Prospective Comparison of Continuous and Intermittent Intraoperative Nerve Monitoring in Thyroid Surgery

Year 2022, Volume: 3 Issue: 3, 171 - 179, 30.07.2022

Emre Bozdağ

Abstract

Aim: As technology progresses further in medicine, intraoperative neuro-monitorization has become a powerful safety tool especially for thyroid surgeries. The effectiveness of intermittent or continuous intraoperative nerve monitorization (IONM) on reducing recurrent laryngeal
nerve (RLN) palsy has been a highly debated issue to ensure that RLN
does not get damaged regardless of the surgeon's experience level. In this
prospective study we compared continuous intraoperative nerve monitoring (C-IONM) with intermittent intraoperative nerve monitoring
(I-IONM) for prevention of iatrogenic RLN palsy due thyroidectomy.
Material and Methods: One hundred and nine patients aged between
18 and 75 were divided into 2 groups of 64 and 45, which received either
I-IONM or C-IONM respectively. Patients were selected for minimally
invasive surgery, and those RLN cannot be totally explored or resected
on purpose due to tumor invasion are excluded.
Results: High risk intervention rate was 54% in group 2 and was significantly higher compared with group 1 (p=0.022). Temporary and permanent vocal cord paralysis in group 1 and 2 were 4,5% - 0,6% and 2,8%
- 0% respectively. There were no significant differences between groups
(p>0,05). Multi variant analysis showed that extra laryngeal branching is
an independent risk factor for vocal cord palsy (p=0.21)
Discussion and Conclusion: C-IONM is a superior technique as it enables surgeon to detect and stop preventable RLN damage beforehand.
In order to minimize the number of RLN palsy incidences and to avoid
bilateral RLN paralysis, we believe IONM should be used as a standard
approach during thyroid surgeries

Keywords

Intermittent intraoperative neural monitorization, Continuous intraoperative neural monitorization, Recurrent Laryngeal Nerve palsy

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