Role of intraoperative neuromonitoring of the recurrent laryngeal nerves during thyroid reoperations of recurrent goiter

Sopiński, Jan; Kuzdak, Krzysztof; Hedayati, Masoud; Kołomecki, Krzysztof

doi:10.5604/01.3001.0010.1021

Cited by 7 publications

(12 citation statements)

References 12 publications

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“…In the literature, many studies have investigated RLN identification, dissection, and exposition in thyroid reoperations. In redo surgery, anatomy, anatomical changes, monitoring, morbidity, complication rate, and IONM have been studied regarding only the RLN [61011122930]. Contrary to identification of the EBSLN in primary cases, we could not find any publication about visual and functional identification and electrophysiological monitoring of the EBSLN in redo thyroid surgery.…”

Section: Discussionmentioning

confidence: 97%

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Visual and electrophysiological identification of the external branch of superior laryngeal nerve in redo thyroid surgery compared with primary thyroid surgery

et al. 2019

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Purpose Thyroid reoperations are surgically challenging because of significant anatomical variance. Visual and functional identification of the external branch of the superior laryngeal nerve (EBSLN) were studied in 2 groups of patients who underwent primary and redo thyroid surgery. Methods This study was conducted on 200 patients: 100 patients with redo and 100 patients with primary thyroid surgery. In addition to visual identification, nerve branches were functionally identified by intraoperative nerve monitoring (IONM). Visual, functional, and total identification rates of the EBSLN in both primary and redo surgery were determined and compared between the 2 groups. Results We attempted to identify 138 and 170 EBSLNs at risk in redo and primary surgery, respectively. Visual identification rates were 65.3% and 30.4% (P < 0.001) in primary and redo surgery groups, respectively. In total, 164 (96.5%) and 97 EBSLNs (70.3%) were identified in primary and redo surgery, respectively (P < 0.001), including the use of IONM. In primary surgery group, 53 nonvisualized EBSLNs of 164 identified nerves (32.3%) were determined by IONM alone. In redo surgery group, 55 of 97 identified nerves (56.7%) were determined by IONM alone (P < 0.001). Conclusion Both visual and total identification rates of the EBSLN are significantly decreased in reoperative thyroidectomy. IONM increases the total identification rate of the EBSLN in primary and redo thyroid surgery. Electrophysiological monitoring makes a substantial contribution to the identification of the EBSLN both in primary and especially in redo thyroid surgery.

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Section: Discussionmentioning

confidence: 97%

“…However, nerve visualization is not easy while dissecting scar tissue during thyroid reoperations. Therefore, the risk of injury to both superior and inferior laryngeal nerves is a major concern of redo surgery [1011].…”

Section: Introductionmentioning

confidence: 99%

Visual and electrophysiological identification of the external branch of superior laryngeal nerve in redo thyroid surgery compared with primary thyroid surgery

et al. 2019

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“…Therefore, the risk of RLN injury is the major concern of reoperative thyroid surgery. Such procedures are technically difficult and involve a higher risk of complications than do primary procedures [ 2 , 3 ]. Thyroid reoperations can be challenging, even for a highly experienced thyroid surgeon, as visual identification of the RLN is more difficult during dissection of scar tissue than in the virgin neck [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Displacement of the Recurrent Laryngeal Nerve in Patients with Recurrent Goiter Undergoing Redo Thyroid Surgery

Gürleyik

Cetin

Doğan

et al. 2018

Journal of Thyroid Research

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Thyroid reoperations are surgically challenging because of scarring and disturbances in the anatomy of the recurrent laryngeal nerve (RLN). This study was conducted on 49 patients who underwent redo surgery. 61 RLNs were identified and completely exposed. Their functional integrity was evaluated using intraoperative nerve monitoring (IONM). Indications for secondary surgery, anatomical changes secondary to recurrent goiter mass and prior surgery, and results of IONM were studied. Frequent indications for redo surgery were multinodular goiter (MNG) in 19 (38.8%) and results of cytology in 14 (28.5%) patients. The mean time interval between primary and redo thyroid surgery was 23.4 years. We laterally approached 41 (67.2%) thyroid lobes between the sternocleidomastoid and sternohyoid muscles. 16 (26.2%) RLNs were found to be adherent to the lateral surface of the corresponding thyroid lobe. The functional integrity of all RLNs was confirmed by IONM. The remnant thyroid tissue can then lead to goiter recurrence requiring secondary surgery after a long period of time. The indications for redo surgery were similar to primary cases. Lateral displacement of the RLN which is adherent to the lateral surface of recurrent goiter mass is common anatomic variation. Thyroid reoperations based on awareness of anatomical disturbances can be performed safely by an experienced surgeon with support of ancillary electrophysiological technology.

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“…In the study of Sopinski et al 23 average duration of surgeries was found shorter in the nerve monitoring group (71.29 ± 17.125 minutes and 75.75 ± 17.94 minutes for monitored and non-monitored groups, respectively.) but it was not statistically significant (P=0.377).…”

Section: Discussionmentioning

confidence: 85%

Should intraoperative nerve monitoring be used routinely in primary thyroid surgeries?

et al. 2019

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Objective: This study presents the effects of intraoperative nerve monitoring on RLN injuries in patients who underwent primary surgery for benign thyroid pathology. Methods: We retrospectively evaluated the data of 273 patients who had primary thyroidectomy due to benign thyroid pathology between January 2012 and July 2017. The patients were classified into two groups. Group-1 consists of patients whose nerves were monitored. We separated the patients whose nerves were not monitored into Group-2. Results: There were 140 and 133 patients in Groups 1 and 2, respectively. Regarding the age, gender and surgical indication between the groups, statistically significant difference was not found (P > 0.05). In Group-1, transient paralysis developed in four patients (2.9%). The permanent paralysis developed in one patient (0.7%). In Group-2, transient paralysis developed in nine patients (6.8%). The permanent paralysis developed in four patients (3%). When the groups were evaluated, there was statistically significant difference in terms of transient and permanent paralysis (P=0.01, P =0.001, respectively). Conclusions: In view of the negative effects of RLN injury on the patient, we think that intraoperative nerve monitoring should be used routinely in benign thyroid surgeries. doi: https://doi.org/10.12669/pjms.36.2.1054 How to cite this:Akici M, Cilekar M, Yilmaz S, Arikan Y. Should intraoperative nerve monitoring be used routinely in primary thyroid surgeries? Pak J Med Sci. 2020;36(2):---------. doi: https://doi.org/10.12669/pjms.36.2.1054 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Role of intraoperative neuromonitoring of the recurrent laryngeal nerves during thyroid reoperations of recurrent goiter

Cited by 7 publications

References 12 publications

Visual and electrophysiological identification of the external branch of superior laryngeal nerve in redo thyroid surgery compared with primary thyroid surgery

Visual and electrophysiological identification of the external branch of superior laryngeal nerve in redo thyroid surgery compared with primary thyroid surgery

Displacement of the Recurrent Laryngeal Nerve in Patients with Recurrent Goiter Undergoing Redo Thyroid Surgery

Should intraoperative nerve monitoring be used routinely in primary thyroid surgeries?

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