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Value of intra-operative neuromonitoring of the recurrent laryngeal nerve in total thyroidectomy for benign goitre

Published online by Cambridge University Press:  15 June 2015

C Page*
Affiliation:
ENT and Head & Neck Department, Amiens University Hospital, France
P Cuvelier
Affiliation:
ENT and Head & Neck Department, Amiens University Hospital, France
A Biet
Affiliation:
ENT and Head & Neck Department, Amiens University Hospital, France
V Strunski
Affiliation:
ENT and Head & Neck Department, Amiens University Hospital, France
*
Address for correspondence: Dr C Page, Service d'ORL et de Chirurgie de la Face et du Cou, Centre Hospitalier Nord, Place Victor Pauchet, 80054 Amiens CEDEX, France Fax: 0322668623 E-mail: [email protected]

Abstract

Objective:

This study aimed to evaluate the impact of intra-operative neuromonitoring of the recurrent laryngeal nerve during total thyroidectomy for benign goitre.

Methods:

A single-centre retrospective study using historical controls was conducted for a 10-year period, comprising a series of 767 patients treated by total thyroidectomy for benign goitre. Of these, 306 had intra-operative neuromonitoring of the recurrent laryngeal nerve and 461 did not. Post-operative laryngeal mobility was assessed in all patients by direct laryngoscopy before hospital discharge and at post-operative follow-up visits.

Results:

In all, 6 out of 461 patients (1.30 per cent) in the control group and 6 out of 306 patients (1.96 per cent) in the intra-operative neuromonitoring group developed permanent recurrent laryngeal nerve palsy. No statistically significant difference was observed between the two patient groups.

Conclusion:

Intra-operative neuromonitoring does not appear to affect the post-operative recurrent laryngeal nerve palsy rate or to reliably predict post-operative recurrent laryngeal nerve palsy. However, it can accurately predict good nerve function after thyroidectomy.

Type
Main Articles
Copyright
Copyright © JLO (1984) Limited 2015 

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References

1Dralle, H, Lorenz, K, Manchens, A. Verdicts on malpractice claims after thyroid surgery: emerging trend and future directions. Head Neck 2012;34:1591–6CrossRefGoogle ScholarPubMed
2Barczyński, M, Konturek, A, Cichoń, S. Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy. Br J Surg 2009;96:240–6CrossRefGoogle ScholarPubMed
3Dralle, 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;136:1310–22CrossRefGoogle ScholarPubMed
4Chan, WF, Lang, BH, Lo, CY. The role of intraoperative neuromonitoring of recurrent laryngeal nerve during thyroidectomy: a comparative study on 1000 nerves at risk. Surgery 2006;140:866–72CrossRefGoogle ScholarPubMed
5Shindo, M, Chheda, NN. Incidence of vocal cord paralysis with and without recurrent laryngeal nerve monitoring during thyroidectomy. Arch Otolaryngol Head Neck Surg 2007;133:481–5CrossRefGoogle ScholarPubMed
6Robertson, ML, Steward, DL, Gluckman, JL, Welge, J. Continuous laryngeal nerve integrity monitoring during thyroidectomy: does it reduce risk of injury? Otolaryngol Head Neck Surg 2004;131:596600CrossRefGoogle ScholarPubMed
7Thomusch, O, Sekulla, C, Walls, G, Machens, A, Dralle, H. Intraoperative neuromonitoring of surgery for benign goiter. Am J Surg 2002;183:673–8CrossRefGoogle ScholarPubMed
8Dralle, H, Sekulla, C, Lorenz, K, Brauckhoff, M, Machens, A. German IONM Study Group. Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery. World J Surg 2008;32:1358–66CrossRefGoogle Scholar
9Hermann, M, Alk, G, Roka, R, Glaser, K, Freissmuth, M. Laryngeal recurrent nerve injury in surgery for benign thyroid disease: effect of the nerve dissection and impact of individual surgeon in more than 27,000 nerves at risk. Ann Surg 2002;235:261–8CrossRefGoogle Scholar
10Sitges-Serra, A, Fontané, J, Dueñas, JP, Duque, CS, Lorente, L, Trillo, L et al. Prospective study on loss of signal on the first side during neuromonitoring of the recurrent laryngeal nerve in total thyroidectomy. Br J Surg 2013;100:662–6; discussion 666–7CrossRefGoogle ScholarPubMed
11Phelan, E, Potenza, A, Slough, C, Zurakowski, D, Kamani, D, Randolph, G. Recurrent laryngeal nerve monitoring during thyroid surgery: normative vagal and recurrent laryngeal nerve electrophysiological data. Otolaryngol Head Neck Surg 2012;147:640–6CrossRefGoogle ScholarPubMed
12Melin, M, Schwarz, K, Lammers, BJ, Goretzki, PE. IONM-guided goiter surgery leading to two-stage thyroidectomy – indication and results. Langenbecks Arch Surg 2013;398:411–18CrossRefGoogle ScholarPubMed
13Sadowski, SM, Soardo, P, Leuchter, I, Robert, JH, Triponez, F. Systematic use of recurrent laryngeal nerve neuromonitoring changes the operative strategy in planned bilateral thyroidectomy. Thyroid 2013;23:329–33CrossRefGoogle ScholarPubMed
14Laccourreye, O, Chabolle, F. Laryngeal neuromonitoring in total thyroidectomy for benign goiter: Germany leads the way! Eur Ann Otorhinolaryngol Head Neck Dis 2013;130:301–2CrossRefGoogle ScholarPubMed
15Page, C, Peltier, J, Charlet, L, Laude, M, Strunski, V. Superior approach to the inferior laryngeal nerve in thyroid surgery: anatomy, surgical technique and indications. Surg Radiol Anat 2006;28:631–6CrossRefGoogle Scholar