This journal is
indexed in Scopus
Year 2013 Vol. 21 No 3
GENERAL AND SPECIAL SURGERY
A.V. SHIDLOVSKYI, Y.R. ROZNOVSKYI
PREVENTION OF LARYNX PARESES DURING THYROID SURGERY
SHEE “Ternopil State Medical University named after I.Ya. Gorbachevsky”,
MPH of the Ukraine
Objectives. To reduce frequency of larynx nerves injury by means of improvement of surgical techniques, methods and technology of their identification in the operation wound. To decrease of the incidence of per-operative laryngeal nerve injury by means of improvement of surgical techniques, methods and technology of their identification in the operation wound.
Methods. 57 patients operated on different forms of goiter were enrolled in the research. The developed technical methods of performing operations, the method and technology of electrophysiological identification of the larynx nerves among wound tissues have been approved intraoperative. The principle of the method is based on the registration of sound vibrations produced by air passage through the glottis. Changes of the tension degree of the vocal cords and the glottis lumen area due to electrophysiological stimulation of the wound tissues and larynx nerves are reflected in different degrees on the characteristics of sound waves.
Results. Application of the developed principles of technical performance of surgical interventions at cervical, cervical and retrosternal and retrosternal localization of multinodular or recurrent goiter allows to simplify the operation performance and prevent the larynx nerves injury. Intraoperative identification of larynx nerves among wound tissues has been performed by using the developed method. 57 patients were investigated 201 times. The greatest changes of the amplitude and sound frequency occurred during electrical stimulation of larynx nerves. These fonatory effects allow to identify larynx nerves with absolute reliability. There were no errors in the identification of nerves location and allocation. Post-operative pareses of the larynx was not observed.
Conclusions. The conducted research confirmed the effectiveness of the application of the developed technologies of surgical interventions at different goiter forms and the method of larynx nerves identification among wound tissue to prevent the injury and pareses of the larynx.
- Dolidze DD, Mumladze RB, Vartanian KF, Vardanian AV, Nuzhdin OI, Lalazarian TIu, Karadimitrov GN, Aleksanian AA, Oganian AR, Sultygov AKh. Osobennosti khirurgicheskogo lecheniia bol'nykh s zabolevaniiami zagrudinno raspolozhennoi shchitovidnoi zhelezy [The specificity of the surgical treatment of patients with retrosternal thyroid gland]. Ann Khir, 2009(3):24–8.
- Dolidze DD, Mumladze RB, Lebedinskii IN, Karadimitrov GN, Sultygov AM, Dzhigkaev TD, Lalazarian TIu, Gobeev SV, Mkrtchian A A. Profilaktika povrezhdeniia verkhnego gortannogo nerva pri operatsiiakh na shchitovidnoi zheleze [Prevention of the superior laryngeal nerve damage in thyroid surgery]. Ann Khir. 2008(4):13–8 .
- Barczynski M, Konturek A, Cichon S. Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy. Br J Surg. 2009 Mar;96(3):240-6.
- Loch-Wilkinson TJ, Stalberg PL, Sidhu SB, Sywak MS, Wilkinson JF, Delbridge LW Nerve stimulation in thyroid surgery: is it really useful? ANZ J Surg. 2007 May;77(5):377-80.
- Randolph GW, Dralle H; International Intraoperative Monitoring Study Group, Abdullah H, Barczynski M, Bellantone R, Brauckhoff M, Carnaille B, Cherenko S, Chiang FY, Dionigi G, Finck C, Hartl D, Kamani D, Lorenz K, Miccolli P, Mihai R, Miyauchi A, Orloff L, Perrier N, Poveda MD, Romanchishen A, Serpell J, Sitges-Serra A, Sloan T, Van Slycke S, Snyder S, Takami H, Volpi E, Woodson G. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Laryngoscope. 2011 Jan;121 Suppl 1:S1–16.
- Chiang FY, Lu IC, Kuo WR, Lee KW, Chang NC, Wu CW. The mechanism of recurrent laryngeal nerve injury during thyroid surgery--the application of intraoperative neuromonitoring. Surgery. 2008 Jun;143(6):743–49.
- Thomusch O, Sekulla C, Machens A, Neumann HJ, Timmermann W, Dralle H. Validity of intra-operative neuromonitoring signals in thyroid surgery. Langenbecks Arch Surg. 2004 Nov;389(6):499–503.
- Sh³dlovs'kii VO, Divak MP, Sh³dlovs'kii OV, Kozak OL, Roznovs'kii IaR. Patent Ukra¿ni ¹66648. Pristr³i dlia ³dentif³kats³¿ gortannogo nerva [A device for identification of laryngeal nerve]. Biul Promislova Vlasn³st'. 2012;(1).
- Sh³dlovs'kii VO, Divak MP, Sh³dlovs'kii OV, Kozak OL, Roznovs'kii IaR. Patent Ukra¿ni ¹99228. Pristr³i dlia ³dentif³kats³¿ gortannogo nerva [A device for identification of laryngeal nerve]. Biul. Promislova Vlasn³st'. 2012;(14).
46001, Ukraina, g. Ternopol', maidan Voli, d. 1, GVUZ "Ternopol'skii gosudarstvennyi meditsinskii universitet imeni I.Ia. Gorbachevskogo, MOZ Ukrainy", kafedra obshchei i operativnoi khirurgii s topograficheskoi anatomiei,
Shidlovskii Aleksandr Viktorovich
Shidlovskyi A.V. PhD, associate professor of general and operative surgery chair with topographic anatomy of SHEE “Ternopil State Medical University named after I.Ya. Gorbachevsky, MPH of the Ukraine”.
Roznovskyi Y.R. A post-graduate student of general and operative surgery chair with topographic anatomy of SHEE “Ternopil State Medical University named after I.Ya. Gorbachevsky, MPH of the Ukraine”.