World Journal of Endocrine Surgery

Register      Login

VOLUME 3 , ISSUE 3 ( September-December, 2011 ) > List of Articles

RESEARCH ARTICLE

Intraoperative Monitoring of the Recurrent Laryngeal Nerve during Thyroidectomy: A Standardized Approach (Part 1)

Henning Dralle, Antonio Sitges-Serra, Peter Angelos, Manuel C Durán Poveda, Gianlorenzo Dionigi, Marcin Barczynski, Eimear Phelan, Gregory Randolph

Citation Information : Dralle H, Sitges-Serra A, Angelos P, Poveda MC, Dionigi G, Barczynski M, Phelan E, Randolph G. Intraoperative Monitoring of the Recurrent Laryngeal Nerve during Thyroidectomy: A Standardized Approach (Part 1). World J Endoc Surg 2011; 3 (3):144-150.

DOI: 10.5005/jp-journals-10002-1079

Published Online: 01-12-2011

Copyright Statement:  Copyright © 2011; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

One of the most feared complications in thyroid surgery is injury to the superior laryngeal nerve or recurrent laryngeal nerve. Neural identification during surgery is insufficient to assess nerve injury. Intraoperative nerve monitoring of the vagal nerve and recurrent laryngeal nerve during thyroid surgery is a new adjunct designed to allow better identification of nerves at risk and therefore reduce complications related to their injury. This new working tool does not substitute adequate surgical technique but merely provides the surgeon with an adjunct to routine visual identification and functional assessment. The use of nerve monitoring requires standardization of the monitoring procedure. Pursuant to this, we will discuss in two related articles the current state of the art standardized technique of nerve monitoring in thyroid surgery. The aim of part 1 is to provide a concise overview of nerve monitoring in thyroid surgery and its effectiveness. This will include a brief review of the surgical anatomy of the recurrent laryngeal nerve and the key landmarks used to identify the nerve during surgery. Part 2 will describe how to perform the standardized nerve monitoring in a step by step fashion during thyroid surgery which will diminish variable results and misleading information associated with a nonstandardized nerve monitoring procedure.


PDF Share
  1. Recurrent laryngeal nerve electrophysiologic monitoring in thyroid surgery: The standard of care? J Voice 2005;19:497-500.
  2. New technologies in ambulatory thyroid surgery. Int J Surg 2008;6:S22-25.
  3. Why monitor the recurrent laryngeal nerve in thyroid surgery? J Endocrinol Invest 2010;33:819-22.
  4. Intraoperative neuromonitoring in thyroid surgery and surgery of the parathyroid gland. Zentralb Chir 2002;127:393-94.
  5. Intraoperative neuromonitoring of surgery for benign goiter. AM J Surg 2002;183:673-78.
  6. Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery 2004;136:1310-22.
  7. Intraoperative neuromonitoring of the recurrent laryngeal nerve. Experience of 1000 consecutive patients. G Chir 2007;28:29-34.
  8. German IONM Study Group. Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery. World J Surg 2008;32:1358-66.
  9. What is the learning curve for intraoperative neuromonitoring in thyroid surgery? International Journal of Surgery. Int J Surg 2008;6:S7-12.
  10. The value of neurostimulation and intraoperative nerve monitoring of inferior laryngeal nerve in thyroid surgery. Otolaryngol Head Neck Surg 2009;140:866-70.
  11. The impact of intraoperative neuromonitoring (IONM) on surgical strategy in bilateral thyroid diseases. Is it worth the effort? World J Surg 2010;34:1274-84.
  12. Role of intraoperative neuromonitoring of the recurrent laryngeal nerve in high-risk thyroid surgery. J Otolaryngol Head Neck Surg 2009;38:613-18.
  13. Neuromonitoring in thyroid surgery: Attitudes, usage patterns, and predictors of use among endocrine surgeons. World J Surg 2009;33:417-25.
  14. Intraoperative monitoring of the recurrent laryngeal nerve in 151 consecutive patients undergoing thyroid surgery. Anesth Analg 2001;93:396-99.
  15. New technologies in thyroid surgery. Surg Oncol Clin N Am 2008;17:233-48.
  16. Intraoperative neuromonitoring of the recurrent laryngeal nerve-results and learning curve. Zentralbl Chir 2006;131:443-48.
  17. Validity of intraoperative neuromonitoring signals in thyroid surgery. Langenbecks Arch Surg 2004;389:499-503.
  18. Effectiveness and results of intraoperative neuromonitoring in thyroid surgery. Statement of the interdisciplinary study group on intraoperative neuromonitoring of thyroid surgery. Chirurgia 2004;75:916-22.
  19. Nerve stimulation in thyroid surgery: Is it really useful? ANZ J Surg 2007;77:377-80.
  20. Intraoperative monitoring of the recurrent laryngeal nerve during thyroid surgery revision. Otolaryngol Clin N Am 2008;41:1147-54.
  21. Identification and monitoring of the recurrent laryngeal nerve during thyroidectomy. Surg Oncol Clin N Am 2008;17:121-44.
  22. Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy. Br J Surg 2009;96:240-46.
  23. Standardization of intraoperative neuromonitoring of recurrent laryngeal nerve in thyroid operation. World J Surg 2010;34:223-29.
  24. Pitfalls of intraoperative neuromonitoring for predicting postoperative recurrent laryngeal nerve function during thyroidectomy. World J Surg 2006;30:806-12.
  25. The mechanism of recurrent laryngeal nerve injury during thyroid surgery. The application of intraoperative neuromonitoring. Surgery 2008;143:743-49.
  26. Abdullah H, Barczynski M, Bellantone R, Brauckhoff M, Carnaille B, Cherenko S, et al. In: International Intraoperative Monitoring Study Group. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: International standards guideline statement. Laryngoscope 2011;121:S1-S16.
  27. Phonatory characteristics of patients undergoing thyroidectomy without laryngeal nerve injury. Otolaryngol Head Neck Surg 1997;117:339-404.
  28. Thyroid surgery and voice-related outcomes. Aust N Z J Surg 2000;70:179-83.
  29. Prospective functional voice assessment in patients undergoing thyroid surgery. Ann Surg 2002;236:823-32.
  30. I can not sing anymore: Voice changes after thyroidectomy. Curr Surg 2003;60:554-60.
  31. Voice and swallowing changes after thyroidectomy in patients without inferior laryngeal nerve injuries. Surgery 2006;140:1026-1932.
  32. Intraoperative electrophysiologic monitoring of the recurrent laryngeal nerve. Laryngoscope 1996;106:443-49.
  33. A prospective evaluation of recurrent laryngeal nerve paralysis during thyroidectomy. Arch Surg 2000;135:204-07.
  34. Prospective analysis of the efficacy of continuous intraoperative nerve monitoring during thyroidectomy, parathyroidectomy and paratidectomy. Otolaryngol Head Neck Surg 2001;124:537-43.
  35. Advantages of RLN identification in thyroidectomy and parathyroidectomy and the importance of preoperative and postoperative laryngoscopic examination in more than 1000 nerves at risk. Laryngoscope 2002;112:124-33.
  36. Recurrent laryngeal nerve palsy after thyroidectomy with routine identification of the recurrent laryngeal nerve. Surgery 2005;137:342-47.
  37. Surgical anatomy of the recurrent laryngeal nerve. In: Randolph GW (Ed). Surgery of the Thyroid and Parathyroid Glands. Philadelphia, PA: Saunders 2003:300-42.
  38. Complications following thyroid surgery. Arch Otolaryngol Head Neck Surg 1991;117:516-18.
  39. Recurrent nerve palsy after thyroid operations-principal nerve identification and a literature review. Surgery 1994;115:139-44.
  40. Intraoperative monitoring of recurrent laryngeal nerve function. Am Surg 2000;66:595-97.
  41. The recurrent laryngeal nerve related to thyroid surgery. Am J Surg 1999;177:485-88.
  42. Anatomic configurations of the recurrent laryngeal nerve and inferior thyroid artery. Surgery 2006;139:181-87.
  43. Surgery of the thyroid gland. In: Tenta LT, Keyes GR, (Eds). Symposium on surgery of the thyroid and parathyroid glands. Vol 13. Piladelphia: WB Saunders 1980:69-83.
  44. Incidence and importance of the tubercle of Zuckerkandl in thyroid surgery. Eur J Surg 2001;167:249-54.
  45. Functional anatomy of the recurrent and superior laryngeal nerve. Langebeck's Arch Surg 2005;391:4-8.
  46. Surgical anatomy of the recurrent laryngeal nerve revisited. Otolaryngol Head Neck Surg 2005;133:514-19.
  47. Revisited anatomy of the recurrent laryngeal nerves. AM J Surg 2004;187(2):249-53.
  48. The anatomy of the inferior laryngeal nerve. Clin Otolaryngol 1997;22:362-69.
  49. The motor fibers of the recurrent laryngeal nerves are located in the anterior extralaryngeal branch. Ann Surg 2010;251:773-74.
  50. Risk factors for transient vocal cord palsy after thyroidectomy. Br J Surg 2008;95:961-68.
  51. The role of intraoperative neuromonitoring of recurrent laryngeal nerve during thyroidectomy: A comparative study on 1000 nerves at risk. Surgery 2006;140:866-72.
  52. Recurrent laryngeal nerve paralysis: Anatomy and aetiology. Otolaryngol Clin North Am 2004;37:25-44.
  53. Intraoperative electromyographic monitoring of recurrent laryngeal nerve in reoperative thyroid and parathyroid surgery. Surgery 2004;136:1107-15.
  54. Prevalence and patterns of intraoperative nerve monitoring for thyroidectomy. Otolaryngology Head and Neck Surg 2007;136:952-56.
  55. Recurrent laryngeal nerve identification and assessment during thyroid surgery: Laryngeal palpation. World J Surg 2004;28:755-60.
  56. Neuromonitoring in otology and head and neck surgery. Raven Press, New York 1992.
  57. Facial nerve monitoring in parotid surgery: The standard of care? Otolaryngol Head Neck Surg 1998;119:468-70.
  58. Intraoperative cranial nerve monitoring. Muscle Nerve 2004;29:339-51.
  59. Intraoperative neurophysiologic monitoring: Indications and techniques for common procedures in otolaryngology, head and neck surgery. Otolaryngol Clin North Am 2005;38:631-42.
  60. Electrical stimulation of the human recurrent laryngeal nerve during thyroid operation. Otolayngol Acta 1969;263:63-67.
  61. Nerve monitoring and thyroid surgery: Is it worthwhile? Clin Otolaryngol Allied Sci 1999;24:487-90.
  62. Thyroid Surgery: Neuromonitoring of the RLN during thyroid surgery. Deutsches Arzteblatt 2004;101:7.
  63. Recurrent laryngeal nerve monitoring in thyroid and parathyroid surgery. The University of Michigan experience. Laryngoscope 2002;112:1594-61.
  64. Sensitivity and specificity of intraoperative recurrent laryngeal nerve stimulation test for predicting vocal cord palsy after thyroid surgery. World J Surg 2006;30:1230-33.
  65. The value of intraoperative neuromonitoring in thyroid surgery— A prospective observational study with 926 patients. Zentralbl Chir 2003;128:187-90.
  66. Evaluation of intraoperative recurrent nerve monitoring in thyroid surgery. World J Surg 2004;28:589-91.
  67. Neuromonitoring in thyroid surgery: Prospective evaluation of intraoperative electrophysiological responses for the prediction of recurrent laryngeal nerve injury. Ann Surg 2004;240:9-17.
  68. Incidence of vocal cord paralysis with and without recurrent laryngeal nerve monitoring during thyroidectomy. Arch Otolaryngol Head Neck Surg 2007;133:481-85.
  69. Continuous laryngeal nerve integrity monitoring during thyroidectomy: Does it reduce risk of injury? Otolaryngol Head Neck Surg 2004;131:596-600.
  70. Clinical evoked electromyography for recurrent laryngeal nerve preservation: Use of an endotracheal tube electrode and postcricoid surface electrode. Laryngoscope 1998;108:1418-20.
  71. Investigation of optimal intensity and safety of electrical nerve stimulation during intraoperative neuromonitoring of the recurrent laryngeal nerve: A prospective porcine model. Head Neck 2010;32:1295-1301.
  72. Recurrent laryngeal nerve monitoring during thyroidectomy and related cervical procedures in the pediatric population. Arch Otolaryngol Head Neck Surg 2009;135:88-94.
  73. Thyroid Surgery, voice and the laryngeal examination-time for increased awareness and accurate evaluation. World Journal of Endocrine Surgery 2009;1:1-5.
  74. Recurrent laryngeal nerve monitoring: State of the art, ethical and legal issues. Surg Clin N Am 2009;89:1157-69.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.