J Endocr Surg.  2017 Jun;17(2):42-56. 10.16956/jes.2017.17.2.42.

Medico-Legal Issues of Intraoperative Neuromonitoring in Thyroid Surgery

• Kim HY
• Liu X
• Sun H
• Wu CW
• Chai YJ
• Chung WY
• Tufano R
• Dralle H
• Lavazza M
• Dionigi G

• KMID: 2383821
• DOI: http://doi.org/10.16956/jes.2017.17.2.42

Abstract

Advances in intraoperative neuromonitoring (IONM) in thyroid surgery have provided significant insights into recurrent laryngeal nerve function during thyroid surgery. Despite the limitations and necessary caution when using intraoperative monitors to interpret neural function, these technologies have been definite steps in the right direction for assessing neural integrity and safe surgical strategy during thyroid operations. The techniques discussed minimize the adverse sequelae of a variety of thyroid gland procedures, reducing the morbidity rates/risks in the perioperative period. Furthermore, it is likely that such monitoring will become a standard of care. Accurate, reliable and continuous monitoring is essential, and on-going large studies with definable end points will be necessary. The use of monitoring, such as continuous one, may improve cost efficiency by reducing permanent nerve injuries. A danger in this process, however, is the potential for public opinion, outside regulatory bodies, or medico-legal implications to drive change and enforce standards of care before appropriate data are available.

Keyword

Thyroid gland; Recurrent laryngeal nerve; Malpractice; Recurrent laryngeal nerve injuries; Thyroidectomy

MeSH Terms

Malpractice
Perioperative Period
Public Opinion
Recurrent Laryngeal Nerve
Recurrent Laryngeal Nerve Injuries
Standard of Care
Thyroid Gland*
Thyroidectomy

Figure

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  Fig. 1 Pre-dissection VN stimulation (V1). VN = vagal nerve.

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  Fig. 2 Type 1 and type 2 injuries. EMG = electromyogram; RLN = recurrent laryngeal nerve; VN = vagal nerve.

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  Fig. 3 Troubleshooting algorithm in case of loss of EMG signal. EMG = electromyogram; RLN = recurrent laryngeal nerve; LOS = loss of signal; LT = laryngeal twitch.

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