Intraoperative neuromonitoring in thyroid surgery: a point prevalence survey on utilization, management, and documentation in Italy

Abstract

The frequency of neuromonitoring during thyroid surgery is underreported in Italy. The present survey depicts and describes the patterns of use, management, documentation for IONM devices of IONM during thyroid surgery by surgeons in Italy. A point prevalence survey was undertaken. Source data were mixed from Italian surgeons attending the 2014 International Neuromonitoring Study Group (INMSG) meeting, four IONM manufacturers available in Italy and surgical units were identified from Company sales data. Qualitative and quantitative data were used to analyze. Questions probed IONM prevalence, surgeon background, hospital geographic practice locations, type of hospital, rationale for IONM use, sources of initial capital investment for IONM acquisition, type of equipment, use of continuous IONM, monitoring management, use of distinctive standards, and IONM documentation. IONM is currently delivered through 48 units in Italy. In 2013, the distribution of IONM by specialties included: general (50 %), ENT (46 %), and thoracic surgery (4 %). Overall, 12.853 IONM procedures were performed in the period from 2006 to 2013: 253 were performed in 2007 and about 5,100 in 2013. Distribution according to the type of hospital is: public 48 %, academic setting 37 %, and private maintenance 15 %. The use category of high volume thyroid hospitals represented 33 %. Initial capital investment for the acquisition of the monitoring equipment was 67 % public and 33 % with charitable/private funding. Audio plus graphic and EMG electrodes surface endotracheal tube-based monitoring systems accounted for the majority. Continuous IONM was introduced in 5 Academic Centers. Overall motivations expressed are legal (30 %), RLN confirmation (20 %), RLN identification (20 %), prognosis (10 %), helpful in difficult cases (10 %), decrease surgical time (5 %), and educational (5 %). The survey revealed that participants had few experience with the standardized approach of IONM technique (28 %). General IONM information to patients and/or subsequent specific IONM informed consent was initiated in 8 % of centers. EMG determinations were included in medical chart in 20 %. There were no significant associations found between all parameters considered. The present study describes an increased utilization of IONM in Italy. We highlighted areas for improvement in the management and documentation of IONM.

International survey on the identification and neural monitoring of the EBSLN during thyroidectomy

“…Dionigi et al recently published outcomes of a point prevalence survey on utilization, management, and documentation of intraoperative neuromonitoring in thyroid surgery in Italy . Source data were mixed from Italian surgeons attending the Annual Meeting of the INMSG in 2014, four IONM manufacturers available in Italy, and surgical units identified from company sales data.…”

“…The survey revealed that participants had limited experience with the standardized approach for IONM (28%). General IONM information to patients and/or subsequent specific IONM informed consent was initiated in 8% of centers …”

Increased prevalence of neural monitoring during thyroidectomy: Global surgical survey

“…Intraoperative neural monitoring (IONM) for thyroid and parathyroid surgery is one of several important technological advancements incorporated into head and neck surgery . IONM has become increasingly prevalent, with many surgeons using it routinely . Although IONM has become more widespread, universal incorporation and attitudes toward its utility in preventing recurrent laryngeal nerve (RLN) dysfunction have remained heterogeneous …”

Impact of positional changes in neural monitoring endotracheal tube on amplitude and latency of electromyographic response in monitored thyroid surgery: Results from the Porcine Experiment

“…This allows evoked surface electromyography (EMG) monitoring of the left and right thyroarytenoid muscles during stimulation of recurrent laryngeal nerve (RLN) and vagus nerve (VN) . Endotracheal tube‐based surface recording electrodes systems are now commonly applied because of their availability and significant advantages over needle electrodes inserted into thyroarytenoid muscle (noninvasive nature, safety, ease of setup, and use) . Novel EMG tubes have been developed to achieve optimal RLN and external branch of the superior laryngeal nerve monitoring …”