Intraoperative neuromonitoring of the external branch of the superior laryngeal nerve during robotic thyroid surgery: a preliminary prospective study

Su-Jin Kim, Kyu Eun Lee, Byung-Mo Oh, Eun Mee Oh, Dong Sik Bae, June Young Choi, Jun Pyo Myong, Yeo-Kyu Youn, Su-Jin Kim, Kyu Eun Lee, Byung-Mo Oh, Eun Mee Oh, Dong Sik Bae, June Young Choi, Jun Pyo Myong, Yeo-Kyu Youn

Abstract

Purpose: The aim of this study was to evaluate the feasibility of monitoring external branch of the superior laryngeal nerve (EBSLN) during robotic thyroid surgery.

Methods: A total of 10 patients undergoing bilateral axillo-breast approach (BABA) robotic thyroid surgery were enrolled. The nerve integrity monitor (NIM Response 2.0 System) was used for EBSLN monitoring. We performed voice assessments preoperatively and at 1 and 3 months postoperatively using Voice Handicap Index-10 (VHI-10), maximal phonation time (MPT), phonation efficient index (PEI), and laryngeal electromyography (EMG).

Results: A total of 19 EBSLNs were at risk and 14 EBSLNs (73.7%) were identified using neuromonitoring. VHI-10 showed a change of voice over time (0.1 vs. 3.6 vs. 1.3); however, this was not statistically significant. VHI-10 scores normalized at 3 months postoperatively compared to the preoperative scores. MPT (a) (16.0 vs. 15.6 vs. 15.4), and MPT (e) (20.1 vs. 15.4 vs. 18.5) showed no significant differences preoperatively compared to the values obtained 1 and 3 months postoperatively. There was a significant change of PEI over time (4.8 vs. 1.1 vs. 4.6) (P = 0.036); however, the values normalized at 3 months postoperatively. Laryngeal EMG results showed 4 cases (21.2%) of neuropathy of EBSLNs at 1 month postoperatively, and electrodiagnostic studies revealed nearly complete recovery of the function of EBSLNs in 4 patients at 3 months postoperatively.

Conclusion: It is suggested that neuromonitoring of EBSLNs during BABA robotic thyroid surgery is feasible and might be helpful to preserve voice quality.

Keywords: Intraoperative neurophysiological monitoring; Laryngeal nerves; Robotic surgical procedures; Thyroidectomy.

Conflict of interest statement

CONFLICTS OF INTEREST: The study was performed with the assistance of a research grant (06-2009-3020) provided by Medtronic Xomed. Except for that, no potential conflict of interest relevant to this article was reported.

Figures

Fig. 1. (A) Comparison of the Voice…
Fig. 1. (A) Comparison of the Voice Handicap Index-10 (VHI-10) preoperatively (preop) and at 1 and 3 months postoperatively. The VHI-10 showed a change of voice over time (0.1 vs. 3.6 vs. 1.3); however, this was not statistically significant (P = 0.056). VHI-10 normalized at 3 months postoperatively compared with VHI-10 preoperatively. Squares indicate mean and bars indicate minimum to maximum range. (B) Comparison of maximal phonation time (MPT) (a) preoperatively and at 1 and 3 months postoperatively. MPT (a) showed no significant change over time (16.0 vs. 15.6 vs. 15.4) (P = 0.889). Squares indicate mean and bars indicate minimum to maximum range. (C) Comparison of MPT (e) preoperatively and at 1 and 3 months postoperatively. MPT (e) showed no significant change over time (20.1 vs. 15.4 vs. 18.5) (P = 0.174). Squares indicate mean and bars indicate minimum to maximum range. (D) Comparison of phonation efficient index (PEI) preoperatively and at 1 and 3 months postoperatively. A significant change of PEI over time was observed (4.8 vs. 1.1 vs. 4.6) (P = 0.036); however, PEI normalized at 3 months postoperatively. Squares indicate mean and bars indicate minimum to maximum range. a,bsymbol of post hoc analysis.

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