Continuous vagal monitoring value in prevention of vocal cord paralysis following thyroid surgery

Kandil, Emad; Mohsin, Khuzema; Murcy, Mohammad A.; Randolph, Gregory W.

doi:10.1002/lary.27144

Cited by 39 publications

(36 citation statements)

References 35 publications

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“…To prevent BVFP, the operation is terminated and re‐scheduled after the condition of the injured side has been verified . I‐IONM cannot discriminate between reversible and permanent RLN injuries and spots the lesion only when it has already happened . C‐IONM technique allows real‐time detection of slight changes in nerve function to indicate beginning RLN injuries during thyroid surgery …”

Section: Introductionmentioning

confidence: 99%

“…10 I-IONM cannot discriminate between reversible and permanent RLN injuries and spots the lesion only when it has already happened. 5,11 C-IONM technique allows real-time detection of slight changes in nerve function to indicate beginning RLN injuries during thyroid surgery. 12,13 Due to the heterogeneous incidence of RLN injuries in the literature regarding complex thyroid surgery, the aim of our study was to compare the paralysis rate in various complex benign pathologies operated with I-IONM and C-IONM.…”

Section: Introductionmentioning

confidence: 99%

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Continuous versus intermittent intraoperative neuromonitoring in complex benign thyroid surgery: A retrospective analysis and prospective follow‐up

Sedlmaier

Steinmüller

Hermanns

et al. 2019

Clinical Otolaryngology

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Objectives To compare continuous (C‐IONM) vs intermittent intraoperative neuromonitoring (I‐IONM) in complex benign thyroid surgery, and to follow up patients with loss of signal (LOS) or unilateral vocal fold paralysis (UVFP). Design Retrospective clinical study, prospective case series. Setting University hospital and academic teaching hospital of Charité—University Medicine Berlin, Germany. Participants C‐IONM‐ and I‐IONM‐assisted thyroid surgery was conducted in 357 patients diagnosed with recurrent goitre, Graves’ disease, complex hyperparathyroidism, cervical preoperation (anterior access) and LOS in primary operation (2‐stage thyroidectomy). Main outcome measures To evaluate the incidence of early postoperative and permanent UVFP, and to report the results of phonosurgical therapy in patients suffering from persisting dysphonia. Results In 346 patients enrolled (81.8% female, 18.2% male) with 613 nerves at risk (NAR) being monitored (409 I‐IONM vs 204 C‐IONM), early postoperative UVFP was observed in 10.5% of I‐IONM vs 4.9% of C‐IONM group (P < .05), permanent paralysis in 1.5% of I‐IONM vs 1.0% of C‐IONM group (P = .619). In total, 72 patients (21%) experienced pathological events (19 LOS < 100 μV, 53 transient or permanent UVFP). Three patients with permanent UVFP and persisting dysphonia received phonosurgery with stable improvements of all acoustic‐aerodynamic parameters. Conclusion Compared to I‐IONM, C‐IONM‐application in complex benign thyroid surgery shows a significant reduction of transient UVFP and a non‐significant trend in preventing permanent UVFP. In persistent UVFP with dysphonia, endolaryngeal phonomicrosurgery and transcervical laryngeal framework surgery are long‐term effective treatment approaches to improve vocal function.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Continuous versus intermittent intraoperative neuromonitoring in complex benign thyroid surgery: A retrospective analysis and prospective follow‐up

Sedlmaier

Steinmüller

Hermanns

et al. 2019

Clinical Otolaryngology

View full text Add to dashboard Cite

show abstract

“…The stability of EMG signals is also important to detect imminent nerve traction injury and to differentiate true signals from false weak signals, particularly when applying continuous intraoperative neural monitoring (C-IONM). 17,18 Alterations in the contact quality between the vocal cords and the tube electrodes can result in substantial change of EMG amplitude due to surgical manipulation on the thyroid lobe or trachea. It can be difficult to distinguish between a true signal and a false weak signal when EMG amplitude decreases intraoperatively.…”

Section: Discussionmentioning

confidence: 99%

Trans–thyroid cartilage recording for neural monitoring of the recurrent laryngeal nerve in thyroid surgery

Chiang

Chang

et al. 2019

The Laryngoscope

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“…After the ipsilateral vagus nerve was identified between the carotid artery and internal jugular vein, the vocal cord movement response (more than 500 μV) was confirmed with an IONM system (NIM response 2.0/3.0 system: Medtronic Japan) by stimulating the nerve via a handheld probe with 1 mA . An automatic periodic stimulation (APS) electrode for CIONM (APS probe: Medtronic Japan) was then placed on the vagus nerve and the patient's baseline amplitude and latency values were determined, and the waveforms were continuously monitored during the surgery with 1 mA stimulation per a second . In case baseline amplitude showed less than 500 μV, electrode was replaced and the endotracheal tube was readjusted until confirming the baseline amplitude of more than 500 μV.…”

Section: Methodsmentioning

confidence: 99%

Continuous intraoperative neuromonitoring for thyroid cancer surgery: A prospective study

Onoda

Noda

Tauchi

et al. 2019

Laryngoscope Investig Oto

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Objective We evaluated the utility of continuous intraoperative neuromonitoring (CIONM) during surgery for thyroid cancer (TC) in an educational university hospital. Study Design Prospective observational study. Methods During the period April 2016 to March 2017, 43 patients who underwent standardized surgery with CIONM were prospectively included: 5 men and 38 women, 24–87 years old (median 52 years); 23 lobectomies and 20 total thyroidectomies with node dissection were conducted. Thirty‐six operations were performed by a supervising surgeon, and seven were performed by trainees. Results Temporal vocal cord paresis (VCP) was identified in 9 of 63 nerves at risk (14.3%) by postoperative laryngoscopy. VCP was not related to clinical factors including the surgeon's experience or the severe nerve stress demonstrated by CIONM. A significant relation only between VCP and loss of signal (LOS) was demonstrated (P = .002). The recovery of VCP was rapid (<1 month) in patients with global injury even when LOS was demonstrated, but was prolonged in patients demonstrating obvious segmental nerve injury and LOS. Conclusion The present standard protocol of CIONM was useful to some extent to protect prolonged VCP, but not enough to detect every nerve stress causing VCP during TC surgery. On the other hand, CIONM is a promising method that could contribute surgical education at training hospitals enabling the instant confirmation of the procedure safely. Levels of Evidence 3b

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Continuous vagal monitoring value in prevention of vocal cord paralysis following thyroid surgery

Abstract: 4. Laryngoscope, 128:2429-2432, 2018.

Cited by 39 publications

References 35 publications

Continuous versus intermittent intraoperative neuromonitoring in complex benign thyroid surgery: A retrospective analysis and prospective follow‐up

Continuous versus intermittent intraoperative neuromonitoring in complex benign thyroid surgery: A retrospective analysis and prospective follow‐up

Trans–thyroid cartilage recording for neural monitoring of the recurrent laryngeal nerve in thyroid surgery

Continuous intraoperative neuromonitoring for thyroid cancer surgery: A prospective study

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