Training in intraoperative neuromonitoring of recurrent laryngeal nerves reduces the risk of their injury during thyroid surgery

Abstract

Introduction: Even though incidence of recurrent laryngeal nerve palsy (RLNP) is low, it affects importantly the quality of life of patients and remains one of main medicolegal litigation problems in surgery. Intraoperative neuromonitoring (IONM) has become widely accepted tool helping in recurrent laryngeal nerve identification, however no clear association of IONM with RLNP rate has been demonstrated. The aim of our study was to assess whether training in IONM influences rates of RNLP after thyroid surgery as an independent factor. Material and methods: We analysed retrospectively 1235 patients who underwent thyroidectomy at the 1st Department of General and Endocrine Surgery, Medical University of Bialystok. Possible risk factors for RLNP were evaluated: application or not of IONM, the extent of surgery or thyroid pathology in correlation with surgeons' experience in IONM (trained or untrained). Results: There were 2351 nerves at risk (NAR) and 39 RNLP were diagnosed after thyroid surgery (1.66%). Surgeons trained in IONM performed 52.2% of all operations (1200 NAR) with 7 RLNP (0.58%), whereas not-trained had 32 RLNP for 1151 NAR (2.8%; p < 0.001). After 182 thyroidectomies (357 NAR) guided by IONM (14.7%) 3 RLNP were observed (0.84%) vs. 36 palsies per 1994 NAR without IONM (1.81%; p = 0.189). The highest danger of RLNP was reported after reoperations and the lowest after subtotal thyroidectomies. We found no association between thyroid pathology and RLNP rate. Conclusions: According to our study training in IONM decreases chances of RLNP especially during total or near total thyroidectomy.

Noticeable effect of lower baseline amplitude on the predictive accuracy of intraoperative amplitude changes for postoperative vocal cord palsy: a prospective cohort study

“…Previous studies have investigated the influence of neural signal changes on VCP during surgery 10 – 13 , as well as the influence of patients’ baseline conditions and postoperative pathological information on VCP 3 , 22 – 27 . Based on our clinical experience, we tested the hypothesis that low initial amplitude for V1 and R1 are associated with postoperative VCP.…”

Routine use of intraoperative nerve monitoring is associated with a reduced risk of vocal cord dysfunction after thyroid cancer surgery

“…Another study comparing outcomes following thyroidectomies with and without standardized and routine use of IONM concluded that routine use of nerve monitoring allows less experienced surgeons to perform surgery safely with a similar RLN palsy rate as experienced surgeons [ 19 ]. Kuryga et al examined 2351 nerves at risk and showed that surgeons trained in IONM had a significantly lower rate of RLN palsy compared to surgeons who were not trained and do not routinely use IONM (0.58% vs. 2.8%, p < 0.01) [ 20 ]. In our study, in the cohort of patients who underwent surgery by surgeons who did not routinely use IONM, nerve monitoring was associated with prior neck surgery, suggesting that IONM was then used selectively for anticipated difficult dissections.…”

The safety, benefits and future development of overnight and outpatient thyroidectomy

“…Intraoperative nerve monitoring technology can effectively detect the relevant recurrent laryngeal nerve injury and effectively reduce the risk of recurrent laryngeal nerve injury during surgery. If intraoperative neuromonitoring has found damage to one RLN, it can effectively remind the surgeon to be more careful when dealing with the contralateral RLN to reduce the risk of bilateral RLN injury ( 37 , 38 ). More importantly, if the recurrent laryngeal nerve injury can be detected in time during the operation, the patient’s vital signs (such as respiratory indicators) can be detected more specifically, and the observation time can be extended, or hospitalization can be selected in the post-surgery period to reduce possible life-threatening risks.…”