title: Continuous intraoperative neuromonitoring (CIONM) of the recurrent laryngeal nerve is sufficient as the only neuromonitoring technique in thyroidectomy performed because of benign goitre.
abstract: BACKGROUND
  Recently, intraoperative neurophysiological neuromonitoring (IONM) of recurrent laryngeal nerves (RLN) has been evolving quickly. This evolution touched many aspects of the technique, leading to continuous stimulation of the RLN with real time analysis of the electrical signal.
  
  
  OBJECTIVE
  The aim of the study was to estimate the value of continuous intraoperative neuromonitoring (CIONM) as the only technique for intraoperative neuromonitoring in thyroidectomy performed because of benign goitre.
  
  
  METHODS
  The study comprised 80 women qualified for thyroidectomy due to nodular goitre. The patients were divided into 4 groups depending on the technique used for RLN integrity verification: group 1 - thyroidectomy with CIONM; group 2 - thyroidectomy with direct, intermittent stimulation of RLN and vagus nerve (NX); group 3 - both CIONM and intermittent stimulation of RLN and NX; group 4 - thyroidectomy without any IONM.
  
  
  RESULTS
  Mean operation time did not differ significantly among the groups with IONM, but was significantly longer in comparison to group 4, as well as the operation's cost. In the analysed groups there was no significant difference in complication ratio.
  
  
  CONCLUSIONS
  CIONM with RLN visualization in thyroidectomy performed because of benign goitre is as safe as other methods of IONM and gives a continuous confirmation of the electrical integrity of the loop NX-RLN-vocal folds during almost the entire procedure. There is a clinical need for the development of external stimulation of NX (transdermal or trancranial), particularly for minimally invasive techniques in which access to NX is limited (i.e. transoral thyroidectomy).
authors.affiliation: 1. Department of Endocrinology and Metabolic Diseases, Medical University, Łódź, Poland 2. Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital/Research Institute, Łódź, Poland.
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Adamczewski
authors.affiliation: Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital/Research Institute, Łódź, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Chwałkiewicz
authors.affiliation: 1. Department of Endocrinology and Metabolic Diseases, Medical University, Łódź, Poland 2. Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital/Research Institute, Łódź, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Lewiński
authors.affiliation: Department of Endocrinology and Metabolic Diseases, Polish Mother's Memorial Hospital/Research Institute, Łódź, Poland.
authors.forename: Jan
authors.initials: J
authors.lastname: Brzeziński
authors.affiliation: Department of Oncological Endocrinology and Nuclear Medicine, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland.
authors.forename: Marek
authors.initials: M
authors.lastname: Dedecjus
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006042:Goiter / Q000601:surgery*; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D011044:Poland; D012009:Recurrent Laryngeal Nerve / Q000502:physiology*; D013965:Thyroidectomy / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D055815:Young Adult