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Standardization of Intraoperative Neuromonitoring of Recurrent Laryngeal Nerve in Thyroid Operation

Background The lack of standardized procedures of intraoperative neuromonitoring (IONM) during thyroid operations may lead to highly variable results, and many of these results can cause misleading information and, conversely, increase the risk of recurrent laryngeal nerve (RLN) injury. Therefore, s...

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Published in:World journal of surgery 2010-02, Vol.34 (2), p.223-229
Main Authors: Chiang, Feng-Yu, Lee, Ka-Wo, Chen, Hui-Chun, Chen, Hsiu-Ya, Lu, I-Cheng, Kuo, Wen-Rei, Hsieh, Ming-Chia, Wu, Che-Wei
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cited_by cdi_FETCH-LOGICAL-c5481-9a68a1329240d47b16286efd276986a9214933e656d7d2d9d760d06b2034658c3
cites cdi_FETCH-LOGICAL-c5481-9a68a1329240d47b16286efd276986a9214933e656d7d2d9d760d06b2034658c3
container_end_page 229
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container_start_page 223
container_title World journal of surgery
container_volume 34
creator Chiang, Feng-Yu
Lee, Ka-Wo
Chen, Hui-Chun
Chen, Hsiu-Ya
Lu, I-Cheng
Kuo, Wen-Rei
Hsieh, Ming-Chia
Wu, Che-Wei
description Background The lack of standardized procedures of intraoperative neuromonitoring (IONM) during thyroid operations may lead to highly variable results, and many of these results can cause misleading information and, conversely, increase the risk of recurrent laryngeal nerve (RLN) injury. Therefore, standardization of IONM procedures is necessary. Methods A total of 289 patients (435 nerves at risk) who underwent thyroidectomy by the same surgeon were enrolled in this study. Each patient was intubated with EMG endotracheal tube by the same anesthesiologist. Standardized IONM procedures were applied in each patient. The procedures include preoperative and postoperative video-recording of vocal cord movement, ensuring the correct position of electrodes after the neck was placed at full extension, vagal stimulation and registration of EMG signals before and after RLN dissection, and photographic documentation of the exposed RLN. Results Five patients encountered dysfunction of IONM, which was caused by malposition of electrodes and the problem was detected at once. One patient with non-RLN was detected at the earlier stage of operation. Eighteen nerves experienced loss of EMG signals during thyroid dissection, and the causes of nerve injuries were well elucidated with the application of our standardized IONM procedures. Conclusions The standardized IONM procedures are useful and helpful not only to eliminate false IONM results, but also to elucidate the mechanism of RLN injury. After ascertaining the surgical pitfalls and improving the surgical techniques, the palsy rate was significantly reduced in this study.
doi_str_mv 10.1007/s00268-009-0316-8
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Therefore, standardization of IONM procedures is necessary. Methods A total of 289 patients (435 nerves at risk) who underwent thyroidectomy by the same surgeon were enrolled in this study. Each patient was intubated with EMG endotracheal tube by the same anesthesiologist. Standardized IONM procedures were applied in each patient. The procedures include preoperative and postoperative video-recording of vocal cord movement, ensuring the correct position of electrodes after the neck was placed at full extension, vagal stimulation and registration of EMG signals before and after RLN dissection, and photographic documentation of the exposed RLN. Results Five patients encountered dysfunction of IONM, which was caused by malposition of electrodes and the problem was detected at once. One patient with non-RLN was detected at the earlier stage of operation. Eighteen nerves experienced loss of EMG signals during thyroid dissection, and the causes of nerve injuries were well elucidated with the application of our standardized IONM procedures. Conclusions The standardized IONM procedures are useful and helpful not only to eliminate false IONM results, but also to elucidate the mechanism of RLN injury. After ascertaining the surgical pitfalls and improving the surgical techniques, the palsy rate was significantly reduced in this study.</description><identifier>ISSN: 0364-2313</identifier><identifier>EISSN: 1432-2323</identifier><identifier>DOI: 10.1007/s00268-009-0316-8</identifier><identifier>PMID: 20020124</identifier><identifier>CODEN: WJSUDI</identifier><language>eng</language><publisher>New York: Springer-Verlag</publisher><subject>Abdominal Surgery ; Biological and medical sciences ; Cardiac Surgery ; Chi-Square Distribution ; Electromyography ; Female ; General aspects ; General Surgery ; Humans ; Iatrogenic Disease - prevention &amp; control ; Intraoperative Complications - etiology ; Intraoperative Complications - prevention &amp; control ; Male ; Medical sciences ; Medicine ; Medicine &amp; Public Health ; Middle Aged ; Monitoring, Intraoperative - standards ; Recurrent Laryngeal Nerve ; Recurrent Laryngeal Nerve Injuries ; Recurrent Laryngeal Nerve Injury ; Surgery ; Thoracic Surgery ; Thyroid Operation ; Thyroidectomy - adverse effects ; Treatment Outcome ; Vagus Nerve ; Vascular Surgery ; Vocal Cord Movement ; Vocal Cord Paralysis - etiology ; Vocal Cord Paralysis - prevention &amp; control</subject><ispartof>World journal of surgery, 2010-02, Vol.34 (2), p.223-229</ispartof><rights>Société Internationale de Chirurgie 2009</rights><rights>2010 The Author(s) under exclusive licence to Société Internationale de Chirurgie</rights><rights>2015 INIST-CNRS</rights><rights>Société Internationale de Chirurgie 2010</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5481-9a68a1329240d47b16286efd276986a9214933e656d7d2d9d760d06b2034658c3</citedby><cites>FETCH-LOGICAL-c5481-9a68a1329240d47b16286efd276986a9214933e656d7d2d9d760d06b2034658c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&amp;idt=22586713$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20020124$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chiang, Feng-Yu</creatorcontrib><creatorcontrib>Lee, Ka-Wo</creatorcontrib><creatorcontrib>Chen, Hui-Chun</creatorcontrib><creatorcontrib>Chen, Hsiu-Ya</creatorcontrib><creatorcontrib>Lu, I-Cheng</creatorcontrib><creatorcontrib>Kuo, Wen-Rei</creatorcontrib><creatorcontrib>Hsieh, Ming-Chia</creatorcontrib><creatorcontrib>Wu, Che-Wei</creatorcontrib><title>Standardization of Intraoperative Neuromonitoring of Recurrent Laryngeal Nerve in Thyroid Operation</title><title>World journal of surgery</title><addtitle>World J Surg</addtitle><addtitle>World J Surg</addtitle><description>Background The lack of standardized procedures of intraoperative neuromonitoring (IONM) during thyroid operations may lead to highly variable results, and many of these results can cause misleading information and, conversely, increase the risk of recurrent laryngeal nerve (RLN) injury. Therefore, standardization of IONM procedures is necessary. Methods A total of 289 patients (435 nerves at risk) who underwent thyroidectomy by the same surgeon were enrolled in this study. Each patient was intubated with EMG endotracheal tube by the same anesthesiologist. Standardized IONM procedures were applied in each patient. The procedures include preoperative and postoperative video-recording of vocal cord movement, ensuring the correct position of electrodes after the neck was placed at full extension, vagal stimulation and registration of EMG signals before and after RLN dissection, and photographic documentation of the exposed RLN. Results Five patients encountered dysfunction of IONM, which was caused by malposition of electrodes and the problem was detected at once. One patient with non-RLN was detected at the earlier stage of operation. Eighteen nerves experienced loss of EMG signals during thyroid dissection, and the causes of nerve injuries were well elucidated with the application of our standardized IONM procedures. Conclusions The standardized IONM procedures are useful and helpful not only to eliminate false IONM results, but also to elucidate the mechanism of RLN injury. 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Therefore, standardization of IONM procedures is necessary. Methods A total of 289 patients (435 nerves at risk) who underwent thyroidectomy by the same surgeon were enrolled in this study. Each patient was intubated with EMG endotracheal tube by the same anesthesiologist. Standardized IONM procedures were applied in each patient. The procedures include preoperative and postoperative video-recording of vocal cord movement, ensuring the correct position of electrodes after the neck was placed at full extension, vagal stimulation and registration of EMG signals before and after RLN dissection, and photographic documentation of the exposed RLN. Results Five patients encountered dysfunction of IONM, which was caused by malposition of electrodes and the problem was detected at once. One patient with non-RLN was detected at the earlier stage of operation. Eighteen nerves experienced loss of EMG signals during thyroid dissection, and the causes of nerve injuries were well elucidated with the application of our standardized IONM procedures. Conclusions The standardized IONM procedures are useful and helpful not only to eliminate false IONM results, but also to elucidate the mechanism of RLN injury. After ascertaining the surgical pitfalls and improving the surgical techniques, the palsy rate was significantly reduced in this study.</abstract><cop>New York</cop><pub>Springer-Verlag</pub><pmid>20020124</pmid><doi>10.1007/s00268-009-0316-8</doi><tpages>7</tpages></addata></record>
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subjects Abdominal Surgery
Biological and medical sciences
Cardiac Surgery
Chi-Square Distribution
Electromyography
Female
General aspects
General Surgery
Humans
Iatrogenic Disease - prevention & control
Intraoperative Complications - etiology
Intraoperative Complications - prevention & control
Male
Medical sciences
Medicine
Medicine & Public Health
Middle Aged
Monitoring, Intraoperative - standards
Recurrent Laryngeal Nerve
Recurrent Laryngeal Nerve Injuries
Recurrent Laryngeal Nerve Injury
Surgery
Thoracic Surgery
Thyroid Operation
Thyroidectomy - adverse effects
Treatment Outcome
Vagus Nerve
Vascular Surgery
Vocal Cord Movement
Vocal Cord Paralysis - etiology
Vocal Cord Paralysis - prevention & control
title Standardization of Intraoperative Neuromonitoring of Recurrent Laryngeal Nerve in Thyroid Operation
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