Transcutaneous laryngeal ultrasonography (TLUS) as an alternative to direct flexible laryngoscopy (DFL) in the perioperative evaluation of the vocal cord mobility in thyroid surgery

Knyazeva, P.; Макарьин, В. А.; Seeliger, Barbara; Chernikov, Roman; Sleptsov, Ilya; Semenov, Arseny; Walz, Martin K.; Alesina, Pier Francesco

doi:10.1007/s00423-018-1734-6

Cited by 20 publications

(40 citation statements)

References 14 publications

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“…Sixteen prospective studies were included in the review following abstract and full-text screening. Eleven studies reported on diagnostic accuracy of TLUSG in either preoperative period (n = 1), postoperative setting (n = 7), or both (n = 3) [14][15][16][17][18][19][20][21][22][23][24]. All of these studies, except one, were included in quantitative analysis to determine diagnostic accuracy of TLUSG in preoperative and postoperative period [13], while the remaining five studies focusing on specific technical aspects of TLUSG were reported in a descriptive manner to elucidate the influence of various technical aspects on TLUSG's diagnostic accuracy [25][26][27][28][29].…”

Section: Resultsmentioning

confidence: 99%

“…Eight studies compared the diagnostic accuracy of TLUSG with DFL [15,[17][18][19][20][22][23][24], while the remaining two studies compared it with VL [16,21]. The study protocols and the examiner experience varied across studies.…”

Section: Operative Periodmentioning

confidence: 99%

“…Three studies assessed the diagnostic accuracy of TLUSG in the preoperative period [16,17,19]. The WAM for VC visualization rate in the preoperative period was 86.28% (range: 79-96.5%).…”

Section: Diagnostic Accuracy Assessmentmentioning

confidence: 99%

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Transcutaneous Laryngeal Ultrasound for Vocal Cord Paralysis Assessment in Patients Undergoing Thyroid and Parathyroid Surgery—A Systematic Review and Meta-Analysis

Patel

Spychalski

Aszkiełowicz

et al. 2021

JCM

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Recurrent laryngeal nerve injury is an important complication following thyroid and parathyroid surgery. Recently, Transcutaneous laryngeal ultrasound (TLUSG) has emerged as a non-invasive alternative to laryngoscopic examination for vocal cord (VC) assessment. The aim of the systematic review and meta-analysis was to determine its diagnostic accuracy in reference to laryngoscopy. It was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. MEDLINE, Scopus, Cochrane library and Web of Science databases were searched to identify relevant articles. Sixteen studies were included in the review. Pooled diagnostic accuracy was calculated based on weighted arithmetic mean and plotting forest plot. The pooled visualization rate was 86.28% and 94.13% preoperatively and postoperatively, respectively. The respective pooled sensitivity and specificity was 78.48% and 98.28%, and 83.96% (CI 95%: 77.24–88.50%) and 96.15% (CI 95%: 95.24–96.88%). The diagnostic accuracy improved if transverse and lateral approaches, and valsalva maneuver were utilized. Male gender and older age were the most crucial risk factors for VC non-visualization. TLUSG is an efficacious screening tool for vocal cord palsy due to its high sensitivity. It is likely to prevent unnecessary laryngoscopic examination in around 80% of patients, with the potential for becoming a gold standard for specific (female/young) patient cohort through assimilative modifications use, increasing expertise and development of objective measurements in the future.

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Section: Resultsmentioning

confidence: 99%

Section: Operative Periodmentioning

confidence: 99%

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Transcutaneous Laryngeal Ultrasound for Vocal Cord Paralysis Assessment in Patients Undergoing Thyroid and Parathyroid Surgery—A Systematic Review and Meta-Analysis

Patel

Spychalski

Aszkiełowicz

et al. 2021

JCM

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“…3 A retrospective study of 668 patients by Kynazeva and colleagues found a preoperative TLUS sensitivity of 67% and specificity of 100%, and a postoperative sensitivity of 86% and specificity of 99% when compared with endoscopic imaging. 4 In the ICU, TLUS has been used to rapidly assess for vocal cord injury, specifically complications of endotracheal intubation, with high sensitivity and specificity, using combined frontal and lateral visualization. 5 Others have confirmed utility, reproducibility, and accuracy among multiple providers in pediatric patients for the assessment of vocal cord function and paralysis.…”

Section: Discussionmentioning

confidence: 99%

A Middle-Aged Man With a History of Asthma Presenting With Recurrent Episodes of Respiratory Distress

Jun

Glassman

Ariniello

et al. 2020

Chest

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“…In some patients, particularly young female patients, laryngeal function can be assessed by means of transcervical ultrasound 11 . Ultrasound assessment of vocal fold function can be limited by laryngeal and anterior neck anatomy, particularly in male or obese patients.…”

Section: Introductionmentioning

confidence: 99%

Cost‐effectiveness of fiberoptic laryngoscopy prior to total thyroidectomy for low‐risk thyroid cancer patients

et al. 2020

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Background Flexible fiberoptic laryngoscopy is performed prior to thyroid surgery to evaluate the function of the recurrent laryngeal nerve. We assess the cost‐effectiveness of preoperative laryngoscopy prior to total thyroidectomy for a low‐risk thyroid cancer patient without dysphonia. Methods A decision tree analysis was performed from a third‐party payer perspective. We assessed the cost‐effectiveness of fiberoptic laryngoscopy prior to total thyroidectomy for T2N0M0 papillary thyroid carcinoma, such that an ipsilateral vocal fold paralysis alters the surgical plan to hemi‐thyroidectomy, when permissible, to avoid the risk of bilateral vocal fold paralysis. Results Performing preoperative laryngoscopy to assess vocal fold function has an incremental cost‐effectiveness ratio (ICER) of 45 193 USD/QALY compared to no laryngoscopy. At a willingness‐to‐pay of 100 K/QALY, the intervention is cost‐effective if the incidence of vocal fold paralysis is at least 0.57%, or when the permissible rate of hemithyroidectomy in cases of incidental paralysis is at least 41%. Probabilistic sensitivity analysis shows that laryngoscopy is cost‐effective in 90.9% of cases. Conclusions Fiberoptic laryngoscopy is a cost‐effective prior to total thyroidectomy in asymptomatic, low‐risk thyroid cancer patients.

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Transcutaneous laryngeal ultrasonography (TLUS) as an alternative to direct flexible laryngoscopy (DFL) in the perioperative evaluation of the vocal cord mobility in thyroid surgery

Cited by 20 publications

References 14 publications

Transcutaneous Laryngeal Ultrasound for Vocal Cord Paralysis Assessment in Patients Undergoing Thyroid and Parathyroid Surgery—A Systematic Review and Meta-Analysis

Transcutaneous Laryngeal Ultrasound for Vocal Cord Paralysis Assessment in Patients Undergoing Thyroid and Parathyroid Surgery—A Systematic Review and Meta-Analysis

A Middle-Aged Man With a History of Asthma Presenting With Recurrent Episodes of Respiratory Distress

Cost‐effectiveness of fiberoptic laryngoscopy prior to total thyroidectomy for low‐risk thyroid cancer patients

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