How neuromonitoring is performed
The device uses electromyography which assesses the function of the vocal cords using surface electrodes. The NIM Response system is the most widely used device and converts laryngeal muscle activity into sound and/or visual signals.
The International Neural Monitoring Study Group (INMSG) defined the standard steps of intraoperative neuromonitoring in thyroid surgery by adding preoperative and postoperative vocal cord examinations.
“During the surgical procedure, neuromonitoring is achieved by repeatedly stimulating the muscle tissues of the larynx, which leads to the correct identification of the nerve and its function, and the medical equipment with an endotracheal tube with electrodes is the simplest and least invasive solution for the patient and , at the same time, the most effective”, states Dr. Octavian Simon.
Intraoperative neuromonitoring completely prevents all operative complications generated by nerve damage, allowing the surgeon to directly visualize the innervation of the larynx and provide an objective assessment of its function during the entire dissection, but also to detect anatomical variations of the nerve and predict the function of the vocal cords after surgery . Furthermore, neuromonitoring can detect non-functioning nerves, even if they appear anatomically intact.
The procedure is standardized, involves equally the surgeon and anesthesiologist, and requires adequate theoretical and practical experience. The anesthesiologist plays a key role in the procedure, particularly in carefully selecting the type of medication used to induce anesthesia, as neuromuscular blocking agents interfere with monitoring, reducing signal amplitude and, consequently, the optimal laryngeal response.
For a minimally invasive approach to the patient, endotracheal tubes come in various sizes. It is inserted by the anesthetist and placed in direct contact with the vocal cords, its position influencing the quality of neuromonitoring. The standard of procedure requires verification of proper functioning before actual intervention on the thyroid gland begins.
In addition to being useful during traditional open thyroidectomy, neuromonitoring may also be useful for laryngeal nerve preservation and in endoscopic thyroid surgeries such as transaxillary or transoral thyroidectomy, although a standardized technique is still lacking with these approaches.
“The performance of the system is very high and the fact that it exists in the Premiere Hospital is a benefit for the patient and for the quality of the surgical act, especially since the predictability rate of the device is 97-98%, so practically maximum. Neuromonitoring is a safe, reliable method that confirms that the operation was done well. Any vocal impairment, which may occur after the intervention, is quickly and completely reversible and is the effect of a local irritation that heals spontaneously in a few days”, explains Dr. Octavian Simon.
2023-09-17 23:43:40
#Intraoperative #neuromonitoring #interventions #thyroid #gland
