Application of the original method of intra-operative electrophysiological stimulation of recurrent laryngeal nerve with surgical interventions on the neck organs

• Main Authors: Yu. V. Kovalenko, A. S. Tolstokorov, S. N. Kotov, G. A. Manakhov, E. N. Kurochkina
• Format: Article
• Language: Russian
• Published: Pavlov First Saint Petersburg State Medical University 2020-08-01
• Series: Вестник хирургии имени И.И. Грекова
• Subjects: thyroid glands; parathyroid glands; paresis of the larynx; paralysis of the larynx; neuromonitoring of laryngeal nerve
• Online Access: https://www.vestnik-grekova.ru/jour/article/view/1552

The OBJECTIVE was the reduction in the frequency of specific complications of surgical treatment of patients with pathology of the thyroid and parathyroid glands using the original method of monitoring the neuro-functional activity of the recurrent laryngeal nerve.METHODS AND MATERIALS. The research was conducted in two stages. At the first stage, the object of the topographic-anatomical study was 50 male and female corpses. The research, based on the fixed material, was focused upon the study of the anatomic special features of recurrent laryngeal nerves, their relations with neighboring structures, the study of peculiarities of recurrent laryngeal nerve syntopy and its neighboring structures to find the least traumatic way of incision during electroneurophysiological monitoring of activity. At the second stage, the object of the study was 60 patients with a benign pathology of the thyroid gland, who were operated on with the use of the original method of intra-operational visualization and control method over neuro-functional activity of recurrent laryngeal nerve.RESULTS. The frequency of the three different variants of topographic-anatomical position of recurrent laryngeal nerve depends on the side of the body. The safest, stable and the fastest one to be found is the left recurrent laryngeal nerve. Postoperative unilateral paresis of the larynx, diagnosed in 4 of 60 patients, is regarded as postischemic. Two-sided paresis of the larynx was diagnosed in 1 patient.CONCLUSION. This method allows to minimize the development of severe intraoperative complications, to reduce the frequency of postoperative paralysis and paresis of the larynx. Intra-operative visualization of recurrent laryngeal nerves is especially necessary during the repeated surgeries with postoperative scar transformations with wrong syntopy of neck organs and vascular-nerve structures, which makes it possible to minimize the number of postoperative paralyses and paresis of larynx and to get positive effect without carrying out the intubation of trachea among patients with postoperative paralysis of larynx or stenosis, and to avoid more serious damage of larynx or trachea in case of intubation.