Continuous intraoperative neuromonitoring (CIONM) of the recurrent laryngeal nerve is sufficient as the only neuromonitoring technique in thyroidectomy performed because of benign goitre

Zbigniew Adamczewski 1, Michał Chwałkiewicz 2, Andrzej Lewiński 3, Jan Brzeziński 2, Marek Dedecjus 4
1 - 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
2 - Department of Endocrinology and Metabolic Diseases, Polish Mother’s Memorial Hospital/Research Institute, Łódź, Poland
3 - 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
4 - Department of Oncological Endocrinology and Nuclear Medicine, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland
Ann Agric Environ Med
2015; 22 (3):
ICID: 1167722
Article type: Original article
 
 
Introduction. 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.
Material and 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.
Conclusion. 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).
DOI: 10.5604/12321966.1167722
PMID 26403123 - click here to show this article in PubMed
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