title: Double probe intraoperative neuromonitoring with a standardized method in thyroid surgery.
abstract: BACKGROUND
  The purpose of this study was to evaluate the effectiveness of intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN) and the vagus nerve (VN) with a standardized approach in thyroid surgery.
  
  
  METHODS
  Retrospective study with an experimental group with which IONM was used, both with the RLN that the VN, and a control one, each consisting of 300 total thyroidectomies. Each patient underwent a pre-and post-operative videolaryngoscopy. The number of RLNs identified and the number of transient and permanent RNL injuries for each group were assessed, and then compared with χ(2) tests. In the experimental group Sensitivity, Specificity, Positive Predictability, Negative Predictability and Accuracy of IONM were evaluated, depending on the number of true positive results, false negatives, true negatives and false positives obtained by comparing the results of IONM with the post-operative videolaryngoscopies.
  
  
  RESULTS
  The results obtained for the experimental group vs. the control group were: RLNs identified 595 (99.1%) vs. 552 (92%) -P Value <0.0001; Permanent RLNs injuries 4 (1.33%) vs. 5 (1.67%) -P Value 1; transient RLNs injuries 1 (0.33%) vs. 8 (2.67%) -P Value 0.044. The IONM system, for the RLN and VN showed respectively: Sensitivity 66.7% vs. 83.3%; specificity 97.6% vs. 99.5%; Positive Predictability 22.2% vs. 62.5%; Negative Predictability 99.6% vs. 99.3%; Accuracy 97.3% vs. 99.3%.
  
  
  CONCLUSIONS
  Our study highlights that using IONM with a standardized method in thyroid surgery, improves the ability to identify the RLN and a reduction in the incidence rate of transient RLN injuries.
authors.affiliation: 5th Division of General Surgery and Surgical Special Techniques, Seconda Università di Napoli, Naples, Italy. Electronic address: massimo.defalco@unina2.it.
authors.forename: Massimo
authors.initials: M
authors.lastname: De Falco
authors.affiliation: 5th Division of General Surgery and Surgical Special Techniques, Seconda Università di Napoli, Naples, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Santangelo
authors.affiliation: 5th Division of General Surgery and Surgical Special Techniques, Seconda Università di Napoli, Naples, Italy.
authors.forename: Santolo
authors.initials: S
authors.lastname: Del Giudice
authors.affiliation: 5th Division of General Surgery and Surgical Special Techniques, Seconda Università di Napoli, Naples, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Gallucci
authors.affiliation: 5th Division of General Surgery and Surgical Special Techniques, Seconda Università di Napoli, Naples, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Parmeggiani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D007828:Laryngoscopy; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation / Q000379:methods*; D012009:Recurrent Laryngeal Nerve / Q000502:physiology; D061226:Recurrent Laryngeal Nerve Injuries / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D013965:Thyroidectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome; D014630:Vagus Nerve / Q000502:physiology; D055815:Young Adult
keywords: Intraoperative neuromonitoring; Laryngeal nerve; Thyroid surgery