Evolution of Intra-operative Nerve Monitoring as a revolution in Thyroid Surgery: A PRISMA compliant Systematic Review

Authors

  • Haleema Sadia ..
  • Hira Ashraf
  • Talat Waseem

Keywords:

Intra-operative nerve monitoring (IONM), recurrent laryngeal nerve (RLN), recurrent laryngeal nerve palsy, thyroidectomy, continuous intro-operative nerve monitoring (c-IONM), intermittent intro-operative nerve monitoring (I-IONM)

Abstract

Introduction: Intra-operative nerve monitoring (IONM) has matured into a powerful risk minimisation tool in the past two decades. Meta-analysis and articles, most of which were limited by poor study designs, have failed to demonstrate superiority of IONM over visual identification of RLN during thyroidectomy in the absence of IONM. Continuous intra-operative nerve monitoring (C-IONM) is superior to intermittent intra-operative nerve monitoring (I-IONM) due to its real time electromyographic tracings during surgery and thus reducing the RLN palsy which in turn decreases vocal cord paralysis post-operatively. C-IONM urges surgeons to reverse the harmful surgical manoeuvres to avoid the permanent traction related nerve injury; it also forms an integral part in the surgical concept of staged thyroidectomy.

Objective: Objective of this review article is to shed some light on IONM technique, discuss its pros and cons and detailed review of its two types and how it is taking the neck surgery by storm, also how it’s equipping young surgeons with confidence by honing their surgical skills.

Methods: This review article is written according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Literature search was done through PubMed, Google scholar and ERIC. Search terms were: “intra-operative neuromonitoring” AND “continuous intro-operative nerve monitoring” or “intermittent intro-operative nerve monitoring” AND “recurrent laryngeal nerve” or “RLN” AND “thyroid gland” or “thyroidectomy”. 433 articles were identified out of which 41 were used for thematic analysis. 

Results: In recent years, the volume of thyroid procedures are expanding, so did risk minimization measures protecting RLN, although the incidence of RLN palsy is low in experienced hands, it results in permanent post-operative compromise of voice quality that may diminish the patient’s quality of life and trigger litigation for malpractice for the surgeon. IONM especially C-IONM helps decreasing the incidence of imminent RLN palsy by providing the real-time neuromonitoring intra-operatively, it also helps in perfecting the surgical skills of young surgeons. Proper documentation of IONM helps in case of litigation as well.

Conclusion: This review article concludes that IONM could reduce the incidence of total, transient and permanent RLN injury compared with conventional visual identification of RLN. IONM has increased the precision in signaling impending nerve injury early on and in correctly predicting post-operative vocal cord palsy. This enables surgical teams to reflect on timely and improve their surgical skills.

Keywords: Intra-operative nerve monitoring (IONM), recurrent laryngeal nerve (RLN), recurrent laryngeal nerve palsy, thyroidectomy, continuous intro-operative nerve monitoring (c-IONM), intermittent intro-operative nerve monitoring (I-IONM).

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Published

2020-03-28

Issue

Section

Original Research: Systematic Literature Review

How to Cite

Evolution of Intra-operative Nerve Monitoring as a revolution in Thyroid Surgery: A PRISMA compliant Systematic Review . (2020). Archives of Surgical Research, 1(1), 17-28. http://www.archivessr.com/index.php/asr/article/view/82