The role of intraoperative neuromonitoring of recurrent laryngeal nerve during thyroidectomy: A comparative study on 1000 nerves at risk

Chan, Wai Ming; Lang, Brian Hung‐Hin; Lo, Chung‐Yau

doi:10.1016/j.surg.2006.07.017

Cited by 291 publications

(281 citation statements)

References 15 publications

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“…permanent RLNP is 2-30% for re-operative procedures. 4,[12][13][14][15][16] In re-operative surgery, anatomical planes are distorted due to scarring from the primary procedure, resulting in difficult RLN identification and increased nerve traction.…”

Section: Risk Factors For Rlnp In Thyroid Surgerymentioning

confidence: 99%

“…Several studies show a small reduction in RLNP incidence using IONM, but fail to exhibit statistical significance when compared with direct visualization alone. 6,12,13,17,[49][50][51][52][53][54] The one published randomized control trial comparing IONM versus identification alone in bilateral thyroid surgery concluded that IONM reduced rates of transient but not permanent palsies. 55 The recent meta-analysis by Higgins et al analysed 56 There are some instances where evidence for IONM use is stronger, suggesting that it can aid in the identification of the nerve, correlating with decreased complication rates.…”

Section: The Role Of Ionmmentioning

confidence: 99%

“…55 The recent meta-analysis by Higgins et al analysed 56 There are some instances where evidence for IONM use is stronger, suggesting that it can aid in the identification of the nerve, correlating with decreased complication rates. 12,49,55,57 The large International Intraoperative Monitoring Study Group strongly advocate the use of IONM, applying its use to aid in the initial identification, dissection and prognostication of post-operative function. 58 Dralle et al identified that surgeons undertaking a 'low volume' of thyroid surgery benefitted from IONM in reducing RLNP rates when compared with 'high volume' counterparts.…”

Section: The Role Of Ionmmentioning

confidence: 99%

“…In these instances, a trend for slightly reduced RLNP rates is observed, although not to statistically significant levels in all instances. 12,13,17,45,59 The Yarbrough et al study exclusively analysed re-operative thyroid procedures and showed no difference in RLNP rates between monitored and unmonitored groups. 17 There is some evidence suggesting that IONM may reduce palsy rates in Hashimoto's and Graves' disease.…”

Section: The Role Of Ionmmentioning

confidence: 99%

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Recurrent laryngeal nerve injury in thyroid surgery: a review

Hayward

Grodski

Yeung

et al. 2012

ANZ Journal of Surgery

206

129

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Recurrent laryngeal nerve palsy (RLNP) is an important and potentially catastrophic complication of thyroid surgery. Permanent RLNP occurs in 0.3-3% of cases, with transient palsies in 5-8%. A literature review and analysis of recent data regarding RLNP in thyroid surgery was performed, with particular focus on the identification of high-risk patients, the role of intraoperative identification and dissection of the nerve, and the role of intraoperative neuromonitoring (IONM) and optimal perioperative nerve assessment. In conjunction with the review, data from the Monash University/ Alfred Hospital Endocrine Surgery Unit between January 2007 and October 2011 were retrospectively analysed, including 3736 consecutive nerves at risk (NAR). The current literature and our data confirm that patients undergoing re-operative thyroid surgery and thyroid surgery for malignancies are at increased risk of RLNP. Intraoperative visualization and capsular dissection of the RLN remain the gold standard for intraoperative care during thyroid surgery for reducing RLNP risk. IONM should not be used as the sole mechanism for identifying and preserving the nerve, although it can be used to aid in the identification and dissection of the nerve, and may aid in nerve protection in high-risk cases including cancer surgery and re-operative surgery.

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Section: Risk Factors For Rlnp In Thyroid Surgerymentioning

confidence: 99%

Section: The Role Of Ionmmentioning

confidence: 99%

Section: The Role Of Ionmmentioning

confidence: 99%

Section: The Role Of Ionmmentioning

confidence: 99%

See 2 more Smart Citations

Recurrent laryngeal nerve injury in thyroid surgery: a review

Hayward

Grodski

Yeung

et al. 2012

ANZ Journal of Surgery

206

129

View full text Add to dashboard Cite

show abstract

“…Paradoxically, dissection and preservation of the RLN may be easier if some amount of residual normal thyroid tissue is present, because this often indicates a previously unviolated surgical plane. Intraoperative RLN monitoring may be a useful adjunct [21][22][23], but it is important to recognize that preservation of anatomic integrity of the nerve does not always result in preservation of vocal cord function. Patients requiring reoperative thyroid bed surgery for recurrent tumor rather than residual normal tissue that is RAI avid should be counseled, therefore, regarding the considerably elevated risk for postoperative RLN and PT gland dysfunction.…”

Section: Reoperative Thyroid Surgerymentioning

confidence: 99%

Surgery for Thyroid Cancer

Gil¹,

Patel²

2008

Surgical Oncology Clinics of North America

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Surgical resection of the thyroid gland is standard treatment for management of carcinomas and is performed by a variety of specialists, including general surgeons, otolaryngologists, endocrine surgeons, and oncologic surgeons. Oncologic thyroid surgery has three main objectives: to assure complete removal of one or both of the thyroid lobes, to preserve the parathyroid (PT) glands and their blood supply, and to prevent injury to the superior and recurrent laryngeal nerves (RLNs). To perform safe and efficient thyroid surgery, surgeons should be familiar not only with the anatomy of the thyroid gland and the vital structures along the course of the gland but also with the anatomic variations in regional anatomy. Although postoperative complications are infrequent in experienced hands, hypocalcemia and vocal cord paralysis can lead to significant morbidity and impaired quality of life. The operation of thyroidectomy has been performed for more than a century [1] and is well described in the literature with the expected variation in the actual technique of the procedure.This article describes the technique of thyroidectomy in detail as practiced by the authors at Memorial Sloan-Kettering Cancer Center for the surgical treatment of thyroid cancer. A technique that facilitates complete extracapsular resection of the thyroid, preserves the PT glands with their blood supply, the RLNs, and the superior laryngeal nerves, and minimizes postoperative complications is emphasized. Management of certain specific situations, such as retrosternal goiter, locally invasive thyroid cancer, and reoperative surgery for locally recurrent cancer, is discussed but management of the regional lymph nodes is not addressed here. Standard surgical technique of thyroidectomyThe extent of surgical resection of the thyroid gland for well-differentiated thyroid cancer (WDTC) has been debated extensively and the indications and pros and cons of hemiversus total thyroidectomy are discussed in the article by Witt elsewhere in this issue. The authors practice a policy of risk stratification in deciding the extent of surgery, and the

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Laryngeal Complications After Thyroidectomy

Echternach¹

2009

Arch Surg

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The role of intraoperative neuromonitoring of recurrent laryngeal nerve during thyroidectomy: A comparative study on 1000 nerves at risk

Cited by 291 publications

References 15 publications

Recurrent laryngeal nerve injury in thyroid surgery: a review

Recurrent laryngeal nerve injury in thyroid surgery: a review

Surgery for Thyroid Cancer

Laryngeal Complications After Thyroidectomy

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