Literature on intraoperative neuro monitoring (IONM) during endocrine surgery have increased over recent years. A comprehensive understanding of the role of IONM for prevention of nerve injuries is critical to maximize safety during surgery of the anterior compartment of the neck. Neuromonitoring techniques are currently considered safe technique and technology; however, albeit sporadically, have been reported some complications and related side effects using such methods. The complications described can be related to the electrodes positioned at the larynx, at the obstruction of the endotracheal tube, the drugs used for anesthesia and the effects of electrical stimulation on nerve structures and systemic levels. This review will explore the safety issues of IONM to improve the outcomes among patients undergoing monitored thyroidectomy.
Two patients complained of hoarseness, respiratory distress and swallowing disorders early after total bilateral thyroidectomy for multinodular goiter and cancer, respectively. Faulty surgical techniques had caused injury to bilateral recurrent laryngeal nerves (RLNs) during thyroidectomy and the associated central lymph node dissection. The operation notes showed no statement regarding the identification, dissection, exposure and/or functional integrity of the RLN on either side of the thyroid and no mention of the first resected lobe. This report reviews the personal experience of the authors in thyroid surgery for use in 2 medical malpractice claims and for future reference.
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