Study Comparing Different Nerve Monitoring Techniques During Scarless Trans-oral Endoscopic Thyroid Surgery

What this Trial Is About

This research investigates different techniques of intraoperative neuromonitoring IONM used during transoral endoscopic thyroidectomy vestibular approach TOETVA, a method that avoids visible scarring but carries risk of recurrent laryngeal nerve RLN injury. The study compares intermittent and continuous monitoring methods to evaluate their safety, effectiveness, and ability to detect nerve injury early during thyroid surgery. A new percutaneous continuous IONM technique using an external fixator was developed and is assessed against other methods. The study includes 304 patients who underwent TOETVA and were grouped based on the type of IONM used percutaneous continuous, peroral intermittent, or continuous monitoring. The percutaneous continuous method involves a fixed stimulation probe to continuously monitor RLN function in real time, aiming to reduce nerve injury risk. Data collected include electrode setup time, operative time, stimulation intensity, and nerve palsy rates. Participants age, sex, BMI, thyroid disease type, and operation details are recorded to compare outcomes between monitoring techniques. Researchers measure EMG signals from vocal cords, record occurrences of nerve palsy through laryngeal examination, and track electrode displacement during surgery. The study observes patients over approximately one year to assess the feasibility, safety, and effectiveness of each monitoring approach while monitoring nerve function continuously or intermittently during surgery.

Comparison of Intr-operative Neuromonitoring Technique in Trans-oral Endoscopic Thyroidectomy Vestibular Approach