ConclusionsĪ significant reduction in vagus nerve EMG amplitude at medialisation of the thyroid and the end of case compared to baseline indicates that stretch injury or traction forces during thyroid mobilisation are the most likely mechanism of RLN impairment during conventional thyroidectomy. RLN had no significant amplitude drop at R2 compared to R1 ( P = 0.207). Cases without LOS demonstrated a highly significant vagus nerve median percentage amplitude drop at medialisation of the thyroid lobe (− 17.9 ± 53.1%, P < 0.001), and end of case (− 16.0 ± 47.2%, P < 0.001) compared to baseline. ResultsĪ total of 100 consecutive patients undergoing thyroidectomy were studied with 126 RLN at risk. RLN signal amplitude was recorded at two time points after medialisation of the thyroid lobe (R1), and end of case (R2). The ipsilateral vagus and RLN was stimulated, and vagus nerve signal amplitude recorded at five time points during thyroidectomy (baseline, after mobilisation of superior pole, medialisation of the thyroid lobe, before release at Ligament of Berry, end of case).
MethodsĪ prospective study of consecutive patients undergoing thyroidectomy was performed with intermittent IONM using the NIM Vital nerve monitoring system. The correlation of intraoperative electromyographic amplitude changes (EMG) with surgical manoeuvres could help identify mechanisms of LOS during conventional thyroidectomy. The underlying mechanism for loss of signal (LOS) in a visually intact nerve is poorly understood. Intraoperative nerve monitoring (IONM) of the vagus and recurrent laryngeal nerve (RLN) enables prediction of postoperative nerve function.
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