Experience of using a neuromonitor during thyroid surgery in children

Abstract

Background. Thyroid surgery is associated with the risk of complications that worsen the course of the postoperative period and lead to disability of patients. One of these complications is damage to the recurrent laryngeal nerve, causing impaired phonation, and in the case of bilateral lesions, respiratory impairment. The aim of this work was to study the features of the technique and the effectiveness of the use of neuromonitoring during operations on the thyroid gland. Materials and methods. The study was conducted on a series of 55 clinical observations of thyroid diseases in children. Intraoperative monitoring was performed using the Inomed C2 Nerve Monitor, which records the action potential on the vocal folds caused by electrical stimulation of the recurrent laryngeal nerve. Results. In 52 cases, no decrease in the amplitude of the neuromonitor signal was observed during surgical interventions. In two cases, intraoperatively, a decrease in the signal amplitude associated with excessive traction of the nerve was revealed. Another observation noted the absence of a signal at the end of the operation and the preservation of the mobility of the vocal cords in the postoperative period, probably due to technical errors in performing intraoperative monitoring. In one patient, during the operation, changes in the neuromonitor signal did not occur, but after surgery, a violation of the vocal function was noted, which fully recovered within 3 months. In all likelihood, these changes are due to the technique of tracheal intubation. Conclusions. Neuromonitoring is an additional method for finding the recurrent laryngeal nerve, but in no way replaces the need for delicate anatomical identification of the latter.