Usefulness of Neuromonitoring in Thyroid Surgery

Pardal-Refoyo, José Luis

doi:10.1016/j.otoeng.2012.09.007

Cited by 8 publications

(7 citation statements)

References 41 publications

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“…Advantages of IONM are still widely debated and there is no unambiguous evidence for or against its usefulness in clinical reduction of the RLNP rate [2,[9][10][11][12][13]. Even if there were published some data that IONM reduces the transient but not the permanent RLNP rate, several limitations of IONM persist because of abundant probable reasons for the signal loss, such as RLN extralaryngeal anatomical variations, as well as equipment defects, wrong monitoring setup, incorrect electrodes' placement, muscle relaxant, presence of shunt stimulus, etc.…”

Section: Discussionmentioning

confidence: 99%

“…[ 4 , 8 , 14 ]. Thus, most studies report a high negative predictive value of IONM (92–100%) but also a low and unstable positive predictive value of 10–100%, which divines no postoperative voice changes when the signal feedback is registered [ 2 , 4 , 15 ]. Likewise, the IONM system used in our study (CLEO, the only accessible tool in our hospital in those years) was based on acoustic signalling only whilst visual EMG curve analysis provides much more information for nerve prognostication.…”

Section: Discussionmentioning

confidence: 99%

“…Recurrent laryngeal nerve palsy (RLNP) remains the most dreaded complication in thyroid surgery. Possible mechanisms leading to RLNP include nerve transection, ligation or clamping, thermal injury as a side ef-fect of energy-based hemostatic devices, vacuum pressure, ischemia and -most commonly -traction on the nerve and forced manipulation at the region of Berry's ligament [1][2][3][4][5]. An inappropriate intubation, postoperative cicatricial tissue formation and haematoma are also potential causes of nerve dysfunction.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

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“…In the three cases, the vagus nerve occupied a medial position in the carotid sheath. The search for the nerve in these cases can be done with intraoperative pneuromonitoring (Pardal-Refoyo, 2012;Cai et al;Gao et al, 2014;Juárez-Ferrer et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

Prevalence of the Right Nonrecurrent Inferior Laryngeal Nerve in a Series of 100 Total Thyroidectomies

et al. 2018

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The right nonrecurrent inferior laryngeal nerve (NRILN) is a rare occurrence generally associated with an aberrant right subclavian artery. Its prevalence ranges from 0.3 to 1.8 %. It is found mainly in thyroid surgeries, the most frequently performed cervical surgeries. This neural anomaly is almost never diagnosed preoperatively. Dysphagia may be a warning symptom, sometimes being incorrectly related to esophageal compression due to a goiter or thyroid cancer. The postoperative diagnosis of an accompanying aberrant right subclavian artery should be done to confirm the clinical picture and inform the patient of any possible future medical/ surgical procedures. The aim of this work is to determine the prevalence of the NRILN in patients undergoing total thyroidectomy in two reference centers for head and neck surgery in Paraguay. Prospective cross-sectional study in a series of 100 consecutive total thyroidectomies in the INCAN and the ORL Service in the Hospital Central of the IPS. 100 patients underwent a total thyroidectomy, 90 of whom were women. The average age was 47 years. 6 % also underwent a neck dissection for thyroid cancer. The preoperative diagnosis was multinodular goiter (MNG) in 84 cases and thyroid cancer in the remaining 16 (16 %). In one man aged 47 years (1 %) operated on for MNG and presenting slight to solid dysphagia, there was difficulty finding the right NRILN. It was located at the level of the lower edge of the inferior pharyngeal constrictor and its downward anomalous course was proven. Postoperatively, after confirmation of the diagnosis that the thyroid pathology was benign, a color echo-Doppler and a CT angiography corroborated the diagnosis of an associated aberrant right subclavian artery. Given the difficulty in locating the recurrent inferior laryngeal nerve in thyroid surgery, it is advisable to consider the possibility that it may be nonrecurrent and should be looked for at the level of its entrance to the larynx below the inferior constrictor. In such cases it is recommended that the patient be examined postoperatively to rule out an associated vascular anomaly. A tomography study of each patient with a thyroid pathology and dysphagia could contribute to the diagnosis of the vascular anomaly and maximize precautions in the nerve dissection, including use of a neurostimulator. The NRILN is a rare entity. In this case study, it represents 1 % of the patients operated on for thyroid pathology in the INCAN and IPS in a 1-year period (July 2016-June 2017).

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“…[7][8][9][10][11][12][13] Intraoperative neuromonitoring can also help to predict and prognosticate the degree of RLN nerve injury. [14][15][16][17] Previous studies of normative EMG data have been done in American and European populations.…”

Section: Role Of Intraoperative Neuromonitoringmentioning

confidence: 99%

Experience of Intraoperative Recurrent Laryngeal Nerve monitoring in a Single Center-normative Recurrent Laryngeal Nerve Electromyographic Data

Parameswaran¹,

Soh²,

Lee³

et al. 2017

World Journal of Endocrine Surgery

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Usefulness of Neuromonitoring in Thyroid Surgery

Cited by 8 publications

References 41 publications

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

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

Prevalence of the Right Nonrecurrent Inferior Laryngeal Nerve in a Series of 100 Total Thyroidectomies

Experience of Intraoperative Recurrent Laryngeal Nerve monitoring in a Single Center-normative Recurrent Laryngeal Nerve Electromyographic Data

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