal IONM prevents recurrent laryngeal nerve paralysis by revealing initial EMG changes of impending neuropraxic injury: a prospective, multicenter study. Laryngoscope. 2014;124(6):1498–505.
- Schneider R, Randolph GW, Sekulla C, Phelan E, Thanh PN, Bucher M, et al. Continuous intraoperative vagus nerve stimulation for identification of imminent recurrent laryngeal nerve injury. Head Neck. 2013;35(11):1591–8. Sitges-Serra A, Gallego-Otaegui L, Fontané J, Trillo L, Lorente-Poch L, Sancho J. Contralateral surgery in patients scheduled for total thyroidectomy with initial loss or absence of signal during neural monitoring. J Br Surg. 2019;106(4):404–11.
- Sadowski SM, Soardo P, Leuchter I, Robert JH, Triponez F. Systematic use of recurrent laryngeal nerve neuromonitoring changes the operative strategy in planned bilateral thyroidectomy. Thyroid. 2013;23(3):329– 33.
- Dralle H, Sekulla C, Lorenz K, Brauckhoff M, Machens A. Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery. World J Surg. 2008;32(7):1358–66.
- Wu C-W, Wang M-H, Chen C-C, Chen H-C, Chen H-Y, Yu J-Y, et al. Loss of signal in recurrent nerve neuromonitoring: causes and management. Gland Surg. 2015;4(1):19.
- Türk Y, Kıvratma G, Özdemir M, İçöz G, Makay Ö. The use of thyroid cartilage needle electrodes in intraoperative neuromonitoring during thyroidectomy: C ase–control study. Head Neck. 2021;43(11):3287–93.
- Chiang F-Y, Lu I-C, Chen H-C, Chen H-Y, Tsai C-J, Hsiao P-J, et al. Anatomical variations of recurrent laryngeal nerve during thyroid surgery: how to identify and handle the variations with intraoperative neuromonitoring. Kaohsiung J Med Sci. 2010;26(11):575–83.
- Chiang F, Lu I, Chen H, Chen H, Tsai C, Lee K, et al. Intraoperative neuromonitoring for early localization and identification of recurrent laryngeal nerve during thyroid surgery. Kaohsiung J Med Sci. 2010;26(12):633–9.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Genel Cerrahi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 12 Haziran 2023 |
| Gönderilme Tarihi | 26 Ekim 2022 |
| Yayımlandığı Sayı | Yıl 2023 |