How does neural monitoring help during thyroid sugery for Graves’ disease?

Zhou, Le; Dionigi, Gianlorenzo; Pontin, Alessandro; Pino, Antonella; Caruso, Ettore; Wu, Che‐Wei; Sun, Hui; Tufano, Ralph P.; Kim, Hoon Yub

doi:10.1016/j.jcte.2018.11.002

Cited by 12 publications

(14 citation statements)

References 25 publications

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“…There exists only one retrospective series of 209 patients comparing intermittent, continuous IONM and visualization alone with thyroidectomy for GD. RLN palsy occurred at a rate of 3.6% in the I-IONM group, 2.7% in the C-IONM group and 5.4% in the visualization group, and could not demonstrate a significant reduction of RLNP ( p = 0.058) [ 55 ]. The presented analysis showed a rate of transient RLN palsy after use of continuous IONM of 3.4% compared to 4.1% when intermittent IONM was used ( p = 0.059).…”

Section: Discussionmentioning

confidence: 99%

Short-Term Outcomes of Surgery for Graves’ Disease in Germany

Maurer

Vorländer

Zielke

et al. 2020

JCM

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Background: Surgical treatment of Graves’ disease (GD) has a potentially increased incidence of postoperative hypoparathyroidism, recurrent laryngeal nerve palsy (RLNP) and bleeding. The aim of this study was to evaluate the current extent of surgery for the treatment of GD and its safety as a short-term outcome. Methods: Patients who underwent thyroid resection for GD were identified from the prospective StuDoQ/Thyroid registry. Patient data were retrospectively analyzed regarding demographics, surgical procedures and perioperative outcomes. Statistics were performed with Student’s t-test or Fisher’s exact test and multivariate Cox regression analysis. The level of statistical significance was set at p < 0.05. Results: A total of 1808 patients with GD with a median age of 44 (range 14–85) years were enrolled in a 25-month period by 78 departments, of which 35.7% (n = 645) had an endocrine orbitopathy and 0.1% (n = 6) had thyrotoxic crisis. Conventional open surgery was used in 98.6% of cases and minimally invasive or remote-access approaches were used in 1.4%. Total thyroidectomy was performed in 93.4% of cases (n = 1688). Intraoperative neuromonitoring (IONM) was used in 98.9% (n = 1789) of procedures. In 98.3% (n = 1777) at least one parathyroid gland was visualized and in 20.7% (n = 375) parathyroids were autografted. The rates of unilateral and bilateral transient RLNP were 3.9% (n = 134/3429 nerves at risk) and 0.1% (n = 4/3429 NAR). The rates of transient RLNP tended to be higher when intermittent IONM was used compared to continuous IONM (4.1% vs. 3.4%, p < 0.059). The rate of transient postoperative hypoparathyroidism was overall 29% (n = 525/1808). Multivariate analysis revealed fewer than 300 thyroid resections and fewer than 15 thyroid resections for GD per year, male sex, BMI > 30, autotransplantation of parathyroid glands and previous bilateral thyroid surgery as independent risk factors for postoperative temporary hypoparathyroidism. Reoperations for bleeding (1.3%) were rare. Conclusion: Total thyroidectomy with IONM is safe and currently the most common surgical therapy for GD in Germany. Postoperative hypoparathyroidism is the major complication which should be focused on.

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Section: Discussionmentioning

confidence: 99%

Short-Term Outcomes of Surgery for Graves’ Disease in Germany

Maurer

Vorländer

Zielke

et al. 2020

JCM

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“…Nevertheless, it has yet to be adopted as a routinely utilized adjunct to the established technique of intermittent intraoperative RLN monitoring and direct visualization. Although demonstrated to be a safe and effective technique of nerve monitoring in multiple centers, [1][2][3][4][5][6][7][8][9][10][11] this study aims to demonstrate the summative result of this data in a metaanalysis of C-IONM-related recurrent laryngeal nerve outcomes in thyroid surgery.…”

Section: Introductionmentioning

confidence: 99%

Meta‐analysis on continuous nerve monitoring in thyroidectomies

Hui

Cheung

et al. 2021

Head & Neck

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In the last decade, the introduction of continuous intraoperative recurrent laryngeal nerve (RLN) monitoring (C-IONM) has enabled the operator to verify the functional integrity of the vagus nerve-recurrent laryngeal nerve (VN-RLN) axis in real-time. We aim to present the current evidence on C-IONM utility for thyroid surgery by conducting the first meta-analysis on this technique. A systematic review of literature was conducted by two independent reviewers via Ovid in the Medline, EMBASE, and Cochrane reviews databases. The search was limited to human subject research in peer-reviewed articles of all languages published between Jan 1946 and April 2020. Medical subject headings (MeSH) terms utilized were thyroid surgery, thyroidectomies, recurrent laryngeal nerve, vagal nerve, monitor, and stimulation. Thirty-eight papers were identified from Ovid, another six papers were identified by hand-search. A random effect meta-analysis was performed with assessment of heterogeneity using the I 2 value. A total of 23 papers that investigated the use of continuous vagal nerve monitoring during thyroid surgery were identified. The proportion of nerves at risk (NAR) with temporary RLN paralysis postoperation was 2.26% (95% CI: 1.6-2.9, I 2 = 37). The proportion of NAR with permanent RLN palsy postoperation was 0.05% (95% CI: 0.08-0.2, I 2 = 0). In this meta-analysis, there is one case of temporary vagal nerve paralysis secondary to VN electrode dislodgement, and a case of hemodynamic instability manifested in bradycardia and hypotension in the initial phase of surgery shortly after calibration. C-IONM is a safe and effective means by which RLN paralyses in thyroid surgery can be reduced.

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“…Nevertheless, it has yet to be adopted as a routinely utilised adjunct to the established technique of intermittent intraoperative recurrent laryngeal nerve monitoring and direct visualisation. Although demonstrated to be a safe and effective technique of nerve monitoring in multiple centres [1][2][3][4][5][6][7][8][9][10][11], this study aims to demonstrate the summative result of this data in a meta-analysis of CIONM-related recurrent laryngeal nerve outcomes in thyroid surgery. transection, CIONM can detect early EMG changes that are associated with imminent nerve injuries, thus preventing nerve injuries caused by mechanical, thermal or cumulative trauma by forewarning the surgeons of impending nerve injury and allowing the surgeons to perform corrective manoeuvres [26].…”

Section: Introductionmentioning

confidence: 99%

Continuous Intraoperative Nerve Monitoring in Thyroidectomies: A Systematic Review and Meta-Analysis

Dominic¹,

Hui²,

Cheung³

et al. 2021

J Head Neck Surg

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Objective: Application of intermittent intra-operative nerve monitoring (I-IONM) as an aid in thyroidectomies is common practice worldwide. While I-IONM is significantly beneficial in thyroid surgeries, it is limited by its intermittent nature, thereby allowing the recurrent laryngeal (RLN) nerve to be at risk of injury in-between stimulations. In the last decade, the introduction of continuous intraoperative RLN monitoring (CIONM) has overcome this limitation by enabling the operator to verify the functional integrity of the vagus nerve-recurrent laryngeal nerve (VN-RLN) axis in real-time. We aim to present the current evidence on CIONM utility for thyroid surgery by conducting the first meta-analysis on this technique.Methods: A systematic review of literature was conducted by two independent reviewers via Ovid in the Medline, EM-BASE and Cochrane reviews databases. The search was limited to human subject research in peer-reviewed articles of all languages published between Jan 1946 and April 2019. Medical subject headings (MeSH) terms utilised were thyroid surgery, thyroidectomies, recurrent laryngeal nerve, vagal nerve, monitor and stimulation. Thirty-eight papers were identified from Ovid, another six papers were identified by hand-search. A random effect meta-analysis was performed with assessment of heterogeneity using the I 2 value.Results: A total of 23 papers that utilised continuous vagal nerve monitoring during thyroid surgery were identified. The proportion of temporary and permanent recurrent laryngeal nerve paralysis post-operation was 2.5% (95% CI 1.7-3.2%, I 2 = 37.7). The proportion of patients with permanent recurrent laryngeal nerve palsy post-operation was 0.05% (95% CI 0.08 -0.2%, I 2 = 0). Conclusion:CIONM is a safe and effective means by which RLN paralyses in thyroid surgery can be reduced.

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How does neural monitoring help during thyroid sugery for Graves’ disease?

Abstract: Graphical abstract

Cited by 12 publications

References 25 publications

Short-Term Outcomes of Surgery for Graves’ Disease in Germany

Short-Term Outcomes of Surgery for Graves’ Disease in Germany

Meta‐analysis on continuous nerve monitoring in thyroidectomies

Continuous Intraoperative Nerve Monitoring in Thyroidectomies: A Systematic Review and Meta-Analysis

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