Is the use of intraoperative nerve monitoring an effective method to reduce the rate of permanent recurrent laryngeal nerve paralysis?

Abstract

Aim: Recurrent laryngeal nerve (RLN) paralysis is a common complication of thyroid surgery. In recent years, intraoperative nerve monitoring (IONM) has been used to reduce the risk of RLN paralysis. The purpose of this study was to assess the role of IONM in reducing RLN paralysis.

Methods: A retrospective clinical study was conducted between January 2015 and January 2017 in a two-center-clinical trial at Lutfiye Nuri Burat State and Haseki Teaching and Research Hospitals. Patients who underwent thyroidectomy using IONM (Group A, n=100) or direct visual technique (Group B, n=232) were included. Patients' files were reviewed for age, body mass index, gender, American Society of Anesthesiologists score, calcium levels, complications, duration of operation and follow-up. Postoperative complications were regarded as the main outcomes.

Results: A total of 332 patients (52 male, 280 female) with a mean age of 46.4±12.9 years were enrolled. 30.1% of the patients were in Group A (IONM). Bilateral and unilateral thyroidectomies were performed in 70.8% and 29.2% of the operations, respectively. Operative time was shorter in Group A (76.9±12.0 minutes vs 97.7±27.6 minutes, p <0.001). There was no significant difference between the two groups in terms of preoperative and postoperative calcium levels (p=0.407).There was no statistically significant difference in early RLN paralysis rates between the two groups (for Group A and Group B, 10 (10%) and 34 (14%), respectively) (p=0.251) While it was not present in Group A, permanent RLN paralysis was found in 10 patients in Group B (4.3%) (p = 0.035).

Conclusion: The use of IONM may be useful in reducing the rate of permanent RLN paralysis.

Keywords

• Thyroidectomy,recurrent laryngeal,nerve monitoring

İntraoperatif sinir monitorizasyonu kalıcı rekürren laringeal sinir paralizi oranının azaltılmasında etkili bir yöntem midir?

Öz

Amaç: Rekürren laringeal sinir (RLN) paralizisi tiroid ameliyatının bilinen bir komplikasyonudur. RLN paralizisi riskini azaltmak için son yıllarda intraoperative sinir monitorizasyonu (İONM) yöntemi kullanılmaktadır. Bu çalışmanın amacı İONM kullanılmasının RLN paralizisinin azaltılmasındaki potansiyel rolünü değerlendirmektir.

Yöntemler: Ocak 2015-Ocak 2017 tarihleri arasında çift merkezli, retrospektif klinik bir çalışmada Lütfiye Nuri Burat Devlet Hastanesi ve Haseki Eğitim ve Araştırma hastanesinde yapılan tiroidektomi ameliyatları incelendi. Hastalar İONM kullanılarak yapılan troidektomi (Grup A, n=100) ve direkt görsel teknik kullanılarak yapılan troidektomi (Grup B, n=232) olarak çalışmaya dahil edildi. Hastaların dosyaları incelenerek yaş, vücut kitle indeksi, cinsiyet, ASA skoru, kalsiyum seviyeleri, komplikasyonlar, ameliyat süreleri, takip süreleri incelendi. Postoperatif komplikasyonlar esas çıktı olarak belirlendi.

Bulgular: Çalışmaya tiroid operasyonu yapılan yaş ortalamaları 46,4±12,9 yıl olan 52 erkek, 280 kadın toplam 332 hasta dahil edildi. Hastaların %30,1’i İONM kullanılan, %69,9’u kullanılmayan grupta idi. Operasyonların %70,8’i çift taraflı, %29,2’si tek taraflıydı. İONM grubunda ameliyat süreleri diğer gruptan daha kısa idi (76,9±12,0 dakika ve 97,7±27,6 dakika, p<0.001). Preoperatif ve postoperatif kalsiyum seviyeleri açısından iki grup arasında anlamlı bir fark saptanmadı (p=0.407). İki grup arasında erken dönem RLN paralizisi oranlarında istatistiksel olarak anlamlı fark saptanmadı (Grup A için 10 (%10) ve Grup B için 34 (%14) (p=0.251). İONM grubunda kalıcı RLN paralizi saptanmazken, direkt görsel teknikte istatistiksel olarak anlamlı fark oluşturan kalıcı RLN paralizi 10 hastada (% 4,3) tespit edildi (p=0,035). 

Sonuç: İONM kullanımı, direkt görsel teknikle karşılaştırıldığında geçici paralizi oranlarında fark olmasa da, kalıcı RLN paralizi oranını azaltmada faydalı olabilir.

Anahtar Kelimeler

• Tiroidektomi,rekürren laringeal,sinir monitorizasyonu

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