Predictors and consequences of recurrent laryngeal nerve injury during open thyroidectomy: An American College of Surgeons National Surgical Quality Improvement Project database analysis

Mahoney, Reid C.; Vossler, John D.; Murayama, Kenric M.; Woodruff, Stacey

doi:10.1016/j.amjsurg.2020.07.023

Cited by 6 publications

(3 citation statements)

References 21 publications

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“…Furthermore, with the exception of two ( 33 , 36 ), all the other meta-analyses/review incorporate in their comparative evaluation dissimilar surgical approaches (robotic, endoscopic-minimally invasive and conventional thyroid surgery) that involve totally different RLN handling and dissecting techniques during thyroidectomy. Additionally, no information or comments are noticed on the importance of standardization or reporting the type of RLN identification technique in recently published prospectively designed audits ( 52 – 55 ) and in articles about the history of thyroid surgery as well ( 56 ). Undoubtedly, the absence or inadequate reporting of surgical technique in surgical studies is not a recent finding ( 57 ).…”

Section: Discussionmentioning

confidence: 99%

Visualization of the recurrent laryngeal nerve alone versus intraoperative nerve monitoring in primary thyroidectomy: a framework approach to a missing typology

Papagoras¹,

Tzikos²,

Douridas³

et al. 2023

Front. Surg.

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IntroductionSurgical studies evaluating a device or technology in comparison to an established surgical technique should accurately report all the important components of the surgical technique in order to reduce the risk of intervention bias. In the debate of visualization of the recurrent laryngeal nerve alone (VONA) versus intraoperative nerve monitoring (IONM) during thyroidectomy, surgical technique plays a key role in both strategies. Our aim was to investigate whether the surgical technique was considered as a risk of intervention bias by relevant meta-analyses and reviews and if steps of surgical intervention were described in their included studies.MethodsWe searched PUBMED, CENTRAL—Cochrane library, PROSPERO and GOOGLE for reviews and meta-analyses focusing on the comparison of IONM to VONA in primary open thyroidectomy. Τhen, primary studies were extracted from their reference lists. We developed a typology for surgical technique applied in primary studies and a framework approach for the evaluation of this typology by the meta-analyses and reviews.ResultsTwelve meta-analyses, one review (388,252 nerves at risk), and 84 primary studies (128,720 patients) were included. Five meta-analyses considered the absence of typology regarding the surgical technique as a source of intervention bias; 48 primary studies (57.14%) provided information about at least one item of the typology components and only 1 for all of them.DiscussionSurgical technique of thyroidectomy in terms of a typology is underreported in studies and undervalued by meta-analyses comparing VONA to IONM. This missing typology should be reconsidered in the comparative evaluation of these two strategies.

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Section: Discussionmentioning

confidence: 99%

Visualization of the recurrent laryngeal nerve alone versus intraoperative nerve monitoring in primary thyroidectomy: a framework approach to a missing typology

Papagoras¹,

Tzikos²,

Douridas³

et al. 2023

Front. Surg.

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“…The relationship between the vagus nerve, the carotid artery, and the internal jugular vein in the cervical sheath is variable ( 48 , 49 ), so intraoperative attention must be paid to ectopic parathyroid glands and the course of the nerve carefully determined. Intraoperative IONM improves the identification of the vagus nerve and reduces identification time ( 50 , 51 ). In our group of SHPT patients, two patients had two parathyroid glands in the unilateral cervical sheath, and one of the preoperative patients had a parathyroid gland near the vagus nerve, which could be removed without injury to the vagus nerve by using IONM.…”

Section: Discussionmentioning

confidence: 99%

Recurrent laryngeal never monitoring versus non-monitoring in parathyroid surgery

Mu,

Bian,

Yang

et al. 2023

Front. Endocrinol.

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BackgroundAlthough intraoperative neural monitoring (IONM) is well established in thyroid surgery, it is less commonly analyzed in parathyroid operations. This study presents the results of IONM for primary and secondary hyperparathyroidism surgery.MethodsWe retrospectively assessed 270 patients with primary hyperparathyroidism (PHPT), 53 patients with secondary hyperparathyroidism (SHPT), and 300 patients with thyroid cancer from June 2010 to June 2022 in one hospital in China. The follow-up was 12 months. Demographic, electromyography data from IONM, laboratory, and clinical information were collected. Laryngoscopy was collected from 109 patients with PHPT in whom IONM was not used. All groups were assessed by Pearson’s chi-square test and Fisher’s exact probability method to verify the relationship between parathyroid size and location, duration of surgery, preoperative concordant localization, laryngeal pain, IONM outcomes, cure rate, and RLN injury. Visual analog scale (VAS) assessed laryngeal pain. RLN outcomes were measured according to nerves at risk (NAR).ResultsThe study comprehended 918 NAR, that is 272, 105, 109, and 432 NAR for PHPT, SHPT with IONM, PHPT without IONM, and thyroid surgery control group, respectively. IONM successfully prevented RLN injury (P<0.001, P=0.012): Fifteen (5.51%) RLNs experienced altered nerve EMG profiles during surgery, and five (1.84%) experienced transient RLN injury in PHPT patients. Five (4.76%) RLNs were found to have altered EMG profiles during surgery, and one (0.95%) RLN had a transient RLN injury in SHPT patients. There was no permanent nerve injury (0.00%) in this series. There was no association between location, gland size, preoperative concordant localization, cure rate, duration of surgery, and IONM (P >0.05). Duration of surgery was associated with postoperative pharyngeal discomfort (P=0.026, P=0.024). Transient RLN injury was significantly lower in patients with PHPT who underwent IONM than in those who did not. Intraoperative neuromonitoring played an effective role in protecting the recurrent laryngeal nerve (P=0.035). Compared with parathyroidectomy, thyroidectomy had a higher rate of RLN injury (5.32%, P<0.001).ConclusionIONM for SHPT and PHPT offers rapid anatomical gland identification and RLN functional results for effective RLN protection and reduced RLN damage rates.

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“…Fourteen of the 20 included studies in this review reported on recurrent nerve damage, some of which were transient and some permanent, making a general estimation of nerve damage difficult from this material. However, studies investigating nerve damage in thyroid surgeries report that exposure of the recurrent nerve and use of nerve monitoring reduced the rate of recurrent laryngeal nerve injury [ 37 , 38 ]. When introducing day-care surgery, the patients must be well informed of the risks, particularly PTB, and infection and recurrent nerve damage should also be discussed.…”

Section: Discussionmentioning

confidence: 99%

Risk of hematoma after hemithyroidectomy in an outpatient setting: a systematic review and meta-analysis

Jeppesen

Moos

Holm

et al. 2022

Eur Arch Otorhinolaryngol

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Purpose After thyroid surgery, the overriding concern is the risk of post-thyroid bleeding (PTB). This systematic review and meta-analysis aimed to assess the safety of hemithyroidectomy in an outpatient setting compared to an inpatient setting. The objectives were to (1) find the proportion of PTB in patients scheduled for outpatient hemithyroidectomy, (2) examine if outpatient hemithyroidectomy is clinically safe compared to an inpatient setting and (3) evaluate which selection criteria are most relevant for hemithyroidectomy in an outpatient setting. Methods A systematic review was conducted using the following databases: MEDLINE (Ovid), EMBASE (Ovid) and the Cochrane Library from inception until September 2021. We included studies reporting on PTB of patients after hemithyroidectomy in an outpatient setting. The risk of bias was assessed using the Newcastle-Ottawa tool. The results were synthesised using Bayesian meta-analysis. Certainty in evidence was assessed using the GRADE approach. Results This review included 11 cohort studies and 9 descriptive studies reporting solely on outpatients resulting in a total of 46,866 patients. PTB was experienced by 58 of the 9025 outpatients (0.6%) and 415 of the 37,841 inpatients (1.1%). There was no difference between the PTB rate of outpatients and inpatients (RR 0.715 CrI [0.396–1.243]). The certainty of the evidence was very low due to the high risk of bias. Conclusion The risk of PTB in an outpatient setting is very low, and outpatient hemithyroidectomy should be considered clinically safe. The most relevant selection criteria to consider in outpatient hemithyroidectomy are (1) relevant comorbidities and (2) psycho/-social factors.

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Predictors and consequences of recurrent laryngeal nerve injury during open thyroidectomy: An American College of Surgeons National Surgical Quality Improvement Project database analysis

Cited by 6 publications

References 21 publications

Visualization of the recurrent laryngeal nerve alone versus intraoperative nerve monitoring in primary thyroidectomy: a framework approach to a missing typology

Visualization of the recurrent laryngeal nerve alone versus intraoperative nerve monitoring in primary thyroidectomy: a framework approach to a missing typology

Recurrent laryngeal never monitoring versus non-monitoring in parathyroid surgery

Risk of hematoma after hemithyroidectomy in an outpatient setting: a systematic review and meta-analysis

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