Document Detail


Prospective study on loss of signal on the first side during neuromonitoring of the recurrent laryngeal nerve in total thyroidectomy.
MedLine Citation:
PMID:  23341266     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Staged thyroidectomy has been recommended when loss of the signal from intraoperative nerve monitoring is observed after first-side dissection of the recurrent laryngeal nerve. There is no high-quality evidence supporting this recommendation. In addition, it is not clear whether signal loss predicts postoperative vocal cord paralysis.
METHODS: This was a prospective observational study of consecutive adult patients undergoing neuromonitored total thyroidectomy for either malignancy or multinodular goitre. The prevalence of first-side loss of signal was recorded. Surgery was completed, and vagus and laryngeal nerves on the first side were rechecked at the end of the procedure.
RESULTS: Two-hundred and ninety patients were included. Loss of signal on the first side was noted in 16 procedures (5.5 per cent). Thyroidectomy was completed and, at retesting, 15 of 16 initially silent nerves recovered an electromyographic signal with a mean(s.d.) amplitude of 132(26) mcV. Mean time to recovery was 20.2 (range 10-35) min. In no patient was the signal lost on the opposite side. Only three of 15 nerves with a recovered signal were associated with transient vocal cord dysfunction.
CONCLUSION: After loss of signal of the recurrent laryngeal nerve dissected initially, there was a 90 per cent chance of intraoperative signal recovery. In this setting, judicious bilateral thyroidectomy can be performed without risk of bilateral recurrent nerve paresis.
Authors:
A Sitges-Serra; J Fontané; J P Dueñas; C S Duque; L Lorente; L Trillo; J J Sancho
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2013-01-23
Journal Detail:
Title:  The British journal of surgery     Volume:  100     ISSN:  1365-2168     ISO Abbreviation:  Br J Surg     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-03-04     Completed Date:  2013-04-18     Revised Date:  2013-10-22    
Medline Journal Info:
Nlm Unique ID:  0372553     Medline TA:  Br J Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  662-6     Citation Subset:  AIM; IM    
Copyright Information:
© 2013 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd.
Affiliation:
Endocrine Surgery Unit, Hospital del Mar, Barcelona, Spain. asitges@hospitaldelmar.cat
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MeSH Terms
Descriptor/Qualifier:
Adult
Dissection / methods
Electromyography
Female
Goiter, Nodular / surgery
Humans
Male
Monitoring, Intraoperative / methods*
Postoperative Complications / etiology*,  physiopathology
Prospective Studies
Recovery of Function / physiology
Recurrent Laryngeal Nerve / physiology,  surgery*
Recurrent Laryngeal Nerve Injuries / prevention & control
Thyroid Neoplasms / surgery
Thyroidectomy / methods*
Vocal Cord Paralysis / etiology*,  physiopathology
Comments/Corrections
Comment In:
Br J Surg. 2013 Apr;100(5):666-7   [PMID:  23456630 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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