Meta‐analysis on continuous nerve monitoring in thyroidectomies

Abstract

In the last decade, the introduction of continuous intraoperative recurrent laryngeal nerve (RLN) monitoring (C-IONM) has enabled the operator to verify the functional integrity of the vagus nerve-recurrent laryngeal nerve (VN-RLN) axis in real-time. We aim to present the current evidence on C-IONM utility for thyroid surgery by conducting the first meta-analysis on this technique. A systematic review of literature was conducted by two independent reviewers via Ovid in the Medline, EMBASE, and Cochrane reviews databases. The search was limited to human subject research in peer-reviewed articles of all languages published between Jan 1946 and April 2020. Medical subject headings (MeSH) terms utilized were thyroid surgery, thyroidectomies, recurrent laryngeal nerve, vagal nerve, monitor, and stimulation. Thirty-eight papers were identified from Ovid, another six papers were identified by hand-search. A random effect meta-analysis was performed with assessment of heterogeneity using the I 2 value. A total of 23 papers that investigated the use of continuous vagal nerve monitoring during thyroid surgery were identified. The proportion of nerves at risk (NAR) with temporary RLN paralysis postoperation was 2.26% (95% CI: 1.6-2.9, I 2 = 37). The proportion of NAR with permanent RLN palsy postoperation was 0.05% (95% CI: 0.08-0.2, I 2 = 0). In this meta-analysis, there is one case of temporary vagal nerve paralysis secondary to VN electrode dislodgement, and a case of hemodynamic instability manifested in bradycardia and hypotension in the initial phase of surgery shortly after calibration. C-IONM is a safe and effective means by which RLN paralyses in thyroid surgery can be reduced.

An improved method of searching inferior parathyroid gland for the patients with papillary thyroid carcinoma based on a retrospective study

“…(4) The number of cases was small, and a large number sample study with multiple centers was recommended. (5) This anatomical connection was used in the search and preservation of IPG during thyroid surgeries performed on or after August 1, 2019. However, grouping based on this date is indeed affected by several confounding factors, which will be further solved through the subsequent prospective study.…”

“…The incidence of permanent hypoparathyroidism was around 1.5%, which would seriously affect the quality of patient's living standards, including numbness of patient's hands and feet, osteoporosis, and other problems (4,5). The difficulty of PG protection was to identify PG promptly, especially for the inferior parathyroid gland (IPG) during surgery.…”

The efficacy and safety of tension-free thyroidectomy in the clinical work of the Endocrine Surgery Department Pavlov State Medical University, pilot study

“…Однако, несмотря на весь технический прогресс, процент специфических осложнений в профильных отделениях по всему миру варьирует незначительно. Так, вероятность пареза ВГН в среднем составляет 9,8% [3,4], паралича -от 0,5% до 2,7% [5,6] в зависимости от использования интраоперационного нейромониторинга и выполнения ларингоскопии в послеоперационном периоде. Частота временного гипопаратиреоза достигает 26-35% [7][8][9], постоянного -от 0,4% до 13,8% [10,11].…”

Intraoperative EMG recovery patterns and outcomes after RLN traction-related amplitude decrease during monitored thyroidectomy

“…Animal and clinical studies of RLN traction injury with the application of continuous IONM (C-IONM) ( 11 – 14 ) revealed an EMG amplitude decrease during RLN traction and progressive recovery after releasing traction stress. C-IONM is reported to be helpful for the early detection of EMG amplitude decreases caused by traction distress ( 15 – 17 ). Stimulating dissecting instrument (SDI) is a novel and real-time I-IONM stimulating method during surgical procedure.…”