피부 부착형 전극을 이용한 갑상선 수술 중 신경 모니터링의 효용성
Efficacy of Intraoperative Neuromonitoring during Thyroidectomy with Transcutaneous Adhesive Skin Electrodes
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Background and Objectives Variable types of electrodes for intraoperative neuromonitoring(IONM) during thyroid surgery have been introduced to make up for the shortcomings ofconventional endotracheal electromyogram tube. In this study, we sought to evaluate the efficacyof transcutaneous adhesive skin electrodes for IONM of recurrent laryngeal nerve (RLN)during thyroidectomy. Subjects and Method A total 97 nerves at risk of 80 patients were enrolled in this study. Two disposable adhesive skin electrodes were attached at both upper margins of thyroid cartilage. Using NIM 3.0 system (Medtronic), we recorded the amplitude and latency of signals ofvagus nerve and RLN following the standard procedure of IONM. Clinicopathologic factors aswell as the preoperative and postoperative vocal cord functions of the patients were analyzed. Results IONM was successful in all nerves at risk without any false loss of signals. Therewere no complications nor any significant time delay due to adhesive skin electrodes. The meanamplitudes from the vagus nerve (V1) and RLN (R1) were 230.64 μV and 293.48 μV, respectively. Two nerves at risk showed loss of signal and the two patients showed postoperative temporaryvocal cord paralysis. The amplitude of signals from the vagus nerve (V1, V2) was significantlyhigher in the lower body mass index (BMI) group compared to that of the higher BMIgroup. Conclusion IONM using transcutaneous skin electrodes may be considered as an alternativetechnique for IONM during thyroid surgery.
Abstract
Background and Objectives Variable types of electrodes for intraoperative neuromonitoring(IONM) during thyroid surgery have been introduced to make up for the shortcomings ofconventional endotracheal electromyogram tube. In this study, we sought to evaluate the efficacyof transcutaneous adhesive skin electrodes for IONM of recurrent laryngeal nerve (RLN)during thyroidectomy. Subjects and Method A total 97 nerves at risk of 80 patients were enrolled in this study. Two disposable adhesive skin electrodes were attached at both upper margins of thyroid cartilage. Using NIM 3.0 system (Medtronic), we recorded the amplitude and latency of signals ofvagus nerve and RLN following the standard procedure of IONM. Clinicopathologic factors aswell as the preoperative and postoperative vocal cord functions of the patients were analyzed. Results IONM was successful in all nerves at risk without any false loss of signals. Therewere no complications nor any significant time delay due to adhesive skin electrodes. The meanamplitudes from the vagus nerve (V1) and RLN (R1) were 230.64 μV and 293.48 μV, respectively. Two nerves at risk showed loss of signal and the two patients showed postoperative temporaryvocal cord paralysis. The amplitude of signals from the vagus nerve (V1, V2) was significantlyhigher in the lower body mass index (BMI) group compared to that of the higher BMIgroup. Conclusion IONM using transcutaneous skin electrodes may be considered as an alternativetechnique for IONM during thyroid surgery.
참고문헌 (15)
- 정규원, "Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2016", Cancer Research and Treatment, 51(2), pp.417~430 (2019), 대한암학회
- Lee KD, "Complications following thyroid surgery", Korean J Otolaryngol, 44(5), pp.522~527 (2001)
- Zheng S, "Effect of intraoperative neuromonitoring on recurrent laryngeal nerve palsy rates after thyroid surgery--a meta-analysis", J Formos Med Assoc, 112(8), pp.463~472 (2013)
- Sun H, "Clinical guidelines on intraoperative neuromonitoring during thyroid and parathyroid surgery", Ann Transl Med, 3(15), pp.213~ (2015)
- Yang S, "Systematic review with meta-analysis of intraoperative neuromonitoring during thyroidectomy", Int J Surg, 39, pp.104~113 (2017)
- Chiang FY, "Comparison of EMG signals recorded by surface electrodes on endotracheal tube and thyroid cartilage during monitored thyroidectomy", Kaohsiung J Med Sci, 33(10), pp.503~509 (2017)
- Wu CW, "Transcutaneous recording during intraoperative neuromonitoring in thyroid surgery", Thyroid, 28(11), pp.1500~1507 (2018)
- Lee HS, "Intraoperative neuromonitoring of recurrent laryngeal nerve during thyroidectomy with adhesive skin electrodes", World J Surg, 44(1), pp.148~154 (2020)
- 김훈엽, "Loss of the Neuromonitoring Signal on the First Side in Planned Total Thyroidectomy", The Journal of Endocrine Surgery, 17(3), pp.89~95 (2017), 대한갑상선-내분비외과학회[DOI]
- Chiang FY, "Standardization of intraoperative neuromonitoring of recurrent laryngeal nerve in thyroid operation", World J Surg, 34(2), pp.223~229 (2010)
- Wu CW, "Recurrent laryngeal nerve injury with incomplete loss of electromyography signal during monitored thyroidectomyevaluation and outcome", Langenbecks Arch Surg, 402(4), pp.691~699 (2017)
- Chen HC, "Risk factors for thyroid surgery-related unilateral vocal fold paralysis", Laryngoscope, 129(1), pp.275~283 (2019)
- Liddy W, "Anterior laryngeal electrodes for recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery : New expanded options for neural monitoring", Laryngoscope, 128(12), pp.2910~2915 (2018)
- Lorenz K, "What are normal quantitative parameters of intraoperative neuromonitoring (IONM) in thyroid surgery?", Langenbecks Arch Surg, 395(7), pp.901~909 (2010)
- Nordander C, "Influence of the subcutaneous fat layer, as measured by ultrasound, skinfold calipers and BMI, on the EMG amplitude", Eur J Appl Physiol, 89(6), pp.514~519 (2003)