Is intraoperative nerve monitoring useful for surgical training in thyroid surgery?
Candaş Erçetin1, Alper Şahbaz2, Sami Acar3, Fırat Tutal4, Nihat Aksakal5, Serkan Sarı6, Yeşim Erbil7
1Department of General Surgery, Health Sciences University, Bağcılar Training and Research Hospital, İstanbul, Turkey
2Department of General Surgery, Health Sciences University, Bakırköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey
3Department of General Surgery, Acıbadem Taksim Hospital, İstanbul, Turkey
4Department of General Surgery, Kolan International Hospital, İstanbul, Turkey
5Department of General Surgery, İstanbul University Istanbul School of Medicine, İstanbul, Turkey
6Department of General Surgery, Health Sciences University, İstanbul Training and Research Hospital, İstanbul, Turkey
7Department of General Surgery, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
Abstract
Objective: Parathyroid glands and recurrent laryngeal nerves (RLNs) are at risk during thyroid surgery. However, the identification of the nerves has reduced these risks. Intraoperative nerve monitoring (IONM) during thyroid surgery has gained widespread acceptance as an aid to the gold standard of visually identifying the RLN. The aim of the present study was to evaluate the effect of the identification of the RLN during thyroidectomy by using IONM.
Material and Methods: Seven hundred forty-eight patients were included in our prospectively designed study. Of these 748 patients, 1496 nerves at risk were studied. Group 1 consisted of 736 nerves that were identified using IONM, whereas Group 2 consisted of 760 visually identified nerves.
Results: In the non-IONM group, the rate of temporary nerve palsy was lower in patients operated by experienced surgeons than in patients operated by residents (p= 0.001). In the IONM group, RLN injury rates were similar between experienced surgeons and residents.
Conclusion: In spite of the fact that the duration of the operation was lower with IONM, the abbreviated duration may not appear to have clinical significance. The main advantage is for less experienced surgeons. IONM significantly decreases RLN palsy rates of the surgeons with limited experience in thyroid surgery.
Keywords: Thyroidectomy, nerve injury, nerve monitoring
Cite this article as: Erçetin C, Şahbaz A, Acar S, Tutal F, Aksakal N, Sarı S, Erbil Y. Is intraoperative nerve monitoring useful for surgical training in thyroid surgery? Turk J Surg 2019; 35 (4): 259-264.
Ethics committee approval was received for this study from the institutional Ethics Committee of İstanbul University, İstanbul Medical Faculty (762/2007).
Written informed consent was obtained from patients who participated in this study.
Externally peer-reviewed.
Concept - C.E., Y.E.; Design - C.E., Y.E., N.A.; Supervision - A.Ş., S.A., S.S.; Resource - C.E., F.T., S.A.; Materials - C.E., N.A., S.A.; Data Collection and/or Processing - C.E., N.A., S.S.; Analysis and/or Interpretation - C.E., A.Ş., Y.E.; Literature Search - S.A., F.T., A.Ş.; Writing Manuscript - C.E., A.Ş., Y.E.; Critical Reviews - F.T., N.A., S.S.
The authors have no conflicts of interest to declare.
The authors have no conflicts of interest to declare.