http://chineseinput.net/에서 pinyin(병음)방식으로 중국어를 변환할 수 있습니다.
변환된 중국어를 복사하여 사용하시면 됩니다.
Intraoperative Neural Monitoring in Thyroid Surgery: Role and Responsibility of Surgeon
Hoon Yub Kim,Ralph P. Tufano,Young Jun Chai,Marcin Barczynski,ozer Makay,Che-Wei Wu,Eren Berber,Hui Sun,Gianlorenzo Dionigi,the Korean Intraoperative Neural Monitoring Society (KINMoS) 대한갑상선-내분비외과학회 2018 The Koreran journal of Endocrine Surgery Vol.18 No.1
Surgeons who introduce intraoperative neural monitoring (IONM) or a new IONM accessory, or related procedure in their practice should have completed relevant surgical training, possess operating privileges in the affected endocrine system, and be able to address anticipated complications. Surgeon responsibility in monitoring is dual component. First, technical component is using and setting up the IONM equipment correctly and understanding the inherent properties of the system to avoid an erroneous setup (e.g., no muscle relaxation, correct electrode placement, low impedance, etc.). Second, interpretive component is performing the monitoring able to distinguish between a true response versus an artifactual one. Organizations such as the International Neural Study Group and the Korean Intraoperative Neural Monitoring Society provide training courses for surgeon, as well as a means to certify levels of monitoring interpretative competence.
Predictive Risk Factors for Recurrence or Metastasis in Papillary Thyroid Cancer
김완욱,이지연,정진향,박호용,정지윤,박지영,Ralph P. Tufano 대한갑상선학회 2020 International Journal of Thyroidology Vol.13 No.2
Background and Objectives: This study investigated predictive risk factors for cervical nodal recurrence ormetastasis in papillary thyroid carcinoma (PTC). Materials and Methods: From September 2014 to February 2015,a total of 321 PTC patients were enrolled retrospectively. Except for 154 N0 patients, the remaining 167 patientswere divided into two groups as follows: Group I (n=140), central lymph node (LN) metastasis (pN1a); GroupII (n=27), lateral LN metastasis (pN1b, n=23) or LN recurrence (n=4). The patients who had LN metastasis orrecurrence underwent selective LN dissection or recurrent LN excision. Results: Central LN metastases were foundin 44.0% (142/321) of patients. Two hundred thirty patients (71.7%) were classified as being at low-risk forLN disease, as evidenced by N0 or fewer than five micrometastases. The mean size of central metastatic LNs was0.37±0.34 cm. A total of 76 patients (46.6%) presented with micrometastasis, and ten (3.1%) presented withextranodal extension (ENE). The multiple/bilateral cancer, Extrathyroidal extension, size of metastatic LN, ENE, highrisk LN disease (>5, macrometastasis, >3.0 cm) and high thyroglobulin were significant risk factors in predictingLN recurrence or lateral LN metastasis (p<0.05) in univariate analysis. Patients with ENE were 10.3 times moreat risk for recurrence or metastasis than patients without ENE. Conclusion: We consider the ENE was the mostpotent risk factors for LN recurrence or lateral LN metastasis in PTC.
Standards for Intraoperative Neuromonitoring in Thyroid Operations
Hoon Yub Kim,Xiaoli Liu,Young Jun Chai,Ralph Tufano,Henning Dralle,Gianlorenzo Dionigi,the Korean Intraoperative Neural Monitoring Society(KINMoS) 대한갑상선-내분비외과학회 2018 The Koreran journal of Endocrine Surgery Vol.18 No.1
After the introduction of intraoperative neural monitoring (IONM) of the recurrent laryngeal nerve (RLN) in clinical thyroid practice almost 16 years ago, the procedure has expanded rapidly with an area-wide spread in Asia, Europe, and USA. While the visual nerve presentation with the eye or the magnifying glass technique is capable of assessing the anatomical continuity of the RLN, IONM additionally allows a functional analysis that has a high correlation, i.e., prediction of postoperative vocal motility. Although the predictive value of the IONM is much higher (>97%) in the case of an intact signal than in the case of a signal failure (40%-70%), the prediction is also unequally higher than the visual-anatomical assessment of the nerve. Thus, IONM can be used as a basis for an intraoperative decision-making of a 1-side or 2-side procedure to avoid bilateral RLN palsy in a bilateral procedure. A precondition for the safe application of IONM is the perfect knowledge of the technology and technique, the routine execution of preoperative and postoperative laryngoscopy, the strict standardization of the neurostimulation (electromyography documentation of the vagal nerve stimulation before and after resection), and an adequate management of technically or operationally caused incidents (i.e., systematic application of troubleshooting algorithms). The following review provides a synopsis of the experiences of the Korean Intraoperative Neural Monitoring Society (KINMoS) for the correct use of IONM.
Loss of the Neuromonitoring Signal on the First Side in Planned Total Thyroidectomy
Hoon Yub Kim,Hui Sun,Young Jun Chai,Ralph Tufano,Henning Dralle,Giuseppe Navarra,Gianlorenzo Dionigi 대한갑상선-내분비외과학회 2017 The Koreran journal of Endocrine Surgery Vol.17 No.3
With an increased use of intraoperative neural monitoring (IONM), an adaptation of the resection strategy appears to be necessary in case of an intraoperative loss of signal (LOS) of the first operated side with total thyroidectomy planned. The contralateral side resection with intact recurrent laryngeal nerve (RLN) function from the surgical point of view, basically has 3 options: 1) no contralateral resection in bilateral goiter, Graves disease, or low risk thyroid carcinoma (differentiated and medullary thyroid carcinomas) with the aim of 2-stage completion surgery after recovery of nerve function; 2) contralateral subtotal resection ventrally of the RLN plane in benign goiter with a safety distance to the nerve with the aim of avoiding further surgery; and 3) total thyroidectomy as planned for advanced thyroid carcinomas (including undifferentiated thyroid carcinomas) with the aim of immediate postoperative radioiodotherapy. The following document provides a synopsis of the experiences of the Korean Intraoperative Neural Monitoring Society (KINMoS) for the strategy for planned total thyroidectomy and loss of the neuromonitoring signal on the first thyroid lobe.
김완욱,Jeeyeon Lee,정진향,Ho Yong Park,김원화,Hye Jung Kim,박지영,Ralph P. Tufano 영남대학교 의과대학 2020 Yeungnam University Journal of Medicine Vol.37 No.4
Background: This study evaluated the usefulness of judgment of central lymph node (LN) metastasis by surgeon’s palpation in papillary thyroid cancer. Methods: This study included 127 patients who underwent thyroidectomy and central compartment node dissection between October 2014 and February 2015. The criterion for suspicious LNs was hardness. Results: Of the 20.5% (28/127) of suspicious for metastatic LNs according to surgeon determination, 92.8% (26/28) were confirmed to be metastatic in the final pathological examinations. Metastatic LNs were found in 38 (38.3%) of 99 patients without suspicious LNs, 29 of whom (76.3%) had micrometastases. The sensitivity, specificity, and positive and negative predictive values for the determination of LN metastasis by a surgeon were 40.6%, 96.8%, 92.9%, and 61.6%, respectively. Conclusion: Determination of central LN metastasis by a surgeon’s palpation may be useful to evaluate LNs owing to the high specificity and positive predictive values, especially in macrometastasis or high-risk LN disease.
Medico-Legal Issues of Intraoperative Neuromonitoring in Thyroid Surgery
Hoon Yub Kim,Xiaoli Liu,Hui Sun,Che-Wei Wu,Young Jun Chai,Woong Youn Chung,Ralph Tufano,Henning Dralle,Matteo Lavazza,Gianlorenzo Dionigi 대한갑상선-내분비외과학회 2017 The Koreran journal of Endocrine Surgery Vol.17 No.2
Advances in intraoperative neuromonitoring (IONM) in thyroid surgery have provided significant insights into recurrent laryngeal nerve function during thyroid surgery. Despite the limitations and necessary caution when using intraoperative monitors to interpret neural function, these technologies have been definite steps in the right direction for assessing neural integrity and safe surgical strategy during thyroid operations. The techniques discussed minimize the adverse sequelae of a variety of thyroid gland procedures, reducing the morbidity rates/risks in the perioperative period. Furthermore, it is likely that such monitoring will become a standard of care. Accurate, reliable and continuous monitoring is essential, and on-going large studies with definable end points will be necessary. The use of monitoring, such as continuous one, may improve cost efficiency by reducing permanent nerve injuries. A danger in this process, however, is the potential for public opinion, outside regulatory bodies, or medico-legal implications to drive change and enforce standards of care before appropriate data are available.