J Endocr Surg.  2018 Jun;18(2):91-97. 10.16956/jes.2018.18.2.91.

The Consistency of Intraoperative Neural Monitoring in Thyroid Surgery

• Dionigi G
• Chai YJ
• Freni F
• Makay O
• Galletti B
• Galletti F
• Kim HY

• KMID: 2420764
• DOI: http://doi.org/10.16956/jes.2018.18.2.91

Abstract

Numerous operating tools and technology transfers are available for thyroid surgery teams performing open, endoscopic and robotic procedures but none, or very few, of them constitutes a mandatory prerequisite. Over the past decade, the choice of intraoperative neurophysiological monitoring (IONM) of the recurrent laryngeal nerve (RLN), has been reached certain consensus, which must at least be selected on an individual basis. Identification and intraoperative assessment of the RLN seems to be more effectively performed with IONM than solely visually or endoscopically. Today, IONM has evolved sufficiently to increase the likelihood of successful functional outcomes in many patients. The transition from the concept of intermitted neural monitoring of the RLN to that of continuous functions evaluation that must be appreciate requires highly skilled knowledge of IONM. This goal will be more likely achieved in centers highly specialized in thyroid surgery.

Keyword

Thyroid gland; Thyroidectomy; Injury; Innervation

MeSH Terms

Consensus
Humans
Intraoperative Neurophysiological Monitoring
Recurrent Laryngeal Nerve
Technology Transfer
Thyroid Gland*
Thyroidectomy

Figure

• 

  Fig. 1 The EMG signal for IONM in thyroid surgery. (A) Technology trigger: This is the first phase, a breakthrough that occurs when IONM is launched on the market generating interest and attraction, due mainly as a non-invasive devices (EMG tubes) and commercial effort. (B) Peak of inflated expectations: This is what happens when overenthusiasm and unrealistic expectations are generated. In this phase, successful applications and failures of a technology occur (first false-negative and false-positive results appearing in the literature). (C) Trough of disillusionment: This is what happens when expectations are not met and technologies become unfashionable. This may correspond to IONM limits evidence, false-negative results, specificity, sensitivity, failures, malfunctions, evidence based medicine lacking. (D) Slope of enlightenment: This is the phase of maturity, when in spite of some failures, research continues to grow, identify reliable goals, and extend applications. Furthermore IONM societies development, standardization, extended applications, CIONM, trouble shooting algorithms application. (E) The plateau of productivity: In tertiary care hospitals and academic institutions where it is performed according to both the highest professional level and standards of care, perfect knowledge of IONM, neuroanatomy, clinical judgement, endoscopic and robotics application, simplification of technology. EMG = electromyographic; IONM = intraoperative neurophysiological monitoring; CIONM = continuous intraoperative neurophysiological monitoring.

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