Intraoperative neuromonitoring in thyroidectomy: the learning curve

Area of Science:

• Endocrinology
• Surgical Neurology
• Thyroidology

Background:

• Recurrent laryngeal nerve (RLN) injury is a primary concern in thyroid surgery.
• Intraoperative neuromonitoring (IONM) is increasingly adopted for thyroidectomy.
• Understanding the learning curve for IONM is crucial for optimizing its application.

Purpose of the Study:

• To assess the learning curve associated with performing intraoperative neuromonitoring of the recurrent laryngeal nerve and vagus nerve during thyroid surgery.
• To evaluate the effectiveness of IONM in preventing nerve damage and improving surgical outcomes.

Main Methods:

• A consecutive series of 140 patients undergoing thyroid surgery were analyzed.
• All patients received intraoperative neuromonitoring of the recurrent laryngeal nerve and vagus nerve.
• Patients were divided into 7 groups to track adverse events during the learning phase.

Main Results:

• A total of 271 nerves were monitored, with a transient paralysis incidence of 0.73%.
• IONM demonstrated high diagnostic accuracy: sensitivity 100%, specificity 99%, negative predictive value 100%.
• No significant differences were observed in calcium levels or operative time across learning groups.

Conclusions:

• IONM facilitates early localization, identification, and dissection of the RLN during thyroidectomy.
• The technology aids in avoiding damage from excessive traction and identifying/preserving parathyroid glands.
• A learning curve of approximately 60 consecutive cases is recommended for proficiency in IONM for thyroid surgery.