Intraoperacinės palpacinės neurostimuliacijos ir gerklų sonoskopijos reikšmė optimizuojant tiroidektomijos saugumą

Recurrent laryngeal nerve (RLN) injury is one of the major complications related to thyroid surgery. Bilateral laryngeal nerve injury is a particularly pressing concern for a surgeon as it can inflict such serious ill effects as breathing difficulties, reintubation, tracheostomy or even death. Injury identification intraoperatively is crucial, because it can change the operative strategy: the operation on the second side can be canceled, two-stage thyroidectomy planned and bilateral nerve injury avoided. Only some kind of intraoperative neural testing can be relied on to indicate the function of the RLN, as information on neuropraxic nerve injury is missing through visual assessment alone. The main objective of the prospective cohort study was to determine the reliability of intraoperative neurostimulation using laryngeal palpation and intraoperative laryngeal ultrasound for evaluating the RLN functional status during thyroid surgery. The intraoperative laryngeal ultrasound has never been tested in the intraoperative setting, and the validity of the method was not documented before our study was conducted. Only those patients who had no evidence of RLN palsy were enrolled in the study and underwent thyroid surgery. Neurostimulation combined with laryngeal ultrasonography and laryngeal palpation was performed intraoperatively to evaluate recurrent laryngeal nerve functional status. Recurrent laryngeal nerve injury was confirmed by laryngoscopy, which was performed on the first postoperative day and considered to be the gold standard method. Sensitivity, specificity, positive and negative predictive values, and accuracy were calculated for both methods. Our study demonstrated that both methods are effective for intraoperative RLN functional status evaluation. There is no statistically significant difference between the results obtained by both methods. The visualization rate of the intraoperative laryngeal ultrasound is 100%. Both methods can be used intraoperatively based on the individual preference.