SURGICAL TREATMENT OF THYROID GLAND AND INTRAOPERATIVE IDENTIFICATION OF LARYNGEAL NERVES

Backround. During an operation on the thyroid gland the most frequent complications are injuries of laryngeal nerves, clinical manifestations of which are paresis or paralysis of the larynx. Nowadays available methods are designed only for visual confirmation of nerve tissue. So, it is very important to introduce a more perfect method to identify and monitor the laryngeal nerves.

Methods of research. Conventionally the area of laryngeal nerves is divided into three zones: I — the trunk of recurrent laryngeal nerve, II — zone, where the recurrent nerve enters the larynx, III — the passage of the upper laryngeal nerve.

An anesthetist carries out a typical anesthesia using a laryngeal mask. Patient’s right deltoid muscle is connected to the passive electrode. The active electrode is applied into the wound. Active and passive electrodes are connected to the alternator. Further access is performed with the help of Kocher’s method, after both pole parts of the thyroid glands being reached, instrumental verification of recurrent nerves is carried out by means of wound tissues being stimulated with an active electrod. Having identyfied and visualized nerves a surgeon continues performing an operation periodically monitoring the conductivity of recurrent nerves.

Results. From 2009 to 2014 years there were examined 156 patients being operated on the thyroid gland. Having been identified and monitored 260 recurrent nerves and 260 upper laryngeal nerves, it was proved that the amplitude and frequency of the output informative signal depends on the distance from the active electrode to the laryngeal nerve, reaching its peak during the stimulation of nerve tissue.

Conclusions. Proposed method is highly effective, it allows searching laryngeal nerves and verifying their integrity during surgical operations on the thyroid gland without any errors.