Evidence-based Analysis on The Clinical Impact of Intraoperative Neuromonitoring in Thyroid Surgery: State of the Art and Future Perspectives.
Laryngeal nerve injuries are one the most critical complications during thyroid and parathyroid surgery. Iatrogenic damages to the recurrent laryngeal nerve (RLN) are relevant in terms of clinical implications, economic costs, and for malpractice litigation. In order to minimize potential neural damages, a standardized surgical technique is mandatory. Intraoperatory neuromonitoring (IONM) of the RLN is an important adjunct to the traditional approach and is a reliable tool for neural mapping and in dissection and prognostication of postoperative neural function 4. Because of this, most of the iatrogenic damages are not related to direct transection, but they are visually undetectable. Notwithstanding the increasing use of IONM at this stage, there is still the need for prospective, randomized, well-powered, and well-designed trials in order to further validate (via evidence-based data) the role of IONM in thyroid surgery. The aim of this review is to provide a critical analysis of the scientific evidences on the clinical impact of IONM in thyroid surgery showing the unsolved problems and the future challenges.
Department of Surgical and Morphological Sciences, Research Center in Endocrine Surgery, 1st Division of General Surgery Ospedale di Circolo e Fondazione Macchi Insubria University Varese, Italy.
Alberto
A
Mangano
Department of Otolaryngology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan.
Che-Wei
CW
Wu
Department of Surgery, Ioannina University Hospital, Ioannina, Greece.
Georgios D
GD
Lianos
Department of Surgery, Korea University College of Medicine, Seoul, Korea.
Hoon Yub
HY
Kim
Department of Otolaryngology, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan.
Feng-Yu
FY
Chiang
Department of General Surgery, The Second Affiliated Hospital, School of Medicine Zhejiang University, Hangzhou, China.
Ping
P
Wang
Department of Thyroid and Parathyroid Surgery, China-Japan Union Hospital Jilin University e Jilin Provincial Key Laboratory of Surgical Translational Medicine, Changchun, China.
Liu
L
Xiaoli
Department of Thyroid and Parathyroid Surgery, China-Japan Union Hospital, Jilin University e Jilin Provincial, Key Laboratory of Surgical Translational Medicine, Changchun, China.
Sun
S
Hui
Cerrahpasa Medical Faculty Department of General Surgery,Istanbul University, Istanbul, Turkey.
Serkan
S
Teksöz
Istanbul University Cerrahpasa Medical, Faculty Department of General Surgery Istanbul, Turkey.
Yusuf
Y
Bukey
Department of Surgical and Morphological Sciences, Head of 1st Division of General Surgery, Head of Research Center in Endocrine Surgery, Ospedale di Circolo e Fondazione Macchi, Insubria Univerisity, Varese, Italy.
Gianlorenzo
G
Dionigi
Department of Surgical and Morphological Sciences, 1st Division of General Surgery, Ospedale di Circolo e Fondazione Macchi, Insubria Univerisity, Varese, Italy.
Stefano
S
Rausei