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- 저자 : Henning Dralle (검색결과 3 건)
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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.
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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.
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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.
KCI
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