Intraoperative intermittent neuromonitoring of inferior laryngeal nerve and staged thyroidectomy: our experience

Cavicchi, Ottavio; Burgio, Luca; Cioccoloni, Eleonora; Piccin, Ottavio; Macrı̀, Giovanni; Schiavon, Patrizia; Dionigi, Gianlorenzo

doi:10.1007/s12020-018-1739-5

Cited by 28 publications

(32 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The main benefit of I‐IONM is that the surgeon can confirm an impairment of RLN function intraoperatively which enables changes of surgical strategy and avoids the risk of bilateral RLN injury in planned bilateral procedures. I‐IONM may also help prevent nerve injury and VFP by virtue of its nerve localization abilities—an especially important consideration for junior and low volume surgeons—although many studies comparing I‐IONM to no monitoring have not demonstrated a strident improvement in VFP rates with I‐IONM 8,33,35,38,65–67 . This finding likely reflects the fact that most of these studies were performed at high‐volume centers where rates of VFP were already low by virtue of the surgeon's experience.…”

Section: Resultsmentioning

confidence: 99%

Clarifying optimal outcome measures in intermittent and continuous laryngeal neuromonitoring

et al. 2021

View full text Add to dashboard Cite

Background Intraoperative neuromonitoring (IONM) techniques have evolved over the past decade into intermittent IONM (I‐IONM) and continuous IONM (C‐IONM) modes of application. Despite many prior publications on both types of IONM, there remains uncertainty about what outcomes should be measured for each form of IONM. The primary objective of this paper is to define categories of benefit for I‐IONM/C‐IONM and to clarify and standardize their reporting outcomes. Methods Expert review consensus statement utilizing modified Delphi methodology. Results I‐IONM provides diagnosis, classification, and prevention of nerve injury through accurate and early nerve identification. C‐IONM provides real‐time information on nerve functional integrity and thus may prevent some types of nerve injury but cannot assist in nerve localization. Sudden mechanisms of nerve injury cannot be predicted or prevented by either technique. Conclusions I‐IONM and C‐IONM are complementary techniques. Future studies evaluating the utility of IONM should focus on outcomes that are appropriate to the type of IONM being utilized.

show abstract

Section: Resultsmentioning

confidence: 99%

Clarifying optimal outcome measures in intermittent and continuous laryngeal neuromonitoring

et al. 2021

View full text Add to dashboard Cite

show abstract

“…The best known technique to avoid injury to RLN is meticulous dissection of the nerve throughout its anatomic pathway. However, functional impairment of RLN is not visible macroscopically and IONM has been developed to monitor the nerve to avoid unnecessary dissection (9,10). Meticulous hemostasis can be achieved with harmonic sealing instrument, since improper hemostasis is known to increase the risk of RLNI (4).…”

Section: Discussionmentioning

confidence: 99%

Recurrent laryngeal nerve injury (RLNI) in total thyroidectomy with intraoperative nerve monitoring (IONM) and harmonic sealing instrument: A retrospective analysis and treatment results

Yuksekdag¹,

Topcu²,

Deveci³

et al. 2019

Eastern J Med

View full text Add to dashboard Cite

The aim of the current study was to reveal the incidence of RLNI in our patients with total thyroidectomy and to evaluate their clinical outcomes. Charts of 260 patients who underwent total thyroidectomy between 2014 and 2018 were interrogated retrospectively. Standard IONM and harmonic seal were used in all. Patients with suspect of RLNI were further evaluated. Demographics, etiologic disease and the overall treatment results were presented. A total of 12 patients with RLNI (4.6 %) were presented. Nine (75 %) were women and 3 (25 %) were men. Mean age was 51 years (range, 32-67). RLNI was unilateral in 8 patients (3 %; 50 % in right RLN and 50 % in left RLN) and bilateral in four (1.5 %). All were started corticosteroid and follow-up period was 26 months (range, 9-52). Mean hospital stay was 4 days (range, 2-14). Histopathological evaluations revealed papillary carcinoma (n=7, 58 %), multinodular goitre with thyroiditis (n=4, 34 %) and multinodular goitre with parathyroid adenoma (n=1, 8 %). In a patient with bilateral RLNI (0.3 %), tracheostomy was done on postoperative day 2, and closed on postoperative month 4. Thyroplasty and suture lateralization were applied to other bilateral RLNI cases. In 5 patients with unilateral RLNI and one with bilateral palsy, vocal cords became normal in first 6 months (transient palsy, 2.3 %). Careful surgical dissection with harmonic and IONM employed in total thyroidectomy are both reliable methods. In case of inevitable RLNI, a close follow-up and cooperation are mandatory to have optimal results.

show abstract

“…Nerve identification alone is insufficient because visual integrity does not guarantee normal RLN functional status [7, 8]. One of the most significant attributes of neural testing is prognostication of postoperative neural function and its impact on surgical strategy in bilateral thyroid disease [9, 21, 29, 30]. Accurate identification of unilateral RLN injury might allow second lobe surgery and bilateral nerve injury to be avoided.…”

Section: Discussionmentioning

confidence: 99%

Recurrent laryngeal nerve injury assessment by intraoperative laryngeal ultrasonography: a prospective diagnostic test accuracy study.

Rybakovas

Baušys

Žaldokas

et al. 2018

Videosurgery and Other Miniinvasive Techniques

View full text Add to dashboard Cite

IntroductionRecurrent laryngeal nerve injury is one of the major complications related to thyroid surgery. Intraoperative recurrent laryngeal nerve functional status monitoring is becoming a standard part of thyroid surgery. However, the current methods for intraoperative nerve functional status assessment are associated with a demand for specialized devices and increased costs.AimTo assess the validity of a new method – intraoperative laryngeal ultrasonography – for prediction of recurrent laryngeal nerve injury.Material and methodsThis prospective diagnostic test accuracy study included 112 patients undergoing thyroid surgery in Vilnius University Hospital Santaros Clinics. Neurostimulation combined with laryngeal ultrasonography and laryngeal palpation was performed intraoperatively to evaluate recurrent laryngeal nerve functional status. Recurrent laryngeal nerve injury was confirmed by laryngoscopy, which was performed on the first postoperative day and considered to be the gold standard method.ResultsData on 112 consecutive patients and 200 nerves at risk were collected. The temporary vocal cord palsy rate was 5.4% per patient and 3% per nerve at risk. No permanent palsy or bilateral injury cases were registered in the study cohort. Laryngeal ultrasound sensitivity counted per nerve at risk was 83.3%, specificity 97.2%, accuracy 96.4%, positive predictive value 62.5% and negative predictive value 99%.ConclusionsLaryngeal ultrasonography is a feasible new technique for accurate intraoperative recurrent laryngeal nerve injury evaluation.

show abstract

Intraoperative intermittent neuromonitoring of inferior laryngeal nerve and staged thyroidectomy: our experience

Abstract: High sensitivity and specificity values confirm the validity of I-IONM with NSLP in predicting postoperative normal vocal cord function. Our results confirm that I-IONM may safely guide an ST overall in benign thyroid diseases and in low-grade malignancies.

Cited by 28 publications

References 38 publications

Clarifying optimal outcome measures in intermittent and continuous laryngeal neuromonitoring

Clarifying optimal outcome measures in intermittent and continuous laryngeal neuromonitoring

Recurrent laryngeal nerve injury (RLNI) in total thyroidectomy with intraoperative nerve monitoring (IONM) and harmonic sealing instrument: A retrospective analysis and treatment results

Recurrent laryngeal nerve injury assessment by intraoperative laryngeal ultrasonography: a prospective diagnostic test accuracy study.

Contact Info

Product

Resources

About