IONM-guided goiter surgery leading to two-stage thyroidectomy—indication and results

Abstract

We have shown a significant difference in the rate of bilateral RLNP when comparing termination and continuation of a bilateral procedure after primary IONM signal loss. We strongly recommend a two-stage thyroidectomy after signal loss on the primary side of resection in benign bilateral goiter surgery.

Does intraoperative nerve monitoring reliably aid in staging of total thyroidectomies?

“…If the procedure is staged at that point, however, the risk does not increase any further . Our findings support the idea that IONM is a reliable tool for avoiding increasing the risk of bilateral nerve injury beyond that caused by injury on the side of initial dissection . Functional dynamic information afforded through neural monitoring allows the surgeon an opportunity to make surgical decisions based on full knowledge of the situation.…”

“…The American Thyroid Association Surgical Affairs Committee consensus statements on outpatient thyroid surgery and management of goiters agrees that neural monitoring helps confirm intact neural function and may play a role in discharge planning . Given IONM's function in prognostication of postoperative neural function, it has been suggested that it may guide decision to stage bilateral thyroid and central neck surgery when loss of RLN signal on initial side of dissection is detected . To date, there are very little published data regarding reliability, safety, and practicality of using IONM feedback to stage the surgical procedure.…”

EMG changes during continuous intraoperative neuromonitoring with sustained recurrent laryngeal nerve traction in a porcine model

“…Bilateral RLN injury, the most dreaded complication, can be avoided by intraoperative neuromonitoring. Neuromonitoring predicts postoperative vocal fold function and allows changing operative strategy to a two-stage thyroidectomy if necessary [6, 7]. Unilateral postoperative vocal fold palsy rates have, however, not been reduced by intermittent intraoperative neuromonitoring (I-IONM) [1, 4, 8].…”

Staged Thyroidectomy: A Single Institution Perspective

“…Thus, in the case of intraoperative LOS on the first‐operated side in a planned total thyroidectomy, the thyroid surgeon essentially has three options for surgery on the contralateral side if RLN function is intact. Figure summarizes the three options Perform staged surgery on the second side.…”