Wyniki wyszukiwania - Biblioteka Nauki

1

Non-Recurrent Laryngeal Nerve

100%

Buła G. , Mucha R. , Paliga M. , Koziołek H. , Niedzielski Z. , Gawrychowski J.

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2015

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tom 87

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nr 7

336-339

EN

The aim of the study was to assess the frequency of non-recurrent laryngeal nerves (Non-RLN). Material and methods. A total of 6110 patients were operated in our hospital between 1 January 2005 and 31 December 2013 for various goiters (5429) and various types of hyperparathyroidism (618). Laryngeal nerve was exposed during operation in 1700 patients from superior aperture of the chest to superior aperture of the larynx. Identification process of RLN was started with dissecting inferior thyroid artery (ITA) and its junction with the nerve. Then main trunk of the nerve was exposed backwards till the region of superior aperture of the chest together with the end portion till the nerve outlet to the larynx. Results. In the group of 1700 patients, RLN was exposed bilaterally in 1400 (82.4%) and unilaterally in 300 (17.6%). In the group of 3100 dissected RLNs the course of RLN was observed on the right side in 1710 patients and on the left in 1390. Irreversible nature RLN was shown in four cases (0.1%) – four women (02%) aged 42-55 (mean 49.3) – three operated for non-toxic nodular goiter and one for primary hyperparathyroidism. Each time the Non-RLN was seen on the right side. The other patients manifested recurrent character RLN. Moreover, interstitial course of RLN was found on the left side in one man. Conclusion. Non recurrent laryngeal nerve is a rare anatomical variation, occurring more frequently on the right side. Surgeon during surgery of the thyroid and parathyroid glands should be aware of its existence to avoid damage.

2

Evaluation of the Learning Curve for Intraoperative Neural Monitoring of the Recurrent Laryngeal Nerves in Thyroid Surgery*

80%

Pragacz K. , Barczyński M.

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nr 12

584-593

EN

Intraoperative neuromonitoring facilitates identification of the recurrent laryngeal nerves (RLN) and allows for predicting their postoperative function. Nevertheless, the outcome of thyroid surgery monitoring is affected by both the experience of the operator and his mastering of the technique. The aim of the study was the assessment of the learning curve for intraoperative RLN neuromonitoring. Material and methods. The prospective analysis included 100 consecutive thyroid operations performed by a single surgeon during implementation of RLN neuromonitoring in a district surgical ward in Staszów. RLN neuromonitoring was performed in keeping with the recommendations of the International Neural Monitoring Study Group using a C2 NerveMonitor (Inomed, Germany). The outcomes of initial 50 procedures (group I: 08/2012-07/2013) were compared with the results of subsequent 50 operations (group II: 08/2013-07/2014). The evaluation included demographic and intraoperative data along with predictive value of the method and complications. Results. In group II as compared to group I, a significant reduction of operative time was noted (102.1±19.4 vs 109.9±19; p=0.045), along with an increased percentage of identified RLNs (99% vs 89.2%; p=0.006), a decreased percentage of correction-requiring technical errors (8% vs 24%; p=0.029), an improved negative predictive (99% vs 89.3%; p<0.001) and positive value (75% vs 55.6%; p<0.001), as well as a decreased percentage of RLN injuries (3% vs 14%; p=0.006). Conclusions. Mastering the technique of intraoperative RLN neuromonitoring in thyroid surgery requires the surgeon to perform independently approximately 50 monitored procedures, what allows for achieving the predictive value of the method that is comparable to outcomes published by referral centers.

3

Role of intraoperative neuromonitoring of the recurrent laryngeal nerves during thyroid reoperations of recurrent goiter

80%

Sopiński J. , Kuzdak K. , Hedayati M. , Kołomecki K.

Polish Journal of Surgery

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2017

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tom 89(3)

11-15

EN

Reoperations of the thyroid gland are challenging to any surgeon. Such procedures are technically difficult and involve higher risk of complications than primary procedures. Recurrent laryngeal nerve (RLN) palsy is one of such complications The aim of the study was to evaluate the effectiveness of intraoperative neuromonitoring (IONM) in preventing RLN palsy during recurrent goiter operations. Material and methods. We retrospectively analyzed the results of thyroid reoperation performed at the Department of Endocrine, General and Vascular Surgery of Medical University of Lodz in the period from January 2014 to June 2016. The study included 80 patients, who were divided into 2 groups: group A consisted of 27 patients, who had undergone surgery with the use of IONM, while group B included 53 patients, in whom RLN was identified visually. During statistical analysis we took into account the number of nerves at risk, not the number of patients. There were 47 nerves at risk In group A and 86 in group B. We analyzed whether application of IONM had any effect on the frequency of RLN palsy and procedure duration. Results. The frequency of RLN palsy was 10.64% (5/47) in group A and 15.12% (13/86) in group B (no statistical significance, p=0,47). Mean operation time was shorter in group B 71.29 ± 17.125 minutes vs. 75.75 ± 17.94 minutes in group A (no statistical significance, p=0,377). Conclusion. Use of IONM did not significantly reduce the occurrence of RLN palsy and procedure duration.

4

Total Thyroidectomy for Nodular, Benign Thyroid Diseases in Terms of Larynx Function Examinations - Is it a New Treatment Standard?

70%

Kaczka K. , Jankowski W. , Kopczyński J. , Kwiecień J. , Pomorski L.

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tom 82

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nr 1

4-11

EN

Aim of the study was the assessment of total thyroidectomy (TT) value as a treatment method of goiter with particular emphasis on the results of laryngological examination.Material and methods. From 15th April 2008 to 1st July 2009 there were 125 (72.7%) TTs, 12 (7%) TTs and appropriate lymphadenectomies, 9 (5.2%) near TTs, 14 (8.1%) lobectomies, 5 (2.9%) completion thyroidectomies and 6 (3.4%) other operations. Vocal cords function was assessed routinely one day before, two days after operation by an otolaryngologist. Voice quality was assessed by patients in VHI questionnaire theirselves.Results. Five patients had one-sided vocal cord paralysis before the operation. The one-sided transient recurrent laryngeal nerve injuries was observed in 16 other patients (9.3% among patients and 4.6% among nerves at risk) in the second day after the operation. There was no bilateral recurrent laryngeal nerve injury. From three to six months after the operation, 21 (among 23) patients with vocal cord movement disability were examined once again by the same otolaryngologist. The same vocal cord paralysis was observed in 4 sicks (one person died), which was found preoperatively. Seven (4%) other patients had permanent one vocal cord paresis. This represents 2% the nerves at risk. Three of them were recognized benign lesions and four thyroid cancer. Our percentage of early, postoperative hypoparathyroidism was 6.4% and persistent was 1.7%. VHI score in the group with paresis or paralysis of vocal cord gave the score of 4 to 90 points- an average of 49 points. In patients with proper vocal cord movement there were results from 0 to 6 points- an average of 2 points.Conclusions. 1. Total thyroidectomy in the treatment of bilateral goiter without malignancy features is radical and safe procedure. 2. It protects against goiter relapse and its consequences. 3. Complications rates after total thyroidectomy are at acceptable and comparable proportions to the other operation types.

5

Does neuromonitoring affect voice quality in patients subjected to a complete thyroidectomy ?

60%

Bryk P. , Głuszek S.

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nr 5

16-23

EN

Introduction: Voice dysfunction is the most common complication of thyroid surgery. The use of intraoperative neuromonitoring (IONM) is to protect the recurrent laryngeal nerves, the damage of which causes voice dysfunction. Aim: The aim of the study was to evaluate voice quality in patients who underwent complete thyroidectomy operated on with the application of IONM as well as a group of patients operated on with only macroscopic nerve visualization. In the analysis, clinical voice assessment was performed with particular focus on voice efficiency using the Voice Handicap Index (VHI), Vocal Tract Discomfort (VTD) and GRBAS scale. Material and methods: The study group consisted of 205 patients operated on with IONM. The control group consisted of 162 patients subjected to surgery only with macroscopic visualization of recurrent laryngeal nerves, without IONM. During the follow-up period from 2 to 10 years after surgery, checkups were performed. Each patient who came for a checkup was subjected to perceptual voice evaluation with the use of the GRBAS scale, indirect laryngoscopy procedure and voice selfevaluation with two questionnaires (VHI and VTD). Results: The frequency of vocal fold palsy did not differ significantly statistically in the study group and the control group. Both in the study group and in the control group, patients with vocal fold paralysis had statistically significantly higher results in the VHI and VTD questionnaires as well as in the GRBAS study. Conclusion: Patients with recurrent laryngeal nerve injury show significant differences in the scope of voice handicap, both in the voice quality assessment with the use of the GRBAS scale, and self-evaluation questionnaires: VHI and VTD. All voice disorders evaluated with self-assessment are medium voice disability

6

Branches of the recurrent laryngeal nerves in the vicinity of the inferior thyroid arteries

60%

Stryjewska-Makuch G. , Aleksandrowicz R.

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nr 1-2

7

Mathematical model in task of recurrent laryngeal nerve identification by electrophysiological method

51%

Dyvak M. , Pukas A. , Melnyk A. , Kłos-Witkowska A. , Karpiński M.

Przegląd Elektrotechniczny

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2017

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tom R. 93, nr 12

266--270

EN

The method of constructing the mathematical model for visualization the recurrent laryngeal nerve positioning during neck surgery is described in this paper. Proposed model shows the dependence between the amplitude of information signal as response on stimulation the recurrent laryngeal nerve and the coordinates of stimulation point based on interval data analysis.

PL

Poniższy artykuł opisuje metodę konstrukcji modelu matematycznego do wizualizacji, podczas operacji, położenia nerwu krtaniowego wstecznego. Proponowany model pokazuje zależność między amplitudą sygnału informacyjnego, jako odpowiedzią na symulacje nerwu krtaniowego wstecznego a współrzędną punktu symulacji bazującego na interwałowej analizie danych.