Protective Effects of Intraoperative Nerve Monitoring (IONM) for Recurrent Laryngeal Nerve Injury in Thyroidectomy: Meta-analysis

Bai, Binglong; Chen, Wuzhen

doi:10.1038/s41598-018-26219-5

Cited by 99 publications

(113 citation statements)

References 49 publications

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“…The results of neuro‐monitoring during primary thyroid surgery are mixed. Recent meta‐analyses have shown a reduction in transient rates of RLN injury up to 36% and permanent RLN injury by up to 2.75% . Benefits in reducing EBSLN injury by 9% have also been reported .…”

Section: Discussionmentioning

confidence: 99%

“…Increases in the usage of IONM have been reported worldwide with rates up to 90% in Germany, 80% in the USA, and 50% in the rest of Europe . Whilst direct visualization of the recurrent laryngeal nerve (RLN) remains the gold standard, there is evidence that the routine use of IONM may reduce temporary, bilateral and permanent RLN palsy rates . However, on the other hand, large multicentre studies have shown no impact on RLN injury rates .…”

Section: Introductionmentioning

confidence: 99%

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Intraoperative nerve monitoring in endocrine surgery: prevalence and reasons for its use in Australia and New Zealand

Leong

Ryan

et al. 2019

ANZ Journal of Surgery

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Background: Intraoperative nerve monitoring (IONM) has increasingly been used in thyroid surgery by general, endocrine and head and neck surgeons. The purpose of this paper was to explore the prevalence and reasons for the usage of IONM in endocrine surgery in Australia and New Zealand. Methods: A survey was sent to general surgeons registered with the Royal Australasian College of Surgeons involved in endocrine surgery and members of the Australian and New Zealand Endocrine Surgeons. Users were divided into surgeon type, area of work, hospital type and volume of surgery. These data were analysed with univariate and multivariate logistic regression models. Results: Significant differences in IONM usage levels were observed between endocrine and general surgeons, area of work and volume of surgery performed. Endocrine surgeons are significantly more likely to use IONM than general surgeons. Surgeons who work in tertiary hospitals are more likely to use IONM as compared to those working in district hospitals. Surgeons who perform less than 100 thyroidectomies were more likely to be users of IONM. Conclusion: IONM is not routinely used in thyroid surgery in Australia and New Zealand. The main reasons for the use of IONM given in our study by routine users were to establish familiarity of equipment and medicolegal reasons. Selective users chose as the most common reasons, a documented pre-existing unilateral nerve paresis or a hostile surgical field. Non-users stated that there was conflicting evidence that it improves outcomes and increased costs. © 2019 Royal Australasian College of Surgeons ANZ J Surg 90 (2020) 867-871ANZJSurg.com

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Intraoperative nerve monitoring in endocrine surgery: prevalence and reasons for its use in Australia and New Zealand

Leong

Ryan

et al. 2019

ANZ Journal of Surgery

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“…IONM during thyroid surgery has been used worldwide [23], and a recent meta-analysis reported that IONM could decrease both temporary and permanent VFP rates [24]. However, other studies have reported that IONM during thyroid surgery is controversial because VFP was not significantly reduced [23,[25][26][27][28][29][30].…”

Section: Discussionmentioning

confidence: 99%

Development of a Novel Intraoperative Neuromonitoring System Using an Accelerometer Sensor in Thyroid Surgery: A Porcine Model Study

Sung

Lee

Shin

et al. 2019

Clin Exp Otorhinolaryngol

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Objectives. The sensitivity and positive predictive value of widely used intraoperative neuromonitoring (IONM) using electromyography (EMG) of the vocalis muscle in thyroid surgery are controversial. Thus, we developed a novel IONM system with an accelerometer sensor that uses the piezoelectric effect instead of EMG to detect laryngeal twitching. The objective of this study was to evaluate the feasibility and safety of this novel IONM system during thyroid surgery in a porcine model. Methods.We developed an accelerometer sensor that uses the piezoelectric effect to measure laryngeal twitching in three dimensions. This novel accelerometer sensor was placed in the anterior neck skin (transcutaneous) or postcricoid area. Stimulus thresholds, amplitude, and latency of laryngeal twitching measured using the accelerometer sensor were compared to those measured through EMG of the vocalis muscle.Results. The amplitudes of the accelerometer sensor at the anterior neck and postcricoid area were significantly lower than those of EMG because of differences in the measurement method used to evaluate laryngeal movement. However, no significant differences in stimulus thresholds between the EMG endotracheal tube and transcutaneous or postcricoid accelerometer sensors were observed. Conclusion.Accelerometer sensors located at the anterior neck or postcricoid area were able to identify laryngeal twitching. The stimulus intensity measured with these sensors was equivalent to that from conventional vocalis EMG. Our novel IONM system with an accelerometer sensor that checks changes in surface acceleration can be an alternative to EMG of the vocalis muscle for IONM in the future.

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“…The best known technique to avoid injury to RLN is meticulous dissection of the nerve throughout its anatomic pathway. However, functional impairment of RLN is not visible macroscopically and IONM has been developed to monitor the nerve to avoid unnecessary dissection (9,10). Meticulous hemostasis can be achieved with harmonic sealing instrument, since improper hemostasis is known to increase the risk of RLNI (4).…”

Section: Discussionmentioning

confidence: 99%

Recurrent laryngeal nerve injury (RLNI) in total thyroidectomy with intraoperative nerve monitoring (IONM) and harmonic sealing instrument: A retrospective analysis and treatment results

Yuksekdag¹,

Topcu²,

Deveci³

et al. 2019

Eastern J Med

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The aim of the current study was to reveal the incidence of RLNI in our patients with total thyroidectomy and to evaluate their clinical outcomes. Charts of 260 patients who underwent total thyroidectomy between 2014 and 2018 were interrogated retrospectively. Standard IONM and harmonic seal were used in all. Patients with suspect of RLNI were further evaluated. Demographics, etiologic disease and the overall treatment results were presented. A total of 12 patients with RLNI (4.6 %) were presented. Nine (75 %) were women and 3 (25 %) were men. Mean age was 51 years (range, 32-67). RLNI was unilateral in 8 patients (3 %; 50 % in right RLN and 50 % in left RLN) and bilateral in four (1.5 %). All were started corticosteroid and follow-up period was 26 months (range, 9-52). Mean hospital stay was 4 days (range, 2-14). Histopathological evaluations revealed papillary carcinoma (n=7, 58 %), multinodular goitre with thyroiditis (n=4, 34 %) and multinodular goitre with parathyroid adenoma (n=1, 8 %). In a patient with bilateral RLNI (0.3 %), tracheostomy was done on postoperative day 2, and closed on postoperative month 4. Thyroplasty and suture lateralization were applied to other bilateral RLNI cases. In 5 patients with unilateral RLNI and one with bilateral palsy, vocal cords became normal in first 6 months (transient palsy, 2.3 %). Careful surgical dissection with harmonic and IONM employed in total thyroidectomy are both reliable methods. In case of inevitable RLNI, a close follow-up and cooperation are mandatory to have optimal results.

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Protective Effects of Intraoperative Nerve Monitoring (IONM) for Recurrent Laryngeal Nerve Injury in Thyroidectomy: Meta-analysis

Cited by 99 publications

References 49 publications

Intraoperative nerve monitoring in endocrine surgery: prevalence and reasons for its use in Australia and New Zealand

Intraoperative nerve monitoring in endocrine surgery: prevalence and reasons for its use in Australia and New Zealand

Development of a Novel Intraoperative Neuromonitoring System Using an Accelerometer Sensor in Thyroid Surgery: A Porcine Model Study

Recurrent laryngeal nerve injury (RLNI) in total thyroidectomy with intraoperative nerve monitoring (IONM) and harmonic sealing instrument: A retrospective analysis and treatment results

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