Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery.

By H. Dralle, C. Sekulla, J. Haerting, W. Timmermann, H. Neumann, E. Kruse, S. Grond, H. P. Mühlig, C. Richter, J. Voss and 5 more. Surgery, 2004

667 citations recorded by the source corpus.

BACKGROUND Recurrent laryngeal nerve monitoring (RLNM) has been suspected to reduce postoperative RLN paralysis (RLNP). However, functional outcome of RLNM in comparison with no nerve identification and visual nerve identification only has not been analyzed. METHODS Analysis of 16,448 consecutive multi-institutional operations resulted in 29,998 nerves at risk. Three groups of different RLN treatment were compared: group 1, no RLN identification; group 2, visual RLN identification; and group 3, visual RLN identification and electromyographic monitoring. RLNM was performed with a bipolar needle electrode that was placed through the cricothyroid ligament into the vocal muscle. RESULTS Risk factors for permanent RLNP were recurrent benign and malignant goiter (odds ratios, [ORs]), 4.7, and 6.7, respectively), primary surgery in thyroid malignancy (OR, 2.0), lobectomy (OR, 1.8), no nerve identification (OR, 1.4), low or medium volume hospital (OR, 1.3), and low volume surgeons (OR, 1.2). CONCLUSIONS Based on these data, visual nerve identification was identified to be the gold standard of RLN treatment in thyroid surgery. RLNM is a promising tool for nerve identification and protection in extended thyroid resection procedures. However, because of the overall low frequency of RLNP, no statistical difference compared with visual nerve identification only was reached in the setting of this study.

Subfields: Anesthesiology and Pain Medicine, Physiology, Surgery

View Paper: https://www.semanticscholar.org/paper/d88c7536e6256ced0d92f5cf59d50019e7e8da79

Citations in the corpus

• Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: International standards guideline statement (2011, background): “have shown higher sensitivity, slightly higher specificity, higher positive predictive value, and slightly higher negative predictive value for vagal stimulation as opposed to RLN stimulation in the prediction of vocal cord paralysis postoperatively.(16) Vagal stimulation allows for testing of the e”
• 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer (2009, critical): “Studies with or without intraoperative nerve monitoring demonstrate similar patient outcomes with regard to nerve injury rates (420), but studies likely have been underpowered to detect statistically significant differences (413,424).”