Experience with the use of intraoperative continuous nerve monitoring in video-assisted neck surgery and external cervical incisions

Horner syndrome after thyroid-related surgery: a review

BACKGROUND

Horner syndrome (HS) is caused by damage to the cervical sympathetic nerve. HS is a rare complication after thyroidectomy. The main manifestations of HS include miosis and ptosis of the eyelids, which seriously affect esthetics and quality of life. At present, there is a lack of research on HS after thyroidectomy, and its etiology is not completely clear. This review aimed to evaluate how to reduce the incidence of HS and promote the recovery from HS as well as to provide a reference for the protection of cervical sympathetic nerves during surgery.

RESULTS

HS caused by thyroid surgery is not particularly common, but it is still worthy of our attention. After searching with "Horner Syndrome," "Thyroid" as keywords, a total of 22 related cases were screened in PubMed. The results showed that open surgery, endoscopy, microwave ablation, and other surgical methods may have HS after operation. In addition, the statistics of 1213 thyroid surgeries in our hospital showed that the incidence of HS after endoscopic surgery (0.39%) was slightly higher than that after open surgery (0.29%). Further, this review analyzed potential causes of HS after thyroidectomy, so as to provide a theoretical basis for reducing its incidence.

CONCLUSION

Preventing HS during thyroidectomy is a difficult problem. The close and highly variable anatomical relationship between the thyroid and cervical sympathetic nerves increases the risk of sympathetic nerve damage during thyroidectomy. Surgery and the use of energy equipment are also closely related to the occurrence of HS.

Endoscopic thyroidectomy to minimize light exposure of an erythropoietic protoporphyria patient: A case report

Introduction and importance

Erythropoietic protoporphyria is a rare form of cutaneous porphyria that presents with photosensitivity. During surgery, light shielding is required to prevent acute attacks due to photosensitivity. In this study, we report a case of successful endoscopic thyroidectomy using video-assisted neck surgery (VANS) method for a thyroid tumor in a patient with erythropoietic protoporphyria.

Case presentation

A 32-year-old woman with a history of erythropoietic protoporphyria and an enlarged left thyroid gland was referred to our hospital. The referring physician had noted a left lobe tumor of the thyroid gland with a maximum diameter of 5 cm. Computed tomography and ultrasonography showed the tumor shape as smooth and well-defined. A lobectomy of the thyroid gland was performed using the VANS method through a 3-cm incision on the skin. Surgical light was not used and exposure to ambient light was minimized by covering the patient's neck with a drape. No acute attack of porphyria or photosensitivity was observed during the surgery or the follow-up. Postoperative complications such as asphyxia, blood loss, or nerve palsy were absent. The patient was discharged 5 days after the surgery.

Clinical discussion

While the VANS method is known to have mainly cosmetic advantages, this case demonstrates that it is also a method that can minimize the exposure of the patient's skin to light with using an additional drape.

Conclusion

The VANS method should be considered as an option for thyroidectomy in patients with protoporphyria because it can reduce the exposure to light during surgery.

•

A case of thyroid tumor with erythropoietic protoporphyria

•

Exposure of patient's skin to light should be minimized.

•

The VANS method can be chosen to reduce light exposure during surgery.

Lateral approach contributes to shortened surgical time in video-assisted neck surgery (VANS) for thyroid nodule

Background

Despite endoscopic thyroid surgery contributing to excellent cosmetic outcomes, it requires longer surgical time than open surgery. This study evaluates the factors associated with operative time in video-assisted neck surgery.

Methods

We retrospectively reviewed patients who underwent hemithyroidectomy by video-assisted neck surgery at a single hospital between 2017 and 2021. The clinical parameters were evaluated: age, sex, body weight, body mass index, coexistence of Hashimoto thyroiditis, side of operation, surgical approach to thyroid (midline approach or lateral approach), operation time, amount of blood loss during surgery, maximum tumor diameter and tumor volume, and postoperative complications. These parameters were compared to investigate the association of operative time and surgical approach.

Results

Seventy consecutive patients were enrolled in this study, the median age at operation was 50 years, and there were 6 (8.6%) men and 64 (91.4%) women. The median body weight and body mass index at operation were 56.6 kg and 21.5, respectively. Coexistence of Hashimoto thyroiditis was found in 17 (24.3%) patients. Significant differences were found between the groups with longer and shorter operation time than median 201 minutes in surgical approaches to the thyroid (P < .001) and the amount of bleeding during surgery (P = .039). There were no differences in other candidates between the groups. Median operation times were 242 minutes in midline approach and 131 minutes in lateral approach (P < .001).

Conclusion

The lateral approach of video-assisted neck surgery to the thyroid can contribute to shortened surgical time in the case of benign thyroid nodules.

•

VANS has contributed to excellent cosmetic outcomes for hemithyroidectomy, but significantly extended compared with conventional surgery.

•

The lateral approach should be selected to shorten surgical time for hemithyroidectomy in VANS.

Clinical Experience of Use of Percutaneous Continuous Nervemonitoring in Robotic Bilateral Axillo-Breast Thyroid Surgery

INTRODUCTION AND OBJECTIVE

There is a need for a simplified technique for C-IONM in robotic surgery. The primary aim of this study was to describe our clinical experience with the use of percutaneous C-IONM in robotic bilateral axillary thyroid surgery.

METHODS

This study prospectively enrolled 304 consecutive patients who underwent robotic thyroidectomy via the bilateral axillo-breast approach and standardized C-IONM via percutaneous probe stimulation.

RESULTS

323 RLNs were analyzed. C-IONM with percutaneous probes was feasible in all cases. During this study, we did not record any cases of probe displacement, and no additional robotic maneuvers were required. The average stimulation intensity was 2 mA. There were no adverse local or systemic C-IONM side effects. The mean time required for probe positioning was 3 minutes. The EMG amplitude signal of 48 RLNs decreased significantly, < 50% from the original V1 signal. In these cases, the surgical procedure was modified.

CONCLUSION

The proposed percutaneous C-IONM provides a simplification of the continuous monitoring procedure for robotics. The advantage of percutaneous C-IONM is that it does not require additional trocar space, repeated instrument changes, and unmodified cosmesis. To our knowledge, this is the first study on the application of percutaneous C-IONM in robotic thyroid surgery.