title: [Evaluation of implementation phase of intraoperative neural monitoring of the recurrent laryngeal nerves in thyroid surgery in a district hospital].
abstract: OBJECTIVE
  Intraoperative neuromonitoring of the recurrent laryngeal nerves (RLN) has gained an increasing acceptance in thyroid surgery in nerve identification and prognostication of nerve function. However, outcomes of monitored thyroid surgery depend on surgical experience and skills in technical application of this adjunct. The aim of this paper was to evaluate the implementation stage of intraoperative neuromonitoring of the RLNs in a district unit of general surgery.
  
  
  METHODS
  This prospective study comprised of 50 patients undergoing consecutive thyroid operations during the implementation phase of intraoperative neuromonitoring of the RLNs in 08/2012--07/2013 at a district unit of general surgery in Staszów. Neuromonitoring of the RLNs was conducted in concordance with the International Neural Monitoring Study Group guideline statement, using C2 NerveMonitor (Inomed, Germany). The following parameters were analyzed: patients demographic data, mean operating time, number of identified RLNs, prevalence of loss of signal, predictive value of the method, and prevalence of temporary and permanent RLN injury assessed by videolaryngoscopy in a 6-month postoperative follow-up.
  
  
  RESULTS
  The study group comprised of 93 RLNs at risk during 50 thyroid operations (43 total thyroidectomies, and 7 lobectomies), including 46 women and 4 men, at mean age of 56.0 ± 11.1 years. Mean operating time was 109.9 ± 19.0 min. Eighty-three of 93 (89.2%) RLNs were identified intraoperatively. Technical setup problems necessitating corrections were encountered in 12 (24.0%) operations. Negative predictive value of neuromonitoring was 89.3%, while positive predictive value was 55.6%. Temporary versus permanent RLN injury was diagnosed in 7 (7.5%) vs. 6 (6.5%) nerves at risk, respectively.
  
  
  CONCLUSIONS
  Technical setup problems necessitating corrections are common during the implementation phase of the intraoperative RLNs neuromonitoring leading to a prolonged duration of surgery and limited predictive value of the method.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Pragacz
authors.forename: Marcin
authors.initials: M
authors.lastname: Barczyński
mesh_terms: D005260:Female; D006767:Hospitals, District; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D061226:Recurrent Laryngeal Nerve Injuries / Q000209:etiology / Q000517:prevention & control*; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods*