Tiroid Cerrahisi Sırasında Sinyal Kaybı Gelişiminde Klinik Faktörlerin Rolü

Year 2023, Volume: 76 Issue: 3, 244 - 251, 30.06.2024

Can Konca , Atilla Halil Elhan

https://doi.org/10.4274/atfm.galenos.2023.53765

Abstract

Ethical Statement

This study has been approved by the Ankara University Faculty of Medicine, Human Research Ethics Committee (decision no: İ07-506-23, date: 21.08.2023).

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The Role of Clinical Factors in the Development of Loss of Signal During Thyroid Surgery

Abstract

Objectives: This study aims to identify clinical parameters beyond recurrent laryngeal nerve (RLN) anatomy contributing to loss of signal (LOS) during thyroid surgery.

Materials and Methods: We retrospectively analyzed the records of 171 initial thyroid surgery patients under intraoperative nerve monitoring (IONM) by a single surgeon. Patient characteristics, surgical details, and LOS data were recorded. All surgical procedures were performed using intermittent IONM in accordance with international guideline statements. Patients were categorized according to the presence of LOS (LOS+ and LOS-), and logistic regression analysis was used to identify LOS-related factors.

Results: Among 171 patients, 8 (4.7%) experienced LOS. LOS+ cases showed significantly lower tumor/nodule size and thyroid volume. No significant differences were observed in other variables between the LOS+ and LOS- groups. Logistic regression analysis identified tumor/nodule size ≤10 mm (p=0.006) and thyroid volume ≤12 mL (p=0.013) as significant factors. In 8 LOS+ patients, traction injuries were prevalent (87.5%), mainly at the level of Berry’s ligament, left-sided, and single-branch nerve anatomy in 87.5%. Complete recovery of LOS occurred in 37.5% of LOS+ cases after the termination of traction.

Conclusion: Small thyroid volume increases the risk of the development of LOS, due to excessive RLN stretching during surgery. Our findings highlight the importance of minimizing traction and using continuous IONM to prevent LOS and subsequent vocal cord paralysis.

Key Words: Thyroidectomy, Electromyography, Vocal Cord Paralysis, Loss of Signal, Intraoperative Neuromonitoring

Keywords

Thyroidectomy , Electromyography , Vocal Cord Paralysis , Loss of Signal , Intraoperative Neuromonitoring

Ethical Statement

This study has been approved by the Ankara University Faculty of Medicine, Human Research Ethics Committee (decision no: İ07-506-23, date: 21.08.2023).

Supporting Institution

-

Project Number

-

Thanks

-

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