What is the learning curve for intraoperative neuromonitoring in thyroid surgery?

Abstract

This is the first series of thyroidectomies with standardized IONM technique performed in Italy. Neuromonitoring was effective in providing identification and function of laryngeal nerves. IONM successful rates were affected considerably by the extent of surgical and anaesthesiological experiences, starting with relatively low rates in the beginner group and then increasing. We assessed the learning curve: improved operative variables and safe technique were seen in about 50 patients.

Intermittent neural monitoring of the recurrent laryngeal nerve in surgery for recurrent goiter

“…Routine identification of the RLN has been the gold standard in thyroid surgery for three decades, and is the best way to prevent inadvertent injury and to minimize the rate of postoperative vocal cord palsy (24)(25)(26)(27)(28). In recent years intraoperative neuromonitoring (IONM) has gained more acceptances among endocrine surgeons and laryngologists as an adjunct to visual RLN identification (29)(30)(31)(32).…”

Report of a rare case: Double recurrent laryngeal nerve

“…A good dissection will reduce the risk of nerve injury to a minimum in case of double recurrent laryngeal nerve abnormality, although very rare. If possible, the use of nerve monitoring device that is currently becoming popular and being widely used in many centers will help nerve exploration and minimize the likelihood of injury (14). …”

Opportunities and challenges of intermittent and continuous intraoperative neural monitoring in thyroid surgery

“…Equipment malfunction and endotracheal tube dislocation or rotation ( Figure 2B), and the choice of an inappropriately sized tube can alter the electrophysiological signal and cause misinterpretation, potentially putting the RLN at jeopardy (13)(14)(15)(16). In CIONM (as opposed to intermittent IONM), the baseline amplitude is calibrated such that the highest possible amplitude is obtained by maximizing the contact of the recording electrodes on the orotracheal tube with the glottis wall.…”

“…With the advent of intermittent IONM, surgeons initially were on a steep learning curve before becoming more familiar with the technology (13,14). This learning curve arguably may be steeper for CIONM, because the operating surgeon needs to constantly monitoring the electrophysiological response signals (21).…”