Supero-inferior Thyroidectomy Technique in Papillary Thyroid Carcinoma: Preliminary Results of Thirteen Cases with Intraoperative Nerve Monitoring
Yıl: 2020 Cilt: 10 Sayı: 2 Sayfa Aralığı: 129 - 132 Metin Dili: İngilizce DOI: 10.4274/jarem.galenos.2019.2952 İndeks Tarihi: 30-10-2020
Supero-inferior Thyroidectomy Technique in Papillary Thyroid Carcinoma: Preliminary Results of Thirteen Cases with Intraoperative Nerve Monitoring
Öz: Objective: This study aimed to investigate the novel use of a surgical technique using intraoperative nerve monitoring (IONM) technology inconjunction with supero-inferior thyroid dissection technique for selected cases of diagnosed papillary carcinoma. We also aimed to determine theminimal stimulation thresholds for the recurrent laryngeal nerve (RLN) before its insertion into the larynx through the cricothyroid membrane.Methods: In this retrospective analysis, 13 consecutive patients (11 women, 2 men) aged 42-71 years (median, 53 years) who underwent totalthyroidectomy with a preoperative diagnosis of papillary thyroid carcinoma only were included. The supero-inferior dissection technique has beendetailed within the manuscript. After completion of thyroidectomy, the minimum current enough to stimulate the RLN at the most distal point wasmeasured and recorded.Results: The mean minimum stimulation current was 0.26±0.07 mA and 0.25±0.07 mA on the left and right sides, respectively. No permanent ortransient RLN paralysis was observed postoperatively.Conclusion: The supero-inferior dissection technique may have advantages, such as identification of the RLN in a constant point even in nonrecurrentcases and low complication rates, but it still requires delicate and careful dissection based on our experience and should be combined withthe IONM technique, if possible.
Anahtar Kelime: Papiller Tiroid Karsinomunda Süpero-inferiyor Tiroidektomi Tekniği: İntraoperatif Sinir Monitorizasyonu ile On Üç Olgunun Ön Sonuçları
Öz: Amaç: Çalışmanın amacı, total tiroidektomi planlanan papiller karsinom hastalarında, intraoperatif sinir monitörizasyonu (IONM) ile birlikte süperoinferiyor sinir diseksiyonu cerrahi tekniğinin kullanımının araştırılması, aynı zamanda, rekürren laringeal sinirin (RLN), en distali olan kriktiroid membrandan larinks içerisine giriş noktasındaki minimum stimülasyon eşik değerlerinin belirlenmesidir. Yöntemler: Bu retrospektif çalışmada, preoperatif olarak papiller tiroid karsinomu tanısı ile total tiroidektomi uygulanan ortanca yaşı 53 (42-71) olan 13 hasta (11 kadın, 2 erkek) incelenmiştir. RLN diseksiyonu süpero-inferiyor teknik ile gerçekleştirilmiştir. Süpero-inferiyor diseksiyon tekniği yazı içinde ayrıntılı olarak açıklanmıştır. Tiroidektominin tamamlanmasından sonra, en distal noktada RLN’yi uyarmaya yetecek minimum akım ölçülmüş ve kaydedilmiştir. Bulgular: Ortalama minimum stimülasyon akım değeri, sol tarafta 0,26±0,07 mA ve sağ tarafta 0,25±0,07 mA olarak kaydedildi. Operasyon sonrası gözlenen kalıcı veya geçici RLN felci yoktu. Sonuç: Süpero-inferiyor diseksiyon tekniği ile RLN, non-rekürren sinir varyasyonu durumunda bile çok sabit bir noktada ortaya konulduğundan düşük komplikasyon oranları ile diseke edilebilir ancak deneyimlerimize göre çok hassas ve dikkatli diseksiyon komplikasyonların önüne geçmek için esastır. Sinir lokalizasyonu kolaylaştırdığından mümkün olan durumlarda IONM kullanılması düşünülmelidir.
Anahtar Kelime: Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
- 1. Deniwar A, Kandil E, Randolph G. Electrophysiological neural monitoring of the laryngeal nerves in thyroid surgery: review of the current literature. Gland Surg 2015; 4: 368-75.
- 2. Liu X, Zhang D, Zhang G, Zhao L, Zhou L, Fu Y, et al. Laryngeal nerve morbidity in 1.273 central node dissections for thyroid cancer. Surg Oncol 2018; 27: 21-5.
- 3. Topal Y, Gedik ML, Karagoz I, Gonullu D, Arikan S, Tunalı V, et al. Total Tiroidektomi Yapılan Hastalarda, A. Thyroidea İnferior’un Trunkal Bağlanıp Bağlanmamasının ve N. Laryngeus İnferior’un Diseke Edilip Edilmemesinin Postoperatif Erken Dönem Kan Kalsiyumuna Etkisi. J Acad Res Med 2014; 2: 69-73.
- 4. Wong KP, Mak KL, Wong CKH, Lang BHH. Systematic review and metaanalysis on intra-operative neuro-monitoring in high-risk thyroidectomy. Int J Surg 2017; 38: 21-30.
- 5. Song P, Shemen L. Electrophysiologic laryngeal nerve monitoring in high-risk thyroid surgery. Ear Nose Throat J 2005; 84: 378-81.
- 6. Wu CW, Dionigi G, Barczynski M, Chiang FY, Dralle H, Schneider R, et al. International neuromonitoring study group guidelines 2018: Part II: Optimal recurrent laryngeal nerve management for invasive thyroid cancer-incorporation of surgical, laryngeal, and neural electrophysiologic data. Laryngoscope 2018; 128(Suppl 3): 18-27.
- 7. Veyseller B, Aksoy F, Yildirim YS, Karatas A, Ozturan O. Effect of recurrent laryngeal nerve identification technique in thyroidectomy on recurrent laryngeal nerve paralysis and hypoparathyroidism. Arch Otolaryngol Head Neck Surg 2011; 137: 897-900.
- 8. Randolph GW, Dralle H; International Intraoperative Monitoring Study Group, 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(Suppl 1):1-16.
- 9. Musholt TJ, Clerici T, Dralle H, Frilling A, Goretzki PE, Hermann MM, et al. German Association of Endocrine Surgeons practice guidelines for the surgical treatment of benign thyroid disease. Langenbecks Arch Surg 2011; 396: 639-49.
- 10. Choby G, Hollenbeak CS, Johnson S, Goldenberg D. Surface electrode recurrent laryngeal nerve monitoring during thyroid surgery: normative values. J Clin Neurophysiol 2010; 27: 34-7.
- 11. Julien N, Mosnier I, Bozorg Grayeli A, Nys P, Ferrary E, Sterkers O. Intraoperative laryngeal nerve monitoring during thyroidectomy and parathyroidectomy: A prospective study. Eur Ann Otorhinolaryngol Head Neck Dis 2012; 129: 69-76.
- 12. Postma DS, Becker MO, Roberts A, Gilleon S, Soto J. Thyroidectomy in a community hospital: findings of 100 consecutive cases. Ear Nose Throat J 2009; 88: 30.
- 13. Page C, Peltier J, Charlet L, Laude M, Strunski V. Superior approach to the inferior laryngeal nerve in thyroid surgery: anatomy, surgical technique and indications. Surg Radiol Anat 2006; 28: 631-6.
- 14. Guerrier Y. 3: la chirurgie du corps thyroïde. In: Traité de technique chirurgicale ORL et cervico-faciale Tome 4: cou et cavité buccale, 2ème éd. Editions Masson, Paris: 1998. p. 125-98.
| APA | ilgun a, Kazikdas K (2020). Supero-inferior Thyroidectomy Technique in Papillary Thyroid Carcinoma: Preliminary Results of Thirteen Cases with Intraoperative Nerve Monitoring. , 129 - 132. 10.4274/jarem.galenos.2019.2952 |
| Chicago | ilgun ahmet serkan,Kazikdas K. Cagdas Supero-inferior Thyroidectomy Technique in Papillary Thyroid Carcinoma: Preliminary Results of Thirteen Cases with Intraoperative Nerve Monitoring. (2020): 129 - 132. 10.4274/jarem.galenos.2019.2952 |
| MLA | ilgun ahmet serkan,Kazikdas K. Cagdas Supero-inferior Thyroidectomy Technique in Papillary Thyroid Carcinoma: Preliminary Results of Thirteen Cases with Intraoperative Nerve Monitoring. , 2020, ss.129 - 132. 10.4274/jarem.galenos.2019.2952 |
| AMA | ilgun a,Kazikdas K Supero-inferior Thyroidectomy Technique in Papillary Thyroid Carcinoma: Preliminary Results of Thirteen Cases with Intraoperative Nerve Monitoring. . 2020; 129 - 132. 10.4274/jarem.galenos.2019.2952 |
| Vancouver | ilgun a,Kazikdas K Supero-inferior Thyroidectomy Technique in Papillary Thyroid Carcinoma: Preliminary Results of Thirteen Cases with Intraoperative Nerve Monitoring. . 2020; 129 - 132. 10.4274/jarem.galenos.2019.2952 |
| IEEE | ilgun a,Kazikdas K "Supero-inferior Thyroidectomy Technique in Papillary Thyroid Carcinoma: Preliminary Results of Thirteen Cases with Intraoperative Nerve Monitoring." , ss.129 - 132, 2020. 10.4274/jarem.galenos.2019.2952 |
| ISNAD | ilgun, ahmet serkan - Kazikdas, K. Cagdas. "Supero-inferior Thyroidectomy Technique in Papillary Thyroid Carcinoma: Preliminary Results of Thirteen Cases with Intraoperative Nerve Monitoring". (2020), 129-132. https://doi.org/10.4274/jarem.galenos.2019.2952 |
| APA | ilgun a, Kazikdas K (2020). Supero-inferior Thyroidectomy Technique in Papillary Thyroid Carcinoma: Preliminary Results of Thirteen Cases with Intraoperative Nerve Monitoring. JAREM, 10(2), 129 - 132. 10.4274/jarem.galenos.2019.2952 |
| Chicago | ilgun ahmet serkan,Kazikdas K. Cagdas Supero-inferior Thyroidectomy Technique in Papillary Thyroid Carcinoma: Preliminary Results of Thirteen Cases with Intraoperative Nerve Monitoring. JAREM 10, no.2 (2020): 129 - 132. 10.4274/jarem.galenos.2019.2952 |
| MLA | ilgun ahmet serkan,Kazikdas K. Cagdas Supero-inferior Thyroidectomy Technique in Papillary Thyroid Carcinoma: Preliminary Results of Thirteen Cases with Intraoperative Nerve Monitoring. JAREM, vol.10, no.2, 2020, ss.129 - 132. 10.4274/jarem.galenos.2019.2952 |
| AMA | ilgun a,Kazikdas K Supero-inferior Thyroidectomy Technique in Papillary Thyroid Carcinoma: Preliminary Results of Thirteen Cases with Intraoperative Nerve Monitoring. JAREM. 2020; 10(2): 129 - 132. 10.4274/jarem.galenos.2019.2952 |
| Vancouver | ilgun a,Kazikdas K Supero-inferior Thyroidectomy Technique in Papillary Thyroid Carcinoma: Preliminary Results of Thirteen Cases with Intraoperative Nerve Monitoring. JAREM. 2020; 10(2): 129 - 132. 10.4274/jarem.galenos.2019.2952 |
| IEEE | ilgun a,Kazikdas K "Supero-inferior Thyroidectomy Technique in Papillary Thyroid Carcinoma: Preliminary Results of Thirteen Cases with Intraoperative Nerve Monitoring." JAREM, 10, ss.129 - 132, 2020. 10.4274/jarem.galenos.2019.2952 |
| ISNAD | ilgun, ahmet serkan - Kazikdas, K. Cagdas. "Supero-inferior Thyroidectomy Technique in Papillary Thyroid Carcinoma: Preliminary Results of Thirteen Cases with Intraoperative Nerve Monitoring". JAREM 10/2 (2020), 129-132. https://doi.org/10.4274/jarem.galenos.2019.2952 |
