OC54 Intraoperative nerve integrity monitor as part of safety dissections of recurrent laryngeal nerve in child and adolescents thyroid surgery

Introduction In thyroid cancer (TC) operations most frequently damaged vital structures are recurrent laryngeal nerves (RLN), external branch of superior laryngeal nerves and parathyroid glands. Material and methods To improve our knowledge of RLN surgical anatomy we investigated autopsy material (30 RLN), photo documented 1717 RLNs. There are about 30 variations of RLN and inferior thyroid artery attitude and three most common points of RLN visualization They are: 1 – subclavial point known as Lore’s triangle, 2 – RLN ‘cross point’ with the inferior thyroid artery and 3 – RLN laryngeal entry point. After anatomical investigationswe used the Intraoperative Nerve Integrity Monitor (IONIM) during thyroid operations (2001–2016) in adults (1791), adolescents and children (117 cases). Results It was found that RLNs in 3rdpoint were crossed by blood vessels in 94.9% (Romanchishen F.A., 2006). Ligation and transection of those vessels was very important,because thyroid tissue removal between the trachea and RLN became more convenient. This technique guaranteed safety of the RLN.Our technique of thyroidectomy allowed to find and save 15 (0.37%) nonrecurrent laryngeal nerves among 4070 thyroid patients. Postoperative laryngoscopical control allowed estimating the postoperative laryngeal palsy rate objectively. In 21cases RLN was restored with the perineural suturing under the IONIMcontrol. During 1–2 years postoperatively 15 (71.4%) demonstrated vocal cord function improvement.To protect SAN during lateral neck dissection the procedure of its surgical separation was specified. The best place for the first nerve visualization (because of safety) was the level of sternocleidomastoid muscle’s upper third where it accompanied the internal jugular vein. Our technique assumes dissection of SAN from above with separating and saving of nervous branches to sternocleidomastoid muscle’s, C3 and TM with consecutive moving of SAN from inner to the outer part of the sternocleidomastoid muscle’s by the rubber holder and forceps. Conclusion As a result of regular use of suggested RLN, SAN dissection and IONIMtechnique,the postoperative morbidity rate decreased significantly.