Recurrent laryngeal nerve management in thyroid surgery: consequences of routine visualization, application of intermittent, standardized and continuous nerve monitoring

Angkoon Anuwong, Matteo Lavazza, Hoon Yub Kim, Che Wei Wu, Stefano Rausei, Vincenzo Pappalardo, Cesare Carlo Ferrari, Davide Inversini, Andrea Leotta, Antonio Biondi, Feng Yu Chiang, Gianlorenzo Dionigi

    Research output: Contribution to journalArticlepeer-review

    21 Citations (Scopus)

    Abstract

    The objective is to compare the consequences of routine visualization (RV) and the application of intermitted (I-IONM), standardized (S-IONM), and continuous monitoring (C-IONM) of recurrent laryngeal nerve (RLN) management. RV includes that 698 RLNs managed solely with visual identification. In a second period 777, RLNs were handled by the I-IONM. The third period 768 RLNs monitoring was performed according to the standards. C-IONM via VN stimulation included 626 RLNs. The following issues were analyzed and compared per each period study: RLN identification rate, branching detection, assessment of NRLN, intraoperative recognizable nerve damage, stage thyroidectomy rate, transient or definitive lesions, bilateral nerve palsy, and recovery time. Significance for nerve identification rate was achieved (p = 0.03) when the statistical analysis was applied between RV vs. S-IONM and C-IONM. Extralaryngeal bifurcation was identified in 21, 44, 43, and 46 of RLN dissected, respectively, per period (p = 0.005). The incidence of paralysis in identified and unidentified RLN was 3.8 % (107/2806) and 82 % (52/63), respectively. Rates of temporary/permanent RLNP were 16.7/1.7, 5/1.1, 4.5/1, and 3.1/0 % per period study, respectively (p = 0.07). Recognizable intraoperatively nerve damage was, respectively, 15, 45, 100, and 100 % for period study (p = 0.03). The recovery of injured nerves was significantly faster in C-IONM group. S-IONM and C-IONM cumulate 40-stage procedures. The standardized technique, guidelines adherences, and C-IONM allowed to (1) increase RLN identification; (2) reduce the severity of injuries in terms of (a) reset bilateral RLNP, (b) faster recovery time, and (c) lower definitive RLNP; (3) gather detection of branching and NRLN; (4) recognize nerve stress; and (5) cumulate stage procedures.

    Original languageEnglish
    Pages (from-to)331-341
    Number of pages11
    JournalUpdates in Surgery
    Volume68
    Issue number4
    DOIs
    Publication statusPublished - 2016 Dec 1

    Keywords

    • Intraoperative neuromonitoring
    • Morbidity
    • Nerve injury
    • Stage thyroidectomy
    • Thyroid surgery

    ASJC Scopus subject areas

    • Surgery

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