Application of Continuous and Intermittent Intraoperative Nerve Monitoring in Thyroid Surgery

Yu, Qingan; Liu, KunPeng; Zhang, Shuang; Li, Hao; Xie, Changming; Wu, Yeke; Jiang, Hongchi; Dai, Wenjie

doi:10.1016/j.jss.2019.05.054

Cited by 18 publications

(22 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Vagal CIONM can be performed by two distinct methods: The most commonly performed technique is CMAP-CIONM. [9][10][11][12][13][14][15]23,24,30,31 Despite its potential advantages, several limitations have restricted its widespread adoption, including the requirement for extra neck dissection to place the vagal electrode, the potential for vagus nerve injury during electrode placement, the susceptibility of the electrode to intraoperative displacement, and the extra cost. 2,31 The second method of vagal CIONM as reported in this case series utilizes a physiologic laryngeal reflex (LAR-CIONM) to elicit a contractile response in laryngeal musculature.…”

Section: Discussionmentioning

confidence: 99%

“…After brainstem synapse, efferent impulses are carried via the vagus and RLN to the larynx, resulting in bilateral vocal fold (VF) adduction that can be recorded on ETT surface electrodes. This IONM technique is distinct from CMAP-CIONM [9][10][11][12][13][14][15]23,24 in that it utilizes a brainstem reflex response instead of direct vagal stimulation to elicit laryngeal muscle contraction. [20][21][22][25][26][27][28][29] An initial feasibility study of LAR-CIONM with 134 nerves at risk demonstrated that LAR VF waveforms are distinct from CMAP waveforms, demonstrating that LAR-CIONM is highly sensitive to nerve traction or compression.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Continuous Laryngeal Adductor Reflex Versus Intermittent Nerve Monitoring in Neck Endocrine Surgery

Sinclair¹,

Téllez

Ulkatan

2020

The Laryngoscope

View full text Add to dashboard Cite

Objective Intraoperative neuromonitoring (IONM) techniques aim to identify and potentially prevent nerve injury during surgeries. Prior studies into the efficacy of recurrent laryngeal nerve (RLN) IONM convey mixed results, with some claiming equivalence between IONM and no monitoring at all. The goal of the current study was to compare continuous RLN monitoring using the laryngeal adductor reflex (LAR) to intermittent RLN monitoring (intermittent IONM) to determine whether continuous monitoring reduces the incidence of intraoperative RLN injury during neck endocrine surgeries. Methods In this observational, historical case‐control study, a historical cohort of patients monitored with intermittent‐IONM (group 1, n = 130) were compared to prospectively collected data from consecutive nerves‐at‐risk monitored continuously with the LAR (LAR‐CIONM, group 2, n = 205), at a single center by a single surgeon. The test benefit ratio and relative risk reduction (RRR) for LAR‐CIONM over intermittent IONM were calculated. Results For group 1, nine nerves at risk exhibited intraoperative LOS with transient postoperative vocal fold (VF) hypomobility (n = 2) or immobility (VFI, n = 7). For group 2, two nerves at risk (0.98%) had sudden intraoperative LAR LOS following bipolar cautery, resulting in postoperative transient VFI (P = .004). In each group, there was one case of permanent postoperative VFI. The test benefit rate ratio for LAR‐CIONM demonstrated a dramatic effect at 5.23, with an RRR of 81.0%. Conclusion LAR‐CIONM significantly decreased rates of postoperative transient VF paralysis and paresis over intermittent IONM alone (P = .004). Surgeons should be aware of the benefits and limitations of intermittent IONM versus CIONM. Intermittent IONM, although useful in nerve mapping and intraoperative decision making, has minimal benefit for the prevention of nerve injury, whereas CIONM can potentially reduce nerve injury rates and improve patient outcomes. Level of Evidence 3 Laryngoscope, 131:230–236, 2021

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Continuous Laryngeal Adductor Reflex Versus Intermittent Nerve Monitoring in Neck Endocrine Surgery

Sinclair¹,

Téllez

Ulkatan

2020

The Laryngoscope

View full text Add to dashboard Cite

show abstract

“…However, most papers note that patients at higher risk of nerve paralysis were generally selected for CIONM. There were various definitions of high risk procedures; Yu, et al denoted six patient groups: 1) Revision surgery, 2) Pre-existing unilateral VCP undergoing bilateral thyroidectomy or contralateral thyroidectomy, 3) Involves retrosternal goitre, 4) Suspected bilateral multiple carcinomas, 5) Suspected large carcinomas with dorsal extension invading into surrounding tissue and 6) Graves' disease patients [10].…”

Section: Study Selection and Data Extractionmentioning

confidence: 99%

“…The majority of the papers in this review have reported safe use of VN stimulation without autonomic disturbances when stimulation currents and frequencies were kept low [10,[40][41][42]. The safety of CIONM was also established in paediatric populations [32] and high-risk populations such as those with advanced atrioventribular blocks [2].…”

Section: Safety Of Vn Stimulation During Cionmmentioning

confidence: 99%

“…Nevertheless, it has yet to be adopted as a routinely utilised adjunct to the established technique of intermittent intraoperative recurrent laryngeal nerve monitoring and direct visualisation. Although demonstrated to be a safe and effective technique of nerve monitoring in multiple centres [1][2][3][4][5][6][7][8][9][10][11], this study aims to demonstrate the summative result of this data in a meta-analysis of CIONM-related recurrent laryngeal nerve outcomes in thyroid surgery. transection, CIONM can detect early EMG changes that are associated with imminent nerve injuries, thus preventing nerve injuries caused by mechanical, thermal or cumulative trauma by forewarning the surgeons of impending nerve injury and allowing the surgeons to perform corrective manoeuvres [26].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Continuous Intraoperative Nerve Monitoring in Thyroidectomies: A Systematic Review and Meta-Analysis

Dominic¹,

Hui²,

Cheung³

et al. 2021

J Head Neck Surg

View full text Add to dashboard Cite

Objective: Application of intermittent intra-operative nerve monitoring (I-IONM) as an aid in thyroidectomies is common practice worldwide. While I-IONM is significantly beneficial in thyroid surgeries, it is limited by its intermittent nature, thereby allowing the recurrent laryngeal (RLN) nerve to be at risk of injury in-between stimulations. In the last decade, the introduction of continuous intraoperative RLN monitoring (CIONM) has overcome this limitation by enabling the operator to verify the functional integrity of the vagus nerve-recurrent laryngeal nerve (VN-RLN) axis in real-time. We aim to present the current evidence on CIONM utility for thyroid surgery by conducting the first meta-analysis on this technique.Methods: A systematic review of literature was conducted by two independent reviewers via Ovid in the Medline, EM-BASE and Cochrane reviews databases. The search was limited to human subject research in peer-reviewed articles of all languages published between Jan 1946 and April 2019. Medical subject headings (MeSH) terms utilised were thyroid surgery, thyroidectomies, recurrent laryngeal nerve, vagal nerve, monitor and stimulation. Thirty-eight papers were identified from Ovid, another six papers were identified by hand-search. A random effect meta-analysis was performed with assessment of heterogeneity using the I 2 value.Results: A total of 23 papers that utilised continuous vagal nerve monitoring during thyroid surgery were identified. The proportion of temporary and permanent recurrent laryngeal nerve paralysis post-operation was 2.5% (95% CI 1.7-3.2%, I 2 = 37.7). The proportion of patients with permanent recurrent laryngeal nerve palsy post-operation was 0.05% (95% CI 0.08 -0.2%, I 2 = 0). Conclusion:CIONM is a safe and effective means by which RLN paralyses in thyroid surgery can be reduced.

show abstract

Superiority of continuous over intermittent intraoperative nerve monitoring in preventing vocal cord palsy

Schneider

Machens

Sekulla

et al. 2021

British Journal of Surgery

View full text Add to dashboard Cite

Background Continuous intraoperative nerve stimulation (IONM) with uninterrupted monitoring is likely better than intermittent IONM in preventing vocal cord palsy after thyroid surgery. Methods This was a comparative study of intermittent versus continuous IONM in patients with benign and malignant thyroid disease treated at a tertiary centre over 10 years. Early postoperative and permanent vocal cord palsy rates were estimated. Multivariable logistic regression analysis was used to quantify the contributions of clinical and histopathological variables to early postoperative and permanent vocal cord palsy. Results A total of 6029 patients were included, of whom 3139 underwent continuous and 2890 intermittent IONM. Based on nerves at risk (5208 versus 5024 nerves), continuous IONM had a 1·7-fold lower early postoperative vocal cord palsy rate than intermittent monitoring (1·5 versus 2·5 per cent). This translated into a 30-fold lower permanent vocal cord palsy rate (0·02 versus 0·6 per cent). In multivariable logistic regression analysis, continuous IONM independently reduced early postoperative vocal cord palsy 1·8-fold (odds ratio (OR) 0·56) and permanent vocal cord palsy 29·4-fold (OR 0·034) compared with intermittent IONM. One permanent vocal cord palsy per 75·0 early vocal cord palsies was observed with continuous IONM, compared with one per 4·2 after intermittent IONM. Early postoperative vocal cord palsies were 17·9-fold less likely to become permanent with continuous than intermittent IONM. Conclusion Continuous IONM is superior to intermittent IONM in preventing vocal cord palsy.

show abstract

Application of Continuous and Intermittent Intraoperative Nerve Monitoring in Thyroid Surgery

Cited by 18 publications

References 23 publications

Continuous Laryngeal Adductor Reflex Versus Intermittent Nerve Monitoring in Neck Endocrine Surgery

Continuous Laryngeal Adductor Reflex Versus Intermittent Nerve Monitoring in Neck Endocrine Surgery

Continuous Intraoperative Nerve Monitoring in Thyroidectomies: A Systematic Review and Meta-Analysis

Superiority of continuous over intermittent intraoperative nerve monitoring in preventing vocal cord palsy

Contact Info

Product

Resources

About