Presented at the Triological Society Combined Sections Meeting, Scottsdale, Arizona, U.S.A., January 27–30, 2011.
Head and Neck
Article first published online: 17 NOV 2011
Copyright © 2011 The American Laryngological, Rhinological, and Otological Society, Inc.
Volume 122, Issue 1, pages 110–115, January 2012
How to Cite
Luginbuhl, A., Schwartz, D. M., Sestokas, A. K., Cognetti, D. and Pribitkin, E. (2012), Detection of evolving injury to the brachial plexus during transaxillary robotic thyroidectomy. The Laryngoscope, 122: 110–115. doi: 10.1002/lary.22429
The authors have no funding, financial relationships, or conflicts of interest to disclose.
- Issue published online: 19 DEC 2011
- Article first published online: 17 NOV 2011
- Manuscript Accepted: 13 JUL 2011
- Manuscript Revised: 9 JUL 2011
- Manuscript Received: 7 APR 2011
- Transaxillary robotic thyroidectomy;
- intraoperative neuromonitoring;
- brachial plexus;
- Level of Evidence: 4
Continuous intraoperative neuromonitoring (IONM) of transcranial electric motor evoked potentials (tceMEPs) and somatosensory evoked potentials (SSEPs) has gained universal acceptance as an efficacious method for detecting emerging positional brachial plexopathy or peripheral nerve compression during spinal and shoulder surgery. This has implications for transaxillary thyroid surgery.
Case report with literature review.
The patient underwent robotic transaxillary thyroid surgery with continuous tceMEP and SSEP monitoring of brachial plexus function. We present detailed IONM data depicting the emergence of positional brachial plexopathy.
Significant amplitude loss of both IONM modalities were identified during an evolving positional plexopathy, which resolved upon upper extremity repositioning and conversion to an open procedure. No permanent nerve injury or deficit was noted following surgery.
Given the potential for brachial plexus injury during robotic transaxillary thyroid surgery secondary to arm positioning, we recommend that continuous tceMEP and SSEP monitoring be considered during such procedures.