Optimal Monitoring Technology for Pediatric Thyroidectomy

Abstract

This retrospective study aimed to describe, firstly, characteristics and outcomes of the intraoperative neural monitoring technology in the pediatric population, and secondarily the recurrent laryngeal nerve complication rate. Thirty-seven patients (age <18 years) operated on from 2015 to 2021 by conventional open thyroid surgery were included. Twenty-four (64.9%) total thyroidectomies and 13 (35.1%) lobectomies were performed. Seven central and six lateral lymph node dissections completed 13 bilateral procedures. Histology showed malignancy in 45.9% of the cases. The differences between the electromyographic profiles of endotracheal tubes or electrodes for continuous monitoring were not statistically significant. In our series of young patients, both adhesive (even in 4- or 5-year-olds) and embedded endotracheal tubes were used, while in patients 3 years old or younger, the use of a more invasive detection method with transcartilage placement recording electrodes was required. Overall, out of 61 total at-risk nerves, 5 (8.2%) recurrent laryngeal nerves were injured with consequent intraoperative loss of the signal; however, all these lesions were transient, restoring their normal functionality within 4 months from surgical procedure. To our knowledge, this is the first study of intraoperative neural monitoring management in a cohort of Italian pediatric patients.

Intraoperative Neuromonitoring for Thyroid Surgery in Children and Adolescents: A Single Center Experience

“…Prior researches, especially in adults, showed that IONM combined with visual RLN identification considerably reduces postoperative RLN palsy rates [ 4 , 8 , 9 , 19 , 20 , 21 , 22 ], without lengthening the surgical procedure [ 23 , 24 ]. Especially in complicated operations, such as re-operations, residual thyroidectomy, or inflammation, the RLN may be encased within or displaced by scar tissue, making its visual identification challenging and time-consuming, even for experienced surgeons.…”