Application And Research Of Intraoperative Neuromonitoring In Modified Miccoli Surgery

Objective:Due to the promotion of the concept of minimally invasive, endoscopicthyroid surgery assisted small incision (modified Miccoli surgery) favored bymore and more doctors and patients of all ages. Application and research ofintraoperative nerve monitoring in modified Miccoli surgery reported less atabroad. Compare identification alone with intraoperative neuromonitoring of therecurrent laryngeal nerve during thyroid surgery, we mainly discuss theadvantages and disadvantages in the application of intraoperativeneuromonitoring in modified Miccoli surgery.Methods:Between Feb2013and Feb2014,109consecutive patients underwentmodified Miccoli surgery by a single surgical team. The patients included in thestudy met the following criteria: All patients provided written informed consentfor their information to be stored in the hospital database and used for research.The patients were chose by Miccoli et al proposed the endoscopy assistedthyroid surgery’ indications and contraindications in2010.Intraoperative frozensection pathology guides the scope of surgical resection. Routine vocal cordexamination was performed for all patients before the surgical procedure by otolaryngologists using an indirect or flexible laryngoscope. We comparedpatients who have had neuromonitoring and patients who have undergonesurgery with nerve visualization alone. Patients in which neuromonitoring wasutilized were performed EMG endotracheal intubation and standardized IONMoperation. Comparative analysis the two groups of patients at the time revealedthe recurrent laryngeal nerve, the total operation time, recurrent laryngeal nerveinjury rate, extend the incision rate, blood loss, postoperative drainage and indexhospitalization costs.Result:The109cases of patients aged19to78, the average age was47.34±8.33;male17cases, female92cases; The ratio of men to women was1to5.41. Thefinal diagnosis were: in65cases benign goiter (59.63%), in44papillary thyroidcarcinoma (40.37%). Intraoperative neuromonitoring was performed in41patients on the basis of the availability of the equipment (72nerves at risk).68cases of patients with routine intraoperative RLN visual identificationprotection(78nerves at risk).Identification time and total operation time ofRecurrent laryngeal nerve monitoring group was (4.7±1.4) min and (94.5±7.5) min, temporary and permanent injury rates were:1.39%and0%,extend the incision was2.44%, the average amount of bleeding (32.6±2.5)ml, postoperative drainage was (49.5±6.7) ml, hospitalization cost (20834.3±189) RMB; while the conventional group identification recurrent laryngeal nerve exposed time and total the operative time was (13.3±3.1) min and(137.4±13.3) min, temporary and permanent recurrent laryngeal nerve injuryrate was11.54%and1.28%, respectively, to extend the incision was17.65%.The average amount of bleeding (36.8±5.7) ml, postoperative drainage was(52.1±3.2) ml. Hospital cost (16937±79) RMB. Recurrent laryngealnerve which identification time and total operation time, temporary recurrentlaryngeal nerve injury rate, cuts elongation and hospitalization costs havesignificant difference (p <0.05) between the two groups.Conclusion:A thorough knowledge of identification of the RLN in the neck generally hasbeen considered the best method for the protection of the RLN, but it is difficultto meet the complex needs protection recurrent laryngeal nerve in thyroidsurgery, and nerve monitoring joint visual identification can improve therecognition rate of the recurrent laryngeal nerve. In the modified Miccoli surgery,Applications of intraoperative neuromonitoring can shorten the RLNexploration time and total operating time, reduce the rate of recurrent laryngealnerve injury, reduce incision elongation. Therefore, IONM should be promotedin modified Miccoli surgery.