Continuous intraoperative neuromonitoring for thyroid cancer surgery: A prospective study

Area of Science:

• Otolaryngology
• Surgical Oncology
• Neurophysiology

Background:

• Thyroid cancer surgery carries risks of vocal cord paresis (VCP).
• Continuous intraoperative neuromonitoring (CIONM) is utilized to mitigate these risks.
• Evaluating CIONM's utility in an educational setting is crucial for surgical training and patient safety.

Purpose of the Study:

• To assess the effectiveness of CIONM in preventing VCP during thyroid cancer surgery.
• To determine the correlation between CIONM findings (e.g., loss of signal) and VCP outcomes.
• To explore CIONM's role in surgical education at a university hospital.

Main Methods:

• Prospective observational study including 43 patients undergoing thyroid cancer surgery.
• Standardized surgery with CIONM was performed.
• Postoperative laryngoscopy was used to assess vocal cord function.

Main Results:

• Vocal cord paresis (VCP) occurred in 14.3% of at-risk nerves.
• VCP was significantly associated with loss of signal (LOS) (P = .002), but not surgeon experience.
• Rapid VCP recovery was observed in global nerve injuries with LOS; prolonged recovery occurred with segmental injury and LOS.

Conclusions:

• CIONM protocols offer some protection against prolonged VCP but do not detect all nerve stress.
• CIONM shows promise for surgical education by providing real-time procedural feedback.
• Further refinement of CIONM protocols may enhance its efficacy in preventing VCP during thyroid cancer surgery.