Intraoperative Neuromonitoring: Evaluating the Role of Continuous IONM and IONM Techniques for Emerging Surgical and Percutaneous Procedures

Pace‐Asciak, Pia; Russell, Jonathon O.; Dhillon, Vaninder K.

doi:10.3389/fendo.2022.823117

Front. Endocrinol.

2022

DOI: 10.3389/fendo.2022.823117

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Intraoperative Neuromonitoring: Evaluating the Role of Continuous IONM and IONM Techniques for Emerging Surgical and Percutaneous Procedures

Pia Pace‐Asciak

Jonathon O. Russell

Vaninder K. Dhillon

Abstract: Continuous and intermittent intraoperative nerve monitoring (IONM) has become an important asset for endocrine surgeons over the past few decades. The ability to determine neurophysiologic integrity of the recurrent laryngeal nerve (RLN) and external branch of the superior laryngeal nerve (EBSLN) on top of identification and meticulous dissection of the nerve in the surgical field, has allowed for advances in technology and improved outcomes when it comes to prevention of vocal fold immobility. This article ai… Show more

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2024

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Cited by 5 publications

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The effectiveness of neck stretching exercises in alleviating neck pain and self‐reported disability after thyroidectomy: A systematic review and meta‐analysis of clinical trials

Albazee,

Alsubaie,

Hintze

et al. 2024

Head & Neck

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Thyroidectomy can lead to significant challenges such as neck pain, disability, and limited range of motion. Therefore, our objective is to conduct a systematic review and meta‐analysis of clinical trials to investigate the clinical effectiveness of neck stretching exercises in alleviating neck pain and self‐reported disability immediately after thyroidectomy. We systematically searched PubMed, CENTRAL, Scopus, and Web of Science from inception until July 28th, 2023. We assessed the selected trials for the risk of bias using both the RoB‐2 and ROBINS‐I tools. Our specific outcomes were the severity of neck pain and self‐reported disability after thyroidectomy. The results were synthesized using risk ratio (RR) and standardized mean differences (SMD) with 95% confidence intervals (CI) in a random‐effects model using Stata software. Nine clinical trials, comprising five randomized and four non‐randomized trials, were included, with a total of 1026 patients. Neck stretching exercises were significantly associated with improved mean pain scores both after 1 week (n = 625 patients, SMD = −2.43, 95% CI [−4.65, −0.22], p = 0.03, I2 = 98%) and 1 month (n = 545 patients, SMD = −4.11, 95% CI [−8.12, −0.11], p = 0.04, I2 = 99%). Similarly, neck stretching exercises were significantly associated with improved mean self‐reported disability scores both after 1 week (n = 298 patients, SMD = −0.70, 95% CI [−1.36, −0.04], p = 0.04, I2 = 87%) and 1 month (n = 298 patients, SMD = −0.42, 95% CI [−0.65, −0.19], p = 0.0004, I2 = 0%). The pooled analysis showed heterogeneity (chi‐square p < 0.01, I2 > 80%), except for the mean self‐reported neck disability score after 1 month, which showed homogeneity (chi‐square p > 0.01, I2 = 0%). This systematic review and meta‐analysis, involving 1026 patients, revealed the potential benefits of neck stretching exercises in alleviating neck pain and self‐reported disability after thyroidectomy. However, further research is required to address methodological limitations, evaluate long‐term outcomes, investigate potential moderators (i.e., the duration or intensity of the exercise program), and explore patients' analgesic consumption.

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The effectiveness of neck stretching exercises in alleviating neck pain and self‐reported disability after thyroidectomy: A systematic review and meta‐analysis of clinical trials

Albazee,

Alsubaie,

Hintze

et al. 2024

Head & Neck

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Impact of intraoperative recurrent laryngeal nerve monitoring on minimally invasive esophagectomy outcomes for esophageal cancer: a meta-analysis of case–control studies

Peyser Cardoso,

Agarwal,

Cardoso

et al. 2024

Diseases of the Esophagus

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Summary Esophagectomy and lymphadenectomy for esophageal cancer carry an inherent risk of recurrent laryngeal nerve (RLN) injury. Intraoperative nerve monitoring (IONM) may help prevent RLN damage, though evidence on its effectiveness is still limited. This systematic review and meta-analysis (SRMA) evaluate the feasibility and efficacy of IONM during minimally invasive esophagectomy (MIE) for esophageal cancer. This SRMA followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines, with a registered protocol on PROSPERO (CRD42022367916). Two independent authors conducted a comprehensive literature search across multiple databases, screening studies on MIE for esophageal cancer using IONM. Case–control studies were included, focusing on the RLN palsy (RLNP) rate as the primary outcome. A total of 11 studies involving 1907 patients (IONM group: 752 patients; non-IONM group: 1155 patients) were included in the SRMA. IONM significantly reduced the incidence of RLNP (OR = 0.47, P < 0.001). Length of hospital stay (LOHS) and lower respiratory tract infection (LRTI) rates were significantly reduced with IONM use. No significant differences were observed in anastomotic leak, chylothorax, total number of lymph nodes dissected, operation time, aspiration rates, or intraoperative blood loss. The pooled sensitivity and specificity of IONM for detecting RLN injury were 83.3% and 81%, respectively. IONM during MIE significantly reduces the incidence of RLNP, postoperative LRTI, and shortens the LOHS, without adding operative risks. Further research is needed to evaluate its long-term survival benefits and cost-effectiveness.

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Recurrent laryngeal nerve monitoring by flexible laryngoscopy during thyroid radiofrequency ablation in the awake patient

Teliti,

Occhini,

Fonte

et al. 2024

Front. Endocrinol.

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ObjectiveAlthough radiofrequency ablation (RFA) is a safe and effective non-surgical treatment for benign thyroid nodules, injury to the recurrent laryngeal nerve (RLN), is a potential and feared complication. Intermittent voice checks have been proposed to monitor vocal cord (VC) function during RFA, but such assessment is highly subjective and effort-dependent.MethodsWe are here reporting the methodological use of flexible laryngoscopy (FL) for VC monitoring during bilateral thyroid RFA treatment. The patient, a 35-year-old woman, was referred to the Endocrinology Unit for subclinical hyperthyroidism due to bilateral autonomously functioning thyroid nodules.ResultsAt the end of the treatment of the first nodule, the FL performed by an otorhinolaryngologist specialist allowed evaluating VC function and ruling out possible paralysis before proceeding with the contralateral RFA treatment. The patient was awake during the entire procedure and well tolerated the laryngoscopic examination. The TSH serum evaluations performed one month and 9 months after the procedure assessed an euthyroid state (TSH 3.2 mIU/L and 2.8 mIU/L, respectively).ConclusionDuring bilateral thyroid RFA the use of FL for VC monitoring treatment resulted in a safe, easy-to-perform, and effective strategy to minimize and anticipate RLN injury risk in the awake patient. The prevention of RLN damage is advisable in the case of single RFA treatment, while it should be strongly recommended when RFA is performed on bilateral nodules.

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Intraoperative Neuromonitoring: Evaluating the Role of Continuous IONM and IONM Techniques for Emerging Surgical and Percutaneous Procedures

Cited by 5 publications

References 54 publications

The effectiveness of neck stretching exercises in alleviating neck pain and self‐reported disability after thyroidectomy: A systematic review and meta‐analysis of clinical trials

The effectiveness of neck stretching exercises in alleviating neck pain and self‐reported disability after thyroidectomy: A systematic review and meta‐analysis of clinical trials

Impact of intraoperative recurrent laryngeal nerve monitoring on minimally invasive esophagectomy outcomes for esophageal cancer: a meta-analysis of case–control studies

Recurrent laryngeal nerve monitoring by flexible laryngoscopy during thyroid radiofrequency ablation in the awake patient

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