1
|
Melfa G, Siragusa G, Cocorullo G, Guzzino M, Raspanti C, Albanese L, Mazzola S, Richiusa P, Orlando G, Scerrino G. Effects of Intraoperative Nerve Monitoring Techniques on Voice and Swallowing Disorders after Uncomplicated Thyroidectomy: Preliminary Report of a Bi-Institutional Prospective Study. J Clin Med 2022; 12:jcm12010305. [PMID: 36615105 PMCID: PMC9821617 DOI: 10.3390/jcm12010305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 12/12/2022] [Accepted: 12/28/2022] [Indexed: 01/03/2023] Open
Abstract
Background: Voice and swallowing problems are frequently associated with thyroidectomy. Intermittent nerve monitoring (i-IONM) seems to provide a positive effect in reducing its prevalence. The aim of this study was to test the hypothesis that continuous intraoperative nerve monitoring (c-IONM) may reduce the prevalence of these disorders even further than i-IONM. Methods: This 3-arm prospective bi-institutional study compared 179 consecutive patients that underwent thyroidectomy: 56 without IONM, 55 with i-IONM and 67 with c-IONM. Neck dissections and laryngeal nerve palsies were excluded. Two questionnaires (VHI-10 for voice disorders and EAT-10 for swallowing disorders; both validated for Italian language use) were administered before and 1 month after surgery. Statistical significance was analyzed by the chi-squared test. Results: After thyroidectomy, no statistically significant differences were found in the three groups concerning EAT-10. although these symptoms seemed to be influenced by gastro-esophageal reflux. VHI-10 worsened in the “no-IONM” group compared with both i-IONM (p < 0.09, not quite statistically significant) and c-IONM (p < 0.04). Conclusion: Both i- and c-IONM improve voice quality independently of laryngeal nerve integrity. Reduced dissection and particularly restrained manipulation could explain these results, being particularly favorable for c-IONM.
Collapse
Affiliation(s)
- Giuseppina Melfa
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”—University of Palermo, 90127 Palermo, Italy
| | | | - Gianfranco Cocorullo
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”—University of Palermo, 90127 Palermo, Italy
| | - Marianna Guzzino
- Villa Serena Clinic—Unit of General Surgery, 90100 Palermo, Italy
| | - Cristina Raspanti
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”—University of Palermo, 90127 Palermo, Italy
| | - Leone Albanese
- Villa Serena Clinic—Unit of General Surgery, 90100 Palermo, Italy
| | - Sergio Mazzola
- Unit of Clinical Epidemiology and Tumor Registry, Department of Laboratory Diagnostics, Policlinico “P. Giaccone”—University of Palermo, 90127 Palermo, Italy
| | - Pierina Richiusa
- Section of Endocrinology—Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
| | - Giuseppina Orlando
- Unit of General and Emergency Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”—University of Palermo, 90127 Palermo, Italy
- Correspondence:
| | - Gregorio Scerrino
- Unit of Endocrine Surgery, Department of Surgical Oncological and Oral Sciences, Policlinico “P. Giaccone”—University of Palermo, 90127 Palermo, Italy
| |
Collapse
|
2
|
Wu T, Sui GQ, Teng DK, Luo Q, Wang H, Lin YQ. Study on Changes in Immune Function After Microwave Ablation of Papillary Thyroid Microcarcinoma. Cancer Manag Res 2022; 14:2861-2868. [PMID: 36171864 PMCID: PMC9510695 DOI: 10.2147/cmar.s358649] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 09/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background In recent years, papillary thyroid microcarcinoma (PTMC) has been a main cause of the high incidence of thyroid carcinoma. No existing study has reported whether microwave ablation (MWA) affects patients' immunity. Therefore, this study explored the effects of MWA treatment on the immune functions of patients with PTMC. Methods This study included 50 patients diagnosed with PTMC who received MWA treatment under ultrasound guidance at the ultrasound department of our hospital from January 2019 to October 2020. Changes in immune function after MWA treatment in PTMC patients were detected by T lymphocyte subsets and cytokines secreted by T helper cells. Results At 1 day and 2 weeks after MWA treatment, the proportions of CD3+, CD4+ and CD4+/CD8+ T lymphocyte subsets and the levels of the cytokines interleukin (IL)-2 and interferon (IFN)-γ in the peripheral blood of the patients were significantly higher than those before MWA treatment (P<0.05). The levels of CD8+ T lymphocytes, tumour necrosis factor (TNF)-α, IL-4, IL-6, IL-10 and IL-17A were not significantly different from those before MWA treatment (P>0.05). One month after MWA treatment, the proportions of CD3+, CD4+, CD8+ and CD4+/CD8+ T lymphocytes and the levels of the cytokines IL-2, IL-4, IL-6, IL-10, IFN-γ, TNF-α and IL-17A were not significantly different from those before MWA treatment (P>0.05). Conclusion The immune functions of patients with PTMC are temporarily enhanced after MWA treatment, which has important clinical significance for patients' anti-PTMC ability.
Collapse
Affiliation(s)
- Ting Wu
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130000, People's Republic of China
| | - Guo-Qing Sui
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130000, People's Republic of China
| | - Deng-Ke Teng
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130000, People's Republic of China
| | - Qiang Luo
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130000, People's Republic of China
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130000, People's Republic of China
| | - Yuan-Qiang Lin
- Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, Jilin, 130000, People's Republic of China
| |
Collapse
|
3
|
Wang D, Li L, Zhang C, Liang F, Chen P. A new anesthesia scheme for parathyroidectomy under neuromonitoring: a retrospective cohort study. Gland Surg 2021; 10:1576-1586. [PMID: 34164302 DOI: 10.21037/gs-21-33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Parathyroidectomy under nerve monitoring has been carried out for nearly ten years in the China-Japan Union Hospital of Jilin University. We retrospectively evaluated patients' prognosis with secondary hyperparathyroidism (SH) under neuro- and non-neuro-monitored parathyroidectomy anesthesia. The purpose of this study is to summarize and introduce a new anesthesia scheme for parathyroidectomy under nerve monitoring. Methods From January 2000 to December 2019, 200 patients with SH in the China-Japan Union Hospital of Jilin University were retrospectively analyzed. Among them, 100 patients underwent parathyroidectomy under neurological monitoring (Group A), and 100 patients underwent parathyroidectomy without neurological monitoring (Group B). The dosage of muscle relaxant, parathyroid hormone (PTH), serum calcium, phosphorus, urea, creatinine, and alkaline phosphatase (ALP) was recorded before surgery (T0), after surgery (T1), at discharge (T2), during skin incision (Ta), at four parathyroidectomies (Tb), and 10 min after total removal. The levels of PTH were measured at four-time points (Tc) and 30 minutes (Td) after complete resection. Results After screening and propensity score match (PSM), the data of 92 patients were analyzed. Group A's muscle relaxant dose was significantly less than Group B; the length of hospital stay in Group A was significantly lower than in Group B (P<0.05). The serum calcium levels, phosphorus, urea, and creatinine at T2 in Group A were lower than those in Group B (P<0.05). Conclusions Parathyroid nerve monitoring technology combined with preoperative complete anesthesia scheme, anesthesia induction with one time ED95 (95% effective drug dose) cis-atracurium, end breath gas, and sevoflurane maintenance anesthesia under BIS monitoring can improve the prognosis of patients, shorten the length of hospital stay, and is effective and safe.
Collapse
Affiliation(s)
- Danyang Wang
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Linlin Li
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Chunlu Zhang
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Feng Liang
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Peng Chen
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
| |
Collapse
|
4
|
Garofalo E, Bruni A, Scalzi G, Curto LS, Rovida S, Brescia V, Gervasi R, Navalesi P, Innaro N, Longhini F. Low-Dose of Rocuronium During Thyroid Surgery: Effects on Intraoperative Nerve-Monitoring and Intubation. J Surg Res 2021; 265:131-138. [PMID: 33940235 DOI: 10.1016/j.jss.2021.03.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/04/2021] [Accepted: 03/25/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Intraoperative Neurophysiological Monitoring (IONM) reduces the incidence of Recurrent Laryngeal Nerve (RLN) injuries during thyroid surgery. To preserve nerve function, long acting neuromuscular blocking agents (NMBA) should be avoided. However, NMBA are necessary for laryngoscopy and endotracheal intubation. We designed this double-blinded, randomized, placebo-controlled trial to assess if a low-dose of rocuronium given at intubation would affect the IONM data recorded before the thyroid dissection. METHODS Hundred patients undergoing elective thyroid surgery were randomized to receive either 0.3 mg kg-1 of low dose rocuronium (intervention) or no-NMBA (control). Intubation was performed with video-laryngoscopy. IONM was placed on RLN and nerve stimulation was performed before and after thyroid dissection. The presence of a valid amplitude prior to dissection was defined when the IONM signal was >100 μV. Occurrence of difficult laryngoscopy was reported together with intubation details including time, difficulty and failure. The lowest peripheral saturation (SpO2) and the number of desaturation episodes during the intubation were also registered. RESULTS No patients showed impaired IONM signal before dissection in both groups. Cormack-Lehane grade was higher in the intervention group (11;2) compared to control one (11;1; P = 0.046). No-NMBA patients had increased number of difficult laryngoscopies (21% versus 6%, P = 0.041) and intubations (34% versus 8%; P = 0.003) as well as a longer time to intubation (78 [55; 175] versus 55 [31; 110] sec; P = 0.006). Lower values of peripheral SpO2 during intubation attempt were registered in the no NMBA group (99 [97; 100] versus 99 [99; 100] %; P = 0.020). However, the number of intubation failure was similar between groups (p=0.495). CONCLUSIONS Low-dose of rocuronium does not compromise pre-dissection IONM signal and improves intubation condition when compared to a relaxant free strategy.
Collapse
Affiliation(s)
- Eugenio Garofalo
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Andrea Bruni
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Giuseppe Scalzi
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Lucia Stella Curto
- Endocrine Surgery Unit, "Mater Domini" University Hospital, Catanzaro, Italy
| | - Serena Rovida
- Department of Emergency Medicine, Royal London Hospital, Barts Health NHS Trust, United Kingdom
| | - Vincenzo Brescia
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Rita Gervasi
- Endocrine Surgery Unit, "Mater Domini" University Hospital, Catanzaro, Italy
| | - Paolo Navalesi
- Anesthesia and Intensive Care, Padua Hospital, Department of Medicine - DIMED, University of Padua, Italy
| | - Nadia Innaro
- Endocrine Surgery Unit, "Mater Domini" University Hospital, Catanzaro, Italy
| | - Federico Longhini
- Anesthesia and Intensive Care, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy.
| |
Collapse
|
5
|
Mahoney RC, Vossler JD, Murayama KM, Woodruff SL. Predictors and consequences of recurrent laryngeal nerve injury during open thyroidectomy: An American College of Surgeons National Surgical Quality Improvement Project database analysis. Am J Surg 2020; 221:122-126. [PMID: 32811620 DOI: 10.1016/j.amjsurg.2020.07.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/02/2020] [Accepted: 07/11/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Recurrent laryngeal nerve (RLN) injury is a serious complication of thyroidectomy. The purpose of this study is to determine the predictors and consequences of RLN injury during thyroidectomy. METHODS A retrospective analysis was conducted using the ACS-NSQIP 2016-2017 main and thyroidectomy targeted procedure databases. Data was analyzed by multivariate logistic regression resulting in risk-adjusted odds ratios of RLN injury and morbidity/mortality. RESULTS Age ≥65, black race, neoplastic indication, total or subtotal thyroidectomy, concurrent neck surgery, operation time > median, hypoalbuminemia, and anemia were associated with RLN injury. Use of intraoperative nerve monitoring was associated with decreased RLN injuries. RLN injury is a risk factor for overall morbidity, hypocalcemia, hematoma, pulmonary morbidity, readmission, reoperation, and length of stay > median. CONCLUSION Several predictors of RLN injury during thyroidectomy are identified, while use of intraoperative nerve monitoring was associated with a decreased risk of RLN injury. RLN injury is associated increased postoperative complications.
Collapse
Affiliation(s)
- Reid C Mahoney
- Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, USA
| | - John D Vossler
- Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, USA
| | - Kenric M Murayama
- Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, USA
| | - Stacey L Woodruff
- Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, USA.
| |
Collapse
|
6
|
Jung SM, Tae K, Song CM, Lee SH, Jeong JH, Ji YB. Efficacy of Transcartilaginous Electrodes for Intraoperative Neural Monitoring During Thyroid Surgery. Clin Exp Otorhinolaryngol 2020; 13:422-428. [PMID: 32492990 PMCID: PMC7669316 DOI: 10.21053/ceo.2019.01529] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 01/07/2020] [Indexed: 12/01/2022] Open
Abstract
Objectives. This study was conducted evaluate the efficacy of electromyography (EMG) using transcartilaginous (TC) electrodes through the thyroid cartilage and perichondrium. Methods. We prospectively collected EMG data from intraoperative neuromonitoring (IONM) of 54 nerves at risk in 38 patients during thyroidectomy. We followed standardized IONM procedures in all operations. EMG signals from both endotracheal tube (ET) electrodes and TC needle electrodes were recorded simultaneously. We compared the characteristics of the EMG signals and the efficacy of both methods. Results. Significantly higher mean EMG amplitudes were recorded by TC electrodes than by ET electrodes in all four-step procedures (V1-R1-R2-V2, P<0.001). Loss of signal (LOS) occurred in five patients in ET electrodes, but in only two patients in TC electrodes. Postoperative laryngoscopy revealed recurrent laryngeal nerve palsy in the two patients who showed LOS from both the ET and TC electrodes, and vocal cord movement was intact in the other three patients. Therefore, the positive predictive values of LOS in ET and TC electrodes were 40% and 100%, respectively. Conclusion. EMG recording using TC needle electrodes is feasible and effective, making it a good alternative technique for IONM.
Collapse
Affiliation(s)
- Seon Min Jung
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Kyung Tae
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Chang Myeon Song
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Seung Hwan Lee
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Jin Hyeok Jeong
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Yong Bae Ji
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| |
Collapse
|
7
|
Cherian VT, Vaida S. Post-thyroidectomy laryngeal nerve palsy: an insight. Minerva Anestesiol 2020; 86:476-478. [PMID: 32013335 DOI: 10.23736/s0375-9393.20.14296-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Verghese T Cherian
- Division of Multispecialty Anesthesia, Department of Anesthesiology and Perioperative Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Sonia Vaida
- Division of Obstetric Anesthesia, Department of Anesthesiology and Perioperative Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA -
| |
Collapse
|
8
|
Otsuka K, Murakami M, Goto S, Ariyoshi T, Yamashita T, Saito A, Kohmoto M, Kato R, Lefor AK, Aoki T. Minimally invasive esophagectomy and radical lymph node dissection without recurrent laryngeal nerve paralysis. Surg Endosc 2020; 34:2749-2757. [PMID: 32016515 PMCID: PMC7214392 DOI: 10.1007/s00464-020-07372-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 01/04/2020] [Indexed: 01/01/2023]
Abstract
Background We introduce a novel operative technique to dissect lymph nodes adjacent to the recurrent laryngeal nerve, referred to as the “native tissue preservation” technique. Using this technique, there was no damage to the recurrent laryngeal nerve, which is maintained in its anatomical position. Methods From September 2016 to December 2018, minimally invasive esophagectomy was performed in the left lateral decubitus position in 87 patients with esophageal cancer. The native tissue preservation technique for lymphadenectomy around the recurrent laryngeal nerve was used, and all patients were evaluated for recurrent laryngeal nerve paralysis. Results Minimally invasive esophagectomy was completed in all patients without conversion to thoracotomy. Although an extended lymphadenectomy was performed in all patients, there were no grade II or higher complications (Clavien–Dindo classification) and no incidence of recurrent laryngeal nerve paralysis. Conclusion The native tissue preservation technique may reduce the incidence of recurrent laryngeal nerve paralysis after minimally invasive esophagectomy with radical lymph node dissection. Electronic supplementary material The online version of this article (10.1007/s00464-020-07372-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Koji Otsuka
- Department of Surgery, Division of Gastroenterological and General Surgery, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan.
| | - Masahiko Murakami
- Department of Surgery, Division of Gastroenterological and General Surgery, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Satoru Goto
- Department of Surgery, Division of Gastroenterological and General Surgery, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Tomotake Ariyoshi
- Department of Surgery, Division of Gastroenterological and General Surgery, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Takeshi Yamashita
- Department of Surgery, Division of Gastroenterological and General Surgery, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Akira Saito
- Department of Surgery, Division of Gastroenterological and General Surgery, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Masahiro Kohmoto
- Department of Surgery, Division of Gastroenterological and General Surgery, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Rei Kato
- Department of Surgery, Division of Gastroenterological and General Surgery, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
| | | | - Takeshi Aoki
- Department of Surgery, Division of Gastroenterological and General Surgery, School of Medicine, Showa University, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
| |
Collapse
|
9
|
Effect of nerve monitoring on complications of thyroid surgery. North Clin Istanb 2018; 5:14-19. [PMID: 29607426 PMCID: PMC5864701 DOI: 10.14744/nci.2017.93764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 10/09/2017] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE: The most frequent and critical complications of thyroid surgery are recurrent laryngeal nerve palsy and hypocalcemia. In first years of the 21st century, intraoperative neuromonitoring (IONM) was introduced as a new technique to avoid the recurrent laryngeal nerve (RLN) injury. However, the role and the benefits of IONM are still controversial. In this study, we aimed to compare the postoperative complication rates during thyroid surgery with IONM usage (Group 1) and conventional direct visual technique without IONM usage (Group 2). METHODS: We conducted retrospective review of all patients undergoing thyroid surgery in Lütfiye Nuri Burat State Hospital General Surgery Department between 2014 and 2016 years. Patients have been classified in to two groups: Group 1 and 2. RESULTS: Overall, 191 patients were included in the study; Group 1 comprised 79 patients and Group 2 comprised 112 patients. Unilateral RLN paralysis was observed in 7 patients in Group 1 (8.9%) and 15 patients in Group 2 (13.4%) without any significant difference between the groups (p=0.368). Hypocalcemia was encountered in 5 patients (6.3%) in Group 1 and 18 patients (16.1%) in Group 2; this difference was statistically significant (p=0.045). Other complications (such as hematoma and suture reaction) were not significantly different. Operation time was found to be significantly shorter in Group 1 (Mean time, 93.08 min) than in Group 2 (116.54 min) (p=0.03). CONCLUSION: Proven effect of IONM on RLN paralysis is still controversial. However, easy identification of RLN, which gives more confidence to surgeon, and shorter operation time may be factors to lower hypocalcemia rates.
Collapse
|
10
|
Swallowing disorders after thyroidectomy: What we know and where we are. A systematic review. Int J Surg 2017; 41 Suppl 1:S94-S102. [DOI: 10.1016/j.ijsu.2017.03.078] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/24/2017] [Accepted: 03/28/2017] [Indexed: 01/18/2023]
|