文献摘要
喉返神經解剖時使用LigaSure之安全-連續性神經監測下豬動物模式
Safety of LigaSure in Recurrent Laryngeal Nerve Dissection-Porcine Model Using Continuous Monitoring
Volume 2, Issue 2
關鍵字 ：
喉返神經，肌電圖，LigaSure止血融合刀，甲狀腺切除手術，術中神經監測, Recurrent laryngeal nerve, electromyography, LigaSure, thyroidectomy, intraoperative neuromonitoring
作者 ：
Gianlorenzo Dionigi, MD, FACS; Feng-Yu Chiang, MD; Hoon Yub Kim, MD, PhD; Gregory W. Randolph, MD, FACS, FACE; Alberto Mangano, MD; Pi-Ying Chang, MD; I-Cheng Lu, MD, PhD; Yi-Chu Lin, MD; Hui-Chun Chen, RN; Che-Wei Wu, MD, PhD
譯者 ：
高雄醫學大學附設醫院 江豐裕醫師
摘要：
Objectives/Hypothesis: This study investigated recurrent laryngeal nerve (RLN) real-time electromyography (EMG) data to define optimal safety parameters of the LigaSure Small Jaw (LSJ) instrument during thyroidectomy.
Study Design: Prospective animal model.
Methods: Dynamic EMG tracings were recorded from 32 RLNs (16 piglets) during various applications of LSJ around using continuous electrophysiologic monitoring. At varying distances from the RLN, the LSJ was activated (activation study). The LSJ was also applied to the RLN at timed intervals after activation and after a cooling maneuver through placement on the sternocleidomastoid muscle (cooling study).
Results: In the activation study, there was no adverse EMG event at 2 to 5 mm distance (16 RLNs, 96 tests). In the cooling study, there was no adverse EMG event after 2-second cooling time (16 RLNs, 96 tests) or after the LSJ cooling maneuver on the surrounding muscle before reaching the RLNs (8 RLNs, 24 tests).
Conclusion: Based on EMG functional assessment, the safe distance for LSJ activation was 2 mm. Further LSJ–RLN contact was safe if the LSJ was cooled for more than 2 seconds or cooled by touch muscle maneuver. The LSJ should be used with these distance and time parameters in mind to avoid RLN injury.
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