[Intraoperative neuromonitoring of the recurrent laryngeal nerve - results and learning curve].
Intraoperative neuromonitoring was introduced in thyroid surgery several years ago resulting in a facilitated identification of the recurrent laryngeal nerve and less recurrent laryngeal nerve injuries. Between 1999 and 2004 data of all patients (n=937) undergoing thyroid resection were recorded prospectively and analyzed yearly. The intraoperative identification of recurrent laryngeal nerve succeeded in 99.2% (1665 nerves at risk). The percentage of completely resecting surgical procedures raised from 17% to 56%. Minimal vocal cord dysfunction associated with hematoma and edema in most cases was diagnosed laryngosopically in 1.4-2.4%. Transient recurrent nerve palsies were seen in 2.3% without changes throughout the years. The permanent palsy rate of 0.8% in the first years decreased. No permanent palsies were diagnosed in the last 3 years. Routine introduction of intraoperative neuromonitoring in thyroid surgery is associated with a demonstrable learning curve lasting several years. Permanent palsy rate is decreased. The rate of minimal vocal cord movement disorders and transient recurrent laryngeal nerve palsies is not changed.
Jonas
J
J
Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Städtisches Klinikum Karlsruhe. AllgemeinChirurgie@klinikum-karlsruhe.de
Bähr
R
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004558:Electric Stimulation; D004567:Electrodes, Implanted; D004568:Electrodiagnosis / Q000295:instrumentation*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications / Q000175:diagnosis / Q000503:physiopathology* / Q000517:prevention & control; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation*; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012009:Recurrent Laryngeal Nerve / Q000503:physiopathology; D061226:Recurrent Laryngeal Nerve Injuries; D012086:Reoperation; D012307:Risk Factors; D009435:Synaptic Transmission / Q000502:physiology; D013959:Thyroid Diseases / Q000601:surgery*; D013964:Thyroid Neoplasms / Q000601:surgery*; D013965:Thyroidectomy; D014630:Vagus Nerve / Q000503:physiopathology; D014826:Vocal Cord Paralysis / Q000175:diagnosis / Q000503:physiopathology* / Q000517:prevention & control