Intraoperative Monitoring of the Recurrent Laryngeal Nerve during Thyroidectomy: A Standardized Approach Part 2

ABSTRACT This is the second of two articles on intraoperative neural monitoring. The aim of part one was to provide a concise overview of intraoperative nerve monitoring in thyroid surgery and its effectiveness. Part 1 included a brief review of the surgical anatomy of the recurrent laryngeal nerve and described the surgical landmarks which can be used to identify the nerve during surgery. Part 2 will describe in detail a standardized approach to intraoperative nerve monitoring during thyroid surgery. A brief review of the nerve monitoring procedure and all its requirements will be discussed. The article concludes with the description of a troubleshooting algorithm for intraoperative loss of signal. How to cite this article Poveda MCD, Dionigi G, Sitges- Serra A, Barczynski M, Angelos P, Dralle H, Phelan E, Randolph G. Intraoperative Monitoring of the Recurrent Laryngeal Nerve during Thyroidectomy: A Standardized Approach Part 2. World J Endocr Surg 2012;4(1):33-40.

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Intraoperative Monitoring of the Recurrent Laryngeal Nerve during Thyroidectomy: A Standardized Approach (Part 1)

World Journal of Endocrine Surgery ◽

10.5005/jp-journals-10002-1079 ◽

2011 ◽

Vol 3 (3) ◽

pp. 144-150 ◽

Cited By ~ 7

Author(s):

Henning Dralle ◽

Antonio Sitges-Serra ◽

Peter Angelos ◽

Manuel C Durán Poveda ◽

Gianlorenzo Dionigi ◽

...

Keyword(s):

Recurrent Laryngeal Nerve ◽

Thyroid Surgery ◽

Superior Laryngeal Nerve ◽

Surgical Anatomy ◽

Laryngeal Nerve ◽

Nerve Monitoring ◽

Visual Identification ◽

Current State ◽

Monitoring Procedure ◽

Intraoperative Nerve Monitoring

ABSTRACT One of the most feared complications in thyroid surgery is injury to the superior laryngeal nerve or recurrent laryngeal nerve. Neural identification during surgery is insufficient to assess nerve injury. Intraoperative nerve monitoring of the vagal nerve and recurrent laryngeal nerve during thyroid surgery is a new adjunct designed to allow better identification of nerves at risk and therefore reduce complications related to their injury. This new working tool does not substitute adequate surgical technique but merely provides the surgeon with an adjunct to routine visual identification and functional assessment. The use of nerve monitoring requires standardization of the monitoring procedure. Pursuant to this, we will discuss in two related articles the current state of the art standardized technique of nerve monitoring in thyroid surgery. The aim of part 1 is to provide a concise overview of nerve monitoring in thyroid surgery and its effectiveness. This will include a brief review of the surgical anatomy of the recurrent laryngeal nerve and the key landmarks used to identify the nerve during surgery. Part 2 will describe how to perform the standardized nerve monitoring in a step by step fashion during thyroid surgery which will diminish variable results and misleading information associated with a nonstandardized nerve monitoring procedure.

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Intraoperative monitoring of the recurrent laryngeal nerve in surgeries for thyroid cancer: a review

Journal of Cancer Metastasis and Treatment ◽

10.20517/2394-4722.2021.122 ◽

2021 ◽

Author(s):

SR Priya ◽

Srinjeeta Garg ◽

Mitali Dandekar

Keyword(s):

Recurrent Laryngeal Nerve ◽

Intraoperative Monitoring ◽

Laryngeal Nerve ◽

Remote Access ◽

Minimally Invasive Procedures ◽

Invasive Procedures ◽

Nerve Monitoring ◽

The World ◽

Intraoperative Nerve Monitoring ◽

Objective Tool

Intraoperative nerve monitoring (IONM) has evolved into an objective tool not only for the identification but also for the preservation and prognostication of function of the recurrent laryngeal nerve in thyroid surgeries. Technical improvements have resulted in the increasing incorporation of IONM into operating rooms around the world. The importance of adherence to recommended standards is also recognized as being vital in optimizing the efficacy of IONM. The advent of continuous IONM has made real-time nerve monitoring possible, thus providing the surgeon with an ally in difficult surgeries. Additionally, as thyroid surgeries are evolving into remote access and minimally invasive procedures, so also is the applicability of IONM. This review focuses on the use of IONM for nerve monitoring in thyroidectomies for neoplastic conditions while discussing the rationale, technique, and interpretation of findings and their implications.

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Intraoperative nerve monitoring reduces recurrent laryngeal nerve injury in geriatric patients undergoing thyroid surgery

Acta Oto-Laryngologica ◽

10.1080/00016489.2017.1354397 ◽

2017 ◽

Vol 137 (12) ◽

pp. 1275-1280 ◽

Cited By ~ 4

Author(s):

Huang Kai ◽

Lin Xixia ◽

Long Miaoyun ◽

Chen Qinchang ◽

Peng Xinzhi ◽

...

Keyword(s):

Recurrent Laryngeal Nerve ◽

Nerve Injury ◽

Thyroid Surgery ◽

Geriatric Patients ◽

Recurrent Laryngeal Nerve Injury ◽

Laryngeal Nerve ◽

Nerve Monitoring ◽

Laryngeal Nerve Injury ◽

Intraoperative Nerve Monitoring

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Assessment of recurrent laryngeal nerve function during thyroid surgery

Annals of The Royal College of Surgeons of England ◽

10.1308/003588414x13814021676594 ◽

2014 ◽

Vol 96 (2) ◽

pp. 130-135 ◽

Cited By ~ 7

Author(s):

J Smith ◽

J Douglas ◽

B Smith ◽

T Dougherty ◽

C Ayshford

Keyword(s):

Recurrent Laryngeal Nerve ◽

Vocal Cord ◽

Direct Laryngoscopy ◽

Thyroid Surgery ◽

Vocal Cord Palsy ◽

Laryngeal Nerve ◽

Laryngeal Function ◽

Nerve Monitoring ◽

Vocal Cord Function ◽

Intraoperative Nerve Monitoring

Introduction There is disparity in the reported incidence of temporary and permanent recurrent laryngeal nerve (RLN) palsy following thyroidectomy. Much of the disparity is due to the method of assessing vocal cord function. We sought to identify the incidence and natural history of temporary and permanent vocal cord palsy following thyroid surgery. The authors wanted to establish whether intraoperative nerve monitoring and stimulation aids in prognosis when managing vocal cord palsy. Methods Prospective data on consecutive thyroid operations were collected. Intraoperative nerve monitoring and stimulation, using an endotracheal tube mounted device, was performed in all cases. Endoscopic examination of the larynx was performed on the first postoperative day and at three weeks. Results Data on 102 patients and 123 nerves were collated. Temporary and permanent RLN palsy rates were 6.1% and 1.7%. Most RLN palsies were identified on the first postoperative day with all recognised at the three-week review. No preoperative clinical risk factors were identified. Although dysphonia at the three-week follow-up visit was the only significant predictor of vocal cord palsy, only two-thirds of patients with cord palsies were dysphonic. Intraoperative nerve monitoring and stimulation did not predict outcome in terms of vocal cord function. Conclusions Temporary nerve palsy rates were consistent with other series where direct laryngoscopy is used to assess laryngeal function. Direct laryngoscopy is the only reliable measure of cord function, with intraoperative monitoring being neither a reliable predictor of cord function nor a predictor of eventual laryngeal function. The fact that all temporary palsies recovered within four months has implications for staged procedures.

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