Intraoperative neuromonitoring versus visual nerve identification for prevention of recurrent laryngeal nerve injury in adults undergoing thyroid surgery

Cirocchi, Roberto; D’Andrea, Vito; Arezzo, Alberto; Abraha, Iosief; Passera, Roberto; Avenia, Nicola; Randolph, Justus; Barczyński, Marcin

doi:10.1002/14651858.cd012483

Cited by 61 publications

(53 citation statements)

References 40 publications

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“…On the other hand, a large meta‐analysis with 64 699 nerves at risk showed no benefit . In addition, a recent Cochrane review showed no significant benefit …”

Section: Discussionmentioning

confidence: 96%

“…By contrast, other experts have suggested that the routine use of IONM is not supported by the literature . There have been no randomized control trials demonstrating any benefit in the reduction of RLN injury . Indeed, false‐positive signal loss may result in inappropriate abandonment of procedures and subsequent increased costs to the community.…”

Section: Introductionmentioning

confidence: 99%

“…Whilst direct visualization of the recurrent laryngeal nerve (RLN) remains the gold standard, there is evidence that the routine use of IONM may reduce temporary, bilateral and permanent RLN palsy rates . However, on the other hand, large multicentre studies have shown no impact on RLN injury rates . Experts have suggested that there is considerable value in employing IONM routinely for all thyroid surgery .…”

Section: Introductionmentioning

confidence: 99%

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Intraoperative nerve monitoring in endocrine surgery: prevalence and reasons for its use in Australia and New Zealand

Leong

Ryan

et al. 2019

ANZ Journal of Surgery

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Background: Intraoperative nerve monitoring (IONM) has increasingly been used in thyroid surgery by general, endocrine and head and neck surgeons. The purpose of this paper was to explore the prevalence and reasons for the usage of IONM in endocrine surgery in Australia and New Zealand. Methods: A survey was sent to general surgeons registered with the Royal Australasian College of Surgeons involved in endocrine surgery and members of the Australian and New Zealand Endocrine Surgeons. Users were divided into surgeon type, area of work, hospital type and volume of surgery. These data were analysed with univariate and multivariate logistic regression models. Results: Significant differences in IONM usage levels were observed between endocrine and general surgeons, area of work and volume of surgery performed. Endocrine surgeons are significantly more likely to use IONM than general surgeons. Surgeons who work in tertiary hospitals are more likely to use IONM as compared to those working in district hospitals. Surgeons who perform less than 100 thyroidectomies were more likely to be users of IONM. Conclusion: IONM is not routinely used in thyroid surgery in Australia and New Zealand. The main reasons for the use of IONM given in our study by routine users were to establish familiarity of equipment and medicolegal reasons. Selective users chose as the most common reasons, a documented pre-existing unilateral nerve paresis or a hostile surgical field. Non-users stated that there was conflicting evidence that it improves outcomes and increased costs. © 2019 Royal Australasian College of Surgeons ANZ J Surg 90 (2020) 867-871ANZJSurg.com

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“…On the other hand, a large meta‐analysis with 64 699 nerves at risk showed no benefit . In addition, a recent Cochrane review showed no significant benefit …”

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intraoperative nerve monitoring in endocrine surgery: prevalence and reasons for its use in Australia and New Zealand

Leong

Ryan

et al. 2019

ANZ Journal of Surgery

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“…However, there is no evidence that the use of I-IONM reduces the incidence of RLN injury during thyroid surgery. One possible explanation for this is that I-IONM does not provide real-time feedback about RLN or VN function during surgical maneuvers [10]. On the other hand, C-IONM is an ideal modality to monitor the intactness of the RLN and the VN because it offers real-time feedback to surgeons.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of Attachable Ring Stimulator for Intraoperative Neuromonitoring during Thyroid Surgery

Kim

Moon

Chai

et al. 2020

International Journal of Endocrinology

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Objective. Stimulator-attached dissecting instruments are useful for intraoperative nerve monitoring during thyroidectomy. The aim of this study was to evaluate the feasibility of an attachable ring stimulator (ARS) by comparing the electromyography (EMG) amplitudes evoked by an ARS and a conventional stimulator. Methods. Medical records of fourteen patients who underwent thyroidectomy using intraoperative neuromonitoring between June and August 2019 were retrospectively reviewed. The amplitudes of V1, R1, R2, and V2 signals were checked using both the ARS and a conventional stimulator, at the same point. Results. Both stimulators were tested on 20 recurrent laryngeal nerves (RLNs) and 20 vagus nerves (VNs). In all the nerves, the amplitudes of V1, R1, R2, and V2 were greater than 500 μV. The mean amplitudes of V1, R1, R2, and V2 checked with the ARS were 1175, 1432, 1598, and 1279 μV, respectively. The mean amplitudes of V1, R1, R2, and V2 checked with the conventional stimulator were 1140, 1425, 1557, and 1217 μV, respectively. Difference between amplitudes evoked by the two stimulators for V1, R1, R2, and V2 was 77, 110, 102, and 99 μV, respectively. There was no statistical difference in the amplitudes between the two groups for V1, R1, R2, and V2. Conclusion. The ARS transferred electric stimulation as effectively as the conventional stimulator. It is an effective tool for repeated stimulation and facilitates continuous feedback regarding the functional integrity of nerves during thyroid surgery.

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“…It is our group's opinion that, from a scientific point of view, we should go past the mantra that neuromonitoring prevents either unilateral or bilateral palsy and focus on its many other potential advantages.…”

mentioning

confidence: 99%

Author response to: Comment on: Contralateral surgery in patients scheduled for total thyroidectomy with initial loss or absence of signal during neural monitoring

Sitges‐Serra

2019

British Journal of Surgery

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Intraoperative neuromonitoring versus visual nerve identification for prevention of recurrent laryngeal nerve injury in adults undergoing thyroid surgery

Abstract: This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:\ud To assess the effects of intraoperative neuromonitoring (IONM) versus visual nerve identification for prevention of recurrent laryngeal\ud nerve injury in adults undergoing thyroid surgery

Cited by 61 publications

References 40 publications

Intraoperative nerve monitoring in endocrine surgery: prevalence and reasons for its use in Australia and New Zealand

Intraoperative nerve monitoring in endocrine surgery: prevalence and reasons for its use in Australia and New Zealand

Feasibility of Attachable Ring Stimulator for Intraoperative Neuromonitoring during Thyroid Surgery

Author response to: Comment on: Contralateral surgery in patients scheduled for total thyroidectomy with initial loss or absence of signal during neural monitoring

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