Continuous Laryngeal Nerve Integrity Monitoring During Thyroidectomy: Does it Reduce Risk of Injury?

Robertson, Matt L.; Steward, David L.; Gluckman, Jack L.; Welge, Jeff

doi:10.1016/j.otohns.2004.05.030

Cited by 110 publications

(77 citation statements)

References 18 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

207

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

207

129

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“…When the definitive diagnosis is consistent with malignancy, patients typically undergo a second surgical procedure in the form of a completion thyroidectomy. Furthermore, because 50% to 80% of indeterminate lesions are benign on final pathology, a significant number of patients undergo potentially avoidable surgery with its inherent risks and costs (2,5,6). Although many immunohistochemical and molecular markers have been investigated in recent years in efforts to improve sensitivity and specificity of FNA cytology, none has yet been accepted as integral to the diagnostic armamentarium by clinicians and cytopathologists.…”

Section: Introductionmentioning

confidence: 99%

A Panel of Four miRNAs Accurately Differentiates Malignant from Benign Indeterminate Thyroid Lesions on Fine Needle Aspiration

Keutgen

Filicori

Crowley

et al. 2012

Clinical Cancer Research

145

121

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Purpose: Indeterminate thyroid lesions on fine needle aspiration (FNA) harbor malignancy in about 25% of cases. Hemi-or total thyroidectomy has, therefore, been routinely advocated for definitive diagnosis. In this study, we analyzed miRNA expression in indeterminate FNA samples and determined its prognostic effects on final pathologic diagnosis.Experimental Design: A predictive model was derived using 29 ex vivo indeterminate thyroid lesions on FNA to differentiate malignant from benign tumors at a tertiary referral center and validated on an independent set of 72 prospectively collected in vivo FNA samples. Expression levels of miR-222, miR-328, miR-197, miR-21, miR-181a, and miR-146b were determined using reverse transcriptase PCR. A statistical model was developed using the support vector machine (SVM) approach.Results: A SVM model with four miRNAs (miR-222, miR-328, miR-197, and miR-21) was initially estimated to have 86% predictive accuracy using cross-validation. When applied to the 72 independent in vivo validation samples, performance was actually better than predicted with a sensitivity of 100% and specificity of 86%, for a predictive accuracy of 90% in differentiating malignant from benign indeterminate lesions. When Hurthle cell lesions were excluded, overall accuracy improved to 97% with 100% sensitivity and 95% specificity.Conclusions: This study shows that that the expression of miR-222, miR-328, miR-197, and miR-21 combined in a predictive model is accurate at differentiating malignant from benign indeterminate thyroid lesions on FNA. These findings suggest that FNA miRNA analysis could be a useful adjunct in the management algorithm of patients with thyroid nodules.

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“…Endoscopic ventriculocordectomy, or arytenoidectomy are the surgical procedures of choice for such patients. The use of electrophysiological monitoring of RLN during thyroid surgery has been mentioned in the literature in high risk cases to avoid inuring the nerve [1,9] To conclude, bi-lateral vocal cord palsy is a rare but possible complication in the course of recurrent thyroid surgery, total thyroidectomy, or thyroid carcinoma. Knowledge about the risk factors contributing to this complication, might increase awareness for such an event, thus allowing early intervention to avert adverse or fatal outcomes.…”

Section: Redo Surgery and Ligature Of The Inferior Thyroid Artery [10mentioning

confidence: 99%

“…Better preoperative preparation and proper surgical techniques of thyroidectomy have minimized complications to less than 2-3%. Bilateral recurrent nerve palsy is the rarest of all complications, with a reported incidence varying between 0.4% to 14 %, but can be potentially fatal if missed [1,2].We report a case in which the patient experienced life threatening stridor and severe dyspnoea requiring re-intubation few minutes after extubation.Keywords: Vocal cord palsy, total thyroidectomy, airway obstruction. …”

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confidence: 92%

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Bi Lateral Vocal Cord Paralysis Post Thyroidectomy Causing Total Airway Obstruction: Case Report

Mundada¹

2011

TOATJ

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Thyroid surgery in recent years is generally considered quite safe. Better preoperative preparation and proper surgical techniques of thyroidectomy have minimized complications to less than 2-3%. Bilateral recurrent nerve palsy is the rarest of all complications, with a reported incidence varying between 0.4% to 14 %, but can be potentially fatal if missed [1,2].We report a case in which the patient experienced life threatening stridor and severe dyspnoea requiring re-intubation few minutes after extubation.Keywords: Vocal cord palsy, total thyroidectomy, airway obstruction. CASE REPORTA 29 year old female patient, weighing 48kg, presented with a thyroid swelling of about 3x3 cm in size, that has existed for six months. No retrosternal extension or pressure symptoms were observed. Following her previous diagnosis of thyroid hyperfunction she has been treated with Carbimazole and Propanolol for six months. Presently she was asymptomatic and her thyroid function tests were normal. Preoperative indirect laryngoscopy showed normal cord movements. X-ray of the neck did not show any deviation or tracheal compression. The preoperative histopathology report was suggestive of malignancy.On the day of surgery her pulse rate was 78 beats per minute, rhythmic and her blood pressure was 130/86 mmHg. After securing an intravenous (i.v) line, 1 mg of Midazolam and 100 mcg of Fentanyl were administered intravenously. Anesthesia was induced with 100 mg of Propofol and intubation was facilitated by administereing 75 mg suxamethonium. Anesthesia was maintained with N 2 O, O 2 (60 : 40) and 2% sevoflurane. Vecuronium was used as muscle relaxant and the intraoperative anesthetic course was uneventful.The surgery was performed without complications and lasted for about 3 hours. Before closure, a negative suction drain was inserted into the wound and pressure dressing was applied after surgery.At the end of surgery, neuromuscular blockade was reversed with 2.5 mg Neostigmine in combination with 0.2 mg Glycopyrolate. Once a Train of four (TOF-) ratio of 0.9 was measured, and the patient while intubated showed a normal tidal volume and respiratory rate. After extubation, the patient was obeying commands but was unable to speak

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Continuous Laryngeal Nerve Integrity Monitoring During Thyroidectomy: Does it Reduce Risk of Injury?

Abstract: There were no statistically significant differences in RLN paralysis, paresis, or total injury rates between control and NIM groups, even in subsets with advanced T-stage and increased baseline risk. Advanced T-stage is a significant predictor of RLN paresis in this cohort.

Cited by 110 publications

References 18 publications

Recurrent laryngeal nerve injury in thyroid surgery: a review

Recurrent laryngeal nerve injury in thyroid surgery: a review

A Panel of Four miRNAs Accurately Differentiates Malignant from Benign Indeterminate Thyroid Lesions on Fine Needle Aspiration

Bi Lateral Vocal Cord Paralysis Post Thyroidectomy Causing Total Airway Obstruction: Case Report

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