Intraoperative neuromonitoring of recurrent laryngeal nerve: Initial experience
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Intraoperative Neuromonitoring of Recurrent Laryngeal Nerve: Initial Experience Clinical Study D. Georgiadou, I. Perysinakis, J. Spyridakis, D. Vaidakis, S. Avlonitis, A. Katopodi, N.G. Zografos Received 02/02/2011 Accepted 21/03/2011
Abstract Background - Aim: The role of intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN) in thyroid surgery remains controversial. We present herein the initial experience in the use of the IONM of the RLN in our Department. The objective of the present study was to determine the potential role of IONM in reducing postoperative RLN palsy rate Methods: Between June 1996 and August 2010, 696 patients underwent total thyroidectomy due to benign or malignant conditions of the thyroid gland. From January 2008 to August 2010, IONM of the RLN was applied in 84 of these patients in order to identify and preserve the RLNs, whereas conventional RLN identification was used in the remaining 612 patients. Results: Eighty four total thyroidectomies and two reoperations were performed using IONM of the RLN with 170 nerves at risk and 612 total thyroidectomies and 38 re-operations with 1262 nerves at risk were performed by routine identification. The incidence of transient and permanent RLN paralysis based on nerves at risk was 0.59% (1 of 170) and 0% (0/170) with intraoperative neuromonitoring and 0.24% (3 of 1262) and 0% (0/1262) with conventional RLN identification. Conclusion: Neuromonitoring of the RLN during thyroid surgery could not be demonstrated to reduce RLN injury significantly, compared with routine RLN identification. Nevertheless, its application can be considered in selected high-risk thyroidectomies. This technological process may render safer thyroidectomies performed by junior surgeons or surgeons with low case-load.
D. Georgiadou (Corresponding author) I. Perysinakis, J. Spyridakis, D. Vaidakis, S. Avlonitis, A. Katopodi, N.G. Zografo s- Third Department of Surgery, “George Gennimatas” General Hospital, Athens, Greece e-mail: [email protected]
Key words:
Intraoperative monitoring, Recurrent laryngeal nerve, Thyroid surgery
Introduction Recurrent laryngeal nerve (RLN) palsy is the most common and serious complication after thyroidectomies and parathyroidectomies and it ranks among the leading reasons for medicolegal litigation of surgeons [1]. Several studies have shown that routine identification of the RLN has significantly reduced permanent palsy rates to 1% [2–8]. However, temporary palsy still occurs at rates of up to 6% [7], with cases involving re-exploration, radiation exposure, and large goiters resulting in a higher incidence of in-jury. Injury can occur as a result of stretch, pressure, crush, electrocautery, division and ischaemia, all of which can be difficult to assess during surgery [9]. Various methods of IONM have been described, including direct visualization of the vocal cords during dissection, intermittent monitoring techniques such as palpation of the cricothyroid after stimulation of the nerve with a disposable stimulator and
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