Intraoperative Nerve Monitoring Ought to be Used In Complementary Thyroidectomy

Yıl 2023, Cilt: 20 Sayı: 2, 238 - 241, 31.08.2023

Osman Bardakçı , Faik Tatlı , İbrahim Burak Bahcecioğlu Abdullah Özgönül , Giray Akgül , Muhammet Emin Güldür , Ali Uzunköy

https://doi.org/10.35440/hutfd.1090667

Öz

Background: Injuries to the recurrent inferior laryngeal nerve (RLN) remain one of the major post-operative complications after thyroid surgery. In studies, temporary RLN damage during thyroidectomy is %2-11, and the rate of permanent RLN damage is %0.6-1.6. Complementary thyroidectomies have a higher complication rate compared to the first surgical procedure. In the last two decades, intraoperative neural monitoring has become a powerful tool for risk minimization. In our study, we aimed to retrospectively examine the pa-tients who underwent complementary thyroidectomy and intraoperative nerve monitoring.
Materials and Methods: Between January 2016 and February 2020, the files of 54 patients, who underwent complementary thyroidectomy and nerve monitoring in our clinic, were analyzed retrospectively.Patients who did not undergo nerve monitoring were not included in the study. The age, gender, pathology and indication, first surgery type, and the length of hospital stay of the patients, the reason for undergoing complementary thyroidectomy, and whether or not postoperative complications developed in the patients, were all recorded.
Results: The mean age of the patients was 44.4 (16-82 years). The average length of hospital stay of the patients was 2.37 (1-5 days). According to the initial pathology results of the patients who underwent comp-lementary thyroidectomy, 34 had papillary thyroid cancer, 6 had follicular thyroid carcinoma or suspicion, 1 had medullary thyroid carcinoma, 1 patient had Anaplastic thyroid carcinoma suspicion and 12 patients had Multinodular Goiter recurrence.
Conclusions: As a result, complementary thyroid surgery poses an important problem for surgeons. It has a high rate of complications due to the formation of scar and loss of normal tissue planes. Therefore, we think that the use of intraoperative nerve monitoring during complementary thyroidectomy surgery may be helpful in reducing the occurrence of permanent or temporary recurrent laryngeal nerve damage.

Key Words: Intraoperative Nerve Monitoring Complementary Thyroidectomy, Complication

Anahtar Kelimeler

Complication, Intraoperative Nerve Monitoring, Complementary Thyroidectomy

Tamamlayıcı Tiroidektomide İntraoperatif Sinir Monitörizasyonun Kullanılması Gereklidir

Öz

Amaç: Rekürren inferior laringeal sinir (RLN) yaralanmaları, tiroid cerrahisinden sonra en önemli postopera-tif komplikasyonlardan biri olmaya devam etmektedir. Yapılan çalışmalarda tiroidektomi sırasında geçici RLN hasarı %2-11, kalıcı RLN hasarı oranı %0.6-1.6’dır. Tamamlayıcı tiroidektomilerde ilk cerrahi işleme göre komplikasyon oranı daha fazladır. Son yirmi yılda, intraoperatif sinir monitörizasyonu riski en aza indirmek için güçlü bir araç haline geldi. Çalışmamızda; tamamlayıcı tiroidektomi sırasında intraoperatif sinir monitori-zasyonu kullanılan hastaları retrospektif olarak incelemeyi amaçladık.
Materyal ve Metod: Ocak 2016-Şubat 2020 tarihleri arasında kliniğimizde tamamlayıcı tiroidektomi ve sinir monitorizasyonu yapılan 54 hastanın dosyaları retrospektif olarak incelendi. Sinir monitorizasyonu yapılma-yan hastalar çalışmaya dahil edilmedi. Hastaların yaşı, cinsiyeti, patolojisi ve endikasyonu, ilk ameliyat şekli ve hastanede kalış süreleri, tamamlayıcı tiroidektomi uygulanma nedenleri ve hastalarda postoperatif kompli-kasyon gelişip gelişmediği kaydedildi.
Bulgular: Hastaların ortalama yaşı 44.4 (16-82 yıl) idi. Hastaların ortalama hastanede kalış süresi 2.37 (1-5 gün) idi. Tamamlayıcı tiroidektomi yapılan hastaların ilk patoloji sonuçlarına göre 34'ünde papiller tiroid kanseri, 6'sında foliküler tiroid kanseri veya şüphesi, 1'inde medüller tiroid kanseri, 1'inde Anaplastik tiroid kanseri şüphesi ve 12'sinde Multinodüler Guatr nüksü saptandı.
Sonuç: Sonuç olarak tamamlayıcı tiroid cerrahisi cerrahlar için önemli bir sorun teşkil etmektedir. Skar oluşumu ve normal doku planlarının kaybı nedeniyle komplikasyon oranı yüksektir. Bu nedenle tamamlayıcı tiroidektomi cerrahisi sırasında intraoperatif sinir monitörizasyonunun kullanılmasının kalıcı veya geçici rekürren laringeal sinir hasarı oluşumunu azaltmada yardımcı olabileceğini düşünüyoruz.

Anahtar Kelimeler

İntroperatif Sinir Monitörizasyonu, Tamamlayıcı Tiroidektomi, Komplikasyon

Kaynakça

• Referans1. Chao, T.-C., et al., Reoperative thyroid surgery. World journal of surgery, 1997. 21(6): p. 644-647.
• Referans2. Menegaux, F., et al., Secondary thyroidectomy in patients with prior thyroid surgery for benign disease: a study of 203 cases. Surgery, 1999. 126(3): p. 479-483.
• Referans3. Yarbrough, D.E., et al., Intraoperative electromyographic monitoring of the recurrent laryngeal nerve in reoperative thyroid and parathyroid surgery. Surgery, 2004. 136(6): p. 1107-1115.
• Referans4. Thomusch, O., et al., Intraoperative neuromonitoring of surgery for benign goiter. The American journal of surgery, 2002. 183(6): p. 673-678.
• 5. Abadin, S.S., E.L. Kaplan, and P. Angelos, Malpractice litigation after thyroid surgery: the role of recurrent laryngeal nerve injuries, 1989–2009. Surgery, 2010. 148(4): p. 718-723.
• Referans6. Randolph, G.W., Surgery of the thyroid and parathyroid glands: expert consult premium edition-enhanced online features and print. 2012: Elsevier Health Sciences.
• Referans7. Seiler, C.A., C. Glaser, and H.E. Wagner, Thyroid gland surgery in an endemic region. World journal of surgery, 1996. 20(5): p. 593-597.
• Referans8. Pelizzo, M., et al., Complications in thyroid resurgery: a single institutional experience on 233 patients from a whole series of 4,752 homogeneously treated patients. Endocrine, 2014. 47(1): p. 100-106.
• Referans9. Snyder, S.K., et al., Elucidating mechanisms of recurrent laryngeal nerve injury during thyroidectomy and parathyroidectomy. Journal of the American College of Surgeons, 2008. 206(1): p. 123-130.
• Referans10. Jatzko, G.R., et al., Recurrent nerve palsy after thyroid operations--principal nerve identification and a literature review. Surgery, 1994. 115(2): p. 139-144.
• Referans11. Chiang, F.-Y., et al., The mechanism of recurrent laryngeal nerve injury during thyroid surgery—the application of intraoperative neuromonitoring. Surgery, 2008. 143(6): p. 743-749.
• Referans12. Shindo, M. and N.N. Chheda, Incidence of vocal cord paralysis with and without recurrent laryngeal nerve monitoring during thyroidectomy. Archives of Otolaryngology–Head & Neck Surgery, 2007. 133(5): p. 481-485.
• Referans13. Pisanu, A., et al., Systematic review with meta-analysis of studies comparing intraoperative neuromonitoring of recurrent laryngeal nerves versus visualization alone during thyroidectomy. journal of surgical research, 2014. 188(1): p. 152-161.
• Referans14. Malik, R. and D. Linos, Intraoperative neuromonitoring in thyroid surgery: a systematic review. World journal of surgery, 2016. 40(8): p. 2051-2058.
• Referans15. Dionigi, G. and R. Dionigi, Standardization of intraoperative neuromonitoring of recurrent laryngeal nerve in thyroid operation: to the editor. World journal of surgery, 2010. 34(11): p. 2794.
• Referans16. Johnson, S. and D. Goldenberg, Intraoperative monitoring of the recurrent laryngeal nerve during revision thyroid surgery. Otolaryngologic Clinics of North America, 2008. 41(6): p. 1147-1154.
• Referans17. Shaha, A.R., Revision thyroid surgery–technical considerations. Otolaryngologic Clinics of North America, 2008. 41(6): p. 1169-1183.
• Referans18. Wojtczak, B. and M. Barczyński, Intermittent neural monitoring of the recurrent laryngeal nerve in surgery for recurrent goiter. Gland surgery, 2016. 5(5): p. 481.
• Referans19. Medas, F., et al., Complications after reoperative thyroid surgery: retrospective evaluation of 152 consecutive cases. Updates in surgery, 2019: p. 1-6.