Search

Recurrent laryngeal nerve (RLN) injury is a significant morbidity associated with thyroid surgery. Surgeons have increasingly used intraoperative neural monitoring (IONM) as an adjunct technique for identifying the RLNand predicting the outcome of vocal cord function. Many animal studies have investigated limits, adjournments and new applications of IONM. The advent of animal studies has substantially improved understanding of IONM technology and the electrophysiology of RLN. Lessons learned from animal studies have clinical applications in establishing proper strategies for preventing nerve injury., Atti della Accademia Peloritana dei Pericolanti - Classe di Scienze Medico-Biologiche, Vol 107, No 1 (2019)

Numerous operating tools and technology transfers are available for thyroid surgery teams performing open, endoscopic and robotic procedures but none, or very few, of them constitutes a mandatory prerequisite. Over the past decade, the choice of intraoperative neural monitoring (IONM) of the recurrent laryngeal nerve (RLN), has been reached certain consensus. Identification and intraoperative assessment of the RLN seems to be more effectively performed with IONM than solely visually or endoscopically. Today, IONM has evolved sufficiently to increase the likelihood of successful functional outcomes in many patients. The transition from the concept of intermitted neural monitoring of the RLN to that of continuous functions evaluation that must be appreciate requires highly skilled knowledge of IONM. This goal will be more likely achieved in Centers highly specialized in thyroid surgery., Atti della Accademia Peloritana dei Pericolanti - Classe di Scienze Medico-Biologiche, Vol 106, No 1 (2018)

Transoral thyroidectomy (TT) is a feasible novel surgical procedure that does not need visible incisions, a truly scar-free surgery. Inclusion criteria are (a) patients who have a ultrasonographically (US) estimated thyroid diameter not larger than 10 cm, (b) US estimated gland volume ≤45 mL, (c) nodule size ≤50 mm, (d) a benign tumor, such as a thyroid cyst, single-nodular goiter, or multinodular goiter, (e) follicular neoplasm, (f) papillary microcarcinoma without evidence of metastasis. The procedure is carried out through three-port technique placed at the oral vestibule, one 10-mm port for 30° endoscope and two additional 5-mm ports for dissecting and coagulating instruments. CO2insufflation pressure is set at 6 mmHg. An anterior cervical subplatysmal space is created from the oral vestibule down to the sternal notch, laterally to the sterncleidomuscles. TT is done fully endoscopically using conventional endoscopic instruments. TT represents probably the best scarless approach to the thyroid due to the short distance between the thyroid and the incisions, respecting the surgical planes., Atti della Accademia Peloritana dei Pericolanti - Classe di Scienze Medico-Biologiche, Vol 105, No 2 (2017)