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Article

Neuromonitoring of the Recurrent Laryngeal Nerve Reduces the Rate of Bilateral Vocal Cord Dysfunction in Planned Bilateral Thyroid Procedures

1
Endocrine Center Stuttgart, Department of Endocrine Surgery, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany
2
Outcomes Research Unit, Endocrine Center Stuttgart, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany
3
Endocrine Center Stuttgart, Department of Endocrinology, Diakonie-Klinikum Stuttgart, 70176 Stuttgart, Germany
*
Author to whom correspondence should be addressed.
Academic Editors: Marek Ruchala and Ewelina Szczepanek-Parulska
J. Clin. Med. 2021, 10(4), 740; https://doi.org/10.3390/jcm10040740
Received: 11 November 2020 / Revised: 24 January 2021 / Accepted: 31 January 2021 / Published: 12 February 2021
(This article belongs to the Special Issue Novel Methods of Diagnostics of Thyroid and Parathyroid Lesions)
Purpose: Bilateral vocal cord dysfunction (bVCD) is a rare but feared complication of thyroid surgery. This long term retrospective study determined the effect of intraoperative neuromonitoring (IONM) of the recurrent laryngeal nerve (RLN) during thyroid surgeries with regard to the rate of bVCD and evaluated the frequency as well as the outcome of staged operations. Methods: Retrospective analysis of prospectively documented data (2000–2019) of a tertiary referral centers’ database. IONM started in 2000 and, since 2010, discontinuation of surgery was encouraged in planned bilateral surgeries to prevent bVCD, if non-transient loss of signal (ntLOS) occurred on the first side. Datasets of the most recent 40-month-period were assessed in detail to determine the clinical outcome of unilateral ntLOS in planned bilateral thyroid procedures. Results: Of 22,573 patients, 65 had bVCD (0.288%). The rate of bVCD decreased from 0.44 prior to 2010 to 0.09% after 2010 (p < 0.001, Chi2). Case reviews of the most recent 40 months period identified ntLOS in 113/3115 patients (3.6%, 2.2% NAR), of which 40 ntLOS were recorded during a planned bilateral procedure (n = 952, 2.1% NAR). Of 21 ntLOS occurring on the first side of the bilateral procedure, 15 procedures were stopped, subtotal contralateral resections were performed, and thyroidectomy was continued in 3 patients respectively, with the use of continuous vagal IONM. Eighteen cases of VCD were documented postop, and all but one patient had a full recovery. Seven patients had staged resections after 1 to 18 months (median 4) after the first procedure. Conclusion: IONM facilitates reduced postoperative bVCD rates. IONM is, therefore, recommendable in planned bilateral procedures. The rate of non-complete bilateral surgery after intraoperative non-transient LOS was 2%. View Full-Text
Keywords: thyroid surgery; vocal cord dysfunction; vocal cord palsy; loss of signal; complications thyroid surgery; vocal cord dysfunction; vocal cord palsy; loss of signal; complications
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MDPI and ACS Style

Smaxwil, C.; Aleker, M.; Altmeier, J.; Naddaf, A.; Busch, M.; Wagner, J.; Harsch, S.; Ploner, O.; Zielke, A. Neuromonitoring of the Recurrent Laryngeal Nerve Reduces the Rate of Bilateral Vocal Cord Dysfunction in Planned Bilateral Thyroid Procedures. J. Clin. Med. 2021, 10, 740. https://doi.org/10.3390/jcm10040740

AMA Style

Smaxwil C, Aleker M, Altmeier J, Naddaf A, Busch M, Wagner J, Harsch S, Ploner O, Zielke A. Neuromonitoring of the Recurrent Laryngeal Nerve Reduces the Rate of Bilateral Vocal Cord Dysfunction in Planned Bilateral Thyroid Procedures. Journal of Clinical Medicine. 2021; 10(4):740. https://doi.org/10.3390/jcm10040740

Chicago/Turabian Style

Smaxwil, Constantin, Miriam Aleker, Julia Altmeier, Ali Naddaf, Mirjam Busch, Joachim Wagner, Simone Harsch, Oswald Ploner, and Andreas Zielke. 2021. "Neuromonitoring of the Recurrent Laryngeal Nerve Reduces the Rate of Bilateral Vocal Cord Dysfunction in Planned Bilateral Thyroid Procedures" Journal of Clinical Medicine 10, no. 4: 740. https://doi.org/10.3390/jcm10040740

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