Continuous monitoring of the recurrent laryngeal nerve in thyroid surgery: a critical appraisal.


BACKGROUND AND PURPOSE Intraoperative neuromonitoring (IONM) contributes in several ways to recurrent laryngeal nerve (RLN) protection. Notwithstanding these advantages, surgeons must be aware that the current, intermittent, mode of IONM (I-IONM) has relevant limitations. To overcome these I-IONM limitations, a continuous IONM (C-IONM) technology has been proposed. METHODS A PubMed indexed literature review of the current limitations of I-IONM is presented and a commentary about C-IONM is provided presenting the preliminary results of research on this topic. MAIN FINDINGS I-IONM, despite the advantages it produces, presents some important limitations; to overcome these drawbacks a C-IONM technology has been introduced. CONCLUSIONS RLN traction injury is still the most common cause of RLN injury and is difficult to avoid with the application of I-IONM in thyroid surgery. C-IONM is useful to prevent the imminent traction injury by detecting progressive decreases in electromyographic amplitude combined with progressive latency increases. C-IONM seems to be a technological improvement. Likely, C-IONM by vagal nerve stimulation should enhance the standardization process, RLN intraoperative information, documentation, protection, training, and research in modern thyroid surgery. Although C-IONM is a promising technology at the cutting edge of research in thyroid surgery, we need more studies to assess in an evidence-based way all its advantages.

DOI: 10.1016/S1743-9191(13)60014-X
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@article{Dionigi2013ContinuousMO, title={Continuous monitoring of the recurrent laryngeal nerve in thyroid surgery: a critical appraisal.}, author={Gianlorenzo Dionigi and Gianluca Donatini and Luigi Boni and Stefano Rausei and Francesca Rovera and Maria Laura Piera Tanda and Hoon Yub Kim and Feng-Yu Chiang and Alberto Mangano and Francesco Rulli and Pier Francesco Alesina and Renzo Dionigi}, journal={International journal of surgery}, year={2013}, volume={11 Suppl 1}, pages={S44-6} }