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

Cilt: 3 Sayı: 3 30 Temmuz 2022
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Prospective Comparison of Continuous and Intermittent Intraoperative Nerve Monitoring in Thyroid Surgery

Öz

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

Anahtar Kelimeler

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

Kaynakça

  1. 1. Rosato L, Avenia N, Bernante P, De Palma M, Gulino G, Nasi PG, et al. Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World journal of surgery. 2004;28(3):271-6.
  2. 2. Rahim AAA, Ahmed ME, Hassan MA. Respiratory complications after thyroidectomy and the need for tracheostomy in patients with a large goitre. Journal of British Surgery. 1999;86(1):88-90.
  3. 3. Lahey RF. Routine dissection and demonstration of the recurrent laryngeal nerve in subtotal thyroidectomy. Surg Gynecol Obstet. 1938;66:775-7.
  4. 4. Dralle H, Sekulla C, Haerting J, Timmermann W, Neumann HJ, Kruse E, et al. Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery. 2004;136(6):1310-22.
  5. 5. Hermann M, Alk G, Roka R, Glaser K, Freissmuth M. Laryngeal recurrent nerve injury in surgery for benign thyroid diseases: effect of nerve dissection and impact of individual surgeon in more than 27,000 nerves at risk. Annals of surgery. 2002;235(2):261.
  6. 6. Chiang F-Y, Lu IC, Kuo W-R, Lee K-W, Chang N-C, Wu C-W. The mechanism of recurrent laryngeal nerve injury during thyroid surgery—the application of intraoperative neuromonitoring. Surgery. 2008;143(6):743-9.
  7. 7. Snyder SK, Lairmore TC, Hendricks JC, Roberts JW. Elucidating mechanisms of recurrent laryngeal nerve injury during thyroidectomy and parathyroidectomy. Journal of the American College of Surgeons. 2008;206(1):123-30.
  8. 8. Randolph GW, Dralle H, with the International Intraoperative Monitoring Study G, Abdullah H, Barczynski M, Bellantone R, et al. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. The Laryngoscope. 2011;121(S1):S1-S16.
  9. 9. Calo PG, Medas F, Erdas E, Pittau MR, Demontis R, Pisano G, et al. Role of intraoperative neuromonitoring of recurrent laryngeal nerves in the outcomes of surgery for thyroid cancer. International Journal of Surgery. 2014;12:S213-S7.
  10. 10. Calò PG, Medas F, Gordini L, Podda F, Erdas E, Pisano G, et al. Interpretation of intraoperative recurrent laryngeal nerve monitoring signals: the importance of a correct standardization. International Journal of Surgery. 2016;28:S54-S8.

Kaynak Göster

APA
Bozdağ, E. (2022). Prospective Comparison of Continuous and Intermittent Intraoperative Nerve Monitoring in Thyroid Surgery. Yeni Yüzyıl Journal of Medical Sciences, 3(3), 171-179. https://izlik.org/JA48BF23AR
AMA
1.Bozdağ E. Prospective Comparison of Continuous and Intermittent Intraoperative Nerve Monitoring in Thyroid Surgery. JMS. 2022;3(3):171-179. https://izlik.org/JA48BF23AR
Chicago
Bozdağ, Emre. 2022. “Prospective Comparison of Continuous and Intermittent Intraoperative Nerve Monitoring in Thyroid Surgery”. Yeni Yüzyıl Journal of Medical Sciences 3 (3): 171-79. https://izlik.org/JA48BF23AR.
EndNote
Bozdağ E (01 Temmuz 2022) Prospective Comparison of Continuous and Intermittent Intraoperative Nerve Monitoring in Thyroid Surgery. Yeni Yüzyıl Journal of Medical Sciences 3 3 171–179.
IEEE
[1]E. Bozdağ, “Prospective Comparison of Continuous and Intermittent Intraoperative Nerve Monitoring in Thyroid Surgery”, JMS, c. 3, sy 3, ss. 171–179, Tem. 2022, [çevrimiçi]. Erişim adresi: https://izlik.org/JA48BF23AR
ISNAD
Bozdağ, Emre. “Prospective Comparison of Continuous and Intermittent Intraoperative Nerve Monitoring in Thyroid Surgery”. Yeni Yüzyıl Journal of Medical Sciences 3/3 (01 Temmuz 2022): 171-179. https://izlik.org/JA48BF23AR.
JAMA
1.Bozdağ E. Prospective Comparison of Continuous and Intermittent Intraoperative Nerve Monitoring in Thyroid Surgery. JMS. 2022;3:171–179.
MLA
Bozdağ, Emre. “Prospective Comparison of Continuous and Intermittent Intraoperative Nerve Monitoring in Thyroid Surgery”. Yeni Yüzyıl Journal of Medical Sciences, c. 3, sy 3, Temmuz 2022, ss. 171-9, https://izlik.org/JA48BF23AR.
Vancouver
1.Emre Bozdağ. Prospective Comparison of Continuous and Intermittent Intraoperative Nerve Monitoring in Thyroid Surgery. JMS [Internet]. 01 Temmuz 2022;3(3):171-9. Erişim adresi: https://izlik.org/JA48BF23AR