Intraoperative Nerve Monitoring Can Reduce Prevalence of Recurrent Laryngeal Nerve Injury in Thyroid Reoperations: Results of a Retrospective Cohort Study

Barczyński, Marcin; Konturek, Aleksander; Pragacz, Krzysztof; Papier, Aleksandra; Stopa, Małgorzata; Nowak, Wojciech

doi:10.1007/s00268-013-2260-x

Cited by 153 publications

(162 citation statements)

References 44 publications

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“…IONM of the RLN and the external branch of the superior laryngeal nerve (EBSLN) have been standardized and seem to be beneficial in high risk thyroid operations, particularly in reoperations (25,26). 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).…”

Section: Review Articlementioning

confidence: 99%

“…Barczyński et al showed that almost 20% of the RLNs were identified with IONM before visual exposition of the nerve, and almost twice as many ramified nerves were identified in reoperations with IONM than without monitoring (P<0.001) (17). Moreover, the use of IONM significantly (P=0.02) improved identification of non-recurrent laryngeal nerves (non-RLNs) than in operations without monitoring (17). In a scarred operating field there can be problems with hemostasis because of the high degree of vascularization.…”

Section: Rln Identification and Mappingmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Wojtczak

Barczyński

2016

Gland Surg.

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Reoperative thyroid surgery is still challenging even for skilled surgeons, and is associated with a higher incidence of complications, such as hypoparathyroidism and recurrent laryngeal nerve (RLN) palsy. Displacement of the RLN, scar tissue from previous neck surgery and difficulty in maintaining good hemostasis are risk factors in reoperations. The prevalence of RLN injury in reoperative thyroid surgery ranges as high as 12.5% for transient injury and up to 3.8% for permanent injury. Bilateral paresis can also occur during reoperations, and is a dangerous complication influencing the quality of life, sometimes requiring tracheostomy. RLN identification is the gold standard during thyroidectomy, and the use of intraoperative neuromonitoring (IONM) can be a valuable adjunct to visual identification. This technique can be used to identify the RLN and the external branch of the superior laryngeal nerve (EBSLN), both of which are standardized procedures. The aim of this review was to evaluate the use of intermittent neural monitoring of the RLN in surgery for recurrent goiter, and to assess the prevalence of RLN injury while using IONM reported in the current literature.

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Section: Review Articlementioning

confidence: 99%

Section: Rln Identification and Mappingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Wojtczak

Barczyński

2016

Gland Surg.

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“…(13,14), bazÖ çalÖ malarda ise tiroidektomi sÖ-rasÖnda sinir monitörü kullanÖmÖnÖn önceki cerrahilere ba lÖ anatominin bozuldu u yüksek riskli hastalarda tavsiye edilse de UVKP geli me riskini azaltmadÖ ÖnÖ göstermi tir (15)(16)(17).…”

Section: Methodsunclassified

Unilateral vokal kord paralizisi: etiyolojik faktörlerin demografik verilerle karşılaştırılması

ÜNLÜ¹,

TÜZÜNER²,

DEMİRCİ³

et al. 2016

Ankara Üniversitesi Tıp Fakültesi Mecmuası

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Amaç:Unilateral vokal kord paraizileri (UVKP) vokal kordlarÖn sinirin etkilenme düzeyine ba lÖ olarak farklÖ pozisyonlarda fikse olmasÖyla karakterizedir. Rekürren laringeal sinir ve vagal sinirin uzun seyri boyunca kar Öla tÖ Ö herhangi bir lezyon vokal kord paralizisine neden olabilir.Bu çalÖ manÖn amacÖ UVKPnin nedenlerini ve hastalarÖn demografik verilerini incelemektir.Yöntemler: 2013-2015 yÖllarÖ arasÖnda klini imize ba vuran 47 UVKP hastasÖnÖ etiyolojik açÖdan incelendi ve ya , cinsiyet ve lezyonun tarafÖna göre de erlendirildi. 40 ya altÖ (15 hasta) ve 40 ya üstü (32 hasta) hastalar iki grup halinde etiyolojik nedene göre kar Öla tÖrÖldÖ.Bulgular: KadÖn ve erkek sayÖlarÖ arasÖnda istatistiksel olarak anlamlÖ bir fark izlenmedi (p=0,307). Sa ve sol taraflÖ lezyonlar arasÖnda istatistiksel olarak anlamlÖ bir fark izlenmedi (p=0,884). Tiroidektomi en sÖk UVKP nedeniydi (%55,3). 40 ya üstünde tiroidektomi en sÖk nedenken (%68,7 p=0,017), bunu maligiteler takip etmekteydi.40 ya altÖnda en sÖk cerrahi olmayan nedenler olarak bulundu (%66,7 p=0,028). Cerrahi olmayan nedenlerin en ba Önda ise idiopatik UVKP yer almaktaydÖ. Tiroidektomi ise 40 ya altÖnda ikinci sÖklÖkta görü-len nedendi. Cinsiyetler arasÖnda etiyolojide bir fark izlenmedi. Sadece idiopatik UVKP hastalarÖnda taraf üstünlü ü mevcuttu ve bu grupta taraf üstünlü ü sol tarafaydÖ.Sonuç: UVKP klinikte glottik yetmezlik yapan en sÖk nedenlerden biri olup etyolojinin belirlenmesi prognoz ve ek hastalÖklarÖn tespiti açÖsÖndan oldukça önemlidir. Özellikle 40 ya üstü vakalarda maligniteler UVKP nin sÖk nedenlerinden biri oldu undan ayrÖntÖlÖ fizik muayene ve görüntüleme yöntemleri ile inceleme yapÖlma-lÖdÖr.Anahtar Sözcükler: Unilateral Vokal Kord Paralizisi, Tirodektomi, Rekürren Laringeal Sinir Objective: Unilateral vocal cord paralysis (UVCP) is characterized with fixation of vocal cords at different positions depending on the level where the nerves is affected. Along the long course of recurrent laryngeal and vagal nerve any lesion may lead to vocal cord paralysis. The aim of this study is to analyse causes of UVCP and demographic findings of the patents. Methods:We reviewed 47 patients with UVCP who applied to our clinic between 2013-2015 etiologically and analysed them according to age, gender and side of the lesion. We compare patients in two groups, under 40 years old (15 patients) and over 40 years old (32 patients) according to their ethiology.Results: There was no statistically significant difference between the numbers of male and female patients (p=0,307). There was no statistically significant difference between right and left sided lesions (p=0,884). Thyroidectomy was the most frequent cause of UVCP (55,3%). While thyroidectomy was the most common cause over the age of 40 (68,7% p=0,017), this was followed by malignancies. We found nonsurgical causes as the most common cause under the age of 40 (66,7% p=0,028). Among them idiopathic UVCP was at the top of the nonsurgical causes. Thyroidectomy was the second common cause under the age of 40. Th...

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“…Although there are studies suggesting that intraoperative nerve monitoring decreased injury rates, many studies comparing IONM and nerve dissection did not reveal any superiority of the methods over each other (11)(12)(13)(14). In 2007, Dralle et al (15) stated that not using IONM was considered as malpractice in several lawsuits.…”

Section: Discussionmentioning

confidence: 99%

Analysis of the Istanbul Forensic Medicine Institute expert decisions on recurrent laryngeal nerve injuries due to thyroidectomy between 2008-2012

Karakaya¹,

Koç

Ekiz

et al. 2016

UCD

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Objective: The aim of this study was to evaluate the approach of Forensic Medicine Institution for recurrent laryngeal nerve injuries. In addition, parameters that were taken into consideration by Forensic Medicine Institution in the differentiation of complication and malpractice were evaluated. Material and Methods:The files of 38 patients, with recurrent laryngeal nerve injury following thyroidectomy, that were referred to Istanbul Forensic Medicine Institute with request of expert opinion between 2008-2012 were retrospectively investigated. Data regarding expert decisions, age, gender, diagnosis, hospital type, preoperative vocal cord examination, intraoperative nerve monitoring (IONM), identification of nerve injury during operation, repair of nerve during operation, and type of injury were assessed.Results: Surgeons were found to be faulty in all files with bilateral nerve injury, however, one-sided injury files were considered as a medical complication. Twenty-one (55.2%) patients were female, and 17 (44.8%) were male, with a mean age of 35,8 in women, and 34,1 in men. None of these patients had undergone preoperative vocal cord assessment. The recurrent laryngeal nerve was intraoperatively identified in 21 (55.2%) patients, while it was not seen in 17 (44.8%) patients. IONM was not applied in any patients. There was no attempt for nerve repair during any operation. Nineteen patients had unilateral, and 19 patients had bilateral nerve damage. Conclusion:Bilateral recurrent laryngeal nerve injuries are considered as malpractice, when imaging or pathology reports fail to state a cause for difficulty in nerve identification.

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Intraoperative Nerve Monitoring Can Reduce Prevalence of Recurrent Laryngeal Nerve Injury in Thyroid Reoperations: Results of a Retrospective Cohort Study

Cited by 153 publications

References 44 publications

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

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

Unilateral vokal kord paralizisi: etiyolojik faktörlerin demografik verilerle karşılaştırılması

Analysis of the Istanbul Forensic Medicine Institute expert decisions on recurrent laryngeal nerve injuries due to thyroidectomy between 2008-2012

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