Intraoperative monitoring of the recurrent laryngeal nerve in surgeries for thyroid cancer: a review

Abstract

Intraoperative nerve monitoring (IONM) has evolved into an objective tool not only for the identification but also for the preservation and prognostication of function of the recurrent laryngeal nerve in thyroid surgeries. Technical improvements have resulted in the increasing incorporation of IONM into operating rooms around the world. The importance of adherence to recommended standards is also recognized as being vital in optimizing the efficacy of IONM. The advent of continuous IONM has made real-time nerve monitoring possible, thus providing the surgeon with an ally in difficult surgeries. Additionally, as thyroid surgeries are evolving into remote access and minimally invasive procedures, so also is the applicability of IONM. This review focuses on the use of IONM for nerve monitoring in thyroidectomies for neoplastic conditions while discussing the rationale, technique, and interpretation of findings and their implications.

Intraoperative Monitoring of the Recurrent Laryngeal Nerve with Electromyography Endotracheal Tube in Anterior Cervical Discectomy and Fusion

“…A loss of signal was defined as either a complete loss of amplitude or a decrease of the nerve amplitude to 100 μV after suprathreshold stimulation. 11 A rescue protocol was followed. The rescue protocol included reversal of any antecedent surgical event, maintenance of the mean arterial blood pressure between 85 and 95 mm Hg, evaluation of the monitor leads, determination of whether the neuromuscular blockade had been given, monitoring the mean arterial blood pressure, evaluation of the cervical retractor blade position, pausing any surgical actions, and waiting for resolution of the silent signal from IONM before continuing surgery.…”

Modern Surgical Techniques of Thyroidectomy and Advances in the Prevention and Treatment of Perioperative Complications

“…Continuous IONM (CIONM) is a technique that allows real-time monitoring. As a result, the surgeon is warned of possible RLN injury earlier during the procedure, so its risk is reduced [152]. Schneider et al showed that CIONM is associated with a lower rate of permanent vocal cord palsy than IIONM [153].…”

New developments in management of metastatic thyroid cancer

“…Many patients with metastatic thyroid cancer are elderly and have cardiovascular disease that limits the choice of therapy for the metastases. Izkhakov et al [9] review the influence of cardiovascular disease in the overall prognosis among thyroid cancer survivors.…”