Makarin, Viktor1; Uspenskaya, Anna1; Semenov, Arseny1, 3; Timofeeva, Nataliya1; Chernikov, Roman1; Sleptsov, Ilya1, 3; Chinchuk, Igor1; Karelina, Ulya1; Novokshonov, Kostya1; Fedorov, Elisey1; Malugov, Yury1; Rusakov, Vladimir1; Sablin, Ilya1; Gorskaya, Nataliya1; Denisenkova, Vlada3; Ostanina, Ulya3; Krasnov, Leonid1, 2; Fedotov, Yury1, 2; Bubnov, Alexandr1, 2, 3
1 University Hospital of Saint-Petersburg State University, Saint-Petersburg, Russian Federation
2 North-Western State Medical University named after I.I. Mechnikov, Saint-Petersburg, Russian Federation
3 Saint-Petersburg State University, Russian Federation
Background: Larynx paresis is one of the most frequent complications after thyroid surgery in case of thyroid malignancies. The continuous neural monitoring technique provides valuable advantage of real-time constant control over safe keeping of laryngeal nerve, allowing immediate surgeon”s reactions to any impending nerve injury manoeuvres.
Objectives: demonstration of possibilities and safety of laryngeal nerves stimulation by means of temporary implantable vagus Delta-electrode aiming to prevent bilateral larynx paresis during thyroid operations.
Materials and methods: During the period of Oct. 2015 – Feb. 2016 at the Endocrine Department of the University Clinic 1065 operations were performed with intermittent nerve monitoring and 120 operations with continuous neural monitoring with implantable vagus Delta- electrode.
Results: Among 1065 patients with intermittent nerve monitoring 68 patients (6.3%) had unilateral and 2 (0.1%) bilateral larynx paresis. Among patients with continuous neural monitoring there were no cases with bilateral larynx paresis. Among 70 patients with larynx paresis there was intraoperative LOS in 37 cases (52,8%). Sensitivity of LOS reached 50%, Specificity 99.6%, positive predictive value 89.1%, negative predictive value 96.7%. There was no LOS in the group of patients with continuous neural monitoring due to immediate surgeons reaction in response to change of signal. There were no complications related to vagus dissection.
Conclusions: In the majority of cases LOS is a sign of laryngeal nerve injury. The technique of continuous neural monitoring allows to perform real-time constant control over safe keeping of laryngeal nerve, loosen thyroid traction and decrease the possibility of postoperative paresis.