title: Loss of neuromonitoring signal during bilateral thyroidectomy: no systematic change in operative strategy according to a survey of the French Association of Endocrine Surgeons (AFCE).
abstract: BACKGROUND
  Total thyroidectomy presents a risk of bilateral vocal cord paralysis, which can lead to compromised airway. Visual Recurrent Laryngeal Nerve (RLN) identification significantly decreases this risk of RLN lesion. Yet, an anatomically intact nerve is not always functional. Intraoperative neuromonitoring (IONM) allows to test in real time the function of the RLN. In case of loss of signal (LOS) on the first operated side, some authors recommend to stop the intervention. The purpose of this study was to characterize the operative strategy of the French-speaking surgeons in case of LOS on the first side in planned bilateral thyroidectomies.
  
  
  METHODS
  An online questionnaire was sent to the surgeons of the French Association of Endocrine Surgeons (AFCE).
  
  
  RESULTS
  We collected 69 responses (response rate: 42%). Forty-six surgeons (66%) used IONM. After a signal loss, 22% (N = 10) stopped the operation in all cases, 24% (N = 11) continued the operation in case of malignant disease and stopped in cases of benign disease, and 54% (N = 25) continued the operation contralaterally.
  
  
  CONCLUSIONS
  The majority of surgeons continued the operation contralaterally as originally planned despite a loss of IONM signal at the end of the first side.
authors.affiliation: Faculty of Medicine, University of Geneva, Geneva, Switzerland.|Thoracic and Endocrine Surgery, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Lilly
authors.initials: L
authors.lastname: Khamsy
authors.affiliation: Faculty of Medicine, University of Geneva, Geneva, Switzerland.|Thoracic and Endocrine Surgery, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Constanthin
authors.affiliation: Thoracic and Endocrine Surgery, University Hospitals of Geneva, Geneva, Switzerland.|Endocrine Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Samira M
authors.initials: SM
authors.lastname: Sadowski
authors.affiliation: Faculty of Medicine, University of Geneva, Geneva, Switzerland. Frederic.triponez@hcuge.ch.|Thoracic and Endocrine Surgery, University Hospitals of Geneva, Geneva, Switzerland. Frederic.triponez@hcuge.ch.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Triponez
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring; D008297:Male; D008875:Middle Aged; D061226:Recurrent Laryngeal Nerve Injuries / Q000517:prevention & control*; D066231:Surgeons; D011795:Surveys and Questionnaires; D013965:Thyroidectomy / Q000009:adverse effects* / Q000379:methods*; D014826:Vocal Cord Paralysis / Q000517:prevention & control