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Sinclair CF, Buczek E, Cottril E, Angelos P, Barczynski M, Ho AS, Makarin V, Musholt T, Scharpf J, Schneider R, Stack BC, Tellez MJ, Tolley N, Woodson G, Wu CW, Randolph G. Clarifying optimal outcome measures in intermittent and continuous laryngeal neuromonitoring. Head Neck 2021; 44:460-471. [PMID: 34850992 DOI: 10.1002/hed.26946] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/15/2021] [Accepted: 11/18/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Intraoperative neuromonitoring (IONM) techniques have evolved over the past decade into intermittent IONM (I-IONM) and continuous IONM (C-IONM) modes of application. Despite many prior publications on both types of IONM, there remains uncertainty about what outcomes should be measured for each form of IONM. The primary objective of this paper is to define categories of benefit for I-IONM/C-IONM and to clarify and standardize their reporting outcomes. METHODS Expert review consensus statement utilizing modified Delphi methodology. RESULTS I-IONM provides diagnosis, classification, and prevention of nerve injury through accurate and early nerve identification. C-IONM provides real-time information on nerve functional integrity and thus may prevent some types of nerve injury but cannot assist in nerve localization. Sudden mechanisms of nerve injury cannot be predicted or prevented by either technique. CONCLUSIONS I-IONM and C-IONM are complementary techniques. Future studies evaluating the utility of IONM should focus on outcomes that are appropriate to the type of IONM being utilized.
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Affiliation(s)
- Catherine F Sinclair
- Department of Otolaryngology Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Erin Buczek
- Department of Otolaryngology Head and Neck Surgery, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Elizabeth Cottril
- Department of Otolaryngology Head and Neck Surgery, Jefferson University, Philadelphia, Pennsylvania, USA
| | - Peter Angelos
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - Marcin Barczynski
- Department of Endocrine Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Allen S Ho
- Department of Otolaryngology Head and Neck Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Viktor Makarin
- Saint Petersburg State University Hospital, Saint Petersburg, Russian Federation
| | - Thomas Musholt
- Department of Endocrine Surgery, Gutenberg University Mainz, Mainz, Germany
| | - Joseph Scharpf
- Department of Otolaryngology Head and Neck Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Rick Schneider
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University of Halle-Wittenberg, Halle, Germany
| | - Brendan C Stack
- Department of Otolaryngology Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Maria J Tellez
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York, USA
| | - Neil Tolley
- Department of Otolaryngology Head and Neck Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Gayle Woodson
- Department of Otolaryngology Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Che Wei Wu
- Department of Otorhinolaryngology-Head and Neck Surgery, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Greg Randolph
- Department of Otolaryngology Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
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Scharpf J, Liu JC, Sinclair C, Singer M, Liddy W, Orloff L, Steward D, Bonilla Velez J, Randolph GW. Critical Review and Consensus Statement for Neural Monitoring in Otolaryngologic Head, Neck, and Endocrine Surgery. Otolaryngol Head Neck Surg 2021; 166:233-248. [PMID: 34000898 DOI: 10.1177/01945998211011062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Enhancing patient outcomes in an array of surgical procedures in the head and neck requires the maintenance of complex regional functions through the protection of cranial nerve integrity. This review and consensus statement cover the scope of cranial nerve monitoring of all cranial nerves that are of practical importance in head, neck, and endocrine surgery except for cranial nerves VII and VIII within the temporal bone. Complete and applied understanding of neurophysiologic principles facilitates the surgeon's ability to monitor the at-risk nerve. METHODS The American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) identified the need for a consensus statement on cranial nerve monitoring. An AAO-HNS task force was created through soliciting experts on the subject. Relevant domains were identified, including residency education, neurophysiology, application, and various techniques for monitoring pertinent cranial nerves. A document was generated to incorporate and consolidate these domains. The panel used a modified Delphi method for consensus generation. RESULTS Consensus was achieved in the domains of education needs and anesthesia considerations, as well as setup, troubleshooting, and documentation. Specific cranial nerve monitoring was evaluated and reached consensus for all cranial nerves in statement 4 with the exception of the spinal accessory nerve. Although the spinal accessory nerve's value can never be marginalized, the task force did not feel that the existing literature was as robust to support a recommendation of routine monitoring of this nerve. In contrast, there is robust supporting literature cited and consensus for routine monitoring in certain procedures, such as thyroid surgery, to optimize patient outcomes. CONCLUSIONS The AAO-HNS Cranial Nerve Monitoring Task Force has provided a state-of-the-art review in neural monitoring in otolaryngologic head, neck, and endocrine surgery. The evidence-based review was complemented by consensus statements utilizing a modified Delphi method to prioritize key statements to enhance patient outcomes in an array of surgical procedures in the head and neck. A precise definition of what actually constitutes intraoperative nerve monitoring and its benefits have been provided.
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Affiliation(s)
- Joseph Scharpf
- Cleveland Clinic Foundation Head and Neck Institute, Cleveland, Ohio, USA
| | - Jeffrey C Liu
- Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | | | | | | | - Lisa Orloff
- Stanford University, Palo Alto, California, USA
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Maneeprasopchoke P, Chongkolwatana C, Pongsapich W, Iwata AJ, Kamani D, Randolph GW. Intraoperative nerve monitoring in thyroid surgery: Analysis of recurrent laryngeal nerve identification and operative time. Laryngoscope Investig Otolaryngol 2021; 6:354-361. [PMID: 33869769 PMCID: PMC8035947 DOI: 10.1002/lio2.543] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/12/2021] [Accepted: 02/16/2021] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To evaluate the clinical value of intraoperative nerve monitoring (IONM) by comparing the procedure times for thyroidectomies performed with and without IONM. METHODS A prospective, randomized, controlled study was conducted on 32 patients (representing 41 nerves at risk) undergoing thyroidectomies carried out by two experienced head and neck surgeons (CC & WP). Sixteen thyroidectomies were performed without IONM (the "non-IONM group"), while 16 thyroidectomies were performed with IONM (the "IONM group"). The measured datapoints were setup time, time to visual identification of the recurrent laryngeal nerve (RLN), time to confirm the RLN electrophysiologically, dissection time, and total operative time. RESULTS With both surgeons, the IONM group had shorter visual times to RLN identification than the non-IONM group (CC: 3.7 minutes vs 5.3 minutes; WP: 3.4 minutes vs 9.7 minutes). Additionally, the electrophysiological identification time for the IONM group was shorter than the visual identification time for the non-IONM group. The setup times, dissection times, and total operative times of the 2 groups did not significantly differ (P > .05). No RLN injuries were observed. CONCLUSIONS IONM reduces the time needed for RLN identification in thyroidectomies. Functional RLN confirmation can reassure surgeons of the operative results. Moreover, use of IONM does not significantly impact setup and total operative times. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Prachya Maneeprasopchoke
- Department of Otorhinolaryngology, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
| | - Cheerasook Chongkolwatana
- Department of Otorhinolaryngology, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
| | - Warut Pongsapich
- Department of Otorhinolaryngology, Faculty of Medicine Siriraj HospitalMahidol UniversityBangkokThailand
| | - Ayaka J. Iwata
- Division of Thyroid and Parathyroid Surgery, Department of OtolaryngologyMassachusetts Eye and Ear Infirmary, Harvard Medical SchoolBostonMassachusettsUSA
| | - Dipti Kamani
- Division of Thyroid and Parathyroid Surgery, Department of OtolaryngologyMassachusetts Eye and Ear Infirmary, Harvard Medical SchoolBostonMassachusettsUSA
| | - Gregory W. Randolph
- Division of Thyroid and Parathyroid Surgery, Department of OtolaryngologyMassachusetts Eye and Ear Infirmary, Harvard Medical SchoolBostonMassachusettsUSA
- Division of Surgical Oncology, Department of SurgeryMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
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4
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Kim J, Moon HJ, Chai YJ, Lee JM, Hwang KT, Wu CW, Dionigi G, Kim HY, Park KS, Kim SW, Yi KH. Feasibility of Attachable Ring Stimulator for Intraoperative Neuromonitoring during Thyroid Surgery. Int J Endocrinol 2020; 2020:5280939. [PMID: 32411225 PMCID: PMC7204267 DOI: 10.1155/2020/5280939] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/23/2019] [Accepted: 12/31/2019] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Stimulator-attached dissecting instruments are useful for intraoperative nerve monitoring during thyroidectomy. The aim of this study was to evaluate the feasibility of an attachable ring stimulator (ARS) by comparing the electromyography (EMG) amplitudes evoked by an ARS and a conventional stimulator. METHODS Medical records of fourteen patients who underwent thyroidectomy using intraoperative neuromonitoring between June and August 2019 were retrospectively reviewed. The amplitudes of V1, R1, R2, and V2 signals were checked using both the ARS and a conventional stimulator, at the same point. RESULTS Both stimulators were tested on 20 recurrent laryngeal nerves (RLNs) and 20 vagus nerves (VNs). In all the nerves, the amplitudes of V1, R1, R2, and V2 were greater than 500 μV. The mean amplitudes of V1, R1, R2, and V2 checked with the ARS were 1175, 1432, 1598, and 1279 μV, respectively. The mean amplitudes of V1, R1, R2, and V2 checked with the conventional stimulator were 1140, 1425, 1557, and 1217 μV, respectively. Difference between amplitudes evoked by the two stimulators for V1, R1, R2, and V2 was 77, 110, 102, and 99 μV, respectively. There was no statistical difference in the amplitudes between the two groups for V1, R1, R2, and V2. CONCLUSION The ARS transferred electric stimulation as effectively as the conventional stimulator. It is an effective tool for repeated stimulation and facilitates continuous feedback regarding the functional integrity of nerves during thyroid surgery.
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Affiliation(s)
- Jongjin Kim
- Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul 07061, Republic of Korea
| | - Hyeon Jong Moon
- Department of Thoracic and Cardiovascular Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul 07061, Republic of Korea
| | - Young Jun Chai
- Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul 07061, Republic of Korea
| | - Jung-Man Lee
- Department of Anesthesiology and Pain Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul 07061, Republic of Korea
| | - Ki-Tae Hwang
- Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul 07061, Republic of Korea
| | - Che-Wei Wu
- Department of Otorhinolaryngology–Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Gianlorenzo Dionigi
- Division for Endocrine and Minimally Invasive Surgery, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University Hospital “G. Martino”, University of Messina, Messina, Italy
| | - Hoon Yub Kim
- Department of Surgery, KUMC Thyroid Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea
| | - Kyung Sik Park
- Department of Surgery, Konkuk University School of Medicine, Seoul 05030, Republic of Korea
| | - Sang Wan Kim
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul 07061, Republic of Korea
| | - Ka Hee Yi
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul 07061, Republic of Korea
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Abstract
Surgery for substernal goiters can be technically demanding. Extensive mediastinal extension brings the thyroid gland into close quarters with vital intrathoracic structures. Proper preoperative planning is required to determine the potential need for an extracervical approach. Assessing the risk of requiring an extracervical approach is typically based on findings from cross-sectional imaging of the neck and chest. This article addresses the important anatomical considerations when resecting a large substernal goiter and also reviews various extracervical approaches.
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Affiliation(s)
- Martin A Hanson
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, C-1064, New York, NY 10021, USA.
| | - Ashok R Shaha
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, C-1064, New York, NY 10021, USA.
| | - James X Wu
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, C-1064, New York, NY 10021, USA.
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Schneider R, Machens A, Randolph G, Kamani D, Lorenz K, Dralle H. Impact of continuous intraoperative vagus stimulation on intraoperative decision making in favor of or against bilateral surgery in benign goiter. Best Pract Res Clin Endocrinol Metab 2019; 33:101285. [PMID: 31221571 DOI: 10.1016/j.beem.2019.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The advent of continuous vagus stimulation (CVS), eliminating lag time between nerve preparation with potential trauma and stimulation, has transformed the intraoperative surgical strategy in thyroid surgery. Continuous intraoperative nerve monitoring empowers the surgeon to be optimally aware of traction-related injury to the recurrent laryngeal nerve (RLN). Electromyographic precursor lesions, called combined events, prompt surgeons to cease harmful surgical maneuvers and release the nerve before damage to the nerve is established. Complete RLN recovery, defined as restitution of the nerve amplitude to ≥50% of baseline, assures the surgeon that it is safe to pursue completion surgery of the contralateral side in one procedure. If this restitution is incomplete or absent (<50% of amplitude baseline) immediate vocal cord paralysis is likely and it is advisable to delay completion surgery until the nerve has fully recovered. This review summarizes the tremendous progress made in this dynamic field, delineating the extent to which CVS has changed the landscape: tailoring intraoperative decision making to determine the safest course of action for patients with benign goiter.
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Affiliation(s)
- Rick Schneider
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
| | - Andreas Machens
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Gregory Randolph
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA; Division of Surgical Oncology, Endocrine Surgery Service, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Dipti Kamani
- Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Kerstin Lorenz
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Henning Dralle
- Department of General, Visceral and Transplantation Surgery, Section of Endocrine Surgery, University of Duisburg-Essen, Essen, Germany
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7
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Del Rio P, Bignami E. Intraoperative monitoring in minimally invasive endocrine surgery from minimally invasive video-assisted technique to transoral endoscopic thyroidectomy vestibular approach. Gland Surg 2019; 8:315-317. [PMID: 31538052 DOI: 10.21037/gs.2018.07.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Paolo Del Rio
- Unit of General Surgery, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, Parma University Hospital, Parma, Italy
| | - Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, Parma University Hospital, Parma, Italy
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8
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Sandler ML, Sims JR, Sinclair C, Sharif KF, Ho R, Yue LE, Téllez MJ, Ulkatan S, Khorsandi AS, Brandwein-Weber M, Urken ML. Vagal schwannomas of the head and neck: A comprehensive review and a novel approach to preserving vocal cord innervation and function. Head Neck 2019; 41:2450-2466. [PMID: 30957342 DOI: 10.1002/hed.25758] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/25/2019] [Accepted: 03/18/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Schwannomas, benign tumors arising from neurolemmocytes, are the most common type of peripheral nerve tumors. Extracranial schwannomas are most often found in the parapharyngeal space, commonly involving the vagus nerve to cervical sympathetic trunk. Vagal schwannomas present several unique clinical and therapeutic challenges. METHODS A comprehensive literature review was conducted on 197 articles reporting 235 cases of cervical vagal schwannomas. Presenting symptoms, treatment approach, and postoperative outcomes were recorded and analyzed. RESULTS Vagal schwannomas commonly present as asymptomatic neck masses. When they become symptomatic, surgical resection is the standard of care. Gross total resection is associated with higher postoperative morbidity compared to subtotal resection. Initial reports using intraoperative nerve monitoring have shown improved nerve preservation. Recurrence rates are low. CONCLUSION The combination of intermittent nerve mapping with novel continuous vagal nerve monitoring techniques may reduce postoperative morbidity and could represent the future standard of care for vagal schwannoma treatment.
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Affiliation(s)
- Mykayla L Sandler
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York
| | - John R Sims
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Catherine Sinclair
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kayvon F Sharif
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York
| | - Rebecca Ho
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York
| | - Lauren E Yue
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York
| | - Maria J Téllez
- Department of Intraoperative Neurophysiology, Mount Sinai West Hospital, New York, New York
| | - Sedat Ulkatan
- Department of Intraoperative Neurophysiology, Mount Sinai West Hospital, New York, New York
| | - Azita S Khorsandi
- Department of Radiology, New York Eye & Ear Infirmary of Mount Sinai, New York, New York
| | | | - Mark L Urken
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York.,Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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9
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Schneider R, Randolph GW, Dionigi G, Wu CW, Barczynski M, Chiang FY, Al-Quaryshi Z, Angelos P, Brauckhoff K, Cernea CR, Chaplin J, Cheetham J, Davies L, Goretzki PE, Hartl D, Kamani D, Kandil E, Kyriazidis N, Liddy W, Orloff L, Scharpf J, Serpell J, Shin JJ, Sinclair CF, Singer MC, Snyder SK, Tolley NS, Van Slycke S, Volpi E, Witterick I, Wong RJ, Woodson G, Zafereo M, Dralle H. International neural monitoring study group guideline 2018 part I: Staging bilateral thyroid surgery with monitoring loss of signal. Laryngoscope 2018; 128 Suppl 3:S1-S17. [DOI: 10.1002/lary.27359] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Rick Schneider
- Martin Luther University Halle-Wittenberg; Department of General, Visceral, and Vascular Surgery; Halle Germany
| | - Gregory W. Randolph
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology; Massachusetts Eye and Ear Harvard Medical School; Boston Massachusetts
- Division of Surgical Oncology, Endocrine Surgery Service, Department of Surgery; Massachusetts General Hospital, Harvard Medical School; Boston Massachusetts
| | - Gianlorenzo Dionigi
- Division for Endocrine Surgery, at the Department of Human Pathology in Adulthood and Childhood “G. Barresi,” University Hospital G. Martino; University of Messina; Italy
| | - Che-Wei Wu
- Kaohsiung Medical University Hospital, Kaohsiung Medical University; Otolaryngology-Head and Neck Surgery; Kaohsiung Taiwan
| | - Marcin Barczynski
- Jagiellonian University, Department of Endocrine Surgery, Third Chair of General Surgery; Krakow Poland
| | - Feng-Yu Chiang
- Kaohsiung Medical University Hospital, Kaohsiung Medical University; Otolaryngology-Head and Neck Surgery; Kaohsiung Taiwan
| | - Zaid Al-Quaryshi
- University of Iowa Hospitals and Clinics, Otolaryngology; Iowa City Iowa
| | - Peter Angelos
- University of Chicago; Division of Endocrine Surgery, Department of Surgery; Chicago Illinois
| | - Katrin Brauckhoff
- Haukeland Universitetssjukehus; Department of Breast and Endocrine Surgery; Bergen Norway
| | - Claudio R. Cernea
- University of Sao Paulo Medical School; Department of Head and Neck Surgery; Sao Paulo SP Brazil
| | | | - Jonathan Cheetham
- Cornell University, Clinical Sciences, College of Veterinary Medicine; Ithaca New York
| | - Louise Davies
- VA Outcomes Group at the Veterans Affairs Medical Center; Norwich Vermont
| | - Peter E. Goretzki
- Stadtische Kliniken Neuss Lukaskrankenhaus GmbH; Neuss Nordrhein-Westfalen Germany
| | - Dana Hartl
- Institut Gustave Roussy, Otolaryngology Head & Neck Surgery; Villejuif France
| | - Dipti Kamani
- Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology; Massachusetts Eye and Ear Harvard Medical School; Boston Massachusetts
| | - Emad Kandil
- Department of Surgery; Tulane University School of Medicine; New Orleans Louisiana
| | - Natalia Kyriazidis
- State University of New York Upstate Medical University; Otolaryngology; Syracuse New York
| | - Whitney Liddy
- Northwestern University Feinberg School of Medicine Department of Psychiatry and Behavioral Sciences, Otolaryngology; Chicago Illinois
| | - Lisa Orloff
- Stanford University School of Medicine, Otolaryngology, Division of Head and Neck Surgery; Stanford California
| | | | - Jonathan Serpell
- Alfred Hospital; Melbourne Victoria Australia
- Monash University School of Languages Literatures Cultures and Linguistics; Clayton Victoria Australia
| | | | | | - Michael C. Singer
- Henry Ford Hospital, Otolaryngology-Head & Neck Surgery; Detroit Michigan
| | - Samuel K. Snyder
- University of Texas Rio Grande Valley School of Medicine; Department of General Surgery; Edinburg Texas
| | - Neil S. Tolley
- St. Mary's Hospital, Imperial College Hospitals NHS Trust, St. Mary's Hospital; London United Kingdom
| | | | - Erivelto Volpi
- Hospital das Clinicas-University of Sao Paulo Medical School; Sao Paulo Brazil
| | - Ian Witterick
- Mount Sinai Hospital; Department of Otolaryngology; Toronto Ontario Canada
| | - Richard J. Wong
- Memorial Sloan-Kettering Cancer Center, Department of Surgery, Head and Neck Service; New York New York
| | | | - Mark Zafereo
- MD Anderson Cancer Center, Head and Neck Surgery; Houston Texas U.S.A
| | - Henning Dralle
- Allgemeinchirurgie, Uniklinik Halle; Halle/Saale Germany
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10
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Gambardella C, Polistena A, Sanguinetti A, Patrone R, Napolitano S, Esposito D, Testa D, Marotta V, Faggiano A, Calò PG, Avenia N, Conzo G. Unintentional recurrent laryngeal nerve injuries following thyroidectomy: Is it the surgeon who pays the bill? Int J Surg 2018; 41 Suppl 1:S55-S59. [PMID: 28506414 DOI: 10.1016/j.ijsu.2017.01.112] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 01/27/2017] [Accepted: 01/30/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Thyroidectomy is one of the most common intervention in general surgery and, after the turn of the century, its rate has sharply increased, along with a worldwide increased incidence of differentiated thyroid cancers. Therefore, injuries of the recurrent laryngeal nerve have become one of the most frequent cause of surgical malpractice claims, mostly following surgery for benign pathology. MAIN BODY Even if the incidence of definitive paralysis is generally lower than 3%, during the last 20 years in Italy, the number of claims for damages has sharply raised. As a consequence, a lot of defensive medicine has been caused by this issue, and a witch-hunt has been accordingly triggered, so determining mostly a painful and lasting frustration for the surgeons, who sometimes are compelled to pay a lot of money for increasing insurance premiums and lawyers fees. Recurrent laryngeal nerve injury should be considered as a potentially catastrophic predictable but not preventable event, rather than the result of a surgical mistake. CONCLUSION Purposes of the Authors are analyzing incidence, conditions of risk, and mechanisms of recurrent laryngeal nerve injuries, underlining notes of surgical technique and defining medical practice recommendations useful to reduce the risk of malpractice lawsuits and judgments against surgeons.
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Affiliation(s)
- C Gambardella
- Division of General and Oncologic Surgery, Via Pansini 5, 80131, Napoli, Department of Cardiothoracic Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - A Polistena
- Endocrine Surgery Unit, University of Perugia, Perugia, Italy
| | - A Sanguinetti
- Endocrine Surgery Unit, University of Perugia, Perugia, Italy
| | - R Patrone
- Division of General and Oncologic Surgery, Via Pansini 5, 80131, Napoli, Department of Cardiothoracic Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - S Napolitano
- Medical Officer, Italian Air Force Medical Corps, Ministry of Defence, Rome, Italy
| | - D Esposito
- Division of General and Oncologic Surgery, Via Pansini 5, 80131, Napoli, Department of Cardiothoracic Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - D Testa
- Otolaryngology - Head and Neck Surgery Unit, Department of Cardiothoracic Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - V Marotta
- Department of Molecular and Clinical Endocrinology and Oncology, Federico II University, Naples, Italy
| | - A Faggiano
- Department of Molecular and Clinical Endocrinology and Oncology, Federico II University, Naples, Italy
| | - P G Calò
- Department of Surgical Sciences, University of Cagliari, Cittadella Universitaria, SS554, Bivio Sestu, 09042 Monserrato, CA, Italy
| | - N Avenia
- Endocrine Surgery Unit, University of Perugia, Perugia, Italy
| | - G Conzo
- Division of General and Oncologic Surgery, Via Pansini 5, 80131, Napoli, Department of Cardiothoracic Sciences, University of Campania "Luigi Vanvitelli", Italy.
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11
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Schneider R, Machens A, Randolph GW, Kamani D, Lorenz K, Dralle H. Opportunities and challenges of intermittent and continuous intraoperative neural monitoring in thyroid surgery. Gland Surg 2017; 6:537-545. [PMID: 29142846 DOI: 10.21037/gs.2017.06.08] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The number of thyroid operations and there radically continues to rise in the western hemisphere, bringing prevention of recurrent laryngeal nerve (RLN) palsy to the fore. Overall, the incidence of RLN palsy is fairly low but continues to prompt litigation for malpractice. In an effort to diminish transient, and more importantly permanent, RLN palsy rates, intraoperative neuromonitoring (IONM) has been advocated as a risk minimization tool. Recent meta-analyses of studies, many of which were limited by poor study design and the sole use of intermittent nerve stimulation, were unable to demonstrate superiority of IONM over mere anatomic RLN dissection. This is where continuous IONM (CIONM) comes into play: this technology enables the surgeon to (I) identify impending nerve injury as it unfolds; (II) release distressed nerves by reversing causative surgical maneuvers; and (III) verify functional nerve recovery after intraoperative loss of the electromyographic signal. Despite this superiority, CIONM is not devoid of methodological limitations, which need to be accounted for. This review summarizes the current key achievements of IONM; outlines opportunities for improvement regarding clinical implementation; and suggests areas of future research in this rapidly evolving field.
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Affiliation(s)
- Rick Schneider
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Andreas Machens
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Gregory W Randolph
- Division of Thyroid and Parathyroid Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Dipti Kamani
- Division of Thyroid and Parathyroid Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Kerstin Lorenz
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Henning Dralle
- Department of General, Visceral and Transplantation Surgery, Section of Endocrine Surgery, University of Duisburg-Essen, Essen, Germany
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Dionigi G, Kim HY, Wu CW, Lavazza M, Materazzi G, Lombardi CP, Anuwong A, Tufano RP. Neuromonitoring in endoscopic and robotic thyroidectomy. Updates Surg 2017; 69:171-179. [DOI: 10.1007/s13304-017-0442-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 04/01/2017] [Indexed: 12/01/2022]
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13
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Gastric acid secretion and gastrin release during continuous vagal neuromonitoring in thyroid surgery. Langenbecks Arch Surg 2017; 402:265-272. [DOI: 10.1007/s00423-017-1555-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 01/09/2017] [Indexed: 10/20/2022]
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Schneider R, Randolph GW, Barczynski M, Dionigi G, Wu CW, Chiang FY, Machens A, Kamani D, Dralle H. Continuous intraoperative neural monitoring of the recurrent nerves in thyroid surgery: a quantum leap in technology. Gland Surg 2016; 5:607-616. [PMID: 28149807 PMCID: PMC5233836 DOI: 10.21037/gs.2016.11.10] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 10/18/2016] [Indexed: 12/28/2022]
Abstract
The continuous intraoperative neural monitoring (CIONM) technique is increasingly acknowledged as a useful tool to recognize impending nerve injury and to abort the related manoeuvre to prevent nerve injury during thyroid surgery. CIONM provides valuable real-time information constantly, which is really useful during complex thyroid surgeries especially in the settings of unusual anatomy. Thus, CIONM overcomes the key methodological limitation inherent in intermittent nerve monitoring (IINOM); which is allowing the nerve to be at risk in between the stimulations. The clinically important combined electromyographic (EMG) event, indicative of impending recurrent laryngeal nerve (RLN) injury, prevents the majority of traction related injuries to the anatomically intact RLN enabling modification of the causative surgical manoeuvre in 80% of cases. These EMG changes can progress to loss of EMG signal with postoperative vocal cord palsy (VCP) if corrective action is not taken. As a further extension, CIONM also helps to identify intraoperative functional nerve recovery with restitution of amplitude to ≥50% of initial baseline; this allows continuing of resection of contralateral side. CIONM facilitates for early corrective action before permanent damage to the nerve has been done. CIONM is a recent but rapidly evolving technique, constantly being refined by various studies focusing on improvement in its implementation and interpretation, as well as on the elimination of the technical snags.
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Affiliation(s)
- Rick Schneider
- Medical Faculty, Department of General, Visceral, and Vascular Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Gregory W. Randolph
- Division of Thyroid and Parathyroid Surgery Harvard Medical School, Boston, Massachusetts, USA
| | - Marcin Barczynski
- Department of Endocrine Surgery, 3 Chair of General Surgery, Jagiellonian University, Krakow, Poland
| | | | - Che-Wei Wu
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Feng-Yu Chiang
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Andreas Machens
- Medical Faculty, Department of General, Visceral, and Vascular Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Dipti Kamani
- Division of Thyroid and Parathyroid Surgery Harvard Medical School, Boston, Massachusetts, USA
| | - Henning Dralle
- Medical Faculty, Department of General, Visceral, and Vascular Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Department of General, Visceral and Transplantation Surgery, Section of Endocrine Surgery, University of Duisburg-Essen, Essen, Germany
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Importance of latency and amplitude values of recurrent laryngeal nerve during thyroidectomy in diabetic patients. Int J Surg 2016; 35:172-178. [DOI: 10.1016/j.ijsu.2016.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/23/2016] [Accepted: 10/03/2016] [Indexed: 11/23/2022]
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Abstract
PURPOSE OF REVIEW Laryngeal nerve injury, resulting in speech and swallowing dysfunction, is a feared complication of thyroid operations. Routine visualization of the recurrent laryngeal nerve (RLN) has decreased the likelihood of nerve injury, and intraoperative nerve monitoring has been applied in the hope of further enhancing safety. RECENT FINDINGS There is conflicting evidence about the value of nerve monitoring during thyroid operations, despite ample research. The data favor nerve monitoring in certain situations, such as neck re-explorations, contralateral RLN injury, extensive or challenging dissections, invasive tumors or large goiters, and nonrecurrent or branching recurrent laryngeal nerves. Continuous intraoperative nerve monitoring may reduce the chances of excessive traction, which is the most common mechanism of injury. Nerve monitoring may also identify and protect the external branches of the superior laryngeal nerve. SUMMARY Surgeons should routinely identify recurrent laryngeal nerves during thyroid operations, and intraoperative nerve monitoring might be a useful adjunct to prevent injury. As a result of the relatively low probability of permanent recurrent laryngeal nerve injury, it is difficult to establish the absolute value of nerve monitoring. Further research may focus on continuous nerve monitoring and intraoperative monitoring of the external branches of the superior laryngeal nerves.
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Affiliation(s)
- Ivy H Gardner
- aBoston University School of MedicinebDepartment of Surgery, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, USA
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Li T, Zhou G, Yang Y, Gao ZD, Guo P, Shen ZL, Yang XD, Xie QW, Ye YJ, Jiang KW, Wang S. Identifying a Safe Range of Stimulation Current for Intraoperative Neuromonitoring of the Recurrent Laryngeal Nerve: Results from a Canine Model. Chin Med J (Engl) 2016; 129:1830-4. [PMID: 27453233 PMCID: PMC4976572 DOI: 10.4103/0366-6999.186636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN) has been widely applied during thyroid surgery. However, the safe range of stimulation intensity for IONM remains undetermined. Methods: Total thyroidectomies were performed on twenty dogs, and their RLNs were stimulated with a current of 5–20 mA (step-wise in 5 mA increments) for 1 min. The evoked electromyography (EMG) of vocal muscles before and after supramaximal stimulation were recorded and compared. Acute microstructural morphological changes in the RLNs were observed immediately postoperatively under an electron microscope. Results: The average stimulating threshold for RLNs stimulated with 15 mA and 20 mA showed no significant changes compared to the unstimulated RLNs (15 mA group: 0.320 ± 0.123 mA vs. 0.315 ± 0.097 mA, P = 0.847; 20 mA group: 0.305 ± 0.101 mA vs. 0.300 ± 0.103 mA, P = 0.758). Similar outcomes were shown in average evoked EMG amplitude (15 mA group: 1,026 ± 268 μV vs. 1,021 ± 273 μV, P = 0.834; 20 mA group: 1,162 ± 275 μV vs. 1,200 ± 258 μV, P = 0.148). However, obvious acute microstructural morphological changes were observed in the nerves that were stimulated with 20 mA. Conclusions: A stimulation intensity less than 15 mA might be safe for IONM of the RLN.
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Affiliation(s)
- Tao Li
- Department of Gastrointestinal Surgery, Surgical Oncology Laboratory, Peking University People's Hospital, Peking University, Beijing 100044, China
| | - Gang Zhou
- Department of Gastrointestinal Surgery, Surgical Oncology Laboratory, Peking University People's Hospital, Peking University, Beijing 100044, China
| | - Yang Yang
- Department of Gastrointestinal Surgery, Surgical Oncology Laboratory, Peking University People's Hospital, Peking University, Beijing 100044, China
| | - Zhi-Dong Gao
- Department of Gastrointestinal Surgery, Surgical Oncology Laboratory, Peking University People's Hospital, Peking University, Beijing 100044, China
| | - Peng Guo
- Department of Gastrointestinal Surgery, Surgical Oncology Laboratory, Peking University People's Hospital, Peking University, Beijing 100044, China
| | - Zhan-Long Shen
- Department of Gastrointestinal Surgery, Surgical Oncology Laboratory, Peking University People's Hospital, Peking University, Beijing 100044, China
| | - Xiao-Dong Yang
- Department of Gastrointestinal Surgery, Surgical Oncology Laboratory, Peking University People's Hospital, Peking University, Beijing 100044, China
| | - Qi-Wei Xie
- Department of Gastrointestinal Surgery, Surgical Oncology Laboratory, Peking University People's Hospital, Peking University, Beijing 100044, China
| | - Ying-Jiang Ye
- Department of Gastrointestinal Surgery, Surgical Oncology Laboratory, Peking University People's Hospital, Peking University, Beijing 100044, China
| | - Ke-Wei Jiang
- Department of Gastrointestinal Surgery, Surgical Oncology Laboratory, Peking University People's Hospital, Peking University, Beijing 100044, China
| | - Shan Wang
- Department of Gastrointestinal Surgery, Surgical Oncology Laboratory, Peking University People's Hospital, Peking University, Beijing 100044, China
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Cha W, Cho I, Jang JY, Cho JK, Wang SG, Park JH. Supramaximal neurostimulation with laryngeal palpation to predict postoperative vocal fold mobility. Laryngoscope 2016; 126:2863-2868. [DOI: 10.1002/lary.26011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 01/29/2016] [Accepted: 03/07/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Wonjae Cha
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute; Pusan National University Hospital; Busan South Korea
- Department of Otorhinolaryngology-Head and Neck Surgery; School of Medicine, Pusan National University; Yangsan South Korea
| | - Ilyoung Cho
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute; Pusan National University Hospital; Busan South Korea
| | - Jeon Yeob Jang
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute; Pusan National University Hospital; Busan South Korea
| | - Jae-Keun Cho
- Department of Otolaryngology-Head and Neck Surgery; Inje University Ilsan Paik Hospital and Inje University School of Medicine; Goyang South Korea
| | - Soo-Geun Wang
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute; Pusan National University Hospital; Busan South Korea
- Department of Otorhinolaryngology-Head and Neck Surgery; School of Medicine, Pusan National University; Yangsan South Korea
| | - Ji-Hwan Park
- Department of Otorhinolaryngology-Head and Neck Surgery and Biomedical Research Institute; Pusan National University Hospital; Busan South Korea
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Pardal-Refoyo JL, Ochoa-Sangrador C. Lesión bilateral del nervio laríngeo recurrente en tiroidectomía total con o sin neuromonitorización intraoperatoria. Revisión sistemática y metaanálisis. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2016; 67:66-74. [DOI: 10.1016/j.otorri.2015.02.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 01/16/2015] [Accepted: 02/01/2015] [Indexed: 12/01/2022]
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Pardal-Refoyo JL, Ochoa-Sangrador C. Bilateral Recurrent Laryngeal Nerve Injury in Total Thyroidectomy With or Without Intraoperative Neuromonitoring. Systematic Review and Meta-analysis. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2016. [DOI: 10.1016/j.otoeng.2015.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mangano A, Kim HY, Wu CW, Rausei S, Hui S, Xiaoli L, Chiang FY, Roukos DH, Lianos GD, Volpi E, Dionigi G. Continuous intraoperative neuromonitoring in thyroid surgery: Safety analysis of 400 consecutive electrode probe placements with standardized procedures. Head Neck 2015; 38 Suppl 1:E1568-74. [PMID: 26613871 DOI: 10.1002/hed.24280] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 07/26/2015] [Accepted: 09/09/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Continuous intraoperative neuromonitoring (C-IONM) is a new technology and it is appropriate to analyze its safety. METHODS C-IONM was performed according to a standardized technique to control any adverse events and electrode positioning issues. RESULTS Four hundred vagal nerve dissections were analyzed considering vagal nerve diameter, mean time effort for C-IONM probe positioning, and electrode dislocation rate. A significant superior dislocation rate in case of: (a) when a 3 mm automatic periodic stimulating (APS) electrode size was used in a vagal nerve diameter <2 mm; (b) anterior access; and (c) vagal nerve A subtype in relation (p < .05). No related additional local or systemic morbidity was registered in this series. There was a statistically significant positive relationship between increased diameter of vagal nerve and increased electromyography (EMG) amplitude (p = .03). There was also a significant increase of amplitude between initial and final vagal nerve stimulation in uneventful cases (p = .02). CONCLUSION We analyzed the technical issues to achieve improved vagal nerve critical view of safety dissection, stimulation, and C-IONM probe placement. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1568-E1574, 2016.
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Affiliation(s)
- Alberto Mangano
- First Division of Surgery, Research Center for Endocrine Surgery, Department of Surgical Sciences and Human Morphology, University of Insubria (Como-Varese), Varese, Italy
| | - Hoon Yub Kim
- Department of Surgery, Division of Breast and Endocrine Surgery, Minimally Invasive Surgery and Robotic Surgery Center, KUMC Thyroid Center Korea University, Anam Hospital Seoul, Seoul, Korea
| | - Chei-Wei Wu
- Department of Otolaryngology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Stefano Rausei
- First Division of Surgery, Research Center for Endocrine Surgery, Department of Surgical Sciences and Human Morphology, University of Insubria (Como-Varese), Varese, Italy
| | - Sun Hui
- Jilin Provincial Key Laboratory of Surgical Translational Medicine, Japan Union Hospital of Jilin University, Division of Thyroid Surgery, Changchun City, Jilin Province, China
| | - Liu Xiaoli
- Jilin Provincial Key Laboratory of Surgical Translational Medicine, Japan Union Hospital of Jilin University, Division of Thyroid Surgery, Changchun City, Jilin Province, China
| | - Feng-Yu Chiang
- Department of Otolaryngology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
| | - Dimitrios H Roukos
- Department of General Surgery Ioannina University Hospital, Centre for Biosystems and Genomic Network Medicine Ioannina University, Ioannina, Greece
| | - Georgios D Lianos
- Department of General Surgery Ioannina University Hospital, Centre for Biosystems and Genomic Network Medicine Ioannina University, Ioannina, Greece
| | - Erivelto Volpi
- Department of Head and Neck Surgery, University of São Paulo, São Paulo, Brazil
| | - Gianlorenzo Dionigi
- First Division of Surgery, Research Center for Endocrine Surgery, Department of Surgical Sciences and Human Morphology, University of Insubria (Como-Varese), Varese, Italy
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Mangano A, Mangano A, Lianos GD, Roukos DH, Caprioglio A, Dionigi G. Breakthrough targeted therapeutic approaches to squamous cell carcinoma of the head and neck. Future Oncol 2015; 11:9-12. [PMID: 25572780 DOI: 10.2217/fon.14.190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Alberto Mangano
- First Department of General Surgery, Ospedale di Circolo e Fondazione Macchi Varese, Department of Morphological & Surgical Sciences, Endocrine Surgery Research Center, Insubria University, Varese-Como, Italy
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Dionigi G, Lombardi D, Lombardi CP, Carcoforo P, Boniardi M, Innaro N, Chiofalo MG, Cavicchi O, Biondi A, Basile F, Zaccaroni A, Mangano A, Leotta A, Lavazza M, Calò PG, Nicolosi A, Castelnuovo P, Nicolai P, Pezzullo L, De Toma G, Bellantone R, Sacco R. Intraoperative neuromonitoring in thyroid surgery: a point prevalence survey on utilization, management, and documentation in Italy. Updates Surg 2014; 66:269-76. [DOI: 10.1007/s13304-014-0275-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 11/26/2014] [Indexed: 12/11/2022]
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Mangano A, Lianos GD, Boni L, Kim HY, Roukos DH, Dionigi G. Intraoperative neuromonitoring of the external branch of the superior laryngeal nerve during thyroidectomy: the need for evidence-based data and perioperative technical/technological standardization. ScientificWorldJournal 2014; 2014:692365. [PMID: 25525624 PMCID: PMC4265369 DOI: 10.1155/2014/692365] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 10/26/2014] [Accepted: 10/28/2014] [Indexed: 11/17/2022] Open
Abstract
The external branch of the superior laryngeal nerve (EBSLN) is surgically relevant since its close anatomical proximity to the superior thyroid vessels. There is heterogeneity in the EBSLN anatomy and EBSLN damage produces changes in voice that are very heterogenous and difficult to diagnose. The reported prevalence of EBSLN injury widely ranges. EBSLN iatrogenic injury is considered the most commonly underestimated complication in endocrine surgery because vocal assessment underestimates such event and laryngoscopic postsurgical evaluation does not show standardized findings. In order to decrease the risk for EBSLN injury, multiple surgical approaches have been described so far. IONM provides multiple advantages in the EBSLN surgical approach. In this review, we discuss the current state of the art of the monitored approach to the EBSLN. In particular, we summarize, providing our additional remarks, the most relevant aspects of the standardized technique brilliantly described by the INMSG (International Neuromonitoring Study Group). In conclusion, in our opinion, there is currently the need for more prospective randomized trials investigating the electrophysiological and pathological aspects of the EBSLN for a better understanding of the role of IONM in the EBSLN surgery.
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Affiliation(s)
- Alberto Mangano
- 1st Department of General Surgery Ospedale di Circolo e Fondazione Macchi Varese, Department of Human Morphology and Surgical Sciences Endocrine Surgery Research Center, Insubria University Varese-Como, 21100 Varese, Italy
| | - Georgios D. Lianos
- Department of General Surgery, Ioannina University Hospital and Centre for Biosystems and Genomic Network Medicine Ioannina University, 45110 Ioannina, Greece
| | - Luigi Boni
- 1st Department of General Surgery Ospedale di Circolo e Fondazione Macchi Varese, Department of Human Morphology and Surgical Sciences Endocrine Surgery Research Center, Insubria University Varese-Como, 21100 Varese, Italy
| | - Hoon Yub Kim
- Department of Surgery, KUMC Thyroid Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Dimitrios H. Roukos
- Department of General Surgery, Ioannina University Hospital and Centre for Biosystems and Genomic Network Medicine Ioannina University, 45110 Ioannina, Greece
| | - Gianlorenzo Dionigi
- 1st Department of General Surgery Ospedale di Circolo e Fondazione Macchi Varese, Department of Human Morphology and Surgical Sciences Endocrine Surgery Research Center, Insubria University Varese-Como, 21100 Varese, Italy
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Calò PG, Medas F, Erdas E, Pittau MR, Demontis R, Pisano G, Nicolosi A. Role of intraoperative neuromonitoring of recurrent laryngeal nerves in the outcomes of surgery for thyroid cancer. Int J Surg 2014; 12 Suppl 1:S213-7. [DOI: 10.1016/j.ijsu.2014.05.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 05/03/2014] [Indexed: 11/16/2022]
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