Identification of the External Branch of the Superior Laryngeal Nerve during Thyroid Surgery.

AIM: To compare the level of intra-operative identification of external branch of the superior laryngeal nerve (EBSLN) through classical conventional clinical methods of prevention against those applying intraoperative neuromonitoring (IONM). MATERIALS AND METHODS: The study included 102 patients with interventions on the thyroid gland performed in the surgical clinics of St George University Hospital and the Department of Special Surgery of Plovdiv Medical University. All operative procedures were performed by the standard technique of capsular dissection and IONM. RESULTS: Of all 102 thyroid procedures 87 (85.3%) patients underwent total thyroidectomy and 15 (14.7%) had unilateral thyroid lobectomy. One hundred fifty-five (82.01%) out of 189 expected EBSLN were identified and investigated intraoperatively when trying to identify visually EBSLN by the so called classical (conventional) methods of prevention. With the use of IONM, 181 (96.76%) EBSLN were correctly identified. Compared to the preliminary results of visual identification - 155/189 (82.01%) EBSLN, the degree of identification of EBSLN through IONM reached 96.76% which is a statistically significant difference (P <0.05) Conclusion: The use of IONM during thyroid resection significantly improves the degree of identification of EBSLN compared to conventional means of prevention. Routine use of IONM in surgical interventions on the thyroid gland will be beneficial for more secure identification and prevention of EBSLN.

Prognostic significance of intraoperative PTH test for the development of post-thyroidectomy hypocalcaemia.

The high incidence of postoperative hypoparathyroidism after total thyroidectomy and the significant morbidity associated with it can account for the sustained efforts to find reliable, affordable markers for the prognosis of this condition. Therefore, a lot of attention has been paid recently to the perioperative measurement of the parathyroid hormone (PTH) as an immediate indicator showing the parathyroid glands functional status. There are a lot of studies in the relevant literature demonstrating that PTH is a highly sensitive marker, with high specificity to predict development of postoperative hypocalcemia. Recent studies analyze in-depth not only the absolute values of PTH, but also the dynamics of its levels during surgery. The number and timing of sampling for testing is a matter of discussion. Importance is attached also to the hormone testing methods. Research results determine intraoperative PTH (IOPTH) as a valuable additional test for early risk assessment of hypocalcaemia allowing prevention and timely treatment of patients at risk. Early identification of risk groups of patients creates a real opportunity to reduce the incidence of this complication by autotransplantation of parathyroid glands. Despite the encouraging results the predictive accuracy of this indicator is not 100%, which requires careful result interpretation. The findings of researchers are not uniform, probably due to differences in study design, the methods used in PTH testing, and the accepted reference range of serum calcium. This impedes comparison of data and highlights the need for similar analyzes in each specialized center.