Protecting Recurrent Laryngeal Nerves in Thyroid Radiofrequency Ablation w/ Dr. Valcavi скачать в хорошем качестве

Protecting Recurrent Laryngeal Nerves in Thyroid Radiofrequency Ablation w/ Dr. Valcavi

We are honored to have Dr. Roberto Valcavi present "Recurrent Laryngeal Nerve Protection During Thyroid Radiofrequency Ablation." Dr. Vaninder Dhillon joins as the featured expert discussant. 0:00 Webinar 3:20 Dr. Valcavi presents Dr. Valcavi goes over the anatomy of the recurrent laryngeal nerve. A branch of the Vagus nerve runs posterior to the thyroid gland and enters the larynx at the cricothyroid joint, and the RLN cannot be seen by ultrasound. The Danger Triangle is an area medial and posterior to the thyroid lobe where injury to the RLN causes hoarseness, speech dysfunction, and dysphagia. 8:28 Hydrodissection Techniques Compared Anterior hydrodissection, completed with pericapsular local anesthesia, separates strap muscles from the nodule. Posterior hydrodissection separates nodules from vital nerve structures, while anterolateral hydrodissection poses risks with interference between the RFA electrode and hydrodissection needle and difficulty completing hydrodissection. 17:01 Electrode Position & Settings The needle positions in the inferior area of the nodule, adjacent to the danger zone protected by hydrodissection, which separates the nodule from nerves. Settings include 10-20 watts, with anything above 40W risking surrounding tissue, and the temperature should not increase too high to avoid boiling of the tissue; cooling the needle tip with cold saline is important. 21:19 Ablation of Lower Nodule Ablation starts at the lower nodule, ablated first before hydrodissection diminishes (15-20 minutes). 22:00 Needle Tip Exposure Length A standard 7 mm fixed tip needle made of steel and insulated by Teflon is used, with shorter tip settings allowing lower power settings. Adjustable needle types can be suitable alternatives for more complex cases. 25:36 Sedation Options for Patient Comfort Sedation, almost always advisable, ranges from minimal, allowing normal response to verbal stimulation with oral benzodiazepine, to moderate/analgesia, welcomed by patients and completed with midazolam, fentanyl, and low concentration propofol, to deep sedation, where patients have decreased consciousness and may require airway control. Initially, minimal sedation and local anesthesia were recommended in an ambulatory setting, but has moved to an operating room setting under moderate to deep sedation for patient safety and comfort. 31:21 Sedation Options for Patient Comfort Intraoperative nerve monitoring is generally not feasible in thyroid RFA, with Flexible fiberoptic laryngoscopy being the gold standard, allowing RLN assessment by visualizing vocal cord symmetrical movements. If vocal cord asymmetry appears during RFA, ablation stops immediately and hydrodissection with D5W is repeated. 34:20 Flexible Laryngoscopy for Ablations Patients are asked to say “EEE” to assess vocal cord movements through FFL and US, showing symmetric midline movements of vocal cords. 38:31 Dr. Dhillon presents Dr. Dhillon Highlights the importance of the recurrent laryngeal nerve function for voice, prevention of aspiration, and glottic airway integrity. Videostroboscopy allows greater detail of vocal cord vibrations than FFL. Hydrodissection protects nerve structures and is imperative for nerve protection. The location of ablation and sedation affects voice evaluation, and ultrasound with voice quality assessment from a communicative patient allows accurate voice assessment during RFA. 49:40 Discussion with Q&A ** Check out our other programs! ** The THANC Guide https://thancguide.org/ TIRO: Thyroid Int'l Recommendations Online https://tiro.expert/ ** Follow us on Twitter! ** @thancfoundation - https://shorturl.at/puwS0 THANC on FB - https://shorturl.at/svNY4