Intraoperative nerve monitoring in thyroid surgery: Analysis of recurrent laryngeal nerve identification and operative time

Laryngoscope Investigative Otolaryngology

article

Prachya Maneeprasopchoke MD¹  Cheerasook Chongkolwatana MD¹  Warut Pongsapich MD¹  Ayaka J. Iwata MD²  Dipti Kamani MD²  Gregory W. Randolph MD² 

[1] Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital, Mahidol University;Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School;Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Harvard Medical School

关键词: intraoperative nerve monitoring (IONM);    operative time;    recurrent laryngeal nerve (RLN);    thyroid surgery;    visual identification of RLN;   

DOI  :  10.1002/lio2.543

学科分类：环境科学（综合）

来源: Wiley

【 摘 要 】

Objective To evaluate the clinical value of intraoperative nerve monitoring (IONM) by comparing the procedure times for thyroidectomies performed with and without IONM. Methods A prospective, randomized, controlled study was conducted on 32 patients (representing 41 nerves at risk) undergoing thyroidectomies carried out by two experienced head and neck surgeons (CC & WP). Sixteen thyroidectomies were performed without IONM (the “non-IONM group”), while 16 thyroidectomies were performed with IONM (the “IONM group”). The measured datapoints were setup time, time to visual identification of the recurrent laryngeal nerve (RLN), time to confirm the RLN electrophysiologically, dissection time, and total operative time. Results With both surgeons, the IONM group had shorter visual times to RLN identification than the non-IONM group (CC: 3.7 minutes vs 5.3 minutes; WP: 3.4 minutes vs 9.7 minutes). Additionally, the electrophysiological identification time for the IONM group was shorter than the visual identification time for the non-IONM group. The setup times, dissection times, and total operative times of the 2 groups did not significantly differ ( P  > .05). No RLN injuries were observed. Conclusions IONM reduces the time needed for RLN identification in thyroidectomies. Functional RLN confirmation can reassure surgeons of the operative results. Moreover, use of IONM does not significantly impact setup and total operative times. Level of evidence 2.

【 授权许可】

CC BY|CC BY-NC-ND