In reference to transcricothyroid electromyographic monitoring of the recurrent laryngeal nerve

✍ Scribed by Gianlorenzo Dionigi

• Publisher: John Wiley and Sons
• Year: 2009
• Tongue: English
• Weight: 39 KB
• Volume: 120
• Category: Article
• ISSN: 0023-852X
• DOI: 10.1002/lary.20770

✦ Synopsis

reported their comprehensive experience in intraoperative neuromonitoring (IONM) in thyroid surgery. I have carefully read this excellent paper. Certainly, these colleagues have made several contributions to the literature, and their valuable contributions have advanced our understanding of the surgical technique in neck surgery.

There is a technical issue that I would like to comment on. Dr. Alon and Dr. Hinni stimulated the RLN and not the vagus nerve. The standardization of IONM technique covers a fundamental technical aspect in thyroid surgery. [2][3][4] Vagal stimulation is essential to recognize any RLN lesions and to predict nerve postoperative function; in neurogenic lesions of the RLN, distal stimulation near the larynx produces a false-negative, normal IONM signal. [2][3][4] Only vagal stimulation, in addition to electromyographic (EMG) registration of signals, which easily uncovers all kinds of artifacts, can help avoid spurious EMG findings and clarify the real impact of IONM on thyroidectomy. [2][3][4] This is in concordance with the remarks of Chiang et al., Timmermann et al., Technically, the vagus nerve is stimulated directly by dissecting 1-cm of the carotid sheath; no additional dissection is required. [2][3][4][5] Vagal stimulation does not result in an increase in morbidity, surgical incision length, or operative time. 5 Finally, vagal nerve stimulation permits confirmation of RLN function when visual identification of the RLN is very difficult or hazardous.