Neuromonitoring and video-assisted thyroidectomy: a prospective, randomized case-control evaluation

Dionigi, Gianlorenzo; Boni, Luigi; Rovera, Francesca; Bacuzzi, Alessandro; Dionigi, Renzo

doi:10.1007/s00464-008-0098-3

Cited by 112 publications

(97 citation statements)

References 36 publications

(42 reference statements)

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“…However, the visual identification rate of EBSLN increased to 68.3% with the aid of IONM, which is close to the rates reported in the studies that included the routine division of strap muscles during superior pole dissection. In this study, the functional identification rate of EBSLN with IONM was noted to be 93.5%, which is threefold of the visual identification rate and in accordance with the rate of 83%-100% reported in other studies (2,8,10,11,15,23). We demonstrated that IONM provided a meaningful contribution to visual (p<0.001) and functional (p<0.001) identification of EBSLN.…”

Section: Discussionsupporting

confidence: 90%

“…Similarly, 25.2% of all the EBSLNs were identified with IONM, but all of them were not able to be visualized in the present study. In the present study, the visual identification rate of EBSLNs before being stimulated with a probe was only 27.9%, which was lower than the rate of 33%-93% reported in other studies (2,10,11,17,20). In our opinion, the reason for this low rate is that we did not divide the strap muscles to expose the sternothyroid-laryngeal triangle, except only in the patients with enlarged thyroid lobes and a short neck.…”

Section: Discussioncontrasting

confidence: 87%

“…Routine identification of EBSLN was thought to be almost impossible and harmful to the nerve previously. However, IONM has recently been reported to be helpful and less invasive for identifying EBSLN (8)(9)(10)(11). As these findings increased the surgical interest in using neuromonitoring for the identification of EBSLN, the rate of neuromonitoring use has increased over time.…”

Section: Introductionmentioning

confidence: 99%

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Contribution of intraoperative neuromonitoring to the identification of the external branch of superior laryngeal nerve

2017

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Objective:We evaluated the contribution of intraoperative neuromonitoring to the visual and functional identification of the external branch of the superior laryngeal nerve. Material and Methods:The prospectively collected data of patients who underwent thyroid surgery with intraoperative neuromonitoring for external branch of the superior laryngeal nerve exploration were assessed retrospectively. The surface endotracheal tube-based Medtronic NIM3 intraoperative neuromonitoring device was used. The external branch of the superior laryngeal nerve function was evaluated by the cricothyroid muscle twitch. In addition, contribution of external branch of the superior laryngeal nerve to the vocal cord adduction was evaluated using electromyographic records. Results:The study included data of 126 (female, 103; male, 23) patients undergoing thyroid surgery, with a mean age of 46.2±12.2 years (range, 18-75 years), and 215 neck sides were assessed. Two hundred and one (93.5%) of 215 external branch of the superior laryngeal nerves were identified, of which 60 (27.9%) were identified visually before being stimulated with a monopolar stimulator probe. Eighty-nine (41.4%) external branch of the superior laryngeal nerves were identified visually after being identified with a probe. Although 52 (24.1%) external branch of the superior laryngeal nerves were identified with a probe, they were not visualized. Intraoperative neuromonitoring provided a significant contribution to visual (p<0.001) and functional (p<0.001) identification of external branch of the superior laryngeal nerves. Additionally, positive electromyographic responses were recorded from 160 external branch of the superior laryngeal nerves (74.4%). Conclusion:Intraoperative neuromonitoring provides an important contribution to visual and functional identification of external branch of the superior laryngeal nerves. We believe that it can not be predicted whether the external branch of the superior laryngeal nerve is at risk or not and the nerve is often invisible; thus, intraoperative neuromonitoring may routinely be used in superior pole dissection. Glottic electromyography response obtained via external branch of the superior laryngeal nerve stimulation provides quantifiable information in addition to the simple visualization of the cricothyroid muscle twitch.

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Section: Discussionsupporting

confidence: 90%

Section: Discussioncontrasting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

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Contribution of intraoperative neuromonitoring to the identification of the external branch of superior laryngeal nerve

2017

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“…Some authors have shown that neuromonitoring can decrease operative time. Nonetheless, the decrease in operative time is around seven minutes, and we believe that this small change does not affect the final conclusions (21). Additionally, we only included direct costs and payer perspective in the analysis.…”

Section: Discussionmentioning

confidence: 99%

Análisis económico de la neuromonitoría rutinaria del nervio laríngeo recurrente en tiroidectomía total

Sanábria

Ramírez

2015

biomedica

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Introduction: Thyroidectomy is a common surgery. Routine searching of the recurrent laryngeal nerve is the most important strategy to avoid palsy. Neuromonitoring has been recommended to decrease recurrent laryngeal nerve palsy. Objective: To assess if neuromonitoring of recurrent laryngeal nerve during thyroidectomy is costeffective in a developing country. Materials and methods:We designed a decision analysis to assess the cost-effectiveness of recurrent laryngeal nerve neuromonitoring. For probabilities, we used data from a meta-analysis. Utility was measured using preference values. We considered direct costs. We conducted a deterministic and a probabilistic analysis. Results: We did not find differences in utility between arms. The frequency of recurrent laryngeal nerve injury was 1% in the neuromonitor group and 1.6% for the standard group. Thyroidectomy without monitoring was the less expensive alternative. The incremental cost-effectiveness ratio was COP$ 9,112,065. Conclusion: Routine neuromonitoring in total thyroidectomy with low risk of recurrent laryngeal nerve injury is neither cost-useful nor cost-effective in the Colombian health system.

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“…It is felt that different surgical techniques with different degrees of exposure of the sternothyroid-laryngeal triangle, such as the division of the sternothyroid muscle in Pagedar's series (34), could account for such discrepancy among identification rates (20,24). On the opposite pole of surgical bed exposure, the reports on robotic (72), video-assisted (36), and mini-incision local anesthesia thyroidectomies (37,38) defend that nerve monitoring is feasible and useful in providing, at least, electrophysiological identification of the EBSLN when the field is limited.…”

Section: Intraoperative Ebsln Identification and The Role Of Ionmmentioning

confidence: 99%

Injury of the external branch of the superior laryngeal nerve in thyroid surgery

Potenza¹,

Filho²,

Cernea³

2017

Gland Surg.

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Neuromonitoring and video-assisted thyroidectomy: a prospective, randomized case-control evaluation

Cited by 112 publications

References 36 publications

Contribution of intraoperative neuromonitoring to the identification of the external branch of superior laryngeal nerve

Contribution of intraoperative neuromonitoring to the identification of the external branch of superior laryngeal nerve

Análisis económico de la neuromonitoría rutinaria del nervio laríngeo recurrente en tiroidectomía total

Injury of the external branch of the superior laryngeal nerve in thyroid surgery

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