Computer-assisted evoked electromyography with stimulating surgical instruments for recurrent/external laryngeal nerve identification and preservation in thyroid and parathyroid operation

Alan P B Dackiw, Lorne E. Rotstein, Orlo H. Clark, William B. Inabnet, Ashok R. Shaha, Edwin Kaplan, Henning Dralle, Clive S. Grant

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Background. The reported incidence of recurrent laryngeal nerve (RLN) palsy/paralysis in thyroid and parathyroid operation ranges from 2% to 13%. Injury to the external branch of the superior laryngeal nerve (EBSLN) is less clearly documented. We hypothesized that a novel evoked electromyography system using an audio warning alarm might be beneficial for detection and preservation of the RLN and EBSLN. Methods. A total of 117 thyroid/parathyroid operations were performed using a nerve locator/monitor (Neurovision SE, RLN Systems Inc, Jefferson City, Mo). Dissection was performed using a stimulating hemostat with conduction to an endotracheal surface electrode. Results. A total of 97 thyroidectomies (50 total, 47 lobectomies) and 20 parathyroidectomies (16 directed, 4 bilateral) were performed representing 176 RLN and 152 EBSLN at risk. Of 176 RLN, 161 were correctly identified by the nerve stimulator alarm including 2 nonrecurrent nerves. The cricothyroid space and the superior pole vessels were scanned to identify the EBSLN by observing for cricothyroideus contraction or an alarm. Fourteen of 152 (8.9%) cases of type 2 anatomy were suggested where meticulous dissection of superior pole vessels prevented EBSLN injury. Conclusions. Computer-assisted evoked electromyography with stimulating surgical instruments is a useful surgical tool. This technology may be especially useful in reoperation in dense scar tissue and preserving the EBSLN in thyroid operation.

Original languageEnglish (US)
Pages (from-to)1100-1108
Number of pages9
JournalSurgery
Volume132
Issue number6
DOIs
StatePublished - Dec 1 2002

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Laryngeal Nerves
Recurrent Laryngeal Nerve
Electromyography
Surgical Instruments
Thyroid Gland
Dissection
Laryngeal Nerve Injuries
Vocal Cord Paralysis
Parathyroidectomy
Thyroidectomy
Reoperation
Paralysis
Cicatrix
Anatomy
Electrodes
Technology
Incidence
Wounds and Injuries

ASJC Scopus subject areas

  • Surgery

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Computer-assisted evoked electromyography with stimulating surgical instruments for recurrent/external laryngeal nerve identification and preservation in thyroid and parathyroid operation. / Dackiw, Alan P B; Rotstein, Lorne E.; Clark, Orlo H.; Inabnet, William B.; Shaha, Ashok R.; Kaplan, Edwin; Dralle, Henning; Grant, Clive S.

In: Surgery, Vol. 132, No. 6, 01.12.2002, p. 1100-1108.

Research output: Contribution to journalArticle

Dackiw, Alan P B ; Rotstein, Lorne E. ; Clark, Orlo H. ; Inabnet, William B. ; Shaha, Ashok R. ; Kaplan, Edwin ; Dralle, Henning ; Grant, Clive S. / Computer-assisted evoked electromyography with stimulating surgical instruments for recurrent/external laryngeal nerve identification and preservation in thyroid and parathyroid operation. In: Surgery. 2002 ; Vol. 132, No. 6. pp. 1100-1108.
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abstract = "Background. The reported incidence of recurrent laryngeal nerve (RLN) palsy/paralysis in thyroid and parathyroid operation ranges from 2{\%} to 13{\%}. Injury to the external branch of the superior laryngeal nerve (EBSLN) is less clearly documented. We hypothesized that a novel evoked electromyography system using an audio warning alarm might be beneficial for detection and preservation of the RLN and EBSLN. Methods. A total of 117 thyroid/parathyroid operations were performed using a nerve locator/monitor (Neurovision SE, RLN Systems Inc, Jefferson City, Mo). Dissection was performed using a stimulating hemostat with conduction to an endotracheal surface electrode. Results. A total of 97 thyroidectomies (50 total, 47 lobectomies) and 20 parathyroidectomies (16 directed, 4 bilateral) were performed representing 176 RLN and 152 EBSLN at risk. Of 176 RLN, 161 were correctly identified by the nerve stimulator alarm including 2 nonrecurrent nerves. The cricothyroid space and the superior pole vessels were scanned to identify the EBSLN by observing for cricothyroideus contraction or an alarm. Fourteen of 152 (8.9{\%}) cases of type 2 anatomy were suggested where meticulous dissection of superior pole vessels prevented EBSLN injury. Conclusions. Computer-assisted evoked electromyography with stimulating surgical instruments is a useful surgical tool. This technology may be especially useful in reoperation in dense scar tissue and preserving the EBSLN in thyroid operation.",
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