|
1
|
Smaxwil C, Aleker M, Altmeier J, Naddaf A, Busch M, Wagner J, Harsch S, Ploner O, Zielke A. Neuromonitoring of the Recurrent Laryngeal Nerve Reduces the Rate of Bilateral Vocal Cord Dysfunction in Planned Bilateral Thyroid Procedures. J Clin Med 2021; 10:jcm10040740. [PMID: 33673313 PMCID: PMC7918228 DOI: 10.3390/jcm10040740] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/24/2021] [Accepted: 01/31/2021] [Indexed: 02/07/2023] Open
Abstract
Purpose: Bilateral vocal cord dysfunction (bVCD) is a rare but feared complication of thyroid surgery. This long term retrospective study determined the effect of intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN) during thyroid surgeries with regard to the rate of bVCD and evaluated the frequency as well as the outcome of staged operations. Methods: Retrospective analysis of prospectively documented data (2000–2019) of a tertiary referral centers’ database. IONM started in 2000 and, since 2010, discontinuation of surgery was encouraged in planned bilateral surgeries to prevent bVCD, if non-transient loss of signal (ntLOS) occurred on the first side. Datasets of the most recent 40-month-period were assessed in detail to determine the clinical outcome of unilateral ntLOS in planned bilateral thyroid procedures. Results: Of 22,573 patients, 65 had bVCD (0.288%). The rate of bVCD decreased from 0.44 prior to 2010 to 0.09% after 2010 (p < 0.001, Chi2). Case reviews of the most recent 40 months period identified ntLOS in 113/3115 patients (3.6%, 2.2% NAR), of which 40 ntLOS were recorded during a planned bilateral procedure (n = 952, 2.1% NAR). Of 21 ntLOS occurring on the first side of the bilateral procedure, 15 procedures were stopped, subtotal contralateral resections were performed, and thyroidectomy was continued in 3 patients respectively, with the use of continuous vagal IONM. Eighteen cases of VCD were documented postop, and all but one patient had a full recovery. Seven patients had staged resections after 1 to 18 months (median 4) after the first procedure. Conclusion: IONM facilitates reduced postoperative bVCD rates. IONM is, therefore, recommendable in planned bilateral procedures. The rate of non-complete bilateral surgery after intraoperative non-transient LOS was 2%.
Collapse
Affiliation(s)
- Constantin Smaxwil
- Endocrine Center Stuttgart, Department of Endocrine Surgery, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany; (C.S.); (M.A.); (J.A.); (A.N.); (M.B.); (J.W.)
| | - Miriam Aleker
- Endocrine Center Stuttgart, Department of Endocrine Surgery, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany; (C.S.); (M.A.); (J.A.); (A.N.); (M.B.); (J.W.)
| | - Julia Altmeier
- Endocrine Center Stuttgart, Department of Endocrine Surgery, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany; (C.S.); (M.A.); (J.A.); (A.N.); (M.B.); (J.W.)
| | - Ali Naddaf
- Endocrine Center Stuttgart, Department of Endocrine Surgery, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany; (C.S.); (M.A.); (J.A.); (A.N.); (M.B.); (J.W.)
| | - Mirjam Busch
- Endocrine Center Stuttgart, Department of Endocrine Surgery, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany; (C.S.); (M.A.); (J.A.); (A.N.); (M.B.); (J.W.)
| | - Joachim Wagner
- Endocrine Center Stuttgart, Department of Endocrine Surgery, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany; (C.S.); (M.A.); (J.A.); (A.N.); (M.B.); (J.W.)
| | - Simone Harsch
- Outcomes Research Unit, Endocrine Center Stuttgart, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany;
| | - Oswald Ploner
- Endocrine Center Stuttgart, Department of Endocrinology, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany;
| | - Andreas Zielke
- Endocrine Center Stuttgart, Department of Endocrine Surgery, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany; (C.S.); (M.A.); (J.A.); (A.N.); (M.B.); (J.W.)
- Correspondence: ; Tel.: +49-711-9913301; Fax: +49-711-9913309
| |
Collapse
|
|
2
|
Cherian AJ, Chakravarthy S, Muhammed N, Chinadurai S, Gowri M, Paul MJ, Abraham DT. Thyroidectomy Audit: Effects of Specialised, High Volume Work on Key Performance Indicators. Indian J Surg 2019. [DOI: 10.1007/s12262-018-1820-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
|
3
|
Montgomery J, Melia L, O'Donnell N, MacKenzie K. Intubation trauma and the head and neck surgeon: issues with a shared airway. J R Soc Med 2016; 108:426-8. [PMID: 26609095 DOI: 10.1177/0141076815614803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jenny Montgomery
- Otolaryngology Registrars, Department of Otolaryngology, Head and Neck Surgery, Glasgow Royal Infirmary, Glasgow G4 OSF, UK
| | - Louise Melia
- Otolaryngology Registrars, Department of Otolaryngology, Head and Neck Surgery, Glasgow Royal Infirmary, Glasgow G4 OSF, UK
| | - Neil O'Donnell
- Consultant Anaesthetist, Queen Elizabeth University Hospital, Glasgow G51 4TF, UK
| | - Kenneth MacKenzie
- Consultant Otolaryngology Head and Neck Surgeon, Glasgow Royal Infirmary, Glasgow G4 OSF, UK
| |
Collapse
|