Prospective study on loss of signal on the first side during neuromonitoring of the recurrent laryngeal nerve in total thyroidectomy

Sitges‐Serra, Antonio; Fontané, J; Dueñas, Juan Pablo; Duque, Carlos S.; Lorente, Leyre; Trillo, Lourdes; Sancho, José Luis Valero

doi:10.1002/bjs.9044

Cited by 72 publications

(72 citation statements)

References 17 publications

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“…In general, contralateral thyroid surgery was avoided in patients with benign thyroid disease and the only functioning RLN (permanent palsy), but it was undertaken in selected patients with contralateral loco-regional recurrence of thyroid cancer. The concept of staged thyroidectomy was proven to be effective in preventing bilateral RLN injury [28, 29], which is particularly important in bilateral thyroid reoperations and has been accepted by many [18, 30], but not all, thyroid surgeons [31]. The opponents of staged thyroidectomy indicate that PPV of IONM is relatively low (varying from 50 to 75 % in the majority of reported series), which can result in unnecessary staging of operation in 25–50 % of patients who experience loss of signal on the first side, but have no ipsilateral RLN paresis [31].…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Nerve Monitoring Can Reduce Prevalence of Recurrent Laryngeal Nerve Injury in Thyroid Reoperations: Results of a Retrospective Cohort Study

Barczyński

Konturek

Pragacz³

et al. 2013

World j. surg.

152

141

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BackgroundThe prevalence of recurrent laryngeal nerve (RLN) injury is higher in repeat than in primary thyroid operations. The use of intraoperative nerve monitoring (IONM) as an aid in dissection of the scar tissue is believed to minimize the risk of nerve injury. The aim of this study was to examine whether the use of IONM in thyroid reoperations can reduce the prevalence of RLN injury.MethodsThis was a retrospective cohort study of patients who underwent thyroid reoperations with IONM versus with RLN visualization, but without IONM. The database of thyroid surgery was searched for eligible patients (treated in the years 1993–2012). The primary outcomes were transient and permanent RLN injury. Laryngoscopy was used to evaluate and follow RLN injury.ResultsThe study group comprised 854 patients (139 men, 715 women) operated for recurrent goiter (n = 576), recurrent hyperthyroidism (n = 36), completion thyroidectomy for cancer (n = 194) or recurrent thyroid cancer (n = 48), including 472 bilateral and 382 unilateral reoperations; 1,326 nerves at risk (NAR). A group of 306 patients (500 NAR) underwent reoperations with IONM and 548 patients (826 NAR) had reoperations with RLN visualization, but without IONM. Transient and permanent RLN injuries were found respectively in 13 (2.6 %) and seven (1.4 %) nerves with IONM versus 52 (6.3 %) and 20 (2.4 %) nerves without IONM (p = 0.003 and p = 0.202, respectively).ConclusionsIONM decreased the incidence of transient RLN paresis in repeat thyroid operations compared with nerve visualization alone. The prevalence of permanent RLN injury tended to be lower in thyroid reoperations with IONM, but statistical validation of the observed differences requires a sample size of 920 NAR per arm.

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Section: Discussionmentioning

confidence: 99%

Intraoperative Nerve Monitoring Can Reduce Prevalence of Recurrent Laryngeal Nerve Injury in Thyroid Reoperations: Results of a Retrospective Cohort Study

Barczyński

Konturek

Pragacz³

et al. 2013

World j. surg.

152

141

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“…However, despite a sensitivity >90 % [43], the specificity varies widely (30-80 %) [43][44][45] and the rate of false positives is high. Selective use of IONM has been proposed for high-risk patients (reinterventions, malignancy, and substernal goiter) based on improvements in postoperative outcomes [39], but this result has not been confirmed in other reports [39].…”

Section: Surgical Treatmentmentioning

confidence: 99%

Diagnostic, therapeutic and health-care management protocol in thyroid surgery: a position statement of the Italian Association of Endocrine Surgery Units (U.E.C. CLUB)

Rosato

Crea

Bellantone

et al. 2016

J Endocrinol Invest

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members, via e-mail, in the elaboration phase; all the participants of the XI National Congress of the U.E.C. CLUB held in Naples in the final phase. The following were examined: diagnostic pathway and clinical evaluation; mode of admission and waiting time; therapeutic pathway (patient preparation for surgery, surgical treatment, postoperative management, management of major complications); hospital discharge and patient information; outpatient care and follow-up. Results A clear and concise style was adopted to illustrate the reasons and scientific rationales behind behaviors and to provide health-care professionals with a guide as complete AbstractPurpose The diagnostic, therapeutic and health-care management protocol (Protocollo Gestionale DiagnosticoTerapeutico-Assistenziale, PDTA) by the Association of the Italian Endocrine Surgery Units (U.E.C. CLUB) aims to help treat the patient in a topical, rational way that can be shared by health-care professionals. Methods This fourth consensus conference involved: a selected group of experts in the preliminary phase; all Electronic supplementary material The online version of this article

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“…The feeling of "wasting time" when performing IONM techniques is still a concern for a number of surgeons, as well as the technological, generational hurdle, the personal pride, the lack of audit, absent postoperative laryngeal examination, to still sustain that RLN palsy does not exist in their practice (7,8).…”

Section: The Surgeon and Ionmmentioning

confidence: 99%

The Consistency of Intraoperative Neural Monitoring in Thyroid Surgery

et al. 2018

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Numerous operating tools and technology transfers are available for thyroid surgery teams performing open, endoscopic and robotic procedures but none, or very few, of them constitutes a mandatory prerequisite. Over the past decade, the choice of intraoperative neurophysiological monitoring (IONM) of the recurrent laryngeal nerve (RLN), has been reached certain consensus, which must at least be selected on an individual basis. Identification and intraoperative assessment of the RLN seems to be more effectively performed with IONM than solely visually or endoscopically. Today, IONM has evolved sufficiently to increase the likelihood of successful functional outcomes in many patients. The transition from the concept of intermitted neural monitoring of the RLN to that of continuous functions evaluation that must be appreciate requires highly skilled knowledge of IONM. This goal will be more likely achieved in centers highly specialized in thyroid surgery.

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Prospective study on loss of signal on the first side during neuromonitoring of the recurrent laryngeal nerve in total thyroidectomy

Abstract: After loss of signal of the recurrent laryngeal nerve dissected initially, there was a 90 per cent chance of intraoperative signal recovery. In this setting, judicious bilateral thyroidectomy can be performed without risk of bilateral recurrent nerve paresis.

Cited by 72 publications

References 17 publications

Intraoperative Nerve Monitoring Can Reduce Prevalence of Recurrent Laryngeal Nerve Injury in Thyroid Reoperations: Results of a Retrospective Cohort Study

Intraoperative Nerve Monitoring Can Reduce Prevalence of Recurrent Laryngeal Nerve Injury in Thyroid Reoperations: Results of a Retrospective Cohort Study

Diagnostic, therapeutic and health-care management protocol in thyroid surgery: a position statement of the Italian Association of Endocrine Surgery Units (U.E.C. CLUB)

The Consistency of Intraoperative Neural Monitoring in Thyroid Surgery

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