The value of neurostimulation and intraoperative nerve monitoring of inferior laryngeal nerve in thyroid surgery

Cavicchi, Ottavio; Caliceti, Umberto; Fernandez, Ignacio Javier; Macrı̀, Giovanni; Lieto, Cristiana Di; Marcantoni, Alessandra; Ceroni, Alberto Rinaldi; Piccin, Ottavio

doi:10.1016/j.otohns.2008.12.047

Cited by 41 publications

(47 citation statements)

References 15 publications

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“…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%

Recurrent laryngeal nerve injury in thyroid surgery: a review

Hayward

Grodski

Yeung

et al. 2012

ANZ Journal of Surgery

204

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: The Role Of Ionmmentioning

confidence: 99%

Recurrent laryngeal nerve injury in thyroid surgery: a review

Hayward

Grodski

Yeung

et al. 2012

ANZ Journal of Surgery

204

129

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“…Numerous studies have been published regarding the potential benefits and limitations of RLN neuromonitoring 13-18. The largest non-randomized study of RLN neuromonitoring in thyroid surgery did not show a statistically significant difference in the incidence of RLN injury as a function of neuromonitoring 14.…”

Section: Discussionmentioning

confidence: 99%

Current Practice Patterns Regarding the Conduct of Thyroidectomy and Parathyroidectomy amongst Surgeons - A Survey Study

Henry¹,

Helou²,

Solomon³

et al. 2012

J. Cancer

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Background: Heterogeneity of surgical care exists among surgeons regarding the conduct of thyroidectomy and parathyroidectomy.Aim: To identify the current patterns of technical conduct of operation amongst surgeons performing thyroidectomy or parathyroidectomy.Methods: A survey was designed and beta-tested on five surgical oncologists for face validity and usability. The final version of this survey was constructed and disseminated using the professional version of the internet-based survey mechanism Survey Monkey and consisted of two eligibility questions and 22 questions regarding thyroidectomy/parathyroidectomy treatment patterns. The survey was disseminated electronically to American Association of Endocrine Surgeons (AAES) and American College of Surgeons (ACS) members. Survey results were collected, tabulated and analyzed. Responses among groups were compared using two sample T- tests. Significant responses were subsequently analyzed in generalized linear models to ascertain if significance remained with control of covariates.Results: Of 420 initial web survey visits, 236 (56.2%) surveys were completed. The majority of respondents reported being 'fellowship trained', experienced and 'high-volume' surgeons. The most common fellowship trainings were endocrine (46%), oncology (22%), head & neck (13%), or combinations of the three fellowships (14%). Most surgeons reported that they dissect the course of the recurrent laryngeal nerve (RLN) without using neuromonitoring. Nearly a third of respondents reported routinely using the Harmonic scalpel during the conduct of the operations. Significant differences emerged regarding operative technique according to residency training type, fellowship training, surgeon volume, and practice setting, but only those associated with residency training type and annual surgeon surgical volume remained significant within generalized linear models.Conclusion: Most surgeons who responded to this survey do not routinely use RLN neuromonitoring and most dissect the RLN during thyroidectomy. There are multiple variations in technique according to surgical training, surgeon volume, experience, and practice setting; however, only differences by residency training type and surgeon volume remained correlated significantly to surgeons' approaches to thyroidectomy and parathyroidectomy in multivariate analysis. These data may be useful for surgeons reflecting upon their individual practice, as well as for further defining current standards of practice from a medico legal perspective.

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“…[7][8][9][10][11][12][13] Intraoperative neuromonitoring can also help to predict and prognosticate the degree of RLN nerve injury. [14][15][16][17] Previous studies of normative EMG data have been done in American and European populations. [18][19][20] Hopefully, by defining the normative RLN monitoring parameters, we can predict the degree of nerve injury following which nerve monitoring signals may be altered or lost.…”

Section: Role Of Intraoperative Neuromonitoringmentioning

confidence: 99%

Experience of Intraoperative Recurrent Laryngeal Nerve monitoring in a Single Center-normative Recurrent Laryngeal Nerve Electromyographic Data

Parameswaran¹,

Soh²,

Lee³

et al. 2017

World Journal of Endocrine Surgery

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The value of neurostimulation and intraoperative nerve monitoring of inferior laryngeal nerve in thyroid surgery

Abstract: Our results indicate that NSLP is a safe and reliable intraoperative method of RLN monitoring. Moreover our data confirm that IONM is not a helpful tool to reduce the rate of palsy in thyroid surgery.

Cited by 41 publications

References 15 publications

Recurrent laryngeal nerve injury in thyroid surgery: a review

Recurrent laryngeal nerve injury in thyroid surgery: a review

Current Practice Patterns Regarding the Conduct of Thyroidectomy and Parathyroidectomy amongst Surgeons - A Survey Study

Experience of Intraoperative Recurrent Laryngeal Nerve monitoring in a Single Center-normative Recurrent Laryngeal Nerve Electromyographic Data

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