Int J Thyroidol.  2018 Nov;11(2):130-136. 10.11106/ijt.2018.11.2.130.

Efficacy of Intraoperative Neural Monitoring (IONM) in Thyroid Surgery: the Learning Curve

• Kwak MK
• Lee SJ
• Song CM
• Ji YB
• Tae K

• KMID: 2448983
• DOI: http://doi.org/10.11106/ijt.2018.11.2.130

Abstract

BACKGROUND AND OBJECTIVES
Intraoperative neural monitoring (IONM) of recurrent laryngeal nerve (RLN) in thyroid surgery has been employed worldwide to identify and preserve the nerve as an adjunct to visual identification. The aims of this study was to evaluate the efficacy of IONM and difficulties in the learning curve.
MATERIALS AND METHODS
We studied 63 patients who underwent thyroidectomy with IONM during last 2 years. The standard IONM procedure was performed using NIM 3.0 or C2 Nerve Monitoring System. Patients were divided into two chronological groups based on the success rate of IONM (33 cases in the early period and 30 cases in the late period), and the outcomes were compared between the two groups.
RESULTS
Of 63 patients, 32 underwent total thyroidectomy and 31 thyroid lobectomy. Failure of IONM occurred in 9 cases: 8 cases in the early period and 1 case in the late period. Loss of signal occurred in 8 nerves of 82 nerves at risk. The positive predictive value increased from 16.7% in the early period to 50% in the late period. The mean amplitude of the late period was higher than that of the early period (p < 0.001).
CONCLUSION
IONM in thyroid surgery is effective to preserve the RLN and to predict postoperative nerve function. However, failure of IONM and high false positive rate can occur in the learning curve, and the learning curve was about 30 cases based on the results of this study.

Keyword

Thyroidectomy; Intraoperative neural monitoring; Recurrent laryngeal nerve; Vocal cord paralysis

MeSH Terms

Humans
Learning Curve*
Learning*
Recurrent Laryngeal Nerve
Thyroid Gland*
Thyroidectomy
Vocal Cord Paralysis

Figure

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  Fig. 1 Failure rate of intraoperative neural monitoring in the early and late periods.

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