J Endocr Surg.  2018 Mar;18(1):49-60. 10.16956/jes.2018.18.1.49.

Intraoperative Neural Monitoring in Thyroid Surgery: Role and Responsibility of Surgeon

• Kim HY
• Tufano RP
• Chai YJ
• Barczynski M
• Makay O
• Wu CW
• Berber E
• Sun H
• Dionigi G
• the Korean Intraoperative Neural Monitoring Society (KINMoS)

• KMID: 2414422
• DOI: http://doi.org/10.16956/jes.2018.18.1.49

Abstract

Surgeons who introduce intraoperative neural monitoring (IONM) or a new IONM accessory, or related procedure in their practice should have completed relevant surgical training, possess operating privileges in the affected endocrine system, and be able to address anticipated complications. Surgeon responsibility in monitoring is dual component. First, technical component is using and setting up the IONM equipment correctly and understanding the inherent properties of the system to avoid an erroneous setup (e.g., no muscle relaxation, correct electrode placement, low impedance, etc.). Second, interpretive component is performing the monitoring able to distinguish between a true response versus an artifactual one. Organizations such as the International Neural Study Group and the Korean Intraoperative Neural Monitoring Society provide training courses for surgeon, as well as a means to certify levels of monitoring interpretative competence.

Keyword

Neural monitoring; Thyroid surgery; Recurrent laryngeal nerve; Training

MeSH Terms

Electric Impedance
Electrodes
Endocrine System
Mental Competency
Muscle Relaxation
Recurrent Laryngeal Nerve
Surgeons
Thyroid Gland*

Figure

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  Fig. 1. RLN anatomy studies from 1927 to 2015 (peer-reviewed papers, edited books, abstract meetings) (n=711). RLN = recurrent laryngeal nerve; IONM = intraoperative neural monitoring.

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  Fig. 2. RLN anatomy studies from 1927 to 2015 (peer-reviewed papers, edited books, abstract meetings) (n=711). RLN = recurrent laryngeal nerve; IONM = intraoperative neural monitoring.

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  Fig. 3. The different anatomical course of the right and left RLN. RLN = recurrent laryngeal nerve.

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  Fig. 4. Up to 30 positional variations between RLN and inferior thyroid artery have been reported, in particular the 3 main variants to note are the retrovascular course, the antevascular course, and the intervascular course. RLN = recurrent laryngeal nerve.

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  Fig. 5. Postoperative laryngeal examination represent the final asset of safety evaluation. EBD = energy based device; IONM = intraoperative neural monitoring; RF = radio frequency.

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