Neuromonitoring during thyroid surgery

Abstract

This overview has been prepared to assist members of the Greek Society of Endocrine Surgeons (GSES) in making recommendations about the safety and efficacy of the use of neuromonitoring during thyroid surgery. The international literature was reviewed and 149 articles relevant to neuromonitoring in thyroid surgery were retrieved. All studies were carefully analyzed in order to assist the members of GSES in globally recognizing and defining the subject, and in issuing guidelines. Neuromonitoring (NM) is the use of electrophysiological methods to monitor the functional integrity of neural structures during surgery. We can distinguish continuous intraoperative neuromonitoring (IONM) and stimulated intraoperative neuromonitoring (IONS). From a review of the literature we can definitively conclude that: (i) no type of NM can zero the palsies of Recurrent Laryngeal Nerf (RLN), (ii) high-volume surgeons have the same rates of RLN palsies with or without NM, (iii) the use of NM requires previous training. When NM is employed the algorithm predissection laryngoscopy-vagus nerve stimulation-RLN stimulation and postdissection RLN stimulation- vagus nerve stimulation-laryngoscopy (L1-V1-R1-R2-V2-L2) should be used. Moreover, there seems to be evidence that low-volume surgeon may profit from NM in order to reach complication rates of high-volume surgeons.