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Hiramitsu T, Tomosugi T, Okada M, Futamura K, Goto N, Narumi S, Watarai Y, Tominaga Y, Ichimori T. Preservation of the nonrecurrent laryngeal nerve using intraoperative nerve monitoring during endoscopic thyroidectomy. Asian J Endosc Surg 2022; 15:828-831. [PMID: 35570683 DOI: 10.1111/ases.13079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 04/28/2022] [Accepted: 04/30/2022] [Indexed: 11/29/2022]
Abstract
A 40-year-old woman underwent right lobe thyroidectomy for thyroid nodules that increased in size from 17 mm to 33.5 mm within 1 year. Identification of arteria lusoria using computed tomography suggested the presence of a right nonrecurrent laryngeal nerve (RNRLN). Endoscopic thyroidectomy was performed under general anesthesia. The right vagal nerve was first identified between the common carotid artery and jugular vein. A positive response was confirmed via intraoperative neuromonitoring (IONM), implying that the RNRLN did not branch from the central side of the stimulated point of the vagal nerve. The RNRLN was confirmed using IONM around the middle to lower pole of the right thyroid gland. The right thyroid lobe was successfully removed, with meticulous preservation of the RNRLN. The motion of the vocal cord, examined by an ear-nose-throat doctor postoperatively, was intact. We demonstrated the efficacy of IONM in patients with RNRLN who underwent endoscopic thyroidectomy.
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Affiliation(s)
- Takahisa Hiramitsu
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Toshihide Tomosugi
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Manabu Okada
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Kenta Futamura
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Norihiko Goto
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Shunji Narumi
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Yoshihiko Watarai
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Yoshihiro Tominaga
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
| | - Toshihiro Ichimori
- Department of Transplant and Endocrine Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Nagoya, Aichi, Japan
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Video-assisted neck surgery (VANS) using a gasless lifting procedure for thyroid and parathyroid diseases: "The VANS method from A to Z". Surg Today 2019; 50:1126-1137. [PMID: 31728730 PMCID: PMC7501127 DOI: 10.1007/s00595-019-01908-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 09/04/2019] [Indexed: 12/20/2022]
Abstract
Purpose To describe and evaluate our video-assisted neck surgery (VANS) method for thyroid and parathyroid diseases. Methods We describe in detail the VANS method for enucleation, lobectomy, total (nearly total) thyroidectomy, and lymph node dissection for malignancy and Graves’ disease. In collaboration with the Japan Society of Endoscopic Surgery (JSES), we evaluated several aspects of this method. The JSES evaluated the method for working-space formation and surgical complications, whereas we examined the learning curve of the surgeons, and the cosmetic satisfaction of the patients and the degree of numbness and pain they experienced. We also asked patients who underwent conventional surgery whether they would have selected VANS had it been available. Results The working space for 81.5% of the procedures in Japan was created using the gasless lifting method. The learning curve, considering both blood loss and operating time, decreased after 30 cases. Both factors improved for tumors smaller than 5 cm in diameter. Over 60% of the patients who underwent conventional surgery stated that they would have selected VANS, had it been available. Postoperative pain was worse after conventional surgery than after VANS, but neck numbness after VANS was more frequent than expected. Conclusions The VANS method is a feasible, safe, and cost-effective procedure with clear cosmetic advantages over conventional surgery.
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Nakajo A, Minami K, Shinden Y, Toda H, Hirashima T, Nagata A, Nomoto Y, Maemura K, Natsugoe S. Upgraded bidirectional approach video-assisted neck surgery (BAVANS) using a rigid endoscope with variable viewing direction for advanced endoscopic lymph node dissection in thyroid cancer patients. Surg Today 2019; 50:778-782. [PMID: 31691138 PMCID: PMC7305093 DOI: 10.1007/s00595-019-01909-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/01/2019] [Indexed: 11/29/2022]
Abstract
In 2011, we developed bidirectional approach video-assisted neck surgery (BAVANS) for endoscopic thyroid cancer surgery. BAVANS combines two different approach pathways at 180 degrees to the cervical lesion for endoscopic thyroidectomy and complete cervical lymphadenectomy. We reported previously that the cranio-caudal approach is extremely useful for endoscopic complete lymph node dissection around the trachea. In 2014, we upgraded the initial BAVANS for better maneuverability and quality of lymph node dissection. A new high-tech rigid endoscope with a variable viewing direction (EndoCAMeleon™), has enabled us to reduce the camera port in the anterior neck while keeping the easy maneuverability and the same quality of central lymph node dissection (LND) as with the initial BAVANS. Endoscopic thyroid cancer surgery is now evolving concurrently with new visual technology.
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Affiliation(s)
- Akihiro Nakajo
- Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, Kagoshima, 890-0075, Japan.
| | - Koji Minami
- Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, Kagoshima, 890-0075, Japan
| | - Yoshiaki Shinden
- Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, Kagoshima, 890-0075, Japan
| | - Hiroko Toda
- Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, Kagoshima, 890-0075, Japan
| | - Tadahiro Hirashima
- Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, Kagoshima, 890-0075, Japan
| | - Ayako Nagata
- Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, Kagoshima, 890-0075, Japan
| | - Yuki Nomoto
- Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, Kagoshima, 890-0075, Japan
| | - Kosei Maemura
- Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, Kagoshima, 890-0075, Japan
| | - Shoji Natsugoe
- Department of Surgical Oncology, Digestive Surgery, Breast and Thyroid Surgery, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, Kagoshima, 890-0075, Japan
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