Publication:
Tiroit cerrahisinde intraoperatif sinir monitorizasyonunun temel prensipleri ve standardizasyonu

Simple item page
dc.contributor.authorUludağ, Mehmet
dc.contributor.authorKaya, Cemal
dc.contributor.authorAygün, Nurcihan
dc.contributor.authorTanal, Mert
dc.contributor.authorİşgör, Adnan
dc.contributor.authorOba, Sibel
dc.contributor.institutionT.C. Sağlık Bakanlığı
dc.contributor.institutionT.C. Sağlık Bakanlığı
dc.contributor.institutionT.C. Sağlık Bakanlığı
dc.contributor.institutionT.C. Sağlık Bakanlığı
dc.contributor.institutionBahçeşehir Üniversitesi
dc.contributor.institutionT.C. Sağlık Bakanlığı
dc.date.accessioned2025-09-20T20:01:37Z
dc.date.issued2017
dc.date.submitted29.07.2022
dc.description.abstractTiroit cerrahisinde intraoperatif sinir monitorizasyonunun temel prensipleri ve standardizasyonuTiroit cerrahisi sonrası oluşan sesle ilgili problemler sık ve en önemli komplikasyonlardandır. Cerrahi sonrası hastanın ses ve solunum problemlerini minimalize edebilmek için hem reküren laringeal sinirin (RLS) hem de süperior laringeal sinirin eksternal dalının (SLSE) korunması gerekir. İntraoperatif nöromonitorizasyon (İONM) sinirin gözle görülmesine ek olarak ameliyat sırasında sinirin motor fonksiyonlarının dinamik olarak değerlendirilmesi temeline dayanan bir yöntemdir. Tiroit cerrahisinde İONM 50 yıl önce kullanılmaya başlanmış ve yüzey elektrotlu endotrakeal tüp ile İONM, amaca uygunluk, basitlik, noninvazif olma ve güvenlilik gibi nedenlerle standart uygulanan yöntem haline gelmiş olup, günümüzde tiroit cerrahisinde bu yöntem kullanılmaktadır. Tiroit cerrahisinde RLS ve SLSE için İONM kullanımı giderek artmaktadır. İONM'nin uygun kullanımı için hem anestezist hem cerrah için deneyim ve standardizasyonu şarttır. Bu bağlamda hem cerrahların hem de anestezistler için öğrenme eğrisi yaklaşık 50-100 arası olgudur. İONM hem RLS hem SLSE'nin bulunmasında ve fonksiyonel olarak değerlendirilmesinde önemli katkı sağlar. RLS monitorizasyonu monitorizasyon probu ile aralıklı veya vagusa uygulanan prob yardımı ile sürekli olarak uygulanabilir. RLS monitorizasyonunun standardizasyonu, preoperatif laringoskopi ile vokal kord muayenesi (L1), RLS diseksiyonu öncesi aynı taraf vagustan uyarı alınması (V1), RLS'nin trakeaozefageal olukta ilk bulunduğu noktada uyarılması (R1), diseksiyon bittikten sonra RLS'nin ortaya konduğu en proksimal noktasından uyarılması (R2), cerrahi alanda kanama kontrolü tamamlandıktan sonra vagusun uyarılması (V2), postoperatif laringoskopi ile vokal kord muayenesini (L2) içerir. V2 postoperatif vokal kord fonksiyonunu öngörmede en uygun testtir. RLS aralıklı İONM'sinde sadece sinirin probla uyarıldığı an ve sinirin uyarıldığı nokta distalinin fonksiyonu hakkında bilgi verir. Sürekli İONM ise RLS'nin vagustan ayrılmadan önce boyunda vagusa uygulanan probla yapılan devamlı uyarı sayesinde cerraha tiroidi diseke ederken RLS fonksiyonunun sürekli takip edilmesini sağlar. SLSE monitorizasyonunda primer olarak ameliyat sahasında bulunan ve SLSE'nin motor siniri olduğu krikotiroid kasın kasılması değerlendirilir. İONM hem RLS hem SLSE'nin bulunmasında ve fonksiyonel olarak değerlendirilmesinde önemli katkı sağlaması ile birlikte tiroidektomiye birçok açıdan katkı sağlayan ve tiroidektominin standartlarını arttıran bir yöntemdir
dc.identifier.endpage25
dc.identifier.issn1302-7123
dc.identifier.issn1308-5123
dc.identifier.issue1
dc.identifier.startpage13
dc.identifier.urihttps://hdl.handle.net/20.500.14719/5526
dc.identifier.volume51
dc.language.isotr
dc.relation.journalŞişli Etfal Hastanesi Tıp Bülteni
dc.subjectTıbbi Araştırmalar Deneysel
dc.subjectGenel ve Dahili Tıp
dc.subjectKulak
dc.subjectBurun
dc.subjectBoğaz
dc.subjectCerrahi
dc.titleTiroit cerrahisinde intraoperatif sinir monitorizasyonunun temel prensipleri ve standardizasyonu
dc.typeReview
dcterms.references1. Hermann M, Alk G, Roka R, Glaser K, Freissmuth M. Laryngeal recurrent nerve injury in surgery for benign thyroid diseases: effect of nerve dissection and impact of individual surgeon in more than 27,000 nerves at risk. Ann Surg 2002, 235: 261-8. [CrossRef],2. Bergenfelz A, Jansson S, Kristoffersson A, Mårtensson H, Reihnér E, Wallin G, et al. Complications to thyroid surgery: results as reported in a database from a multicenter audit comprising 3,660 patients. Langenbecks Arch Surg 2008, 393: 667-73. [CrossRef],3. Randolph GW, Dralle H, International Intraoperative Monitoring Study Group, Abdullah H, Barczynski M, Bellantone R, Brauckhoff M, et al. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Laryngoscope 2011, 121(Suppl1): S1-16. [CrossRef],4. Shedd DP, Durham C. Electrical identification of the recurrent laryngeal nerve. I. Response of the canine larynx to electrical stimulation of the recurrent laryngeal nerve. Ann Surg 1966, 163: 47-50. [CrossRef],5. Uludağ M, İşgör A. İntraoperatif sinir monitorizasyonu teknik ayrıntılar. İşgör A, Uludağ M (editör). Tiroit. 1. Baskı. İstanbul: Nobel Tıp Kitabevleri, 2013.p.917-31.,6. Randolph GW. Surgical anatomy of the recurrent laryngeal nerve. In: Randolph GW (ed). Surgery of the Thyoid and Parathyroid Glands. 1st ed. Philadelphia: W.B. Saunders, 2003.p.300-42.,7. Sturgeon C, Sturgeon T, Angelos P. Neuromonitoring in thyroid surgery: attitudes, usage patterns, and predictors of use among endocrine surgeons. World J Surg 2009, 33: 417-25. [CrossRef],8. Ho Y, Carr MM, Goldenberg D. Trends in intraoperative neural monitoring for thyroid and parathyroid surgery amongst otolaryngologists and general surgeons. Eur Arch Otorhinolaryngol 2013, 270: 2525-30. [CrossRef],9. Dralle H, Sekulla C, Lorenz K, Nguyen Thanh P, Schneider R, Machens A. Loss of the nerve monitoring signal during bilateral thyroid surgery. Br J Surg 2012, 99: 1089-95. [CrossRef],10. Barczyński M, Randolph GW, Cernea CR, Dralle H, Dionigi G, Alesina PF, et al. External branch of the superior laryngeal nerve monitoring during thyroid and parathyroid surgery: International Neural Monitoring Study Group standards guideline statement. Laryngoscope 2013, 123(Suppl 4): S1-14. [CrossRef],11. Dionigi G, Bacuzzi A, Boni L, Rovera F, Dionigi R. What is the learning curve for intraoperative neuromonitoring in thyroid surgery? Int J Surg 2008, 6(Suppl 1): S7-12. [CrossRef],12. Jonas J, Bähr R. Intraoperative neuromonitoring of the recurrent laryngeal nerve - results and learning curve. Zentralbl Chir 2006, 131: 443-8. [CrossRef],13. Pragacz K, Barczyński M. Evaluation of the learning curve for intraoperative neural monitoring of the recurrent laryngeal nerves in thyroid surgery. Pol Przegl Chir 2015, 86: 584-93. [CrossRef],14. Lu IC, Wu CW, Chang PY, Chen HY, Tseng KY, Randolph GW, et al. Reversal of rocuronium-induced neuromuscular blockade by sugammadex allows for optimization of neural monitoring of the recurrent laryngeal nerve. Laryngoscope 2016, 126: 1014-9. [CrossRef],15. Kim HY, Tufano RP, Randolph G, Barczyński M, Wu CW, Chiang FY, et al. Impact of positional changes in neural monitoring endotracheal tube on amplitude and latency of electromyographic response in monitored thyroid surgery: Results from the Porcine Experiment. Head Neck 2016, 38(Suppl 1): E1004-E1008. [CrossRef],16. Barber SR, Liddy W, Kyriazidis N, Cinquepalmi M, Lin BM, Modi R, et al. Changes in electromyographic amplitudes but not latencies occur with endotracheal tube malpositioning during intraoperative monitoring for thyroid surgery: Implications for guidelines. Laryngoscope 2016 Nov 16. [Epub ahead of print] [CrossRef],17. Yap SJ, Morris RW, Pybus DA. Alterations in endotracheal tube position during general anaesthesia. Anaesth Intensive Care 1994, 22: 586-8.,18. Chambers KJ, Pearse A, Coveney J, Rogers S, Kamani D, Sritharan N, et al. Respiratory variation predicts optimal endotracheal tube placement for intra-operative nerve monitoring in thyroid and parathyroid surgery. World J Surg 2015, 39: 393-9. [CrossRef],19. Chiang FY, Lee KW, Chen HC, Chen HY, Lu IC, Kuo WR, et al. Standardization of intraoperative neuromonitoring of recurrent laryngeal nerve in thyroid operation. World J Surg 2010, 34: 223-9. [CrossRef],20. Dionigi G, Bacuzzi A, Boni L, Rovera F, Rausei S, Frattini F, et al. The technique of intraoperative neuromonitoring in thyroid surgery. Surg Technol Int 2010, 19: 25-37.,21. Dionigi G, Kim HY, Randolph GW, Wu CW, Sun H, Liu X, et al. Prospective validation study of Cernea classification for predicting EMG alterations of the external branch of the superior laryngeal nerve. Surg Today 2016, 46: 785-91. [CrossRef],22. Scheneider R, Sekulla C, Machens A, Lorenz K, Nguyen-Thanh P, Dralle H. Dynamics of loss recovery of the nerve monitoring signal during thyroidectomy predict early postoperative vocal fold function. Head Neck 2016, 38(Suppl 1): E1144-E1151. [CrossRef],23. Chiang FY, Lu IC, Chen HC, Chen HY, Tsai CJ, Lee KW, et al. Intraoperative neuromonitoring for early localization and identification of recurrent laryngeal nerve during thyroid surgery. Kaohsiung J Med Sci 2010, 26: 633-9. [CrossRef],24. Anuwong A, Lavazza M, Kim HY, Wu CW, Rausei S, Pappalardo V, et al. Recurrent laryngeal nerve management in thyroid surgery: consequences of routine visualization, application of intermittent, standardized and continuous nerve monitoring. Updates Surg 2016, 68: 331-41. [CrossRef],25. Randolph GW. Surgical anatomy and monitoring of the recurrent laryngeal nerve. In: Randolph GW (ed). Surgery of the Thyoid and Parathyroid Glands. 2nd ed. Philadelphia: Elsevier Saunders, 2012.p.306-40.,26. Dralle H, Sekulla C, Lorenz K, Brauckhoff M, Machens A, German IONM Study Group. Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery. World J Surg 2008, 32: 1358-66. [CrossRef],27. Dionigi G, Chiang FY, Rausei S, Wu CW, Boni L, Lee KW, et al. Surgical anatomy and neurophysiology of the vagus nerve (VN) for standardised intraoperative neuromonitoring (IONM) of the inferior laryngeal nerve (ILN) during thyroidectomy. Langenbecks Arch Surg 2010, 395: 893-9. [CrossRef],28. Schneider R, Sekulla C, Machens A, Lorenz K, Nguyen Thanh P, Dralle H. Postoperative vocal fold palsy in patients undergoing thyroid surgery with continuous or intermittent nerve monitoring. Br J Surg 2015, 102: 1380-7. [CrossRef],29. Stopa M, Barczyński M. Prognostic value of intraoperative neural monitoring of the recurrent laryngeal nerve in thyroid surgery. Langenbecks Arch Surg 2016 May 3. [Epub ahead of print] [CrossRef],30. Uludag M, Aygun N, Isgor A. Motor function of the recurrent laryngeal nerve: Sometimes motor fibers are also located in the posterior branch. Surgery 2016, 160: 153-60. [CrossRef],31. Dionigi G, Wu CW, Kim HY, Rausei S, Boni L, Chiang FY. Severity of recurrent laryngeal nerve injuries in thyroid surgery. World j surg 2016, 40: 1373-81. [CrossRef],32. Schneider R, Przybyl J, Pliquett U, Hermann M, Wehner M, Pietsch UC, et al. A new vagal anchor electrode for real-time monitoring of the recurrent laryngeal nerve. Am J Surg 2010, 199: 507-14. [CrossRef],33. Schneider R, Randolph GW, Sekulla C, Phelan E, Bucher M, Thanh PH, et al. Continuous intraoperative vagus nerve stimulation for identification of imminent recurrent laryngeal nerve injury. Head Neck 2013, 35: 1591-8. [CrossRef],34. Jonas J, Boskovic A. Intraoperative neuromonitoring (IONM) for recurrent laryngeal nerve protection: Comparison of intermittent and continuous nerve stimulation. Surg Tecnol Int 2014, 24: 133- 8.,35. Phelan E, Schneider R, Lorenz K, Dralle H, Kamani D, Potenza A, et al. Continuous vagal IONM prevents recurrent laryngeal nerve paralysis by revealing initial EMG changes of impending neuropraxic injury: a prospective, multicenter study. Laryngoscope 2014, 124: 1498-505. [CrossRef],36. Wu BL, Sanders I, Mu L, Biller HF. The human communicating nerve. An extension of the external superior laryngeal nerve that innervates the vocal cord. Arch Otolaryngol Head Neck Surg 1994, 120: 1321-8. [CrossRef],37. Maranillo E, Leon X, Quer M, Orus C, Sanudo JR. Is the external laryngeal nerve an exclusively motor nerve? The cricothyroid connection branch. Laryngoscope 2003, 113: 525-9. [CrossRef],38. Mu L, Sanders I. The human cricothyroid muscle: three muscle bellies and their innervation patterns. J Voice 2009, 23: 21-8. [CrossRef],39. Potenza AS, Phelan EA, Cernea CR, Slough CM, Kamani DV, Darr A, et al. Normative intra-operative electrophysiologic waveform analysis of superior laryngeal nerve external branch and recurrent laryngeal nerve in patients undergoing thyroid surgery. World J Surg 2013, 37: 2336-42. [CrossRef],40. Barczyński M, Konturek A, Stopa M, Honowska A, Nowak W. Randomized controlled trial of visualization versus neuromonitoring of the external branch of the superior laryngeal nerve during thyroidectomy. World J Surg 2012, 36: 1340-7. [CrossRef],41. Uludag M, Aygun N, Kartal K, Besler E, Isgor A. Is intraoperative neural monitoring necessary for exploration of the superior laryngeal nerve? Surgery 2016 Dec 15. [Epub ahead of print] [CrossRef],42. Aygün N, Besler E, Celayir F, Bozdağ E, Çitgez B, Yetkin G ve ark. Süperior laringeal sinirin eksternal dalı’nın belirlenmesinde intraoperatif sinir monitorizasyonunun etkisi ve sinirin tiroaritenoid kasın motor fonksiyonuna katkısı. Şişli Etfal Hastanesi Tıp Bülteni 2016, 50: 97-102.,43. Uludag M, Aygun N, Kartal K, Citgez B, Besler E, Yetkin G, et al. Contribution of intraoperative neural monitoring to preservation of the external branch of the superior laryngeal nerve: a randomized prospective clinical trial. Langenbecks Arch Surg. 2016 Dec 29. [Epub ahead of print] [CrossRef],44. Barczyński M, Konturek A, Stopa M, Honowska A, Nowak W. Randomized controlled trial of visualization versus neuromonitoring of the external branch of the superior laryngeal nerve during thyroidectomy. World J Surg 2012, 36: 1340-7. [CrossRef]
dspace.entity.typePublication
local.indexed.atTRDizin

Files

Original bundle

Now showing 1 - 1 of 1
No Thumbnail Available
Name:
Tiroit cerrahisinde intraoperatif sinir monitorizasyonunun temel prensipleri ve standardizasyonu.pdf
Size:
469.53 KB
Format:
Adobe Portable Document Format
Download

Collections

TR-Dizin İndeksli Yayınlar Koleksiyonu