Selective visualization of the recurrent laryngeal nerve during parathyroidectomy

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery Pub Date : 2025-10-10 DOI:10.1016/j.amjsurg.2025.116659

Marina E. Robson Chase, Mackenzie Donoho, Oliver J. Fackelmayer, William B. Inabnet III, Cortney Y. Lee, David A. Sloan

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引用次数: 0

Abstract

Introduction

Direct visualization of the recurrent laryngeal nerve (RLN) is considered the gold standard for avoiding nerve injury during parathyroidectomy. We hypothesize that with routine intraoperative nerve monitoring (IONM), RLN visualization is not mandatory for safe parathyroidectomy.

Methods

Following institutional review board approval, adult patients undergoing parathyroidectomy using IONM during a two-year period were reviewed. The RLN was only visualized if exposed during parathyroid gland dissection. Outcomes included the rate of nerve visualization and rates of RLN injury.

Results

240 of 479 (50.1 %) nerves at risk were visualized. There was loss of signal in three cases where the RLN was visually identified and none in non-visualized cases. The rates of temporary and permanent RLN injury were 0.99 % and 0 %, respectively.

Conclusion

Routine IONM provides reassurance of nerve integrity in cases where the RLN is not visualized and an acceptably low rate of RLN injury is achieved with selective visualization.

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甲状旁腺切除术中喉返神经的选择性显像。

简介：直接观察喉返神经（RLN）被认为是避免甲状旁腺切除术中神经损伤的金标准。我们假设，在常规术中神经监测（IONM）下，RLN可视化不是安全甲状旁腺切除术的强制性要求。方法：在机构审查委员会批准后，对两年内使用IONM进行甲状旁腺切除术的成年患者进行了回顾。只有在甲状旁腺剥离时暴露RLN才可见。结果包括神经显像率和RLN损伤率。结果：479条危险神经中有240条可见，占50.1%。有三例RLN被视觉识别的病例信号丢失，而非视觉识别的病例没有信号丢失。暂时性RLN损伤率为0.99%，永久性RLN损伤率为0%。结论：常规IONM可以在RLN未显像的情况下保证神经完整性，选择性显像可以实现可接受的低RLN损伤率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.