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Langenbeck's Archives of Surgery

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Open Access 01-06-2017 | RAPID COMMUNICATIONS

Experience with intraoperative neuromonitoring of the recurrent laryngeal nerve improves surgical skills and outcomes of non-monitored thyroidectomy

Authors: Beata Wojtczak, Krzysztof Sutkowski, Krzysztof Kaliszewski, Mateusz Głód, Marcin Barczyński

Published in: Langenbeck's Archives of Surgery | Issue 4/2017

Abstract

Purpose

Intraoperative neuromonitoring (IONM) can serve as a tool to increase skills in recurrent laryngeal nerve (RLN) identification and complete removal of thyroid tissue. The aim of this study was to validate this hypothesis.

Methods

This prospective study involved 632 patients (1161 RLNs at risk) who underwent thyroid surgery in 2011–2014. Although IONM was not used until 2012, this prospective study started on 1 January 2011. The three participating surgeons knew about the study before that date and that the rate of RLN identification would be carefully measured in total and near-total surgery. Solely, visual identification of the RLN was used throughout 2011. IONM was introduced as a training tool in 2012–2014 for the first 3 months of each year. In the remaining months, thyroid operations were performed without IONM. Outcomes of non-monitored thyroid operations were compared before (01-12/2011) vs. after (04-12/2012–2014) 3 months of exposure to IONM yearly (01-03/2012–2014). The rate of RLN identification was assessed in total and near-total thyroidectomies and in totally resected lobes in Dunhill’s operation. The prevalence of RLN injury and the utilization of total thyroidectomy were evaluated.

Results

In 2011, the rate of successful RLN visual identification in total and near-total thyroidectomies and in totally resected lobes in Dunhill’s operation was 45.71 %. After the introduction of IONM in 2012–2014, in the procedures performed without IONM, the rate was 86.66, 90.81, and 91.3 %. The prevalence of RLN injury in 2011 was 6.8 %, while in the years following the introduction of IONM, it was 3.61, 2.65, and 1.45 %. Utilization of total thyroidectomy increased from 47.9 % in 2011 to 100 % in 2014.

Conclusions

Experience with IONM led to an increase in RLN identification (p < 0.0001), a decrease of RLN injury (p < 0.05), and an increase in the safe utilization of total thyroidectomy (p < 0.0001) in non-monitored thyroid operations. IONM is a valuable tool for surgical training.

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Title: Experience with intraoperative neuromonitoring of the recurrent laryngeal nerve improves surgical skills and outcomes of non-monitored thyroidectomy
Authors: Beata Wojtczak
Krzysztof Sutkowski
Krzysztof Kaliszewski
Mateusz Głód
Marcin Barczyński
Publication date: 01-06-2017
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 4/2017
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-016-1449-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Experience with intraoperative neuromonitoring of the recurrent laryngeal nerve improves surgical skills and outcomes of non-monitored thyroidectomy

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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