Academic Journal
Clinical outcomes of percutaneous versus peroral intraoperative neuromonitoring strategies in transoral endoscopic thyroidectomy vestibular approach: A retrospective analysis of 2,201 patients.
| Τίτλος: | Clinical outcomes of percutaneous versus peroral intraoperative neuromonitoring strategies in transoral endoscopic thyroidectomy vestibular approach: A retrospective analysis of 2,201 patients. |
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| Συγγραφείς: | Uen YH; Department of Surgery, Asia University Hospital, Taichung, Taiwan; Department of Surgery, Tainan Municipal An-Nan Hospital, Tainan, Taiwan; Uen YH Surgical Clinic, Tainan, Taiwan., Wu CW; Department of Otorhinolaryngology- Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan., Wen KS; Department of Pharmacy, Chi Mei Medical Center, Tainan, Taiwan., Lin YF; Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan., Lin KY; Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan. Electronic address: d84306@yahoo.com.tw. |
| Πηγή: | Surgery [Surgery] 2026 Oct; Vol. 198, pp. 110432. Date of Electronic Publication: 2026 Jul 01. |
| Τύπος έκδοσης: | Journal Article; Comparative Study |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Mosby Country of Publication: United States NLM ID: 0417347 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1532-7361 (Electronic) Linking ISSN: 00396060 NLM ISO Abbreviation: Surgery Subsets: MEDLINE |
| Imprint Name(s): | Publication: St. Louis, MO : Mosby Original Publication: St. Louis. |
| Ιατρικοί όροι (MeSH): | Thyroidectomy*/methods , Thyroidectomy*/adverse effects , Vocal Cord Paralysis*/prevention & control , Vocal Cord Paralysis*/etiology , Vocal Cord Paralysis*/epidemiology , Recurrent Laryngeal Nerve Injuries*/prevention & control , Recurrent Laryngeal Nerve Injuries*/etiology , Recurrent Laryngeal Nerve Injuries*/epidemiology , Recurrent Laryngeal Nerve Injuries*/diagnosis , Natural Orifice Endoscopic Surgery*/adverse effects , Natural Orifice Endoscopic Surgery*/methods , Intraoperative Neurophysiological Monitoring*/methods , Postoperative Complications*/prevention & control , Postoperative Complications*/etiology , Postoperative Complications*/epidemiology, Humans ; Female ; Retrospective Studies ; Male ; Middle Aged ; Adult ; Treatment Outcome ; Risk Factors ; Aged |
| Περίληψη: | Background: Recurrent laryngeal nerve palsy remains a critical complication in transoral endoscopic thyroidectomy vestibular approach. While intraoperative neuromonitoring is employed, the optimal strategy for reducing vocal cord palsy remains a topic of debate. Methods: This large-scale, retrospective cohort study, based on a prospectively collected database, enrolled 2,201 patients who underwent transoral endoscopic thyroidectomy vestibular approach. We compared outcomes among 3 distinct groups: nonintraoperative neuromonitoring (n = 109), peroral intraoperative neuromonitoring (n = 582, year 2016-2019), and percutaneous intraoperative neuromonitoring (n = 1,510, year 2020-May 2025). The peroral and percutaneous groups were further analyzed according to the technique used: intermittent (intermittent intraoperative neuromonitoring) or combined (intermittent intraoperative neuromonitoring + continuous intraoperative neuromonitoring). End points were the incidence of vocal cord palsy and a multivariate analysis of independent risk factors for vocal cord palsy. Results: The 2,092 intraoperative neuromonitoring patients (peroral and percutaneous) were analyzed in 4 subgroups: peroral intermittent intraoperative neuromonitoring (n = 481), peroral combined (intermittent intraoperative neuromonitoring + continuous intraoperative neuromonitoring, n = 101), percutaneous intermittent intraoperative neuromonitoring (n = 1,100), and percutaneous combined (intermittent intraoperative neuromonitoring + continuous intraoperative neuromonitoring, n = 410). Among these, the percutaneous combination (percutaneous-combined) group had a significantly lower temporary vocal cord palsy rate (0.2%) than all other groups (P < .05). This was attributed to higher technical success: percutaneous-combined intraoperative neuromonitoring achieved higher rates of persistent vagus nerve stimulation (99.7% vs 94.4%), a higher detection rate of imminent recurrent laryngeal nerve injury (4.4% vs 0.7%, P < .05), and a higher intraoperative signal recovery rate (88.9% vs 33.3%). Permanent vocal cord palsy was rare (n = 2), occurring only in the peroral groups. Critically, multivariate analysis confirmed that percutaneous combination intraoperative neuromonitoring was an independent protective factor against vocal cord palsy (odds ratio, 0.08; P = .02), whereas thyroid malignancy (odds ratio, 2.02; P = .02) and Graves disease/thyroiditis (odds ratio, 2.19; P = .03) were 2 independent risk factors. Conclusion: This large-scale study confirms that the percutaneous application of combined intermittent intraoperative neuromonitoring and continuous intraoperative neuromonitoring is a safe, feasible, and effective strategy for protecting the recurrent laryngeal nerve in the transoral endoscopic thyroidectomy vestibular approach. It is associated with reduced vocal cord palsy rates and can be considered a viable option, especially for individuals with high-risk thyroid diseases. (Copyright © 2026 Elsevier Inc. All rights reserved.) |
| Competing Interests: | Conflict of Interest/Disclosure The authors have no related conflicts of interest to declare. |
| Entry Date(s): | Date Created: 20260720 Date Completed: 20260915 Latest Revision: 20260915 |
| Update Code: | 20260916 |
| DOI: | 10.1016/j.surg.2026.110432 |
| PMID: | 42475946 |
| Βάση Δεδομένων: | MEDLINE |
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