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Development of the Novel Intraoperative Neuromonitoring for Thyroid Surgery

갑상선 수술을 위한 새로운 수술 중 신경감시시스템의 개발

  • Sung, Eui Suk (Department of Otolaryngology-Head and Neck Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine) ;
  • Lee, Byung Joo (Department of Otolaryngology-Head and Neck Surgery, Pusan National University Hospital, Pusan National University School of Medicine)
  • 성의숙 (부산대학교 의과대학 양산부산대학교병원 이비인후과학교실) ;
  • 이병주 (부산대학교 의과대학 부산대학교병원 이비인후과학교실)
  • Received : 2018.03.25
  • Accepted : 2018.07.27
  • Published : 2018.11.30

Abstract

It is very important to identify recurrent laryngeal nerve (RLN) and prevent RLN injury during thyroid surgery. The intraoperative neuromonitoring (IONM) for the prevention of RLN injury is a useful method because it can identify the location and status of RLN and predict postoperative vocal cord function easily. The IONM consists of a stimulating side that applies electrical stimulation to the nerve and a recording side that measures the surface electromyography (EMG) of the vocal cord muscle through electrode endotracheal tube. The nerve stimulator and surgical dissector are separate instruments. So, during IONM for the prevention of the RLN injury in conventional, endoscopic, or robotic thyroid surgery, repeated exchanging between surgical instruments and the nerve stimulator is inconvenient and time consuming. On the recording side, the accuracy of the electrode endotracheal tube which measures the EMG of the vocalis muscle can be affected by contact with between electrode and vocal fold and position change of patient. We would like to introduce recent several researches to overcome the current limitations of IONM.

갑상선 수술 후 발생한 성대마비는 삶의 질을 중요시하는 요즘 시대에 제일 치명적 합병증 중 하나이다. 그 결과 수술 중 신경감시시스템의 사용은 보편화되고 있으나 아직 기존의 시스템은 외과 의사가 사용하기에 불편하거나 문제점들이 있다. 그래서 새로운 방식의 신경 탐침과 신경 감시 장치의 개발이 필요한 시점이다. 이에 최근 모든 수술 기구(금속형 기구, 내시경 및 로봇 기구, 에너지 기반 디바이스)에 탈부착이 가능한 신경을 자극하는 신경 탐침 및 후두 떨림을 측정하기 위한 표면압력센서를 이용한 새로운 형태의 수술 중 신경감시시스템의 개발에 대한 연구가 기대된다.

Keywords

References

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  1. Development of a Novel Intraoperative Neuromonitoring System Using an Accelerometer Sensor in Thyroid Surgery: A Porcine Model Study vol.12, pp.4, 2018, https://doi.org/10.21053/ceo.2019.00423