Intermittent intraoperative nerve monitoring in thyroid reoperations: Preliminary results of a randomized, single‐surgeon study

Abstract

Intermittent IONM could not provide additional benefits to reduce the incidence of temporary RLN paralysis and permanent RLN paralysis in thyroid reoperations. It could not reduce the incidence of paralysis caused by unintentional injuries. © 2016 Wiley Periodicals, Inc. Head Neck 38: E1993-E1997, 2016.

Intermittent neural monitoring of the recurrent laryngeal nerve in surgery for recurrent goiter

“…In recent years there have been many publications concerning the introduction of IONM, the learning curve and the technical aspects of new the technology, and assessing the prevalence of complications when utilizing IONM (17,20,(25)(26)(27)(29)(30)(31)(32). But very little data concerning the incidence of RLN injury in reoperations with IONM has been published, and only a few publications have compared the RLN injury rate during secondary thyroid surgery using IONM with procedures using only visual RLN identification (16)(17)(18)(19)33,34).…”

“…In about 50% of cases the nerve branches, and in 0.03% the non-RLN could be present (16)(17)(18)(19)33,34,49). Other risk factors involved in RLN injury are hyperthyroidism, the extent of the surgical treatment and of course the surgeon's experience with endocrine surgery (11,14).…”

“…Usually we find the nerve adherent to the lateral capsule of the remnant thyroid mass or adherent strictly to the inferior part of a recurrent goiter. Another obstacle in reoperations is (as noted earlier) massive scarring after the first operation, in which the nerve could be imbedded (16)(17)(18)(19)33,34). A scarred operating field, in particular after subtotal thyroid operations, makes it difficult not only to find the RLN but also to separate it from other structures.…”

“…Scarring from the first intervention is the main obstacle during reoperations (16)(17)(18)(19)33,34) (Figure 3). As we have pointed out, it makes it difficult to identify and to dissect the RLN, and the operating field is much more prone for bleeding than in first intervention.…”

“…The indications for reoperative surgery for thyroid disease vary, and the patients for this type of procedure are not a homogenous group (11,(16)(17)(18)(19). It is sometimes indicated for nodular recurrence after partial surgery for initially benign thyroid disease, mainly after bilateral subtotal thyroidectomy, or to complete total thyroidectomy when thyroid cancer is recognized in histopathological report after the thyroid gland is partially removed in the initial operation.…”