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Langenbeck's Archives of Surgery

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01-03-2013 | Original Article

IONM-guided goiter surgery leading to two-stage thyroidectomy—indication and results

Authors: Magnus Melin, Katharina Schwarz, Bernhard J. Lammers, Peter E. Goretzki

Published in: Langenbeck's Archives of Surgery | Issue 3/2013

Abstract

Purpose

Intraoperative neuromonitoring (IONM) in thyroid surgery allows for changing the operative strategy during bilateral procedures to avoid bilateral recurrent laryngeal nerve palsy (RLNP). While this strategy is comprehendible for the surgeon, the question remains, whether it is always necessary.

Methods

Two thousand five hundred forty-six patients underwent surgery with IONM between January 2008 and October 2010 (4,012 nerves at risk). We performed a retrospective review of all patients after thyroid surgery. In 98 cases, signal loss occurred on the primary side. Of these patients, 64 required bilateral surgery. We proceeded with the contralateral surgery in 24 cases. Forty operations were ended unilaterally. The second operation was performed on 18 patients in total, 16 after confirmation of primarily intact (n = 8) or recovered vocal cord function (n = 8) and twice under persisting dysfunction. Patient satisfaction was evaluated using a five-point scale.

Results

We have shown a significant difference (p = 0.017) in the rate of bilateral RLNP when signal loss on the primary side resulted in termination of the procedure compared to continuation. Our evaluation of patient satisfaction did not show a significant difference when comparing the two-stage operation to other procedures.

Conclusions

We have shown a significant difference in the rate of bilateral RLNP when comparing termination and continuation of a bilateral procedure after primary IONM signal loss. We strongly recommend a two-stage thyroidectomy after signal loss on the primary side of resection in benign bilateral goiter surgery.

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Title: IONM-guided goiter surgery leading to two-stage thyroidectomy—indication and results
Authors: Magnus Melin
Katharina Schwarz
Bernhard J. Lammers
Peter E. Goretzki
Publication date: 01-03-2013
Publisher: Springer-Verlag
Published in: Langenbeck's Archives of Surgery / Issue 3/2013
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-012-1032-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

IONM-guided goiter surgery leading to two-stage thyroidectomy—indication and results

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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