Association of Intraoperative Neuromonitoring With Reduced Recurrent Laryngeal Nerve Injury in Patients Undergoing Total Thyroidectomy

Vasileiadis, Ioannis; Karatzas, Theodore; Charitoudis, Georgios; Karakostas, Efthimios; Tseleni‐Balafouta, Sofia; Kouraklis, Gregory

doi:10.1001/jamaoto.2016.1954

Cited by 60 publications

(67 citation statements)

References 27 publications

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“…Furthermore, surgical techniques have improved considerably over the nearly four decades this database spans with, for example, the advent of intraoperative neuromonitoring. 18 Nonetheless, these results depict a "real world value" across the board of healthcare over >30 years and thereby support the current view that thyroidectomy should in fact only be performed in top level centres by high level surgeons.…”

Section: Discussionsupporting

confidence: 70%

The time point of completion thyroidectomy has no prognostic impact in patients with differentiated thyroid cancer

Lenschow

Mäder

Germer

et al. 2018

Clinical Endocrinology

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Summary Background After partial resection of the thyroid gland, a second operation referred to as “completion thyroidectomy” may be required if histopathological analysis indicates the presence of differentiated thyroid cancer (DTC). Although there is little evidence, it is assumed that the time point of completion thyroidectomy is not critical for oncological prognosis of patients with DTC. We assessed whether patients with total thyroidectomy (TTx) in a two‐step procedure have an equal long‐term prognosis with regard to disease‐specific survival (DSS) compared to patients immediately undergoing total thyroidectomy in a one‐step procedure. Methods A database study using the Würzburg thyroid cancer database with 2258 patients with pT1a‐pT4b tumours DTC who were operated between 1980 and 2016 was carried out. Results A total of 277 patients with papillary microcarcinoma pT1aN0M0 were treated by hemithyroidectomy. TTx as one‐step procedure was performed in 1114 patients compared to 867 with TTx as a two‐step procedure. Patients with papillary thyroid cancer more frequently had a TTx as one‐step procedure than follicular thyroid cancer patients (59.4% vs 47%; P < 0.001). Compared to a one‐step thyroidectomy, overall complication rate was not different compared to patients undergoing a single operation. Multivariate analysis showed that the presence of distant metastases, T‐stage and age at diagnosis were the only independent determinants for DTC‐specific survival, regardless of a one‐ or two‐time thyroidectomy. Conclusion The present study on the largest of such patient collectives provides evidence that a delayed completion operation does not affect DSS in DTC, nor does it lead to a significant increase in complication rates.

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Section: Discussionsupporting

confidence: 70%

The time point of completion thyroidectomy has no prognostic impact in patients with differentiated thyroid cancer

Lenschow

Mäder

Germer

et al. 2018

Clinical Endocrinology

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“…Despite the rate being very low in the present day due to a better operative technique (40,41), it is better to avoid this problem. Inabnet et al (34), Dionigi et al (36), and Wang et al (33) demonstrated intraoperative neuromonitoring in TOETVA operations with good results.…”

Section: Discussionmentioning

confidence: 96%

Transoral endoscopic thyroidectomy using vestibular approach: updates and evidences

2017

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Recently, natural orifice transluminal endoscopic surgery (NOTES) has been applied in thyroid surgery with transoral access. The benefit of transoral endoscopic thyroidectomy is the potential for scar-free surgery. However, there are many concerns over some aspects, such as infection, recurrent laryngeal nerve injury, and oncological outcome. In this paper, we have reviewed the development history and the current clinical evidence of this innovative surgery. We conclude that the transoral endoscopic thyroidectomy vestibular approach (TOETVA) is feasible and can be considered no longer an experimental operation.

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“…The routine use of IONM in thyroid surgery is controversial. Existing data do not support that the routine use of IONM reduces the rate of RLN damage . IONM, however, may be beneficial in procedures that are either high risk or performed by low‐volume surgeons .…”

Section: Discussionmentioning

confidence: 99%

Nonrecurrent laryngeal nerve in thyroid surgery: Frequency, anatomical variations according to a new classification and surgery consideration

Ngo

2019

Head & Neck

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Background The nonrecurrent laryngeal nerve (NRLN) is a rare embryologically derived variant of the RLN. We aimed to identify the proportion of NRLN (during thyroidectomy), classify clinical NRLN types, and recommend some surgical considerations. Method In this prospective study, from May 2017 to September 2018, our hospital carried out 2158 thyroid operations. We reported the NRLN rate and distinguished NRLN into four types. Results Overall, NRLN had an incidence rate of 0.74% (16 out of 2158 total thyroid surgeries). We did not detect any patient with left‐sided NRLN. The traveling patterns of the nerves could be classified as descending (12.5%), vertical (25%), ascending (37.5%), or V‐shaped (25%). Conclusion The NRLN is a rare variation of the RLN. From our experience, we recommend the guidelines will help surgeons to avoid NRLN injury.

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Association of Intraoperative Neuromonitoring With Reduced Recurrent Laryngeal Nerve Injury in Patients Undergoing Total Thyroidectomy

Cited by 60 publications

References 27 publications

The time point of completion thyroidectomy has no prognostic impact in patients with differentiated thyroid cancer

The time point of completion thyroidectomy has no prognostic impact in patients with differentiated thyroid cancer

Transoral endoscopic thyroidectomy using vestibular approach: updates and evidences

Nonrecurrent laryngeal nerve in thyroid surgery: Frequency, anatomical variations according to a new classification and surgery consideration

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