• Magnus Melin, Katharina Schwarz, Bernhard J Lammers, and Peter E Goretzki.
• Department of General Surgery, Endocrine Surgery, Abdominal Surgery, Thorax Surgery, Vascular Surgery, Colorectal and Hernia Surgery, Lukaskrankenhaus GmbH, Preußenstraße 84, 41464 Neuss, Germany. mmelin@lukasneuss.de
• Langenbecks Arch Surg. 2013 Mar 1; 398 (3): 411-8.

PurposeIntraoperative neuromonitoring (IONM) in thyroid surgery allows for changing the operative strategy during bilateral procedures to avoid bilateral recurrent laryngeal nerve palsy (RLNP). While this strategy is comprehendible for the surgeon, the question remains, whether it is always necessary.MethodsTwo thousand five hundred forty-six patients underwent surgery with IONM between January 2008 and October 2010 (4,012 nerves at risk). We performed a retrospective review of all patients after thyroid surgery. In 98 cases, signal loss occurred on the primary side. Of these patients, 64 required bilateral surgery. We proceeded with the contralateral surgery in 24 cases. Forty operations were ended unilaterally. The second operation was performed on 18 patients in total, 16 after confirmation of primarily intact (n = 8) or recovered vocal cord function (n = 8) and twice under persisting dysfunction. Patient satisfaction was evaluated using a five-point scale.ResultsWe have shown a significant difference (p = 0.017) in the rate of bilateral RLNP when signal loss on the primary side resulted in termination of the procedure compared to continuation. Our evaluation of patient satisfaction did not show a significant difference when comparing the two-stage operation to other procedures.ConclusionsWe have shown a significant difference in the rate of bilateral RLNP when comparing termination and continuation of a bilateral procedure after primary IONM signal loss. We strongly recommend a two-stage thyroidectomy after signal loss on the primary side of resection in benign bilateral goiter surgery.

27 keywords...

hide…