Retrospective Evaluation of the Use of Percutaneous Needle Electrode in Intraoperative Neuromonitoring in Minimally Invasive Parathyroid Surgery
Project no. 25267 · Status: Kapanmış (Yayın bekleniyor) · 2023
Summary
<p>Despite the technical and technological advancements in thyroid and parathyroid surgery, vocal cord paralysis due to recurrent laryngeal nerve (RLN) injury remains a significant complication. The most important and effective method used to accurately detect this complication, manage it, and reduce permanent vocal cord paralysis is intraoperative neuromonitoring. This method simply involves electromyography of the vagal nerve and recurrent laryngeal nerve. There are many effective methods used for neuromonitoring. The most commonly used methods include endotracheal tube electrodes and needle electrodes. The use of needle electrodes is both cheaper and provides higher amplitude values compared to the use of endotracheal tubes. Needle electrode usage is one of the anterior laryngeal neuromonitoring methods and is commonly used transcartilaginously. For this usage, the thyroid cartilage must be visible during surgery, necessitating the expansion of the dissection area to the thyroid cartilage. During thyroid surgery, this area is routinely dissected as it already contains the pyramidal thyroid tissue. However, for parathyroid adenoma surgery, which is the most common cause of primary hyperparathyroidism, this dissection is not required. Nowadays, focused surgery is applied for parathyroid surgery. In preoperatively identified parathyroid glands, minimally invasive focused surgery is applied without unnecessary dissection to avoid increasing complications. Therefore, a general neck exploration is not required, and only the adenoma region identified by imaging methods is explored. Intraoperative neuromonitoring is the most important auxiliary method in preventing RLN complications during parathyroid surgery. In classical neuromonitoring using needle electrodes, the needle is placed transcartilaginously, complicating the application of focused parathyroid surgery. For the transcartilaginous placement of the needle electrode, the surgical incision site must be close to the thyroid cartilage, requiring dissection of that area. This changes the location of the incision, necessitating a larger incision and more dissection, which increases the possibility of postoperative seroma. This is a factor that can increase the likelihood of complications and is contrary to the general principles of minimally invasive parathyroid surgery. Needle electrodes can be placed percutaneously in the same region, making this method suitable for minimally invasive parathyroid surgery. The project has two main aims: first, by applying percutaneously placed needle electrodes in minimally invasive parathyroid surgery, to avoid complications such as excessive dissection, increased risk of seroma formation, inability to place the surgical incision appropriately according to adenoma localization, and the need for a larger incision, which can reduce postoperative aesthetics and satisfaction. Additionally, to demonstrate that needle electrode application, which is cheaper and more effective, can be used effectively in parathyroid surgery instead of the more widely used endotracheal tube application globally. We determined that 30 patients should be included in our project; however, so far, 17 patients with suitable values have been included in our study. In our study, the average amplitude values obtained from the intraoperative nerve monitoring device were V1: 1850 microvolts, R1: 1730 microvolts, V2: 1690 microvolts, and R2: 2140 microvolts. No signal loss was experienced in any patient during the operations. The perioperative parathyroid hormone levels of all patients were measured and found to be an average of 23.4 picograms per milliliter. For patients with a preoperative parathyroid hormone average of 113.9 picograms per milliliter, this indicates a drop of more than 50%. Patients who visit the endocrine surgery clinic and have a surgical treatment indication will continue to be included in the project after being informed and giving their consent. During the operation, needle electrodes will be placed percutaneously, and the globally standard neuromonitoring application principles will continue to be applied. Values before and after adenoma excision will continue to be recorded. Our project is supported by the BAP Unit. With this project, it has been shown that percutaneous needle application in minimally invasive parathyroid surgery is both feasible and cost-effective, providing a guiding study in this field.</p>