Value of recurrent laryngeal nerve monitoring in the operative strategy during total thyroidectomy and parathyroidectomy

Périé, Sophie; Aït-Mansour, A.; Devos, M.; Sonji, G.; Baujat, B.; Guily, Jean Lacau St

doi:10.1016/j.anorl.2012.09.007

Cited by 56 publications

(21 citation statements)

References 19 publications

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“…Thus, in the case of intraoperative LOS on the first‐operated side in a planned total thyroidectomy, the thyroid surgeon essentially has three options for surgery on the contralateral side if RLN function is intact. Figure summarizes the three options Perform staged surgery on the second side.…”

Section: Discussionmentioning

confidence: 99%

“…This strategy was applied in 13% of patients LOS on the initially operated side. After LOS on the initially operated side, resection of the contralateral side is technically possible if the surgeon has sufficient experience . However, such a procedure should be discussed in detail with the patient and weighed against the possible need for a two‐stage procedure.…”

Section: Discussionmentioning

confidence: 99%

“…Studies show that more than 80% of functionally impaired RLNs completely recover within the first 75 days after injury. Therefore, a 2‐day completion operation can be performed after 3 months with no risk of bilateral VCP . According to the literature, nerve function completely recovers within 3 to 12 months …”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Staged Thyroidectomy: A Single Institution Perspective

Sun

Zhang

et al. 2018

Laryngoscope Investig Oto

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Staged Thyroidectomy: A Single Institution Perspective

Sun

Zhang

et al. 2018

Laryngoscope Investig Oto

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“…The rate of permanent hypoparathyroidism is low (0.9% in 1 study), but the rate of transient hypocalcemia can be much higher (27.9% in the same study) (23). Bilateral vocal cord paralysis is observed in 0.2 to 0.5% of thyroidectomies but is a very significant complication (24). Thyroid lobectomy for small tumors is an accepted treatment option that avoids the risk of bilateral vocal cord paralysis, hypoparathyroidism and, in many cases, the need for thyroid hormone supplementation (9,25,26).…”

Section: Active Surveillance: a Potentially Useful And Cost-effectivementioning

confidence: 99%

Active Surveillance for Papillary Thyroid Microcarcinoma: New Challenges and Opportunities for The Health Care System

Haser

Tuttle

et al. 2016

Endocrine Practice

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Objective The dramatic increase in papillary thyroid carcinoma (PTC) is primarily a result of early diagnosis of small cancers. Active surveillance is a promising management strategy for papillary thyroid microcarcinomas (PTMCs). However, as this management strategy gains traction in the U.S., it is imperative that patients and clinicians be properly educated, patients be followed for life, and appropriate tools be identified to implement the strategy. Methods We review previous active surveillance studies and the parameters used to identify patients who are good candidates for active surveillance. We also review some of the challenges to implementing active surveillance protocols in the U.S. and discuss how these might be addressed. Results Trials of active surveillance support nonsurgical management as a viable and safe management strategy. However, numerous challenges exist, including the need for adherence to protocols, education of patients and physicians, and awareness of the impact of this strategy on patient psychology and quality of life. The Thyroid Cancer Care Collaborative (TCCC) is a portable record keeping system that can manage a mobile patient population undergoing active surveillance. Conclusion With proper patient selection, organization, and patient support, active surveillance has the potential to be a long-term management strategy for select patients with PTMC. In order to address the challenges and opportunities for this approach to be successfully implemented in the U.S., it will be necessary to consider psychological and quality of life, cultural differences, and the patient’s clinical status.

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“…Also, with revision thyroidectomy, NIM has shown a statistically significant increase in operative times [29]. Périé, et al documented that risk of bilateral RLN paralysis could be minimized by RLN monitoring in bilateral RLN dissection [11]. With the variations in the trend of operative times reported with the use of IONM, it would be reasonable to extend this debate to the parathyroid surgery as well, where established studies are still warranted.…”

Section: Reviewmentioning

confidence: 99%

Role of Intraoperative Nerve Monitoring During Parathyroidectomy to Prevent Recurrent Laryngeal Nerve Injury

Ghani

Assad

2016

Cureus

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Injury to the recurrent laryngeal nerve (RLN) is a well known, though less frequent, complication of parathyroid surgery. In recent years, the use of intraoperative nerve monitoring (IONM) has gained popularity amongst surgeons when operating on thyroid gland; however, its utilization in parathyroid surgery is not established. This trend continues to rise, despite multiple studies documenting no statistically significant difference that IONM decreases the incidence of RLN injury. Most surgeons use this technology as an adjunct to visualization alone for identification of RLN. The purpose of this review is to discuss the possible role of IONM in parathyroid surgery with regards to the accuracy, efficacy, and recent trends in the utilization of this technology. There is insufficient evidence that IONM reduces the risk of RLN injury in parathyroidectomy. Although IONM may decrease the likelihood of nerve injury by helping to identify and map the RLN during thyroidectomy, we did not find studies exclusive to parathyroid surgery to see if its use can be supported for parathyroidectomy. Despite this lack of evidence, we believe that IONM is a promising adjunct to visualization alone in detecting nerve structures during neck dissection, but more clinical trials are warranted to establish its role in preventing nerve injury in parathyroid surgery.

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Value of recurrent laryngeal nerve monitoring in the operative strategy during total thyroidectomy and parathyroidectomy

Cited by 56 publications

References 19 publications

Staged Thyroidectomy: A Single Institution Perspective

Staged Thyroidectomy: A Single Institution Perspective

Active Surveillance for Papillary Thyroid Microcarcinoma: New Challenges and Opportunities for The Health Care System

Role of Intraoperative Nerve Monitoring During Parathyroidectomy to Prevent Recurrent Laryngeal Nerve Injury

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