Intraoperative recurrent laryngeal nerve monitoring in revision thyroidectomy.
Recurrent laryngeal nerve (RLN) palsy is one of the most important complications after thyroid and parathyroid surgery. There is controversy in the literature regarding whether or not intraoperative nerve monitoring decreases the risk of injury. We report our experience using Nerve Integrity Monitoring (NIM) system in cases of revision thyroidectomy, providing clear indications for its use. A series of 97 patients who underwent revision thyroidectomy with and without intraoperative NIM alternately was evaluated. There were 121 RLN patients at risk. Use of NIM during revision thyroidectomy was not statistically significant compared to revision operation without monitoring (p value = 0.059). Furthermore, comparison of operative times either with or without NIM showed that use of NIM led to statistically significant prolonged operation time (p value <0.001). There is no strict indication to use RLN monitoring during thyroid surgery, especially as there is no statistical evidence that the use of this technique decreases the incidence of RLN palsy, although there is a trend especially in difficult revision cases.
Department of Otorhinolaryngology, University of Crete School of Medicine, A Building 3rd Floor, University Hospital of Crete, University Avenue, 71110 Heraklion, Crete, Greece.
Emmanuel
E
Prokopakis
Antigoni
A
Kaprana
Stylianos
S
Velegrakis
Irene
I
Panagiotaki
Nikolaos
N
Chatzakis
Heinrich
H
Iro
George
G
Velegrakis
D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000209:etiology*; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012009:Recurrent Laryngeal Nerve / Q000503:physiopathology*; D061226:Recurrent Laryngeal Nerve Injuries / Q000209:etiology* / Q000517:prevention & control; D012086:Reoperation; D013965:Thyroidectomy / Q000379:methods; D014826:Vocal Cord Paralysis / Q000209:etiology* / Q000517:prevention & control