Monitored transoral endoscopic thyroidectomy via long monopolar stimulation probe

Area of Science:

• Endocrinology
• Surgical Innovation
• Neuroscience

Background:

• Transoral endoscopic thyroidectomy vestibular approach (TOETVA) offers a minimally invasive option for thyroid surgery.
• Recurrent laryngeal nerve (RLN) injury is a potential complication in thyroidectomies.
• Intraoperative neuromonitoring (IONM) is a technique used to assess nerve function during surgery.

Purpose of the Study:

• To describe the role and technical aspects of IONM during TOETVA.
• To emphasize the identification and monitoring of the vagus nerve and RLNs.
• To evaluate the feasibility and safety of IONM in this specific surgical approach.

Main Methods:

• Standardized IONM technique involving identification and monitoring of the vagus nerve and RLNs.
• V1, V2, R1, R2 IONM points used for nerve assessment before and after resection.
• Focus on technical and technological aspects of IONM application in TOETVA.

Main Results:

• IONM during TOETVA is demonstrated to be feasible and safe.
• Successful identification and functional assessment of laryngeal nerves were achieved.
• IONM enhances surgeon confidence in performing TOETVA, including extended indications.

Conclusions:

• IONM is a valuable tool during TOETVA, aiding in laryngeal nerve identification and function assessment.
• The technique appears safe and feasible, potentially increasing surgeon comfort.
• Larger studies are required to definitively evaluate IONM's impact on reducing RLN complication rates.