Abstract:
INTRODUCTION:Intraoperative neural monitoring of the recurrent laryngeal nerve has been widely used to avoid nerve injury during thyroidectomy. We discuss the results of the change in surgical strategy after unilateral signal loss surgeries using intermittent intraoperative neural monitoring in a high-volume referral centre. MATERIALS AND METHODS:Details of consecutive patients who underwent thyroidectomy with intermittent intraoperative neural monitoring between January 2014 and December 2017 were prospectively recorded and retrospectively reviewed. Loss of signal was defined as recurrent laryngeal nerve amplitude level lower than 100 μV during surgery. The rate of loss of signal and change in surgical strategy during the operation were evaluated. RESULTS:Loss of signal was detected in 25 (5.4%) of 456 patients for whom intermittent intraoperative neural monitoring was performed. Four patients had anatomic nerve disruption and surgery was completed by an experienced endocrine surgeon making use of intraoperative neural monitoring with continuous vagal stimulation. Staged thyroidectomy was performed on 16 patients with unilateral loss of signal in whom the nerves were intact visually. Postoperative vocal cord paralysis was encountered in 18 of 21 (85.7%) patients with loss of signal, and 16 of 18 (88.8%) were improved during the follow-up period. Patients' voices were subjectively normal to the surgeon postoperatively in 9 of 21 (42.8%) patients who were found to have loss of signal with intact nerves. CONCLUSIONS:Intraoperative neural monitoring can be used safely in thyroid surgery to avoid recurrent laryngeal nerve injury. It enables the surgeon to diagnose recurrent laryngeal nerve injury intraoperatively to estimate the postoperative nerve function and to modify the surgical strategy to avoid bilateral vocal cord paralysis.
journal_name
Ann R Coll Surg Engljournal_title
Annals of the Royal College of Surgeons of Englandauthors
Gür EO,Haciyanli M,Karaisli S,Haciyanli S,Kamer E,Acar T,Kumkumoglu Ydoi
10.1308/rcsann.2019.0087subject
Has Abstractpub_date
2019-11-01 00:00:00pages
589-595issue
8eissn
0035-8843issn
1478-7083journal_volume
101pub_type
杂志文章abstract:INTRODUCTION:Screening for prostate cancer with serum prostate specific antigen (PSA) remains a controversial topic. The UK NHS Executive has issued extensive guidance stressing the importance of adequate counselling prior to performing this test. This study aims to assess men's knowledge of the PSA test at the time of...
journal_title:Annals of the Royal College of Surgeons of England
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doi:10.1308/003588406X98685
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abstract::Gastric tube conduit is the method of choice for restoring continuity of the digestive track after a partial or total esophagectomy. Redundant gastric conduit (i.e. an elongated, floppy conduit) is a rare cause of dysphagia in patients with long survival. Gastric tube volvulus is exceedingly rare with only three cases...
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journal_title:Annals of the Royal College of Surgeons of England
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