World Journal of Endocrine Surgery

Register      Login

VOLUME 9 , ISSUE 1 ( January-April, 2017 ) > List of Articles

RESEARCH ARTICLE

Experience of Intraoperative Recurrent Laryngeal Nerve monitoring in a Single Center-normative Recurrent Laryngeal Nerve Electromyographic Data

Rajeev Parameswaran, Gilbert Soh, James Wai Kit Lee, Oh Han Boon, Tan Wee Boon, Ngiam Kee Yuan

Citation Information : Parameswaran R, Soh G, Lee JW, Boon OH, Boon TW, Yuan NK. Experience of Intraoperative Recurrent Laryngeal Nerve monitoring in a Single Center-normative Recurrent Laryngeal Nerve Electromyographic Data. World J Endoc Surg 2017; 9 (1):1-6.

DOI: 10.5005/jp-journals-10002-1198

Published Online: 01-04-2017

Copyright Statement:  Copyright © 2017; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction

Injury to the recurrent laryngeal nerve (RLN) remains a significant morbidity during thyroid and parathyroid surgery. The aim of this study is to elucidate normative RLN electromyographic (EMG) parameters.

Materials and methods

This is a retrospective cohort study of patients who underwent Intraoperative neuromonitoring during thyroid and parathyroid surgery from February 2014 to March 2015. The inomed C2 NerveMonitor was used. We recorded the stimulation current, amplitude, and latency of the RLN before and after nerve dissection. We also observed the number of patients who had hoarse voice after surgery.

Results

A total of 46 patients (14 male, 32 female) averaging 51 years old in age (20-77 years) were analyzed. The most commonly performed surgical procedure was total thyroidectomy (53.2%).

The median stimulation current for both the right and left RLN was 0.500 mA. The median amplitude for the left RLN was 1.060 mV and greater than that for the right RLN (0.930 mV) (p = 0.30). The median latency for the right RLN and left RLN was 2.40 ms with no difference between the sides. (p = 0.58).

Post dissection, the right RLN amplitude remained identical whereasthe left RLN amplitude decreased. Latencies of both RLNs decreased although the difference was not significant. Nature of pathology and site of surgery did not influence RLN latency and amplitude. No patients had hoarse voice.

Conclusion

This study highlights the normative EMG parameters for bilateral RLN nerve stimulation in an Asian population. No significant difference was noted in both pre- and postdissection RLN EMG parameters.

How to cite this article

Soh G, Lee JWK, Boon OH, Boon TW, Parameswaran R, Yuan NK. Experience of Intraoperative Recurrent Laryngeal Nerve monitoring in a Single Centernormative Recurrent Laryngeal Nerve Electromyographic Data. World J Endoc Surg 2017;9(1):1-6.


PDF Share
  1. Surgery of the thyroid gland. In: De Groot LJ, Beck-Peccoz P, Chrousos G, (Eds). Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000.
  2. Routine exposure of the recurrent laryngeal nerve is important during thyroidectomy. In: Simmons RL, Udekwu AO (Eds). Debates in Clinical Surgery, volume 1, Chicago USA: Yearbook; 1990. p.191–206.
  3. Outcomes and complications of thyroid surgery: retrospective study. Hong Kong Med J 2001 Sep;7(3):261-265.
  4. Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbecks Arch Surg 2008 Sep;393(5):667-673.
  5. Medical malpractice and the thyroid gland. Head Neck 2003 Jun 25(6):429-431.
  6. Medicolegal analysis of errors in diagnosis and treatment of surgical endocrine disease. Surgery 1993 Dec;114(6):1167-1173.
  7. Thyroid surgery and the usefulness of intraoperative neuromonitoring, a single center study. J Invest Surg 2015 Apr;28(2):86-94.
  8. Usefulness of neuromonitoring in thyroid surgery. Eur Arch Otorhinolaryngol 2015 Oct;272(10):3039-3043.
  9. Usefulness of neuromonitoring in thyroid surgery. Acta Otorrinolaringol Esp 2012 Sep-Oct;63(5):355-363.
  10. Evidence-based analysis on the clinical impact of intraoperative neuromonitoring in thyroid surgery: state of the art and future perspectives. Surg Technol Int 2014 Nov;25:91-96.
  11. Intraoperative neural monitoring in thyroid cancer surgery. Langenbecks Arch Surg 2014 Feb;399(2):199-207.
  12. Evaluation of implementation phase of intraoperative neural monitoring of the recurrent laryngeal nerves in thyroid surgery in a district hospital. Przegl Lek 71(10):532-536.
  13. Intraoperative laryngeal nerve monitoring during thyroidectomy and parathyroidectomy: A prospective study. Eur Ann Otorhinolaryngol Head Neck Dis 2012 Apr;129(2):69-76.
  14. Value of intra-operative neuromonitoring of the recurrent laryngeal nerve in total thyroidectomy for benign goitre. J Laryngol Otol 2015 Jun;129(6), 553-557.
  15. The value of neurostimulation and intraoperative nerve monitoring of inferior laryngeal nerve in thyroid surgery. Otolaryngol Head Neck Surg 2009 Jun;140(6):866-870.
  16. Value of the intraoperative neuromonitoring in surgery for thyroid cancer in identification and prognosis of function of the recurrent laryngeal nerves. Endokrynol Pol 2006 Jul-Aug;57(4):343-346.
  17. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Laryngoscope 2011 Jan;121 (Suppl 1):S1-16.
  18. Recurrent laryngeal nerve monitoring during thyroid surgery: normative vagal and recurrent laryngeal nerve electroal data. Otolaryngol Head Neck Surg 2012 Oct;147(4):640-646.
  19. What are normal quantitative parameters of intraoperative neuromonitoring (IONM) in thyroid surgery? Langenbecks Arch Surg 2010 Sep;395(7):901-909.
  20. Intraoperative monitoring: normative range associated with normal postoperative glottic function. Laryngoscope, 2013 Dec;123(12):3026-3031.
  21. (Neuromonitoring in thyroid surgery: prospective evaluation of intraoperative electrophysiological responses for the prediction of recurrent laryngeal nerve injury. Ann Surg 2004 July;240(1):9-17.
  22. Traction injury of the recurrent laryngeal nerve: Results of continuous intraoperative neuromonitoring in a swine model. Head Neck 2016 Apr;38(4):582-588.
  23. Intraoperative neuromonitoring for the early detection and prevention of RLN traction injury in thyroid surgery: a porcine model. Surg 2014 Feb;155(2):329-339.
  24. Intraoperative monitoring of the recurrent laryngeal nerve during thyroidectomy: a standardized approach (part 1). World J End Surg 2011;3(3):144-150.
  25. Intraoperative monitoring of the recurrent laryngeal nerve during thyroidectomy: a standardized approach part 2. World J End Surg 2012;4(1):33-40.
  26. Stimulation threshold greatly affects the predictive value of intraoperative nerve monitoring. Laryngoscope. 2015 May;125(5):1265-1270.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.