Browsing by Author "Chiang, Feng-Yu"

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Peculiar anatomic variation of recurrent laryngeal nerve and EMG change in a patient with right substernal goiter and pre-operative vocal cord palsy-case report
(2020-06-01)
Wang, Jia Joanna
;
Lu, I-Cheng
;
Chang, Pi-Ying
;
Wu, Che-Wei
;
Wang, Ling-Feng
We report a patient with right substernal goiter and preoperative vocal cord palsy (VCP). During dissection, an anatomic variation of the recurrent laryngeal nerve (RLN) and a prolonged EMG were detected by intraoperative neuromonitoring (IONM). Symmetrical vocal cord movement was recorded one month after surgery. The potential for recovery of vocal cord function is high after surgical treatment of a thyroid tumor with preoperative VCP. An IONM enables early localization of the RLN position. lb the best of our knowledge, this case of prolonged EMG in an abnormal acquired-ventral RLN trajectory is the first reported in the literature.
Safety of Ligasure exact dissector in thyroidectomy with continuous neuromonitoring: a porcine model
(2020-06-01)
Huang, Tzu-Yen
;
Lin, Yi-Chu
;
Tseng, Hsin-Yi
;
Dionigi, Gianlorenzo
;
Kim, Hoon-Yub
Background: The purpose of this study was to investigate and define safety parameters for using the Ligasure exact dissector (LED) for dissection close to the recurrent laryngeal nerve (RLN) during thyroidectomy. Methods: Real-time electrophysiologic electromyographic (EMG) tracings were recorded in 16 RLNs (8 piglets) during various applications of LED under continuous intraoperative monitoring in this prospective porcine model study. In the activation study, LED was activated at varying distances from the RLN. In the cooling study, LED was activated with different cooling times or after touching the sternodeidomastoid muscle before application to the RLN. Results: In the activation study, no adverse EMG events occurred at distances longer than I rum. In the cooling study, no adverse EMG events occurred after a 2-second cooling time. Additionally, no adverse EMG events occurred when a sternodeidomastoid muscle touch maneuver was used for cooling. Conclusions: The LED can be safely used at distance of 1 mm or longer, and it should be cooled for at least 2 seconds or by muscle touch maneuver. Thyroid surgeons can avoid RLN injury if standard procedures for LED use are observed.
Safety parameters of ferromagnetic device during thyroid surgery: Porcine model using continuous neuromonitoring
(1970-01-01)
Huang, Tzu-Yen
;
Lin, Yi-Chu
;
Tseng, Hsin-Yi
;
Dionigi, Gianlorenzo
;
Kim, Hoon Yub
Background The ferromagnetic (FM) device is a new surgical energy modality. This study investigated dynamic recurrent laryngeal nerve (RLN) electromyographic (EMG) data to define safety parameters for using FM devices in thyroidectomy. Methods Real-time EMG tracings obtained under continuous neuromonitoring were recorded from 24 RLNs (12 piglets). In the activation study, FM devices were activated at varying distances from the RLN. In the cooling study, FM devices were cooled for varying time intervals, or muscle touch maneuver was performed, before contact with the RLN. Results During the FMwand/FMsealer activation, no adverse EMG events occurred at distances of 2 mm or longer. The cooling study revealed no adverse EMG events after 1-second (FMwand) or 3-second (FMsealer) intervals or after muscle touch maneuver. Conclusions An FM device should be activated at a distance of 2 mm from the RLN and should be adequately cooled before further contact with the RLN. Surgeons can avoid RLN injury by observing standard procedures for using FM devices.
U-shaped strap muscle flap for difficult thyroid surgery
(2020-04-01)
Ko, How-Yun
;
Lu, I-Cheng
;
Chang, Pi-Ying
;
Wang, Ling-Feng
;
Wu, Che-Wei
Background: Open thyroidectomy via conventional midline approach can be challenging in complex thyroid surgeries. This study proposes a U-shaped strap muscle flap (USMF) technique that provides adequately wide exposure of the surgical field. Methods: Strap muscles were cut close to the clavicle and along the anterior margin of both sternocleidomastoid muscles followed by total thyroidectomy in 20 patients as USMF group, and surgical outcomes were compared with 40 patients who had received total thyroidectomy via midline approach. Results: No patient had postoperative hematoma, vocal cord paralysis, permanent hypocalcaemia, wound infection or flap necrosis. At 2 months post-surgery, objective voice analysis and subjective assessment of voice and swallowing showed no significant difference between groups. Conclusions: USMF provides superb surgical field exposure, and the voice and swallowing functions after USMF are comparable to those obtained by midline approach. The USMF approach is a feasible option for selective difficult thyroid surgery.