Intraoperative nerve monitoring in thyroid surgery: analysis of United Kingdom registry of endocrine and thyroid surgery database

Abdelhamid, Amir; Aspinall, Sebastian

doi:10.1093/bjs/znaa081

Cited by 26 publications

(20 citation statements)

References 19 publications

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“…Shuwen et al, in their systematic review, report a slight benefit from the use of IONM without reaching statistically significant values [ 45 ]. The results reported by the United Kingdom registry of endocrine and thyroid surgery, on the other hand, show a significant reduction in temporary and definitive nerve injuries with the use of IONM [ 46 ]. There are no specific reports on the use of IONM during neck dissection, but we can reasonably assume that its use can be beneficial especially in cases of re-operation.…”

Section: Discussionmentioning

confidence: 99%

Surgical Skills and Technological Advancements to Avoid Complications in Lateral Neck Dissection for Differentiated Thyroid Cancer

Bove

Farrukh

Gioia

et al. 2021

Cancers

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Neck dissection is a surgical procedure reserved for thyroid cancer cases with clinically evident lymphatic invasion. Although neck dissection is a reliable and safe procedure, it can determine a significant morbidity involving a variety of structures of nervous, vascular and endocrine typology. A careful pre-operative study is therefore essential to better plan surgery. Surgical experience, combined with accurate surgical preparation and merged with adequate and specific techniques, can certainly help reduce the percentage of complications. In recent years, however, technology has also proved to be useful. Its crucial role was already recognized in the safeguard of the integrity of the laryngeal nerve through neuro-monitoring, but new technologies are emerging to help the preservation also of the parathyroid glands and other structures, such as the thoracic duct. These surgical skills combined with the latest technological advancements, that allow us to reduce the incidence of complications after neck dissection for thyroid cancer, will be reported in the present article. This topic is of significant interest for the endocrine and metabolic surgeons’ community.

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Section: Discussionmentioning

confidence: 99%

Surgical Skills and Technological Advancements to Avoid Complications in Lateral Neck Dissection for Differentiated Thyroid Cancer

Bove

Farrukh

Gioia

et al. 2021

Cancers

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“…Use of IONM in thyroid surgery has become well established in the past two decades, and surgical applications of IONM are increasingly accepted throughout the world. Recent registrybased studies performed in Sweden (SQRTPA) (33), Europe (EUROCRINE ® ) (34), United Kingdom (UKRETS) (35), and other regions (36) provide insight into current IONM practices. Most studies agree that a large and growing majority of thyroid surgeons currently use IONM for anatomical identification of the RLN and for evaluating RLN injury.…”

Section: Discussionmentioning

confidence: 99%

New Developments in Anterior Laryngeal Recording Technique During Neuromonitored Thyroid and Parathyroid Surgery

Liu

Huang

et al. 2021

Front. Endocrinol.

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A recurrent laryngeal nerve (RLN) injury resulting in vocal fold paralysis and dysphonia remains a major source of morbidity after thyroid and parathyroid surgeries. Intraoperative neural monitoring (IONM) is increasingly accepted as an adjunct to the standard practice of visual RLN identification. Endotracheal tube (ET) surface recording electrode systems are now widely used for IONM; however, the major limitation of the clinical use of ET-based surface electrodes is the need to maintain constant contact between the electrodes and vocal folds during surgery to obtain a high-quality recording. An ET that is malpositioned during intubation or displaced during surgical manipulation can cause a false decrease or loss of electromyography (EMG) signal. Since it may be difficult to distinguish from an EMG change caused by a true RLN injury, a false loss or decrease in EMG signal may contribute to inappropriate surgical decision making. Therefore, researchers have investigated alternative electrode systems that circumvent common causes of poor accuracy in ET-based neuromonitoring. Recent experimental and clinical studies have confirmed the hypothesis that needle or adhesive surface recording electrodes attached to the thyroid cartilage (transcartilage and percutaneous recording) or attached to the overlying neck skin (transcutaneous recording) can provide functionality similar to that of ET-based electrodes, and these recording methods enable access to the EMG response of the vocalis muscle that originates from the inner surface of the thyroid cartilage. Studies also indicate that, during surgical manipulation of the trachea, transcartilage, percutaneous, and transcutaneous anterior laryngeal (AL) recording electrodes could be more stable than ET-based surface electrodes and could be equally accurate in depicting RLN stress during IONM. These findings show that these AL electrodes have potential applications in future designs of recording electrodes and support the use of IONM as a high-quality quantitative tool in thyroid and parathyroid surgery. This article reviews the major recent developments of newly emerging transcartilage, percutaneous, and transcutaneous AL recording techniques used in IONM and evaluates their contribution to improved voice outcomes in modern thyroid surgery.

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“…One major change in the past decade is the widespread use of IONM to identify the RLN, adjunct to the standard practice of visual identification. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 With the application of IONM, the surgeon can qualify and quantify the real‐time functional status of the RLN based on the evoked laryngeal EMG response via electrical RLN or vagus nerve stimulation. At times, there may be a partial or total loss of nerve conduction to stimulation indicating RLN stress or injury; the surgeon can also evaluate the surgical maneuver that produced the impending or actual RLN injury.…”

Section: Discussionmentioning

confidence: 99%

“…Recurrent laryngeal nerve (RLN) and external branch of the superior laryngeal nerve (EBSLN) dysfunctions remain significant sources of morbidity after thyroid surgery. Intraoperative neuromonitoring (IONM) of the RLN and EBSLN is a useful adjunct technique in thyroid surgery and has gained widespread acceptance in the international community 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 Electromyographic (EMG) endotracheal tube (ET) surface recording electrode systems are now used worldwide for IONM‐assisted thyroidectomy. Accurately positioning the EMG ET is a key step in successful IONM.…”

Section: Introductionmentioning

confidence: 99%

Optimization of electromyographic endotracheal tube electrode position by UEScope for monitored thyroidectomy

Huang

Hsu

et al. 2021

Laryngoscope Investig Oto

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Objective: Proper position of an electromyographic (EMG) endotracheal tube within the larynx plays a key role in functional electrophysiologic intraoperative neural monitoring (IONM) in thyroid surgery. The purpose of this study was to determine the feasibility of a portable video-assisted intubation device (UEScope) to verify the optimal placement of an EMG tube.Methods: A retrospective study enrolled 40 consecutive patients who underwent monitored thyroidectomies. After positioning the patient for surgery, an anesthesiologist performed tracheal intubation with UEScope and checked the position of the tube at the proper depth without rotation to the vocal cords. The main outcome measured was the proper EMG tube position, free from further adjustment. The secondary outcomes assessed were the percentage of available initial vagal stimulation (V1) signals.Results: All tracheal intubations were successful at first attempt. Proper EMG tube placement without position adjustment was found in 97.5% of the patients. Tube withdrawal was required in a male patient. All patients obtained detectable V1 signals; the lowest and median V1 amplitude was 485 and 767 μV as a reference value, respectively. Conclusion:The UEScope is a valuable and reliable tool for placing an EMG tube and confirming its position during monitored thyroidectomy. In addition, further tube adjustment might be waived in most cases when the anesthesiologist placed the I-Cheng Lu and Che-Wei Wu contributed equally to this work.

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Intraoperative nerve monitoring in thyroid surgery: analysis of United Kingdom registry of endocrine and thyroid surgery database

Cited by 26 publications

References 19 publications

Surgical Skills and Technological Advancements to Avoid Complications in Lateral Neck Dissection for Differentiated Thyroid Cancer

Surgical Skills and Technological Advancements to Avoid Complications in Lateral Neck Dissection for Differentiated Thyroid Cancer

New Developments in Anterior Laryngeal Recording Technique During Neuromonitored Thyroid and Parathyroid Surgery

Optimization of electromyographic endotracheal tube electrode position by UEScope for monitored thyroidectomy

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