Loss of the nerve monitoring signal during bilateral thyroid surgery

Dralle, Henning; Sekulla, Carsten; Lorenz, Kerstin; Thanh, Phuong Nguyen; Schneider, Rick; Machens, Andreas

doi:10.1002/bjs.8831

Cited by 133 publications

(130 citation statements)

References 34 publications

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“…En relación con el momento operatorio, las lesiones inadvertidas del nervio laríngeo recurrente se asocian con compresión, tracción, ligadura, lesión por diatermia o sección del nervio, que producen alteraciones que van desde la neuropraxia hasta la neurotmesis 22,24,25 . Dionigi, et al y posteriormente Chiang et al, después de una fase experimental con modelos porcinos sobre la fisiopatología de los diferentes mecanismos de lesión, y de un estudio clínico prospectivo de 3.143 pacientes con monitorización neural intraoperatoria y caracterización de 281 lesiones intraoperatorias del nervio laríngeo recurrente y sus secuelas funcionales, propusieron una clasificación para unificar de manera universal dichas lesiones intraoperatorias (tabla 4) 26 .…”

Section: Etiología Y Clasificación De Las Lesiones Del Nervio Laríngeunclassified

Técnica de Horsley para la reconstrucción del nervio laríngeo

et al. 2018

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Trabajo presentado durante el Congreso Nacional de Cirugía 2017, concurso Simposio Nacional del Residente Quirúrgico ResumenIntroducción. La temida complicación de la tiroidectomía es la parálisis de las cuerdas vocales secundaria a lesiones del nervio laríngeo recurrente. En este estudio se analiza una técnica de reconstrucción para estas lesiones neurales. Objetivo. Describir los resultados funcionales de la reconstrucción inmediata de las lesiones del nervio larín-geo recurrente con la técnica de Horsley. Material y métodos. Se llevó a cabo un estudio prospectivo entre enero del 2000 y diciembre del 2015, en pacientes con sección del nervio laríngeo recurrente y reconstrucción de Horsley, en el cual se evalúan: a) los índices del análisis acústico de voz [tiempo máximo de fonación, perturbación involuntaria de la frecuencia (jitter), perturbación de la amplitud (shimmer) y frecuencia fundamental], b) los hallazgos estroboscópicos, y c) el índice de discapacidad vocal. El análisis estadístico se hizo con la prueba exacta de Fisher y con el programa SPSS™. Resultados. Se practicaron 1.547 tiroidectomías y se produjeron 10 secciones del nervio laríngeo recurrente (0,64 %): dos (0,12 %) inadvertidas (p=0,0001) y 8 (0,51 %) advertidas por infiltración tumoral. En los exámenes de la calidad de voz, se encontraron: frecuencias fundamentales bajas con medias de 104,79 ± 0,29 Hz en hombres (valor de referencia, VR=141,74) y de 208,12 ± 22,72 Hz en mujeres (VR=241,08), que se correlaciona con un jitter de 1,39 ± 0,99 % (VR=1,04); y también, disminución del tiempo máximo de fonación (media=10,9 ± 3,07 s). El índice de percepción de calidad de la voz fue de discapacidad leve de la voz (22,7 ± 11,8

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Section: Etiología Y Clasificación De Las Lesiones Del Nervio Laríngeunclassified

Técnica de Horsley para la reconstrucción del nervio laríngeo

et al. 2018

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“…As a matter of fact, intraoperative stimulation of the VN affords reliable distinction between RLN lesions and technical artefacts. Yet a 2012 survey on usage patterns with nerve monitoring revealed that vagal stimulation was routinely carried out in Germany in 49.3% of patients before and 73.8% of patients after thyroidectomy only (9). Higher rates of routine vagal stimulation before and after resection were associated with an institution's frequent use of RLN monitoring and higher surgical caseload.…”

Section: The Ionm Formula Standard: Room For Improvementmentioning

confidence: 99%

“…Some 53% of general surgeons and up to 65% of otolaryngologists in the United States reportedly used intermittent IONM for some or all thyroid operations (11,12), whereas German surgical departments indicated that more than 92% of their staff surgeons routinely used intermittent IONM during thyroidectomy (9). There are no corresponding data for CIONM, which may have been used in 2015 on almost 10% of all thyroid operations in Germany based on personal information (unpublished data).…”

Section: Challenges Of Implementation and Technological Pitfalls Of Ionmmentioning

confidence: 99%

Opportunities and challenges of intermittent and continuous intraoperative neural monitoring in thyroid surgery

Schneider¹,

Machens²,

Randolph³

et al. 2017

Gland Surg.

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“…In the case of the occurrence of bilateral resection and signal failure on the first operated side, the risk of bilateral paresis should be considered (7). In rare cases, such as benign struma, a partial resection, contralateral at a safe distance from the RLN, can be considered.…”

Section: Surgical Consequences Of Signal Lossmentioning

confidence: 99%

Medico-Legal Issues of Intraoperative Neuromonitoring in Thyroid Surgery

et al. 2017

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Advances in intraoperative neuromonitoring (IONM) in thyroid surgery have provided significant insights into recurrent laryngeal nerve function during thyroid surgery. Despite the limitations and necessary caution when using intraoperative monitors to interpret neural function, these technologies have been definite steps in the right direction for assessing neural integrity and safe surgical strategy during thyroid operations. The techniques discussed minimize the adverse sequelae of a variety of thyroid gland procedures, reducing the morbidity rates/risks in the perioperative period. Furthermore, it is likely that such monitoring will become a standard of care. Accurate, reliable and continuous monitoring is essential, and on-going large studies with definable end points will be necessary. The use of monitoring, such as continuous one, may improve cost efficiency by reducing permanent nerve injuries. A danger in this process, however, is the potential for public opinion, outside regulatory bodies, or medico-legal implications to drive change and enforce standards of care before appropriate data are available. Keywords Conflict of InterestNo potential conflict of interest relevant to this article was reported.procedure codes were evaluated for claimant information, insured's specialty, loss description, causation, and claim outcomes (1). During the 24-year period reviewed, 380 claims related to thyroid surgery were reported. One hundred twenty-eight claims (33.7% of total claims) resulted in an indemnity payment either due to settlement or a finding against the defendant. The average indemnity payment was $185,366 (range, $363 to $2,000,000). Among the cases in which a specific outcome was reported, 55 were related to laryngeal nerve injury or voice disturbance. No substantial change occurred in the incidence of claims across the study period. During this time, approximately $2,585,000 thyroidectomies were performed. Extrapolating from the PIAA data, this represents an estimated 5.9 claims per 10,000 cases (1).Using the LexisNexis Academic legal database, a retrospective review of all relevant federal and state cases from 1989 to 2009 was performed using the search terms "thyroid," "surgery," and "medical malpractice" (2). A total of 143 medical malpractice cases involving thyroid surgery were retrieved from our search from 1989 to 2009. After reviewing all cases, 33 cases in which the alleged negligence occurred after thyroid surgery were used for analysis. Of these cases, 15 involved recurrent laryngeal nerve (RLN) injury. Interestingly, no mention of RLN monitoring was noted in any of the cases (2).For the evaluation of a vocal cord paralysis (VCP) that has occurred after a thyroid surgery using intraoperative neuromonitoring (IONM), it is of crucial importance to take into account whether or not the published standards for proper use of IONM were applied correctly, and whether or not changes of neuromonitoring signal and electromyogram (EMG) were correctly interpreted intraoperatively and accordingl...

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Loss of the nerve monitoring signal during bilateral thyroid surgery

Cited by 133 publications

References 34 publications

Técnica de Horsley para la reconstrucción del nervio laríngeo

Técnica de Horsley para la reconstrucción del nervio laríngeo

Opportunities and challenges of intermittent and continuous intraoperative neural monitoring in thyroid surgery

Medico-Legal Issues of Intraoperative Neuromonitoring in Thyroid Surgery

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